Estrategia de Promoción de la Salud y Prevención en el SNS: En el Marco del Abordaje de la Cronicidad en el SNS

Objectives

Spain’s Strategy for Health Promotion and Prevention in the National Health System provides a common framework for progressively improving health and preventing disease, injuries and disability within the implementation plan for the Strategy for Addressing Chronicity. Its mission is to embed health promotion and primary prevention throughout the life course and the National Health System service portfolio, engage sectors beyond healthcare, and enable individuals and communities to exercise greater autonomy and control over their health.[1][2][3]The overarching objective is to improve population health and wellbeing through healthy lifestyles, supportive environments and protection against injuries, while contributing to social cohesion and the medium- and long-term sustainability of health and social care.[2][4][3]The quantified national objective is to increase healthy life expectancy at birth in Spain by two years by 2020.[2][5]

• Strengthen public health, territorial coordination, equity, health-service reorientation, intersectoral action, health empowerment, healthy and safe environments, and community participation.[2][6][7]
• Apply evidence-based, life-course, settings-based, population, positive and integrated approaches that address physical, mental and social health together.[8][9]
• Prioritise children under 15 and people over 50 in the first phase, while planning to address other life stages subsequently.[2][7]
• Address six priority factors: healthy eating, physical activity, harmful alcohol consumption, tobacco use, emotional wellbeing, and environmental safety to prevent unintentional injuries.[10][5]
• Promote healthy lifestyles, safe environments and emotional wellbeing among children through coordinated health, family, community and educational action; support healthy lifestyles during pregnancy and breastfeeding; and promote active and healthy ageing among people over 50.[5][11][12][13]
• Prevent functional decline among people over 70, including through frailty prevention, multidimensional assessment, falls prevention and individual follow-up.[5][14]
• Reduce avoidable health inequalities by applying Health in All Policies and proportionate universalism, identifying barriers to access and adapting interventions to differences in age, sex, socioeconomic position, behaviour, beliefs and local context.[6][15][16]

Implementation

Implementation combines National Health System leadership with coordinated action by central, autonomous-community and local administrations, public health and healthcare services, education, social care, communities and other sectors.[6][7]Primary care is the central delivery setting and gateway to the health system, providing universal assessment, lifestyle promotion, prevention, counselling, screening, referral and follow-up linked to community resources and specialist services where needed.[10][11][17]The strategy was approved by the Interterritorial Council of the National Health System on 18 December 2013.[18]

• Coordinate governance through an Institutional Committee of autonomous-community health departments and relevant national directorates, which supports prioritisation of objectives, interventions and indicators, institutional validation, information-sharing and implementation.[19]
• Inform development and evaluation through a Scientific Committee representing relevant professional and scientific societies, supported by technical coordination from the Subdirectorate-General for Health Promotion and Epidemiology in the Directorate-General for Public Health, Quality and Innovation.[19]
• Establish an Intersectoral Committee to incorporate health into non-health policies and coordinate relevant national institutions, alongside local development plans and public consultation.[5][20][21]
• Select interventions through participatory review of evidence, clinical guidance, national and international technical sources, regional prevention programmes and evaluated good practice from autonomous communities.[22][23]Eligible good practices were required to demonstrate effectiveness, at least one year of implementation, reliable records, evaluation data and sustainable financing.[23][24]
• Implement five integrated multicomponent interventions, comprising three for children and two for older people, after consolidating 14 intervention types across priority factors and settings.[23][25][11]
• Deliver child-focused lifestyle assessment and tailored motivational counselling through primary-care teams, including nurses, doctors and social workers, with family, group, community and specialist support according to need.[11][26]
• Provide pregnancy and breastfeeding support through primary care and maternity professionals, including outreach to vulnerable groups, assessment of alcohol and tobacco use, brief intervention and referral where consumption is identified.[12]
• Provide positive-parenting support and continuing professional training to strengthen children’s emotional wellbeing, safe and non-violent upbringing, child development and access to appropriate services.[12][13]
• Screen adults over 50 for lifestyle risks and people over 75 for frailty, then provide multidimensional assessment, personalised multifactorial plans, multicomponent physical activity, healthy-lifestyle support, falls prevention and follow-up.[13][14]
• Build implementation capacity through online modular training, adaptation of primary-care service portfolios and electronic records, public healthy-lifestyle information platforms, communications and social marketing, local resource mapping, and alliances with municipalities, education and sports bodies.[27][28][20][29][30]
• Monitor progress through process, activity, outcome and broader health and lifestyle-impact indicators, disaggregated by age, sex, socioeconomic position and geography where data permit.[31][32]Coordination arrangements include continuous monitoring, biennial progress reports and a global evaluation at the end of the 2014–2020 first phase.[31]
• Use evaluation and follow-up as transparency instruments, while recognising that final health-promotion outcomes can be difficult to attribute in complex and changing contexts.[6][8]The supplied material does not specify a detailed final indicator set, published reporting format, budget, funding allocation or financing mechanism.[32][5][19][22]

