Agreements and disagreements between community health and the Spanish health system. SESPAS Report 2018

• Published in: Gaceta sanitaria Vol. 32 Suppl 1; p. 17
• Main Authors: Martínez Cía, Nieves, Pérez Pérez, Marta, Heras-Mosteiro, Julio, Gutiérrez Ávila, Gonzalo, Díaz-Olalla, José Manuel, Ruiz-Giménez Aguilar, Juan Luis
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-10-2018
• Subjects: Delivery of Health Care; Guidelines as Topic; Humans; Primary Health Care; Public Health; Research Report; Societies, Medical; Spain; Spain; Salud comunitaria; Healthcare systems; Salud pública; Health care reform; Reforma sanitaria; España; Community health; Atención primaria salud; Sistemas de salud; Primary care; Public health; Spain
• ISSN: 1578-1283

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources.