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        "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">El an&#225;lisis de situaci&#243;n de la salud p&#250;blica en nuestro pa&#237;s pone de manifiesto la existencia de debilidades significativas&#46; Sus dispositivos responden razonablemente en situaciones de crisis&#44; pero resultan en general invisibles y ocupan una posici&#243;n marginal en las agendas pol&#237;tico-institucionales y respecto al sistema asistencial&#46; La organizaci&#243;n de los servicios de salud p&#250;blica resulta obsoleta para promover y proteger la salud comunitaria&#44; prevenir enfermedades y enfrentarse a los retos emergentes del mundo globalizado relacionados con el medio ambiente f&#237;sico y social&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Hay consenso sobre la necesidad ineludible de replantear las funciones&#44; estrategias y organizaci&#243;n de la salud p&#250;blica en Espa&#241;a en la misma l&#237;nea de las tendencias europeas e internacionales&#46; Esta reforma constituye una asignatura pendiente y una prioridad estrat&#233;gica hoy&#46; De hecho&#44; algunas comunidades aut&#243;nomas han iniciado en los &#250;ltimos a&#241;os procesos de reestructuraci&#243;n y cambios&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Recomendamos dotar a la salud p&#250;blica de m&#225;s peso y prioridad en el sector sanitario y en las agendas pol&#237;tico-institucionales&#44; promoviendo los abordajes intersectoriales&#44; la estrategia de &#171;Salud en Todas las Pol&#237;ticas&#187; y la evaluaci&#243;n del impacto en salud&#46; Se sugiere una norma espec&#237;fica en salud p&#250;blica que actualice funciones&#44; organizaci&#243;n y estructuras&#44; distribuya claramente competencias posibilitando consorcios y alianzas&#44; y regule la coordinaci&#243;n e intervenci&#243;n intersectorial&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Se describen elementos clave de la reforma&#58; <span class="elsevierStyleItalic">a&#41;</span> un nuevo liderazgo participativo en salud p&#250;blica&#59; <span class="elsevierStyleItalic">b&#41;</span> generar inteligencia y evidencia&#59; <span class="elsevierStyleItalic">c&#41;</span> mejorar la profesionalizaci&#243;n y competencia profesional&#59; <span class="elsevierStyleItalic">d&#41;</span> la importancia de una actuaci&#243;n y comunicaci&#243;n eficaz&#44; transparente e independiente&#44; y <span class="elsevierStyleItalic">e&#41;</span> una organizaci&#243;n nueva y flexible coherente con las nuevas estrategias&#44; y cercana al &#225;mbito local y los servicios sanitarios&#46; En relaci&#243;n con la relaci&#243;n Estado&#47;comunidades aut&#243;nomas&#44; se apunta hacia una articulaci&#243;n inteligente y funcional que&#44; m&#225;s all&#225; de la actual debilidad&#44; construya espacios comunes de interlocuci&#243;n y corresponsabilizaci&#243;n&#44; como redes&#44; alianzas e iniciativas por la salud p&#250;blica&#46;</p>"
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        "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Public health in Spain shows significant weaknesses&#46; Spanish public health services respond reasonably well in crisis situations but tend to be invisible and occupy a marginal position in political agendas and in relation to health services&#46; The organization of the public health subsystem is clearly out of date in terms of its ability to promote and protect community health&#44; to prevent diseases&#44; and to cope effectively with the new public health threats and challenges related to the physical and social environment in today&#39;s globalized world&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Consequently&#44; there is broad consensus on the need to rethink functions&#44; strategies and the organization of public health in Spain&#44; in line with European and international trends&#46; Thus&#44; public health reform is currently a pending challenge and a strategic priority&#46; Indeed&#44; some Autonomous Communities have initiated a process of modernization and change&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Empowerment of public health in the political agendas and in relation to the health services is strongly recommended by promoting intersectorial approaches&#44; the <span class="elsevierStyleItalic">Health in All Policies</span> strategy and Health Impact Assessment&#46; There is also a need for a specific law that would update public health functions&#44; organization and structures&#44; allocate competencies by facilitating alliances and partnership&#44; and regulate coordination and intersectorial intervention&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">The following key elements related to this reform are described&#58; <span class="elsevierStyleItalic">1&#41;</span> a participatory leadership in public health&#59; <span class="elsevierStyleItalic">2&#41;</span> the generation of intelligence and evidence in public health&#59; <span class="elsevierStyleItalic">3&#41;</span> improvement of professional education and development&#59; <span class="elsevierStyleItalic">4&#41;</span> the importance of transparent&#44; independent and competent performance and communication&#44; and <span class="elsevierStyleItalic">5&#41;</span> new and flexible organization coherent with the new strategies and close to the local level and primary health care services&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">Coordination between the State and the Autonomous Communities should involved a functional and intelligent relationship by building up common spaces&#44; alliances&#44; networks and shared initiatives for public health&#46;</p>"
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Vol. 22. Núm. S1.
Informe SESPAS 2008: Mejorando la efectividad de las intervenciones públicas sobre la salud
Páginas 96-103 (abril 2008)
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Vol. 22. Núm. S1.
Informe SESPAS 2008: Mejorando la efectividad de las intervenciones públicas sobre la salud
Páginas 96-103 (abril 2008)
Capítulo 2. Políticas de salud pública
Open Access
Hacia una nueva organización de los dispositivos de salud pública en España. Informe SESPAS 2008
Toward a new organization of public health services in Spain
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Carlos Artundo Purroy
Autor para correspondencia
c.artundo@telefonica.net

