Life expectancy in Spain is one of the highest in the world (86.2 years for women and 80.4 for men [i]), however, healthy life expectancy is lower than in other countries (65.0 years for both men and women[ii]). In 2013 the Spanish Strategy on Health Promotion and Prevention (SHPP) was launched with the goal of increasing healthy life expectancy by two years by 2020. It was approved by the Minister of Health, Social Services and Equality and the Regional Ministers of Health.
By Pilar Campos (Head of the Health Promotion Unit), María José Andrés (External technical officer (Tragsatec), , Roberto Ravelo (External technical officer (Tragsatec). General Sub-Directorate of Health Promotion and Public Health Surveillance, General Directorate of Public Health, Quality and Innovation, Ministry of Health, Social Services and Equality.
The SHPP promotes the population´s health and well-being by fostering healthy environments and lifestyles, and by improving safety. The strategy has been developed with a life-course approach and addresses the main factors related to non-communicable diseases: healthy eating, physical activity, tobacco consumption and hazardous drinking, emotional wellbeing, and safe environments for the prevention of accidents. Health, educational and community/local settings have been identified as key areas for intervention.
For the development and implementation of the Strategy actors from the national (Ministry of Health, Social Services and Equality (MHSSE)), regional (Autonomous Communities), and local level were involved, as well as scientific societies and professionals from other sectors such as education, social services, and sport.
This strategy is the first focusing on health and a healthy population, and the first involving a public consultation. It is in line with the main international recommendations and strategies for reducing the prevalence of chronic diseases, which are the main cause of preventable morbidity and mortality.
Figure 1. Factors addressed in the Spanish Strategy on Health Promotion and Prevention in the NHS.
The local implementation of the SHPP has been one of the pillars of this Strategy. The Ministry, Autonomous Communities, Local Entities, the Spanish Federation of Municipalities and Provinces (SFMP) through the Spanish Healthy Cities Network, and experts from scientific societies have worked together on establishing the priority actions to be continued.
A guide[iii] for local implementation of the Strategy has been developed in order to establish a common framework, to facilitate implementation, and to propose specific recommendations and tools for action. The essential values that must be present in the local implementation are universality, sustainability, feasibility, and effectiveness, in addition to the guiding principles of the Strategy which are comprehensive, evidence based, cohesion, participation, evaluation, health in all policies and equity.
Spanish municipalities are invited to join the Strategy by expressing their commitment to work on health promotion and prevention. To formalise the process some steps have been defined: to endorse the Strategy by the Plenary of the City Council, to designate a local coordinator, to establish a schedule of the actions to be carried out, and to make a presentation to the public. Once this phase has been completed, the main steps for local implementation include:
- The establishment of an intersectoral group: the objective of this group will be to advance health and equity within the municipality through the participation of different sectors. Health, education, social welfare, transportation, urbanism, sports, and environment have been identified as essential areas, although each municipality can adapt the composition of this working group to its needs and circumstances.
- The Identification of resources for health promotion and prevention. In order to collect information that can improve population’s lifestyles, an online map[iv] of resources for health named LOCALIZA SALUD has been provided by the MHSSE. In this application, municipalities can include information on available resources for the factors addressed in the Strategy. The resources mainly concern physical activity, healthy eating, prevention of harmful consumption of alcohol, smoking prevention, and emotional well-being.
Figure 2. On line map of resources for health LOCALIZA SALUD, provided by the MHSSEIV.
One of the aspects that has contributed to the success of the local implementation is that municipalities can apply annually for funds, which are provided through an Agreement between the MHSSE and the SFMP for promoting the Spanish Healthy Cities Network and enhancing the local implementation of the Strategy. The local implementation of the Strategy is a flexible process, although common guidelines are proposed, they can be adapted to the specific conditions and context of each municipality. Municipalities are encouraged to adopt a Social Determinants of health and Equity approach.
Training of professionals is considered an essential element of the programme. An online course on Local Health (50 hours) has been set up, including information on the local implementation of the Strategy, practical tools, as well as examples of good practices on health promotion and prevention carried out at local level. This course is aimed at professionals who participate in the local implementation of the strategy.
So far 217 municipalities have endorsed the Strategy and more than 3,500 resources have been included on the LOCALIZA SALUD map. Around 2,300 professionals have finished the course on Local Health and about 5,500 students are currently enrolled in the fourth edition.
Considerations for future
Following the establishment of the intersectoral groups and the identification of resources for health, existing interventions will be assessed.
The policies and interventions being carried out at a municipal level by the health sector as well as other sectors which impact health will be reviewed. A tool has been proposed which will help assess effectiveness and how equity has been integrated in the intervention. In a practical way, municipalities should analyse if the policy/intervention is working and for whom.
New interventions will also be established, tailored to the specific needs of the area. These interventions should be evidence-based and contribute to the adoption of healthier lifestyles by making the easiest choice the healthiest. They should cover the whole life course, including parental programmes which encourage a healthy start in life, whilst also promoting active and healthy ageing.
[i] Organisation for Economic Co-operation and Development. OCDE.Stat [Accesed may 26th 2017] http://stats.oecd.org/viewhtml.aspx?datasetcode=HEALTH_STAT&lang=en
[ii] National Statistics Institute (INE) Life expectancy in good health at birth and at 65 years by period and sex. [Accesed may 26th 2017] http://www.ine.es/jaxi/Datos.htm?path=/t00/mujeres_hombres/tablas_1/l0/&file=d02001.px
[iii] Guía para la implementación local de la Estrategia de Promoción de la Salud y Prevención https://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/Estrategia/docs/Guia_implementacion_local.pdf