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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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