[Changes in public health: the role of the state and the autonomous governments. SESPAS Report 2010]

The first responsibilities in health passed on to the autonomous governments were those referring to public health. However, the decentralization process has not been accompanied by an updated management of the collective efforts to promote and protect health, or by a greater weight of public health within the system. To carry out such a reform, public health authorities and the central and autonomic administrations must assume their corresponding roles. The leading role should correspond to the central administration and includes the coordination and evaluation of the entire process, while the regional public health authorities should be in charge of providing public health services to the population, promoting innovations, and collaborating among themselves as well as with the central administration. Recent legal initiatives show some political sensitivity and may provide an opportunity, in addition to those provided by the economic crisis, to emphasize the role of guarantor rather than that of supplier for the state. Paradoxically, the marginality of public health could facilitate the necessary political agreements, even though party interests may be an obstacle. The influence of professional associations could be important.