Monitoring & Evaluation

The strategy establishes evaluation, information-system strengthening and transparency as core implementation functions. Its principal quantified outcome objective is to increase healthy life expectancy at birth in Spain by two years by 2020.[5]A biennial monitoring and evaluation report is envisaged, alongside a global evaluation covering the first implementation phase, 2014–2020.[31]

• Evaluate interventions at national, regional and local levels for implementation, intermediate results, health and wellbeing effects, and longer-term impact; use follow-up and outcome evaluation as transparency instruments.[6]
• Define health- and lifestyle-impact indicators, plus process, activity and outcome indicators, through operational intervention design and the implementation plan.[31]
• Disaggregate indicators by age, sex, socioeconomic position and geographical unit where data sources permit; interpret results in view of external determinants that may also influence outcomes.[31][32]
• Use annual and overall evaluation procedures incorporating process and outcome criteria, monitoring indicators and data extracted from adapted electronic primary-care records where appropriate.[27][28]
• Assign the Institutional Committee a role in prioritising indicators, providing information for formulation and evaluation, validating agreements and supporting implementation; involve the Scientific Committee in indicator prioritisation and strategy evaluation.[19]
• Assign local intersectoral groups responsibility for contextualising, coordinating, monitoring and evaluating interventions in participating territories.[20]
• Strengthen public-health information and evaluation systems, applied research and transfer of findings into practice, recognising that final health-promotion outcomes can be difficult to attribute in complex and changing contexts.[6][8][4]
• Use surveillance and evidence sources including National Health Surveys, primary-care information systems, hospital discharge data, the Minimum Basic Data Set and National Health System key indicators to describe population needs and risk factors.[33][34][35]
• Screen and assess priority risks through activities such as lifestyle assessment, alcohol screening, child weight monitoring, frailty screening and fall-risk assessment.[13][36][37][38]
• Require reliable records and minimum evaluation data when selecting existing good practices, and assess interventions using quantitative scoring, qualitative review, feasibility and implementation criteria.[23][25]
• Maintain transparency through declarations of interest from Institutional and Scientific Committee members.[19]

Indicator definitions and final configurations were still provisional and intended to be completed during implementation.[32]The supplied material does not specify a consolidated indicator set, detailed reporting schedule, surveillance protocol, named evaluation body or formal sanctions for accountability.[31][32]

Costing & Financing

No dedicated strategy budget, itemised implementation cost, financing plan, funding allocation, resource-mobilisation mechanism or quantified funding gap is specified.[5][31]Sustainable short- and medium-term financing is nevertheless a minimum eligibility criterion for identifying and selecting good practice interventions.[23][24]

• Recognise chronic conditions as a major economic burden: they account for an estimated 70% to 80% of healthcare expenditure in Europe and approximately 60% of Spanish hospital expenditure in 2010.[35]
• Associate health promotion and prevention with the medium- and long-term sustainability of health and social-care systems, although the strategy provides no quantified financial assessment of its own actions.[39][4]
• Use economic evidence in intervention selection and planning where available, including cost-effectiveness evidence, economic analyses and local resource assessment, but without prescribing a costing methodology.[40][41][42]
• Identify potential savings from evidence-based prevention, including injury prevention, reduced physical inactivity, tobacco control, salt reduction, positive-parenting programmes and improved mental-health interventions.[43][44][45][46][47][48]
• Recognise growing expenditure pressures associated with ageing, disability, dementia, injuries and long-term care, reinforcing the rationale for prevention and active ageing.[49][50][51]
• Plan implementation resources through workforce identification, professional training, organisational adaptation, local development, community-resource mapping and intersectoral partnerships, without assigning monetary values.[27][28][20][42]

The monetary figures in the source describe disease burdens, projected expenditure or external economic evaluations rather than funded allocations to this strategy.[35][44][52][53]