JOHN CARLOS I

KING OF SPAIN

To all who present it and understand

Sabed: That the General Courts have approved and I come to sanction the following law.

INDEX

Preamble

Preliminary title. General provisions. Public health policy.

Chapter I. Of the object and scope of the law.

Chapter II. General principles of public health.

Title I. Rights, duties and public health obligations.

Chapter I. Citizens ' rights.

Chapter II. Citizens ' duties.

Chapter III. Obligations of public administrations.

Title II. Public health actions.

Chapter I. Public health surveillance.

Chapter II. Health promotion.

Chapter III. Prevention of health problems and their determinants.

Chapter IV. Coordination of health promotion and prevention of diseases and injuries in the National Health System.

Chapter V. Healthcare management as a public health action.

Chapter VI. Protection of the health of the population.

Chapter VII. Health impact assessment of other policies.

Chapter VIII. External health and international health.

Chapter IX. Public Health Information System.

Title III. The planning and coordination of public health.

Title IV. Professional staff and public health research.

Chapter I. Vocational training and development in public health.

Chapter II. Research in the development of public health policies.

Title V. State health authority, surveillance and control.

Chapter I. State health authority.

Chapter II. Special and precautionary measures.

Title VI. Infringements and penalties.

Additional disposition first. The specialization in public health of the health professions.

Additional provision second. Public health in the Armed Forces.

Additional provision third. Public health in the Prison Institutions.

Additional provision fourth. From the State Public Health Center.

Additional provision fifth. Benefits.

Additional provision sixth. Extension of the right to public health care.

Additional provision seventh. Regulation of psychology in the health field.

Single repeal provision. Regulatory repeal.

Final disposition first. Amendment of Law 14/1986 of 25 April, General of Health.

Final disposition second. Amendment of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System.

Final disposition third. Amendment of Law 41/2002 of 14 November, basic regulation of the autonomy of the patient and of rights and obligations regarding information and clinical documentation.

Final disposition fourth. Competence title.

Final disposition fifth. Enabling regulatory development.

Final disposition sixth. Entry into force.

PREAMBLE

The health services are essential to respond to the health problems of the community, as they manage to mitigate the damage of the diseases and allow to recover the lost health and improve the quality of life of sick people. But it is not the health care device the main condition of our health level, health is gained and lost in other fields: before birth, exposures to different factors that can be indelibly determined by the Future health, and from birth to death, are accumulating positive or negative life experiences that shape health. The family environment, education, material goods, social and economic inequalities, access to work and its quality, the design and services of cities and neighborhoods, the quality of the air that is breathed, the water that is born, the The food we eat, the animals we live with, the physical exercise that takes place, the social and environmental environment of people, all of which determines health. Government actions, at any level, public or private interventions, have a greater or lesser degree of impact on health. Hence the current public health approach is aimed at shaping actions that go beyond the scope of health services and therefore require new forms of organization.

The Spanish Constitution of 1978 gave a key step in the way of improving the health of the population by recognizing in its article 43 the right to its protection, entrusting to the public authorities the organization and protection of the population. of public health through preventive measures and the necessary services and services. In its Article 51, it established the defence of consumers and users, protecting, through effective procedures, the safety, health and legitimate economic interests of consumers.

The right to health protection recognized in the Constitution was usually interpreted as the right to receive health care in the face of the disease. Therefore, Law 14/1986, of 25 April, General of Health, one of the fundamental milestones in our effort organized to make the right to the protection of health, established as one of the general principles in its article 3 that the Health system is primarily geared towards prevention and health promotion.

Law 16/2003, of 28 May, on the cohesion and quality of the National Health System, provided the basis for quality care delivery by health services. This essential legislative development has been fundamentally oriented to the important task of ordering and coordinating the activities of the health care, however, the efforts that the society as a whole must do in order to assure a good Health status through disease prevention and health promotion have not been developed in the same way.

Public authorities must ensure and improve the health of the population, the current and the future, understanding investment in health as a decisive contribution to social welfare, both because of the net effect of the gain in health and for the contribution to the sustainability of health and social services, without forgetting the contribution to the overall sustainability by the increase in productivity associated with health and by the positive effect that the policies of care of the environment have in the environment and in human health. The excellent response we have given to the constitutional requirement of health protection from the care of sick people must now be complemented with the preventive and protective aspects and health promotion.

The health of the Spanish population has not only benefited from quality health services and the excellence of the professionals who work in them, it has also made it of its environment, its climate, its social fabric and family, their food and many other factors that have contributed to situating it among the countries with the best health indicators in the world. But there are new realities that remind us that an advanced society must think about the population of the future, without waiting to solve the problems when its social and health services can no longer provide answers. The growing ageing of the population, the rise of single-parent families, the weakening of family and social networks accentuated by scattered urbanisms, globalisation and its emerging risks, consumerism, the growing use of the new technologies, the sedentary way of life, the effects of climate change or immigration, are some of these new social phenomena. New realities that coexist with others that do not for older ones are fully resolved, such as intellectual disability, mental health, the full integration of ethnic minority groups, prison detention or the different situations of social exclusion. Health and social services will only be sustainable if we ensure for our population the best possible levels of health and autonomy in all parts of life and with the guarantee of maximum equality.

The search for health must be a joint and solidarity task that does not recognize borders. This aspect is of particular importance in the globalized world of the 21st century, marked by profound inequalities that follow a social pattern between countries and within the countries themselves, and makes the aspiration to equity not only an end, but a means to achieve better health for all people. Equity is at the end and the end of health and only the societies that seek equality achieve good results in health. Today, threats to public health at the international level cannot be stopped or prevented by a health of borders, of containment. Cooperation and solidarity are the main prevention actions, hence the public health of any territory cannot be addressed without considering international action as an integral part of national public health policy.

The purpose of this law is to give a complete and current response to the requirement contained in article 43 of the Spanish Constitution and, consequently, to try to reach and maintain the maximum possible level of health of the population. Health, defined as an autonomous, supportive and joyful way of living, provides education with the best opportunities for a society to have well-being. By being autonomous, health recognizes the freedom to choose to be aware of the consequences, for which we must provide an education that ensures critical capacity, the possibility of democratic and participatory maturity. After all, education and health are part of the raw material that sustains a democratic society. Both are intimately related and facilitate the desirable social welfare and the necessary sustainable economic development. There is enough scientific knowledge to be able to ensure that a high level of health improves productivity in all areas analyzed, hence investment in health, including investment in the structures that ensure the health of the population, be one of the most profitable public policies and, if it also respects effective, essentially fair, equity.

Achieving the greatest health gains, the object of this law, requires society to be organized in a way that promotes, protects and promotes the health of people, both in their individual and collective spheres, and that this is done from rigorous scientific knowledge and with the necessary anticipation. This organization of the society requires a public health system that unites, coordinates and mediates in three areas of action: 1) the own of the public health devices; 2) the actions of prevention and promotion of health in the services health, and 3) actions and programs that, without being sanitary, have an effect on health and that adequately managed can achieve their primary goals while ensuring the best health outcomes.

Public health devices, specialized in the health of the community, monitor the state of health of the population and its determinants, warning of potential health gains of different policies or interventions; respond to threats about the health of the population and health crises; implement actions in the areas of health protection, by preventing the negative effects of various elements of the environment such as consider environmental health, occupational health, food safety or health; in the area of promoting health, helping to empower citizens to adopt informed and free decisions that best serve their health and well-being; and in the area of disease prevention and injury, through vaccinations and other population interventions. These actions require a common basis for implementation in Spain, which includes guarantees of maximum quality, a human cohesion that will enable the best public health intelligence of our society wherever it is necessary and organization that responds to the challenges of current public health.

The health services surveyed in the National Health System perform some preventive actions in addition to the curative, caring and rehabilitation. However, health services, and in particular primary health care, should play a more relevant role in preventive action and in community health. The effectiveness of these preventive activities is ensured through appropriate coordination with public health actions and through an organization that allows the health services to provide the best preventive recommendations, giving priority to those actions that are more efficient, thus optimizing resources and avoiding unnecessary harm by ineffective preventive actions.

They are essential instruments that, beyond the actions initiated from the health field, ensure that health is considered as one of the expected results of the various policies and interventions at all levels Government. The health of the population is determined by policies and interventions in other areas, therefore, it is necessary for the public administrations to ensure the regulatory framework that maximizes the level of health without detriment to others. social goods which contribute to the welfare of society. The current major health challenges can only be addressed with guarantees of success if the whole of society is governed by taking into account and maximizing the results that the various actions and norms have in health. Putting health and equity in all policies requires an organization that allows adequate coordination between the health sector and other sectors, seeking synergies in their policies or the necessary health protection when they are not possible.

This description of the areas of action already advances some of the criteria that justify and support the reform of the public health organization that faces this law. Spain, due to the characteristics of its economic and social development, must be geared towards ensuring health security. This means that the ability of international influence to act in those decisions affecting public health is necessary and that everything related to the international traffic of goods, services and persons who are aware of Spain, must be especially careful from the public health aspect, requiring appropriate structures for this. Similarly, policies and interventions developed in Spain in any field should be recognized for caring not only for the environment but also for health, requiring a normative provision that requires it. Spain's commitment to health security is linked to economic interests in trade and tourism, but also to the ability to influence decisions in international areas that affect the health of the population. These challenges can be successfully addressed and appropriate provisions are introduced into this law.

Health security itself is based on adequate public health information services with a network of well-coordinated centers. The current situation can make a significant step in quality and operation if the public health surveillance information centers are ordered.

Global scientific development on public health actions and policies should be strengthened to enable it to be able to issue scientifically based recommendations, as is the case in health care areas. In Spain there is sufficient scientific development to be able to have sound recommendations in public health and, if the appropriate organization is available, to make considerable progress in the development of actions based on the knowledge.

Many of the actions that profile the health of the population are the responsibility of the autonomous communities, the cities of Ceuta and Melilla and the municipalities; however, there are determinants of health whose modification can only be be done at national or supranational level. Similarly, there are public health actions whose effectiveness and social efficiency are multiplied when implemented or implemented in a coordinated manner at the state or international level. Furthermore, the development of the territorial structure is heterogeneous, as are the capacities. It is not a question of harmonising actions to complement activities carried out by the regional and local authorities, which is already laid down in a standard way, an organisation which effectively achieves human cohesion in terms of of knowledge, experience and excellence in public health, so that the best public health resources in Spain are always available to any community and any person and to influence and act in the international sphere contributing to the global health. Public health intelligence, understood as the set of people with professional and scientific capacity to address public health problems, is of high level in Spain, but an organization that takes advantage of it has not yet been blocked. efficiently these resources achieving essential human cohesion.

This General Public Health Law responds to the needs and challenges listed and to others that are concretized in the description of the content that is then detailed.

The law, which establishes the legal bases that support the actions of coordination and cooperation of public administrations in the field of public health, is structured in a preliminary title, six titles, three provisions additional provisions, a derogation provision and five final provisions.

The preliminary title establishes in its chapter I the object and scope of the law. Chapter II sets out the general principles of public health, which must be ensured in public health action. Among others, it highlights the requirement that equity and health guide the set of government policies.

Title I consists of three chapters and deals with the rights and duties of citizens and the obligations of public health administrations. The law recognizes the right of citizens, directly or through the organizations in which they are grouped or representing them, to information on public health, with the limitations provided for in the current regulations.

In Chapter I, citizens ' rights are developed in the field of public health, giving importance to values such as information, participation, equality, confidentiality, privacy and dignity. Chapter II sets out the duties of citizens. Chapter III deals with the obligations of public administrations, establishing mechanisms to ensure that scientific and advisory activities in the field of public health are not biased by interests other than the public. health of the public and the public good and independent. The population's confidence in the health authority and its public health recommendations is reinforced with this.

Title II describes the actions of public health. Chapters I and II are dedicated to the regulation of health surveillance and promotion. Based on the experience already developed in this field, particularly in the surveillance of communicable diseases, it now extends to the conditions of health problems that are the object of policies to improve it. This law provides the basis for a comprehensive public health surveillance that covers all health conditions and the state of health. Similarly, the information system in public health complements the work of the Institute of Health Information whose functions provided Law 16/2003, of 28 May, of cohesion and quality of the National Health System in the field of health health information systems and they are developed considering the competences that Law 12/1989, of May 9, of the Civil Statistical Office assigns to the National Institute of Statistics in the coordination of the statistical activity of the General Administration of the State. Currently, advanced disease indicators are available, on health care and on some health-related behaviors, but it is not integrated with information from other social, environmental or other fields. which are essential in order to assess the development of public health and related policies. With this integral vision, the core of the coordination is the Ministry of Health, Social Policy and Equality with the networks of surveillance and information of the autonomous administrations. The Network of Surveillance in Public Health is articulated, which deals with the coordination of the system of monitoring of conditioning factors, the system of health problems and early warning and rapid response systems.

Chapter III sets out the general lines to be followed by policies on the prevention of health problems and their determinants, which aim to reduce the incidence and prevalence of certain diseases, injuries and disabilities in the population and attenuate their negative consequences through policies of a health, environmental, economic, labor, food or physical activity, among others; actions are also regulated (i) specific measures for the protection of the health authorities; They are implemented with the highest possible quality and the greatest possible accessibility for the population by carrying out the appropriate campaigns. This law should be a key instrument to prevent the implementation of supposedly preventive actions, the benefit of which has not been scientifically proven and which can be harmful.

Chapter IV, dedicated to the coordination of health promotion and the prevention of diseases and injuries in the National Health System, lays the foundations for these to be implanted in health services in a way that coordinated with the actions of public health structures.

The importance of health management adapted to public health is dealt with in Chapter V. In order to achieve the objectives described in this law, it is essential that at all levels and levels of care be coordinated appropriately. the prevention of disease and the promotion of health, ensuring the reduction of social and territorial imbalances; therefore, health management will address health outcomes.

What is established in this law on health management is in line with the proposal of the report of the World Health Organization "Report on Health in the World 2000-Improving the performance of health systems" and the Further developments in the international arena, which advocate a direction of care services guided to improve the health of the population.

Chapter VI addresses public health measures in the field of health protection, which are aimed at preventing the negative effects that various elements of the environment may have on the health and well-being of the population. people. It includes the most relevant aspects in which the action of the government of environmental health is based, which has its own space and is defined in the field of public health. Human health depends to a great extent on the environment in which life is unfolding and therefore the healthiness of food, water and air is essential. But the environment in which human life unfolds is not exclusively constituted by the natural environment, but the socially constructed environment formed by housing, the workplace, the school, the places of leisure, the city as a whole and the lifestyles. Actions in the field of occupational health are also established in order to achieve the best prevention of risks in the field of work, and in line with the provisions of Law 31/1995 of 8 November on the Prevention of Occupational Risks, and The promotion of health in the same field is facilitated. The promotion and protection of occupational health, as well as the prevention of risk factors in this field, should be addressed in the public health service portfolio.

Chapter VII determines the application in Spain of the health impact assessment, that is, the combination of procedures, methods and tools by which a program or standard can be evaluated in relation to their the effects and distribution of the effects on the health of the population. The need to advance health security advises that Spain should be of the leading countries to guarantee and promote health in its actions of government, including, as set out in this chapter, the necessary actions to ensure that assess the impact on human health of the various public actions. The inclusion of health impact assessment in our legal system can be placed in the group of the most advanced countries, fostering innovation in the development of reforms related to the sustainable economy that in turn ensure health security.

Chapter VIII is dedicated to external health and international health, an essential part of public health and exclusive competence of the State, as established by the Spanish Constitution. One of the opportunities that this law opens is to adapt the services and devices of the government of Spain to the needs of a globalized world. The paradigm of external health is modified, understanding that in addition to a health in borders an international health must be developed in the sense of considering Spain as a relevant agent of health at international level. It's not just about preventing the importation of communicable diseases, but contributing to a healthier world.

Finally, Chapter IX regulates a Public Health Information System, which enables the exchange of information necessary for the best development of public health actions, with respect to the Law Organic 15/1999, of December 13, Personal Data Protection.

Title III regulates the planning and coordination of public health, with the objective of contributing to maintain and improve the health of the population through an organization that allows to coordinate the existing resources of a efficient way.

The public health articulation in Spain is available through the Public Health Strategy, which defines the actions addressed to the main determinants of health and identifies synergies with policies of other departments and Administrations.

The Advisory Board of Public Health is also created as a collegiate body for consultation and participation, attached to the Ministry of Health, Social Policy and Equality, in which the departments of the Administration are represented. General of the State whose policies have an impact on health and other administrations, agencies and organisations that ensure adequate system governance.

Title IV deals with professional and research staff in public health, and is divided into two chapters. The first chapter speaks of vocational training and development, and the second of the research. The existence of competent public health professionals is the best guarantee that the health authority, directly or through the Ministry of Health, Social Policy and Equality, complies with its obligations to protect health. Given the diversity of health determinants, professional public health personnel should be able to apply a broad spectrum of knowledge and skills, which makes it necessary to integrate people with different academic profiles, so that the multidisciplinary nature of public health is recognised. This means that public health professionals are not necessarily health professionals as laid down in Law 44/2003 of 21 November of management of the health professions; however, their professional performance is specific and The main aim must be to develop the actions described in Title II and to be limited to public health. On the other hand, if public health is to be pursued with a scientific orientation, based on scientific evidence, it is essential to include the research work of professional public health personnel. In order to improve the quality of public health actions, they must be closely linked to a type of research activity that promotes the dissemination of knowledge generated and good practices.

Title V regulates the state health authority and its agents. This authority shall, in the exercise of its responsibility and in accordance with the powers conferred upon it in the field of public health, lay down provisions and be empowered to act, by means of the competent bodies in each case, in the public or private activities to protect the health of the population. Provision is also made for special and precautionary measures.

The law is supplemented by Title VI, which collects the violations and penalties, followed by the additional, repeal, and final provisions.

PRELIMINARY TITLE

General provisions. Public health policy

CHAPTER I

The object and scope of the law

Article 1. Object of the law.

This law aims to establish the basis for the population to reach and maintain the highest level of health possible through policies, programs, services, and in general actions of all kinds developed by the public authorities, companies and citizens ' organizations in order to act on the processes and factors that most influence health, and thus prevent the disease and protect and promote the health of people, both in the individual sphere and in in the collective.

Public health is the set of activities organized by public administrations, with the participation of society, to prevent the disease as well as to protect, promote and recover the health of people, both at the individual level as in the collective and through health, sectoral and cross-cutting actions.

Article 2. Scope of the law.

The provisions of this law will apply to general government and private individuals when specifically provided.

CHAPTER II

General principles of public health

Article 3. From the general principles of public health action.

Public administrations and private individuals, in their public health actions and actions on collective health, will be subject to the following principles:

a) Principle of equity. Policies, plans and programs that have an impact on the health of the population will promote the reduction of social inequalities in health and incorporate actions on their social conditions, including specific objectives in this respect. Equity will be considered in all public reports that have a significant impact on the health of the population. Similarly, public health actions will incorporate the gender perspective and provide specific attention to the needs of people with disabilities.

b) Health principle in all policies. Public health actions will take into account non-health policies that influence the health of the population, promoting those that promote healthy environments and deterring, where appropriate, those that pose risks to the health of the population. health.

Also, public policies that have an impact on health will value this circumstance by reconciling its objectives with the protection and improvement of health.

c) Principle of relevance. Public health actions will address the scale of the health problems they seek to correct, justifying their need in accordance with the criteria of proportionality, efficiency and sustainability.

d) Precautionary principle. The existence of prima facie evidence of a possible serious impact on the health of the population, even if there is scientific uncertainty as to the nature of the risk, will determine the cessation, prohibition or limitation of the activity on which the congran.

e) Principle of assessment. Public health actions should be evaluated in their operation and results, with a periodicity according to the character of the action implemented.

f) Principle of transparency. Public health measures must be transparent. The information on them must be clear, simple and comprehensible for all citizens.

g) Principle of integrality. Public health actions should be organized and developed within the comprehensive conception of the healthcare system.

h) The security principle. The actions in the field of public health shall be carried out after establishing their safety in terms of health.

TITLE I

Rights, duties and obligations in public health

CHAPTER I

Citizens ' rights

Article 4. Right to information.

The citizens, directly or through the organizations in which they are grouped or representing them, has the right to be informed, with the limitations provided for in the current regulations, in matters of public health Competent authorities. This right includes in any case the following:

a) Receive information on the rights granted to them by this law, as well as on ways to exercise such rights.

b) Receive information about public health performances and benefits, their content, and how to access them.

c) Receive information on health conditions as factors that influence the health level of the population and, in particular, the biological, chemical, physical, environmental, climatic or other risks character, relevant to the health of the population and its impact. If the risk is immediate the information will be provided as a matter of urgency.

(d) All information shall be made disaggregated, to be understood according to the collective affected, and shall be available in the conditions and format allowing for full accessibility to persons with disabilities of any type.

Article 5. Right to participate.

1. Citizens, directly or through the organizations in which they are grouped or representing them, has the right to effective participation in public health actions. The competent public authorities shall establish specific channels for the effective exercise of this right.

2. Without prejudice to the duty of collaboration, participation in public health actions shall be voluntary, except as provided for in Organic Law 3/1986 of 14 April of Special Measures on Public Health.

Article 6. The right to equality.

1. All persons have the right to ensure that public health action is carried out on an equal footing without discrimination on grounds of birth, racial or ethnic origin, sex, religion, conviction or opinion, age, disability, sexual orientation or identity, disease or any other personal or social condition or circumstance.

2. In particular, any discrimination between women and men in public health actions is prohibited, in accordance with the provisions of the Organic Law 3/2007 of 22 March on the effective equality of women and men, as well as on the other existing rules in this field.

3. The disease may not differ from treatment other than those resulting from the processing of the disease itself, from the objective limitations imposed by it for the exercise of certain activities or those required for health reasons. public.

4. This right will be implemented in a portfolio of basic and common services in the field of public health, with a set of actions and programs. Such a service portfolio shall include a single vaccination schedule and a unique offering of population cribates.

Article 7. Right to privacy, confidentiality and respect for dignity.

1. All persons have the right to respect for their personal and family dignity and privacy in relation to their participation in public health actions.

2. The personal information used in public health actions will be governed by the provisions of the Organic Law 15/1999 of 13 December, the Protection of Personal Data and Law 41/2002 of 14 November, which is a basic regulation of Patient Autonomy and Rights and Obligations in the field of Clinical Information and Documentation.

CHAPTER II

Citizens ' duties

Article 8. Duty of collaboration.

Citizens will facilitate the development of public health actions and refrain from engaging in conduct that hinders, prevents or distorts their execution.

Article 9. Duty of communication.

1. Persons who are aware of facts, data or circumstances which may constitute a serious risk or danger to the health of the population shall bring them to the attention of the health authorities, who shall ensure that the data are protected personal character.

2. The provisions of the above paragraph are without prejudice to the communication and information obligations imposed on healthcare professionals by laws.

CHAPTER III

Obligations of public administrations

Article 10. Public information on risks to the health of the population.

Without prejudice to the powers of other public authorities, the health authorities shall report on the presence of specific risks to the health of the population. This information will include an assessment of their impact on health, the measures taken by the health administrations in this respect and the recommendations for the population.

Article 11. Collaboration in public health and impartiality in health actions.

Healthcare Administrations will require transparency and impartiality for scientific and professional organizations and experts with whom they collaborate in public health actions, including training and research, as well as individuals and organisations receiving grants or with whom they conclude contracts, agreements, concerts or any kind of agreement.

For these purposes, the composition of the committees or groups evaluating actions or making recommendations on public health, selection procedures, the statement of interests of the interveners, as well as the relevant opinions and documents, with the exception of the limitations laid down by the current rules.

The requirements for the declaration of conflict of interest by experts and representatives of the scientific and professional organizations composing the committees or groups will be developed. evaluate actions or make public health recommendations.

TITLE II

Public health actions

CHAPTER I

Public health surveillance

Article 12. From surveillance in public health.

1. Public health surveillance is the set of activities aimed at collecting, analyzing, interpreting and disseminating information related to the state of the population's health and the factors that condition it, in order to substantiate the public health actions.

2. Without prejudice to the powers of other authorities, public health surveillance shall take into account at least the following factors:

1. The social conditions and inequalities that have an impact on health with measurements at the individual and population levels.

2. The environmental risks and their health effects, including the presence of pollutants in the environment and people, as well as the potential impact on the health of emissions exposure Electromagnetic.

3. Food security, including food risks.

4. The risks related to work and its health effects.

5. Non-communicable diseases.

6. The communicable diseases, including zoonoses and emerging diseases.

7. Health problems related to the international transit of travelers and goods.

8. Injury and violence.

9. Other issues for public health that are on the record.

3. Also, public health surveillance requires early warning and rapid response systems for the detection and evaluation of incidents, risks, syndromes, diseases and other situations that may pose a threat to health. of the population.

4. The autonomous communities, the cities of Ceuta and Melilla and the local authorities will ensure in the field of their competences that the respective systems of surveillance in public health meet at all times with the forecasts of this law. They shall also provide the information to be established by national and international regulations, with the periodicity and unbundling to be determined in each case.

Article 13. Articulation of public health surveillance.

1. It is the responsibility of the General Administration of the State, the Autonomous Communities, the cities of Ceuta and Melilla and the local administration, in the field of their competences, the organization and management of the surveillance in public health.

2. It is up to the Interterritorial Council of the National Health System, through the Public Health Commission, to ensure the cohesion and quality of the management of public health surveillance systems.

3. In order to coordinate the different surveillance systems, the Public Health Surveillance Network will be established, which will include the early warning and rapid response systems among its systems. This system will have continuous and uninterrupted operation twenty-four hours a day. The configuration and functioning of the Public Health Surveillance Network shall be determined by regulation.

Article 14. Of the competencies in Public Health Surveillance of the Ministry of Health, Social Policy and Equality.

Correspond to the Ministry of Health, Social Policy and Equality with the following functions in the field of public health surveillance:

a) The management of alerts of a supra-regional character or that can transcend the territory of an autonomous community.

(b) The management of alerts from the European Union, the World Health Organisation and other international bodies, and in particular those alerts referred to in the International Health Regulations (2005), in their case, in coordination with the autonomous communities and the cities of Ceuta and Melilla.

c) Those provided for in Article 65 of Law 16/2003, of 28 May, of cohesion and quality of the National Health System.

d) The coordination and evaluation of the Public Health Surveillance Network.

e) To ensure that the criteria used for monitoring are homogeneous, approved and for the opportunity, relevance and quality of the information.

f) The design and implementation of a periodic public health survey in coordination with the autonomous communities and cities of Ceuta and Melilla.

g) The coordination and management of exchanges of information on surveillance at national level and at the level of the European Union, the World Health Organisation and other bodies International public health-related issues.

h) The coordination of messages addressed to the population in the event that the health authorities issue statements or recommendations in alert or health crisis situations or that affect uncertain risks that may arise affect more than one autonomous community. For these purposes, the Health Authorities shall inform the Ministry.

Article 15. Resources for public health.

Public health administrations will promote the existence of adequate infrastructure for public health activities, comprising laboratories and other facilities and physical resources (public employees) and virtual services of public health services, covering specific public health needs and ensuring the quality of services.

In addition, public health administrations will regulate the specific regime of public health incentives and incentives in the field of public health, which encourages the training and cooperation of people. physical and legal with the subject, based on principles of publicity, effectiveness, transparency and control, in accordance with the objectives of this law.

CHAPTER II

Health Promotion

Article 16. The promotion of health.

1. The promotion of health will include actions aimed at increasing the knowledge and abilities of individuals, as well as to modify social, labor, environmental and economic conditions, in order to promote their positive impact in individual and collective health.

2. Health promotion actions will pay particular attention to the educational, health, work, local and closed institutions, such as hospitals or residences. In these areas, the Ministry of Health, Social Policy and Equality will support the creation and strengthening of networks.

3. The Ministry of Health, Social Policy and Equality with the participation of the Autonomous Communities will establish and update criteria of good practice for health promotion actions and promote the recognition of the quality of the actions.

4. Social organizations will be able to participate in the development of health promotion activities. Competent public administrations shall promote effective participation in actions to promote the health of citizens, either directly or through the organisations in which they are grouped or represented.

Article 17. Incentive measures.

1. Public administrations shall support and collaborate with entities and organisations that develop public health activities, in particular in relation to the most disadvantaged or discriminated groups in public health matters.

2. Administrations will promote the incorporation of public health as an integral element of corporate social responsibility.

Article 18. Public health communication.

1. The health authorities shall ensure that the information on public health is truthful and complies with the provisions of this law, especially when it is disseminated through the social media.

2. The Ministry of Health, Social Policy and Equality shall make available to the media and other social organisations the criteria of good practice referred to in Article 16.3, in order to achieve its maximum dissemination.

3. The public authorities, in the field of their competences, will carry out a control of commercial advertising so that it meets the criteria of veracity regarding health, as well as public recommendations on health.

4. Public health administrations will have the collaboration of the media to disseminate recommendations on public health.

5. Public administrations that develop actions in the field of health communication shall ensure that information is socially, culturally and linguistically adapted to those sectors of the population that are targeted.

CHAPTER III

Prevention of health problems and their determinants

Article 19. The prevention of health problems.

1. The aim of prevention is to reduce the incidence and prevalence of certain diseases, injuries and disabilities in the population and to mitigate or eliminate as far as possible their negative consequences through policies in line with the objectives of this law.

2. Public administrations, within the scope of their respective competences:

a) They will direct actions and preventive policies on the determinants of health, understanding the social, economic, labor, cultural, food, biological and environmental factors that influence the health of people.

b) Develop programmes for the prevention of zoonoses and emerging diseases and establish the necessary coordination mechanisms with the relevant administrations for the prevention of risk factors in the primary production.

c) Will boost other primary prevention actions, such as vaccination, that will be complemented by secondary prevention actions such as early disease screening programs.

d) Develop prevention programs aimed at all stages of people's lives, with special emphasis on childhood and old age.

e) Promote prevention by informing the population of the benefits of the prevention and following the principles set out in Chapter II of this Title, to avoid unnecessary health interventionism.

(f) They may require, in accordance with the procedure laid down in regulation, the cessation of preventive health practices that have been demonstrated to be ineffective or unnecessary.

3. The Interterritorial Council of the National Health System will agree:

a) A unique vaccine calendar in Spain. The autonomous communities and the cities of Ceuta and Melilla may only modify it for epidemiological reasons.

b) The list of population and individual preventive actions that are recommended.

c) Common preventive actions that meet the criteria to be implemented throughout the territory.

d) The periodic assessment of common preventive programs, the inclusion of new programs, or the suspension of those that do not meet the objectives for which they were designed.

4. Social organizations will be able to participate in the development of health problem prevention activities. Competent public administrations shall promote effective participation in actions to prevent the health problems of citizens, directly or through the organisations in which they are grouped or represented.

Article 20. Specific actions on cribados.

1. For the purposes of this law, screening is understood to be those activities aimed at the early detection of the disease, its diagnosis and early treatment, which are actively offered to the whole of the population susceptible to the disease, even if you have no symptoms or have demanded medical help.

2. The health authorities will promote the screening to be carried out with the highest quality and the greatest accessibility for the population, carrying out the appropriate campaigns.

3. The practice of diagnostic tests for screening purposes should be carried out in accordance with the principles laid down in Chapter II of the Preliminary Title and the scientific criteria based on screening, excluding diagnostic tests. indiscriminate or that they lack an express justification of the health objectives.

4. Labour regulations may provide for screening tests to strictly detect the specific risks and diseases arising from the work, in accordance with the provisions of this law.

Article 21. Previous health acknowledgements.

1. Only pre-employment health checks may be carried out at the disposal of the existing legislation. Where the practice of early detection of disease is required, it should be explicitly justified on the basis of the specific occupational risks and must comply with the principles laid down in Chapter II of the Preliminary this law and the scientific criteria that underpin screening.

2. Only medical examinations prior to the practice of sports can be carried out, where the current sectoral regulations are available. They shall be based on evidence in accordance with the principles set out in Chapter II of the Preliminary Title of this Law and the scientific criteria underpinning the screening.

CHAPTER IV

Coordination of health promotion and prevention of diseases and injuries in the National Health System

Article 22. The prevention of diseases and the promotion of health in health services.

1. The whole of the health care services of the National Health System will contribute to the integral development of prevention and promotion programs, in coordination with public health structures.

2. Health administrations will establish procedures for effective coordination of public health activities that develop in a health area determined with those carried out in primary care, specialized care, and care. sociosanitaria, the prevention services that carry out the health surveillance and when necessary with the services of occupational health as well as for the collaboration with the offices of pharmacy.

3. The health administrations shall establish procedures for public health surveillance to evaluate the actions of prevention and health promotion in the care field, maintaining the correspondence between the populations served. for primary care, specialized care and public health services in a given area, in accordance with the provisions on health care areas in Article 56 of Law 14/1986 of 25 April, General Health.

Article 23. From the collaboration between the care services and the public health services.

1. Health administrations will take the necessary steps to ensure that the care and public health services establish effective coordination to develop the following actions:

a) Interchange the information needed for public health surveillance and the health situation and its social conditions for better care action by the community.

b) Perform clinical tasks arising from the detection of risks to public health.

c) Conduct diagnostic tests derived from health protection actions in the field of food and environmental safety.

d) Run prevention programs according to the priorities established by each health administration by facilitating their population assessment.

e) Develop family and community care by collaborating with health promotion actions in your area of action.

f) Develop preventive actions in the living environment of people including the home.

g) Carry out up-to-date scientific information services for the best effectiveness of prevention and promotion actions.

h) Collaborate with the strategic direction of care teams to meet their health objectives.

i) Develop the necessary coordination mechanisms between primary care and specialized care with occupational risk prevention devices in the Health Areas.

j) Establish the mechanisms to communicate the suspicion of diseases that could be qualified as professionals among the physicians of the National Health System, the managing and collaborating entities of Social Security and prevention services that perform health surveillance.

2. The actions described in the previous paragraph shall be applicable at the local level where municipal public health services are available.

Article 24. From the collaboration of other health centers and establishments with public health.

1. Health administrations may provide for the collaboration of the offices of pharmacy, veterinary centres or establishments of veterinary or other Community health services in public health programmes.

2. Administrations will be able to enable these services in their case to perform the following actions:

a) Participate in public health programs and strategies that design local, regional, and state level public health services.

b) Conduct health promotion and disease prevention activities.

c) Develop activities in animal health, specifically those that contribute to the prevention of zoonoses and other related problems of relevance to the health of the population.

CHAPTER V

Healthcare management as a public health action

Article 25. Nature and objectives of health management.

The main objective of health management will be to improve the health of the population and to reduce social and territorial imbalances, in accordance with Articles 3, 6, 8 and 12 of Law 14/1986 of 25 April, General of Health and as established in this law.

Article 26. Health management in the Health Area.

1. The organs that form the areas of health will have in any case the actions directed to the improvement of the community care, the prevention of the disease, the protection and the promotion of the health.

2. Health management should be guided by the health outcomes that will be explained with a minimum frequency of five years and presented in the health boards of the area.

3. Public health services shall take all measures to ensure that health centres are "health promotion centres", taking into account the guidelines issued by the World Health Organisation, for which they will develop a health promotion plan in coordination with the competent public health unit of the community or autonomous city.

CHAPTER VI

Protecting the health of the population

Article 27. Health protection actions.

1. Health protection is the set of actions, benefits and services aimed at preventing adverse effects that the products, elements and processes of the environment, physical, chemical and biological agents, can have on health and welfare of the population.

2. Public administrations, in the field of their competences, shall protect the health of the population by activities and services acting on the risks present in the environment and in food, to which the services and services will be developed. activities to enable the management of health risks that may affect the population.

3. Health protection measures shall be governed by the principles of proportionality and precaution, and shall be developed in accordance with the principles of cooperation and interadministrative coordination and joint management ensuring the maximum efficiency and efficiency.

