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Universal health, a matter of human rights and a public health priority

On 27 July, the Spanish Parliament validated Royal Decree-Law (7/2018) on universal access to Spain’s National Health System. This represents an important change. Until then, the entitlement to care in the National Health System depended on citizenship, and its recognition was therefore separated from the condition of being insured. Access to health, under conditions of equity and universality, is a basic right of every person. As the Minister of Public Health, Mrs Carmen Montón, pointed out, "Health does not know borders, identity cards, or work and residence permits."

With this new law, Spain recovers the spirit of universality of the General Health Law promoted in 1986 by Minister Ernest Lluch, and the subsequent Public Health Law of 2011. Universality that was drastically abolished in 2012 with the approval of a Royal Decree 16/2012, which restricted the right to universal health for undocumented immigrants, citing budgetary reasons and in an attempt to avoid the so-called sanitary tourism, without citing any report on the savings that this measure would imply for the system. The norm, widely contested by most opposition parties, professional sectors in Spain’s health industry, scientific societies and the civil society, was foreshadowed by a series of mobilisations through various platforms, to finally lead to its repeal.

Withdrawing the right to health as a universal right, in the opinion of its detractors, posed a serious public health problem by impeding the prevention of diseases, their detection and treatment in its initial stages, with all the risks for public health that this entails. This can also lead to higher costs to the health system in the long term despite the short-term savings. In addition, many health professionals refused to stop treating undocumented immigrants, citing ethical conflicts, placing these professionals before disobedience and disrespect before the law. Several regional governments joined this opposition, refusing to eliminate this benefit in their territories, criticising the measure as purely ideological without real impact on public health budgets.

A recent study led by Dr. David Bloom at the Harvard T.H. Chan School of Public Health (United States), which has been published in the Science journal, concludes that universal healthcare, recovered just a few weeks ago in Spain, has benefits that go beyond the obvious effects of improving health, as it helps to increase productivity, whilst reducing economic and social inequalities. "It is difficult to think of an aspiration that reflects and contributes to human progress more than universal health," researchers say.

Antonio Poveda Martínez, Managing Director of the National Organization of HIV (CESIDA)