Correspondencia: Carlos Artundo Purroy. Consultor en Salud Pública.
, Ana Rivadeneyra Sicilia
Consultores en Salud Pública
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Resumen

El análisis de situación de la salud pública en nuestro país pone de manifiesto la existencia de debilidades significativas. Sus dispositivos responden razonablemente en situaciones de crisis, pero resultan en general invisibles y ocupan una posición marginal en las agendas político-institucionales y respecto al sistema asistencial. La organización de los servicios de salud pública resulta obsoleta para promover y proteger la salud comunitaria, prevenir enfermedades y enfrentarse a los retos emergentes del mundo globalizado relacionados con el medio ambiente físico y social.

Hay consenso sobre la necesidad ineludible de replantear las funciones, estrategias y organización de la salud pública en España en la misma línea de las tendencias europeas e internacionales. Esta reforma constituye una asignatura pendiente y una prioridad estratégica hoy. De hecho, algunas comunidades autónomas han iniciado en los últimos años procesos de reestructuración y cambios.

Recomendamos dotar a la salud pública de más peso y prioridad en el sector sanitario y en las agendas político-institucionales, promoviendo los abordajes intersectoriales, la estrategia de «Salud en Todas las Políticas» y la evaluación del impacto en salud. Se sugiere una norma específica en salud pública que actualice funciones, organización y estructuras, distribuya claramente competencias posibilitando consorcios y alianzas, y regule la coordinación e intervención intersectorial.

Se describen elementos clave de la reforma: a) un nuevo liderazgo participativo en salud pública; b) generar inteligencia y evidencia; c) mejorar la profesionalización y competencia profesional; d) la importancia de una actuación y comunicación eficaz, transparente e independiente, y e) una organización nueva y flexible coherente con las nuevas estrategias, y cercana al ámbito local y los servicios sanitarios. En relación con la relación Estado/comunidades autónomas, se apunta hacia una articulación inteligente y funcional que, más allá de la actual debilidad, construya espacios comunes de interlocución y corresponsabilización, como redes, alianzas e iniciativas por la salud pública.

Palabras clave:
Salud pública
Políticas de salud
Formulación de políticas
Políticas públicas
Práctica de la salud pública
Abstract

Public health in Spain shows significant weaknesses. Spanish public health services respond reasonably well in crisis situations but tend to be invisible and occupy a marginal position in political agendas and in relation to health services. The organization of the public health subsystem is clearly out of date in terms of its ability to promote and protect community health, to prevent diseases, and to cope effectively with the new public health threats and challenges related to the physical and social environment in today's globalized world.

Consequently, there is broad consensus on the need to rethink functions, strategies and the organization of public health in Spain, in line with European and international trends. Thus, public health reform is currently a pending challenge and a strategic priority. Indeed, some Autonomous Communities have initiated a process of modernization and change.

Empowerment of public health in the political agendas and in relation to the health services is strongly recommended by promoting intersectorial approaches, the Health in All Policies strategy and Health Impact Assessment. There is also a need for a specific law that would update public health functions, organization and structures, allocate competencies by facilitating alliances and partnership, and regulate coordination and intersectorial intervention.

The following key elements related to this reform are described: 1) a participatory leadership in public health; 2) the generation of intelligence and evidence in public health; 3) improvement of professional education and development; 4) the importance of transparent, independent and competent performance and communication, and 5) new and flexible organization coherent with the new strategies and close to the local level and primary health care services.

Coordination between the State and the Autonomous Communities should involved a functional and intelligent relationship by building up common spaces, alliances, networks and shared initiatives for public health.

Key words:
Public health
Health policies
Policy making
Public policies
Public health practice
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