4. Social organisations will be able to participate in the development of health protection activities. Competent public administrations shall promote effective participation in actions for the protection of the health of citizens, directly or through the organisations in which they are grouped or represented.

Article 28. Characteristics of health protection actions.

1. Health protection shall include the analysis of health risks, including its assessment, management and communication. To this end, actions shall be developed on the risk trigger factors and, where appropriate, in accordance with the specific rules by means of official control procedures.

2. The risks arising from exposure of persons to the environment in which they live and to the agents present in the environment which may affect their physical, mental or social well-being shall be analysed.

Article 29. Health authorization and records.

1. In the event that in accordance with the laws, prior health authorization or mandatory registration is required in a registry, it will be in place for them.

2. Health authorities may provide for the obligation of a responsible declaration or prior notification of initiation of activity for those facilities, establishments, services and industries which carry out activities which may affect health, in accordance with the sectoral rules of application and taking into account the provisions of Law 17/2009 of 23 November on the free access to and pursuit of the activities of services.

Article 30. From environmental health.

1. Environmental health has as functions the identification, evaluation, management and communication of health risks that may arise from environmental conditions; the monitoring of environmental factors of a physical nature; chemical or biological and environmental situations that affect or can affect health; as well as the identification of policies of any sector that reduce environmental health risks.

2. Public administrations will implement environmental health programs, coordinated by the health administrations, to raise the level of health protection to the risks arising from environmental conditions.

Article 31. Actions of the Ministry of Health, Social Policy and Equality in the field of environmental health.

1. It is for the Ministry of Health, Social Policy and Equality to make effective the coordination of the State with the public administrations and the competent bodies, in the exercise of actions aimed at prevention and protection against environmental risks to health.

2. The Ministry of Health, Social Policy and Equality will promote the state-wide services that carry out functions in the fields of identification, evaluation, management and communication of environmental risks to the health of the population. Those which shall include at least the risks related to chemicals and health and climate change may act as a national reference centre in those areas.

The Ministry of Health, Social Policy and Equality, with the agreement of the Interterritorial Council of the National Health System, will demonstrate services that will act as a national reference center in the identification aspects, assessment and management and communication of risks to the health of the population arising from environmental risks.

3. The Public Health Strategy will include the analysis of the state of environmental health and its determinants and will incorporate actions that result in a more favorable environment for health.

Article 32. Occupational health.

Work health aims to achieve the highest degree of physical, mental and social well-being of workers in relation to the characteristics and risks arising from the workplace, the work environment and the influence of the workers. of the latter in its environment, promoting preventive, diagnostic, treatment, adaptation and rehabilitation aspects of the pathology produced or related to the work.

Article 33. Health action in the field of occupational health.

1. Health action in the field of occupational health shall be carried out in a coordinated manner with employers and workers ' representatives and shall cover the following aspects:

a) Promotion, in general, of the integral health of workers.

b) Health surveillance of workers, individually and collectively, to detect early the health risks to which they are exposed.

c) Development and action in the health aspects of the prevention of occupational risks.

d) Promotion of information, training, consultation and participation of health professionals, workers and their legal representatives and employers in health plans, programmes and actions in the field of health occupational health.

2. The health authority, in a coordinated manner with the labour authority, shall carry out the following actions in addition to those already established:

a) Develop a health information system in occupational health that, integrated into the public health information system, supports the monitoring of occupational health risks.

b) Establish a system of indicators for monitoring the health impact of work-related policies.

c) To promote the health of workers through the development of protocols and guidelines for specific health surveillance in the face of the risks to which they are exposed.

d) Develop post-occupational health surveillance programs.

e) Authorizing, evaluating, controlling and advising the health activity of occupational risk prevention services.

f) Establish mechanisms for the integration into the public information systems of the National Health System of information generated by the health activities developed by the risk prevention services In the case of occupational accidents and occupational diseases, occupational diseases and occupational diseases in relation to the health of workers.

g) Promoting health promotion in the workplace, through the promotion and development of healthy living environments and habits.

h) Establish coordination mechanisms in case of pandemics or other health crises, in particular for the development of preventive and vaccination actions.

(i) Other measures that promote improvement in the surveillance, promotion and protection of workers ' health and the prevention of health problems arising from work.

j) Promote the health training of healthcare professionals in public health systems.

Article 34. Participation in occupational health.

Employers and workers, through their representative organizations, will participate in the planning, programming, organization and management of work related health management, at the various levels territorial.

CHAPTER VII

Assessing the health impact of other policies

Article 35. The assessment of the health impact.

1. Public administrations should submit to health impact assessment, the standards, plans, programs and projects that they select to have a significant impact on health, in the terms provided for in this law.

2. The health impact assessment is the combination of procedures, methods and tools with which a standard, plan, program or project can be analyzed in relation to its potential effects on the health of the population and on the distribution of the same.

3. The health impact assessment should provide for the direct and indirect effects of health and non-health policies on the health of the population and social inequalities in health with the objective of improving the actions.

4. The results of these evaluations will be integrated into the public health information system and the Public Health Surveillance Network.

CHAPTER VIII

External health and international health

Article 36. Purpose of external health.

1. In the exercise of the State competition for external health, it is for the Ministry of Health, Social Policy and Equality:

(a) Organize and guarantee the supply and quality of sanitary controls of goods upon importation or export in the facilities of the Spanish borders and in the international means of transport, as well as of the transported by passengers on international transit.

b) to organise and ensure the provision of health care for the international transit of travellers, the prevention of diseases and injuries to the traveller and international vaccination services. Collaboration with the Autonomous Communities may be established by means of management or other forms of collaboration referred to in the legal order in such a way as to make vaccination more accessible to citizens who are required to comply with this requirement.

c) Articulate external health surveillance.

2. The provisions of this Chapter shall be without prejudice to the powers conferred upon the Ministry of Foreign Affairs and Cooperation in the field of international relations, with which appropriate coordination shall be established.

Article 37. External health functions.

Are external health functions:

(a) The control and sanitary surveillance of ports and airports of international traffic and border facilities.

(b) The control and monitoring of hygienic and sanitary conditions in the international traffic of persons, bodies and human remains, animals and goods, including both food and food products and other goods (a) to put at risk the health of the population, such as the international means of transport, without prejudice to the powers of the Ministries of Economy and Finance, the Environment, the Rural and the Marine Environment, as well as the powers of the autonomous communities and the cities of Ceuta and Melilla in the field of verification of the conditions of the food in the exporting establishments.

c) Coordination and collaboration with the competent authorities of other countries and with international health agencies.

d) All of those matching activities to be determined in the future.

Article 38. Of the actions in external health.

1. External health services may act on their own initiative or at the request of a party, as appropriate and appropriately accredited and identified.

2. The staff of the external health services will respond to any event that may pose a public health risk on the Spanish borders, playing the role of the agent of the health authority and coordinating the response with the different administrations at national level.

3. They may require the submission of the authorisations and certifications required by the applicable provisions, in any case related to their actions.

4. Where non-compliance with the hygiene-health rules is detected, they shall act accordingly and, depending on the seriousness of the deficiencies identified, take the appropriate measures. If the severity of the health risks requires it to be able to paralyze the activities of the installation or the means of transport inspected, in accordance with the national and international standards in force.

Article 39. Actions in the field of international health.

1. In the field of international health, the Ministry of Health, Social Policy and Equality shall exercise the following

:

a) Act as a liaison centre for the exchange of any information of interest in international public health.

b) Collect international health risk information and report to the agencies of the General Administration of the State responsible for the coordination of emergencies and civil protection.

c) Develop periodic reports, on the evolution and conditioning of international health and its implications for Spain.

d) Integrate into the Public Health Strategy, those international health actions of interest to the Government of Spain.

e) Establish and coordinate a network of healthcare professionals and teams that are available for immediate health cooperation, in order to be able to respond to international health emergencies.

f) Propose the appointment of experts in public health in the Permanent Representations of Spain to international organizations and institutions in coordination with the competent ministries.

2. The Ministry of Health, Social Policy and Equality will be the National Liaison Centre for continuous communication with the World Health Organisation and other international alert networks, and will be responsible for implementing the Regulation. Health International (2005), maintaining the national capacity to comply with the provisions of the said Regulation in coordination with the Ministry of Territorial Policy and Public Administration.

CHAPTER IX

Public Health Information System

Article 40. Public Health Information System.

1. Information systems in the field of public health, or whose information is relevant to the decision making in this field, regardless of their ownership, shall integrate the Public Health Information System.

2. In order to ensure the compatibility and interoperability of public information systems, the provisions of Chapter V of Law 16/2003, of 28 May, of the cohesion and quality of the National Health System, on the information system, will be dealt with. health.

3. The Public Health Information System shall comprise at least the following:

(a) Statistics, records and surveys that measure health conditions: education, social situation, employment situation, physical and environmental environment, including changes in climate, security, demographics, economy, services, health resources, presence of contaminants in people and any other variables that scientific knowledge and the needs of the health administration make necessary.

b) Statistics, records and surveys that measure the health, quality of life, and well-being of the population.

c) Information on policies and on public health actions in all areas of action.

4. The public health information system shall be composed of indicators based, inter alia, on the criteria of the World Health Organisation and the European Union.

Article 41. Organization of information systems.

1. The health authorities in order to ensure the best protection of the health of the population may require, in the terms laid down in this article, the health services and professionals reports, protocols or other documents for the purpose of health information.

2. The health authorities shall not require the consent of the persons concerned for the processing of personal data, relating to health, as well as their transfer to other public health administrations, where this is not the case. strictly necessary for the protection of the health of the population.

3. For the purposes referred to in the previous two paragraphs, public or private persons shall give the health authority, where required, personal data which are essential for the taking of decisions in health public, in accordance with the provisions of the Organic Law 15/1999 of 13 December on the Protection of Personal Data.

In any case, access to the medical records for epidemiological and public health reasons will be subject to the provisions of Article 16 (3) of Law 41/2002 of 14 November, which is the basic regulation of autonomy. of the Patient and of Rights and Obligations in the field of Clinical Information and Documentation.

Article 42. Basic data and information communication.

1. The Interterritorial Council of the National Health System shall approve the information on public health that is included in the Public Health Information System, to which effect it will define a set of basic data under the conditions and requirements. established in Chapter V of Law 16/2003, of 28 May, of the cohesion and quality of the National Health System.

2. Access to the information by the users of the system will be done in the terms set out in this law and its development provisions.

Article 43. Information security.

1. At all levels of the public health information system, the necessary measures shall be taken to ensure the security of the data.

2. Workers in public and private centres and services and those who, by reason of their activity, have access to information in the information system are obliged to keep secret.

TITLE III

Planning and coordinating public health

Article 44. Public Health Strategy.

1. The Public Health Strategy, without prejudice to those that can be approved by the autonomous communities, aims to encourage health and equity in health to be considered in all public policies and to facilitate inter-sectoral action in this area. material.

2. The Strategy shall define the areas of action on the conditioning factors of health and shall incorporate the actions of public health research referred to in Articles 47, 48 and 49 of this Law.

3. The Public Health Strategy, which will be approved by the Interterritorial Council of the National Health System, will have a five-year duration and will be evaluated on a biennial basis.

Article 45. Creation and composition of the Public Health Advisory Board.

1. The Advisory Board of Public Health is created as a collegiate body for consultation and participation, attached to the Ministry of Health, Social Policy and Equality, in which the Departments of the General Administration of the State are represented. policies have an impact on health, the Autonomous Communities, and those other public health agencies and organisations that ensure adequate system governance.

2. The Public Health Advisory Board is chaired by the person holding the Ministry of Health, Social Policy and Equality.

3. The composition, functions and operating arrangements of the Advisory Board of Public Health shall be determined by regulation, including at least representatives of the professional corporations, as well as of the scientific associations, of the professional associations and non-profit organizations related to public health, trade unions, business organizations, non-profit organizations related to public health and organizations consumers and users.

The composition of this Advisory Board should ensure the appropriate representation of the sectors concerned.

Article 46. Advisory Committee of the Interterritorial Council of the National Health System.

The Advisory Committee of the Interterritorial Council of the National Health System will act as a specialized, collegiate and permanent organ of consultation and social participation in public health policies, in such a way as to ensure adequate system governance.

Article 47. State Public Health Center.

1. The State Public Health Center is attached to the Ministry of Health, Social Policy and Equality, acting under the guidelines of the executive center responsible for public health. Its functions will be established in the corresponding Royal Decree of organic structure.

2. The objective of the State Public Health Center is the technical advice on public health and the evaluation of public health interventions in the field of the General Administration of the State. It will also carry out technical and scientific advisory and evaluation of public health interventions in the field of other administrations.

3. The State Public Health Center will monitor and evaluate the Public Health Strategy and coordinate actions developed by national public health centers.

TITLE IV

Professional staff and public health research

CHAPTER I

Vocational training and development in public health

Article 48. General principles for the exercise of public health activities.

1. For the purposes of this law, professional activities in the field of public health are considered to be the development of the interventions described in Title II of this law and limited to public health excluding those related to the law. health research.

2. Public health has a multidisciplinary nature, and professional staff in public health have a duty to follow a continuous training throughout life, which must also be appropriate to their level of responsibility and competence for ensure a proper professional exercise.

3. Public administrations will facilitate continuing training as a part of professional development in public health and as a strategic investment.

4. Health professionals in public health shall be subject to the provisions of Title III on professional development and their recognition of Law 44/2003 of 21 November of ordination of the health professions, defining necessarily the corresponding professional career.

CHAPTER II

Research in the development of public health policies

Article 49. Priorities of public health research.

The Public Health Strategy will determine the areas related to public health and its social conditions in which, due to the special impact on the population as a whole, it is of particular interest to promote the research.

Article 50. Promotion of public health research.

Health administrations will promote research and communication of their results in the activities of public health professionals. To do this, you will take the following actions:

(a) Facilitate that research on population health problems is carried out with adequate means and quality.

b) Foster the relationship between excellence research groups and professional public health personnel.

c) Stimulating research activity by facilitating access to data and information available in health administrations.

Article 51. Communication of the results of public health research.

1. Independently of the obligations to disseminate the results of the research, provided for in the Law of Science, Technology and Innovation, the competent public administrations in the field of health-related research establish appropriate mechanisms for the results of projects financed from public funds that may have immediate implementation in the decision-making of health policy, especially in the treatment of high-level diseases. impact on the population, be immediately communicated to the health administrations. In any case, the defense of the corresponding intellectual and industrial property rights shall be guaranteed.

2. Health administrations will jointly assess the health impact of the population on the results of publicly funded research.

3. In the establishment of agreements with research groups the competent authorities shall give preference to those groups whose results have led to effective applications and uses by the health authorities.

TITLE V

State health authority, surveillance and control

CHAPTER I

State health authority

Article 52. The State Health Authority.

1. The head of the Ministry of Health, Social Policy and Equality and, within the framework of their respective roles, the heads of the higher bodies and management bodies with responsibilities in the Member States, shall be considered to be State health authorities. public health of that ministerial department with a rank equal to or greater than that of the Director-General.

2. The State health authority shall, in the exercise of its responsibility and in accordance with the relevant powers of the public health authority, lay down provisions and have the power to act, by means of the competent bodies in each case, in public or private activities to protect the health of the population.

3. It is up to the State health authority, in general, in the field of its powers, to adopt measures on the coordination and implementation of public health measures taken into account in this law, as well as the adoption of Any special intervention measures, in accordance with Article 52, in the field of public health are necessary for health reasons of urgency or need or circumstances of an extraordinary nature which represent a clear risk to the public health health of the population, and provided that the available scientific evidence shows it.

4. The health authority may, in the exercise of its functions, request the support, assistance and collaboration of other administrative bodies, public officials or other institutions, and may even require, in the case of strict and urgent need and for the best compliance with the current legislation, the assistance of the State Security Forces and Corps or other agents of the authority entrusted with security functions.

Article 53. Agents of the State Health Authority.

Staff at the service of the General Administration of the State linked to the exercise of powers referred to in this law shall have the status of an agent of the health authority and shall be empowered to carry out inspection. For this purpose, it may take samples and practice the tests, investigations or examinations necessary for the verification of compliance with the health standards in accordance with the procedures laid down.

CHAPTER II

Special and precautionary measures

Article 54. Special and precautionary measures.

1. Without prejudice to the measures provided for in the Organic Law 3/1986 of 14 April of Special Measures in the Field of Public Health, exceptionally and when necessary for reasons of extraordinary seriousness or urgency, the Administration General of the State and those of the autonomous communities and cities of Ceuta and Melilla, within the scope of their respective competences, may take as many measures as are necessary to ensure compliance with the law.

2. In particular, without prejudice to the provisions of Law 14/1986 of 25 April of 25 April, the competent authority may, by means of a reasoned decision, adopt the following measures

(a) The immobilisation and, if appropriate, the confiscation of products and substances.

b) The intervention of material or personal means.

c) The preventive closure of facilities, establishments, services and industries.

d) The suspension of the exercise of activities.

e) The determination of preconditions at any stage of the manufacture or marketing of products and substances, as well as the operation of the facilities, establishments, services and industries to which it relates this law, in order to correct the deficiencies identified.

f) Any other measure adjusted to the law in force if there are rational indications of health risk including the suspension of actions according to the provisions of Title II of this Law.

3. The measures shall be adopted after the hearing of the persons concerned, except in the case of an imminent and extraordinary risk to the health of the population and its duration shall not exceed the time required by the risk situation. The costs arising from the adoption of precautionary measures referred to in this Article shall be borne by the person or undertaking responsible.

The measures to be taken must, in any event, respect the principle of proportionality.

TITLE VI

Violations and penalties

Article 55. Subjects responsible for the infringements.

Without prejudice to the sanctioning regimes established by the sectoral regulations in force, in particular in the work order, the natural or legal persons responsible for the actions or omissions that constitute infractions in the public health shall be sanctioned in accordance with the provisions of this Title.

Article 56. Infringements and sanctioning regime.

1. Administrative offences in public health are the actions and omissions that are identified in the following articles, as well as those which, where appropriate, can be established by regional or local legislation.

2. If the same action or omission is constitutive of two or more infractions, only the one with the greatest sanction shall be taken into consideration.

3. Acts which have been punishable by criminal or administrative punishment shall not be punishable in cases where the identity of the subject, in fact and in substance, is assessed. In cases where the offences may be a crime or a fault, the competent authority shall pass the fault to the competent jurisdiction and shall refrain from pursuing the sanctioning procedure while the competent authority is responsible. judicial has not been pronounced.

If the existence of criminal wrongdoing has not been estimated or if a decision of another type to end the criminal proceedings has been passed, the sanctioning file will be continued, taking into account, where appropriate, the facts that the courts have been considered tested.

4. The processing of a sanctioning procedure for the infringements regulated in this Title will not delay the requirement of the obligations to adopt measures of prevention, avoidance of new damages or reparation, provided for in this law, which shall be independent of the sanction imposed.

Article 57. Rating of the infringements.

1. The offences defined in this law are regarded as very serious, serious and minor, taking into account the risk criteria for the health of the population, the severity of the health or social change produced, the amount of the possible benefit obtained, degree of intentionality and recidivism in the same.

2. In addition to the health violations provided for in Law 14/1986 of 25 April, General Health, the following are classified as public health infractions:

a) These are very serious violations:

1. The conduct of conduct or omissions that result in a very serious risk or harm to the health of the population.

2. The failure to comply, in a repeated manner, with the instructions received from the competent authority, or the failure to comply with a request, if this entails serious damage to health.

3. º Those that are concurrent with other serious health violations, or have served to facilitate or cover up their commission.

4. The recidivism in the commission of serious faults in the last five years.

b) These are serious violations:

1. The conduct of conduct or omissions that may cause a risk or serious harm to the health of the population, where this is not a very serious infringement.

2. The denial of support, assistance or collaboration to health authority agents.

3. The failure to comply with the instructions received from the competent authority, if it causes damage to health, where it is not a very serious infringement.

4. º The resistance or obstruction of those actions that are enforceable, according to the provisions of this law.

5. The failure to communicate information and other obligations under the provisions of Title I of this law, when it is of a serious nature.

6. The recidivism in the commission of minor infractions, in the last twelve months.

c) They are minor violations:

1. The failure to comply with current health regulations, if the effects produced have had little or no direct effect on the health of the population.

2. º Those violations that as set forth in this article do not qualify as serious or very serious.

Article 58. Penalties.

1. The commission of infringements in the field of public health shall give rise to the imposition of the following penalties, without prejudice to those which may be established by the Autonomous Communities and Local Entities in the field of their jurisdiction:

(a) In the case of a very serious infringement: Multa of 60,001 up to EUR 600,000, being able to exceed this amount up to five times the market value of the products or services that are the subject of the infringement.

b) In the case of serious infractions: Multa from 3,001 to 60,000 euros.

c) In the case of minor infractions: Multa up to 3,000 euros.

These amounts may be updated by the Government Regulatively.

2. Without prejudice to the economic penalty which may be imposed, in the case of very serious infringements, the temporary closure of the establishments or services may be agreed by the competent authority for a maximum period of five years.

3. In the imposition of the penalties, the public authorities shall be required to ensure that the seriousness of the fact that the infringement is established and the penalty applied is adequate, in view of the criteria laid down in Article 131. of Law 30/1992 of 26 November 1992 on the Legal Regime of Public Administrations and the Common Administrative Procedure.

Article 59. Limitation of infringements and penalties.

1. Minor infractions will be prescribed for the year, severe for three years and very serious for five years.

The limitation period for infringements shall begin to be counted from the day following that in which the infringement was committed.

In the case of continued infringements, the limitation period shall start from the moment of the completion of the activity or of the last act with which the infringement is consumed. In the event that the facts or activities constituting an infringement are unknown because they are not external signs, the time limit shall be computed from the fact that they are manifest.

Interrupt the prescription of the initiation, with the knowledge of the person concerned, of the sanctioning procedure, resuming the limitation period if the sanctioning file has been paralyzed for more than one month by reason not imputable to the presumed responsible.

2. The penalties imposed by the commission of minor infractions shall be prescribed for the year, those imposed for serious misconduct at three years and those imposed for very serious offences at the age of five.

The limitation period for the penalties shall begin to be counted from the day following the day on which the decision imposing the sanction becomes final.

Interrupt the prescription of the initiation, with the knowledge of the interested party, of the execution procedure, returning to elapse the deadline if the one is paralyzed for more than one month for cause not imputable to the infringer.

Article 60. Sanctioning procedure.

1. The sanctioning procedure, in the field of public health, shall be carried out in accordance with the provisions of this law and Title IX of Law 30/1992 of 26 November of the Legal Regime of Public Administrations. of the Common Administrative Procedure.

2. The deadline for issuing and notifying the resolution of a sanctioning file is nine months.

Article 61. Competent bodies to impose sanctions on public health.

1. The opening, processing and resolution of the sanctioning files shall be the responsibility of the competent authority for the territory and the matter.

2. In the field of the General Administration of the State, the opening of the file shall be the responsibility of the Directorate-General responsible for public health and the decision to the holder of this Directorate-General, in the case of minor offences, to the the holder of the General Secretariat for Health, in the case of serious infringements, and the person holding the Ministry of Health, Social Policy and Equality, for the very serious offences.

3. The competent authorities may publish, once they are firm, the penalties imposed for the offences committed, the facts constituting such offences and the identity of the offender.

Additional disposition first. The specialization in public health of the health professions.

The Government will amend Royal Decree 183/2008 of 8 February, determining and classifying specialties in health sciences and developing certain aspects of the specialized health training system, in order to extend the specialization in public health to the other health professions.

Additional provision second. Public health in the Armed Forces.

In the field of the Armed Forces, the General Inspection of Defense Health, as the health authority of the department, will coordinate with the other health authorities actions aimed at meeting the objectives of the of this law, and will carry out, within the Armed Forces, the necessary actions for the fulfillment of its provisions and those that are consistent, giving an account of these provisions to the Ministry of Health, Social Policy and Equality.

Additional provision third. Public health in the Prison Institutions.

In the field of the Penitentiary Institutions, the prison authority will coordinate with the health authorities the actions aimed at fulfilling the objectives of this law, and will carry out the necessary actions for the compliance with its provisions and those that are consistent with those health services that are dependent on Penitentiary Institutions that have not been transferred to the Autonomous Communities, thereby giving the Ministry of Health care, Social Policy and Equality.

Additional provision fourth. From the State Public Health Center.

The creation of the State Public Health Center, provided for in Article 47, will be carried out by restructuring the existing units referred to in the Royal Decree for the development of the basic organic structure. of the Ministry of Health, Social Policy and Equality, without being able to increase budgetary appropriations.

This center will coordinate its activities with the national centers of Epidemiology, Microbiology, Environmental Health, Tropical Medicine, National School of Health and National School of Labor, and other units, centers and (a) State-owned bodies which have, among their powers, the development of functions in the field of public health in connection with the development of research activities.

Additional provision fifth. Benefits.

The benefits provided by this law will be financed in accordance with the provisions of Article 10 of Law 16/2003 of 28 May, on the cohesion and quality of the National Health System.

Additional provision sixth. Extension of the right to public health care.

1. The right to access to public health care, to all Spaniards residing on national territory, to which they cannot be recognised in application of other rules of the legal order, is extended.

This extension, which will have at least the scope provided for in the portfolio of common services of the National Health System, is done without prejudice to the following paragraphs and the requirement of the corresponding obligations to third parties legally obliged to pay such assistance in accordance with the provisions of the General Law on Health, the recast of the General Law on Social Security and the provisions of Community regulations and international conventions in the field.

The extension provided for in this paragraph shall be effective for persons who have exhausted the unemployment benefit or allowance as from 1 January 2012. For the rest of the groups concerned, it shall be carried out in accordance with the evolution of the public accounts in accordance with paragraph 3.

2. The provisions of the above paragraph do not change the health care system of the persons who are the holders or beneficiaries of the special social security schemes managed by MUFACE, MUGEJU or ISFAS, which shall maintain their legal status specific. In this respect, persons who have chosen to receive healthcare through the insurance institutions shall be treated in the health centres provided by these entities. In the case of receiving assistance in public health centres, the expenditure corresponding to the assistance provided shall be claimed from the third party, in accordance with the rules in force.

3. Within six months, the Government shall determine the terms and conditions of the extension of the right for those exercising an activity on their own account.

Additional provision seventh. Regulation of psychology in the health field.

1. He shall have the status of a health profession entitled and regulated under the name of General Sanitary Psychologist at graduate level, in accordance with the terms of Article 2 of Law 44/2003 of 21 November 2003. Health professions, licentiates/graduates in psychology when they develop their professional activity for their own or others in the health sector, provided that, in addition to the aforementioned university degree, they have the official title of Master in General Health Psychology, whose curricula will be adjusted, whichever is the (a) to the general conditions laid down by the Government under the provisions of Article 15 (4) of Royal Decree 1393/2007 of 29 October 2007 establishing the organisation of university teaching officers.

According to the provisions of article 6.4 of Law 44/2003, of 21 November, it is up to the General Health Psychologist, the carrying out of research, evaluations and psychological interventions on those aspects. the behaviour and activity of persons who have an influence on the promotion and improvement of the general health of their health, provided that such activities do not require specialised care by other healthcare professionals.

2. In accordance with Article 15 (4) of Royal Decree 1393/2007 of 29 October 2007, the Government shall, within six months, lay down the general conditions for the adjustment of the curricula for the attainment of the Master in General Health Psychology, enabling the Ministry of Education to concretize, subject to the provisions of said Royal Decree, the requirements of the Master and the planning of his teachings in the field of all the Status, subject to the following criteria:

(a) The plans of studies corresponding to the official title of Master in General Health Psychology shall guarantee the acquisition of the necessary competences to carry out the activities of the health profession of Psychologist Sanitary General as specified in paragraph 1. To this end, the enabling title for the profession of the General Health Psychologist must demonstrate the improvement of at least 180 ECTS credits of specifically sanitary content in the set of Grade and Master teachings, according to the concreteness to be determined by regulation.

(b) Universities providing Master's degree in General Health Psychology will regulate the procedure to allow for the recognition of graduates/graduates in Psychology who have completed such studies prior to the entry into force of this law, the European credits of such a Master, which in each case correspond, after evaluating the degree of equivalence accredited through the professional experience and training acquired by the interested in Psychology of the Health.

3. In accordance with Article 12 (9) of Royal Decree 1393/2007 of 29 October 2007, the Government, within one year, shall regulate the general conditions to which the plans for studies of the degree in Psychology are to be adjusted, corresponding to the Ministry of Education, in the abovementioned period and subject to the provisions of that Royal Decree, the requirements of the title and the planning of the teaching to which the plans of studies of degree in the the scope of the entire State subject to the following criteria:

(a) The degree in Psychology, which will not, by itself, enable the exercise of psychology in the health sector, will be a necessary requirement for access to the Master of General Health Psychology.

b) Universities that train psychologists seeking to access the Master of General Health Psychology will design the degree in Psychology by providing at least one specific route linked to the psychology of health. This tour will determine an express mention in the corresponding degree in Psychology.

(c) Universities will proceed to adapt the Grade in Psychology study plans already approved to the general conditions mentioned above, requesting their verification in the terms provided for by the legislation in force. The said adaptation shall be carried out within five years of the Government's approval of the general conditions to which the plans of studies of the degree in Psychology are to be adjusted.

4. Psychologists who carry out their activities in centres, establishments and services of the National Health System, or in conjunction with it, to make effective the health benefits derived from the portfolio of common services of the same correspond to those professionals, they must be in possession of the official title of Psychologist Specialist in Clinical Psychology referred to in paragraph 3 of Annex I to Royal Decree 183/2008 of 8 February, for which they are determined and classified Health Sciences specialties and certain aspects of the health system are developed specialised health training.

The provisions of the preceding paragraph shall be without prejudice to the powers of other health specialists and, where appropriate, the multi-professional character of the relevant work teams in the field of health mental.

5. The Health Administrations of the different Autonomous Communities, to register in the corresponding General Register of health centers, services and establishments the units assists/queries of psychology, will require that the You may have obtained the Master's degree in Health Psychology or the Clinical Psychology Specialist Psychologist.

Without prejudice to the provisions of the preceding paragraph, the transitional procedure provided for in number 2 of the sixth additional provision of Law 5/2011 of 29 March 2011 of the Social Economy is maintained for a period of three years. from the entry into force of this law.

Single repeal provision. Regulatory repeal.

1. Article 19 (1), as well as Articles 21 and 22 of Law 14/1986 of 25 April, General of Health, shall be repealed.

2. Article 66 of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, is repealed.

3. Similarly, any provisions of equal or lower rank shall be contrary to the provisions of this law.

Final disposition first. Amendment of Law 14/1986 of 25 April, General of Health.

Article 25 (1) of Law 14/1986 of 25 April, General of Health, is worded as follows:

" 1. The requirement for health authorizations, as well as the obligation to submit to companies or products for health reasons, shall be regulated, on the basis of the provisions of this law, as well as in the General Public Health Law. "

Article 27 of Law 14/1986 of 25 April, General of Health, is worded as follows:

" The public administrations, in the field of their competences, will carry out a control of commercial advertising and propaganda so that they conform to criteria of veracity regarding health and to limit everything which may be detrimental to it, with particular regard to the protection of the health of the most vulnerable population. '

Final disposition second. Amendment of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System.

Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, is amended as follows:

First. Article 2 (c) of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, is worded as follows:

"c) The coordination and cooperation of public health administrations to overcome health inequalities, as provided for in this law and in the General Public Health Law."

Second. Article 2 (d) of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, is worded as follows:

" (d) The provision of comprehensive health care, understanding both its promotion and the prevention of diseases, assistance and rehabilitation, seeking a high level of quality, in the expected terms in this law and in the General Public Health Law. "

Third. Article 11 (2) of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, is worded as follows:

" 2. The provision of public health includes the following actions:

(a) Information and surveillance in public health and epidemiological alert systems and rapid response to public health emergencies.

b) The defense of public health goals and objectives, which is the combination of individual and social actions aimed at obtaining political commitments, support for health policies, social acceptance and support for some specific health objectives or programmes.

c) Health promotion, through cross-sectoral and cross-cutting programs.

d) Prevention of diseases, disabilities and injuries.

e) Health protection, avoiding the negative effects that various elements of the media can have on people's health and well-being.

f) The protection and promotion of environmental health.

g) The protection and promotion of food security.

h) The protection and promotion of occupational health.

i) Health impact assessment.

j) The surveillance and control of any health risks arising from the import, export or transit of goods and international transit of passengers.

k) The prevention and early detection of rare diseases, as well as support for the people who present them and their families.

The provision of public health shall also include all special measures or special measures which, in the field of public health, must be adopted by the health authorities of the various administrations. public, within the scope of its powers, where health circumstances of an extraordinary nature or situations of particular urgency or need so require and the available scientific evidence justifies them. "

Fourth. Article 26 (1) of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System, is worded as follows:

" 1. The health services shall inform the citizenry of their rights and duties, of the benefits and the portfolio of services of the National Health System, of the requirements necessary for the access to these services and of the other rights collected in the Basic law regulating the autonomy of the patient and the rights and obligations regarding information and clinical documentation, as well as the rights and obligations established in the General Public Health Law and the corresponding rules autonomic, if any. "

Fifth. The fourth additional provision of Law 16/2003, of 28 May, of Cohesion and Quality of the National Health System is worded as follows:

" Additional provision fourth. Extension of the content of the service portfolio of the National Health System.

1. The General Mutuality of Civil Servants of the State (MUFACE), the Social Institute of the Armed Forces (ISFAS) and the General Judicial Mutuality (MUGEJU), as members of the National Health System in their capacity as managing entities of the Special Social Security Regimes of the Civil Servants of the State, the Armed Forces and the Personnel to the Service of the Administration of Justice, respectively, will have to guarantee the contents of the service portfolio of the National Health System, as well as guarantees on accessibility, mobility, quality, security, information and time contained in this law, in accordance with the provisions of its specific regulations.

In the field of public health, the actions of epidemiological surveillance, protection and promotion of food security are excepted from the National Health System Services Portfolio in the field of such mutual funds. protection and promotion of environmental health, monitoring and control of the risks arising from the importation and transit of goods and passengers, and the general actions for the protection and promotion of health related to the prevention and epidemics and catastrophes.

In any case, the professionals and health centers that serve the collective protected by the Mutualities of officials under the concerts signed by them with the Free Insurance Entities are obliged to collaborate with the competent authorities in the actions undertaken in the field of public health.

2. Without prejudice to Article 6, the collaborating and mutual entities with responsibilities for the coverage of public health assistance shall be required to ensure, as far as it is applicable, in accordance with the provisions of their legislation. specifies, the contents of the National Health System's service portfolio, as well as the guarantees on accessibility, mobility, quality, security, information and time collected in this law. "

Final disposition third. Amendment of Law 41/2002 of 14 November, basic regulation of the autonomy of the patient and of rights and obligations regarding information and clinical documentation.

Article 16 (3) of Law 41/2002 of 14 November 2002, basic regulation of patient autonomy and rights and obligations in the field of information and clinical documentation, is worded as follows:

" 3. Access to the medical history for judicial, epidemiological, public health, research or teaching purposes is governed by the provisions of the Organic Law 15/1999 of 13 December, the Protection of Personal Data, and the Law 14/1986, of 25 April, General of Health, and other implementing rules in each case. Access to the medical history for these purposes requires the preservation of the patient's personal identification data, separated from those of a clinical care, so that, as a general rule, anonymity is assured, except that the patient has given their consent to not separate them.

The cases of investigation of the judicial authority are excepted, in which it is considered essential to unify the identification data with the care clinics, in which they will be at the disposal of the judges and courts in the relevant process. Access to data and documents in medical history is strictly limited to the specific purposes of each case.

When this is necessary for the prevention of a serious risk or danger to the health of the population, the health administrations referred to in Law 33/2011, General Public Health, will be able to access the data identification of patients for epidemiological or public health protection reasons. Access shall, in any case, be made by a health professional subject to professional secrecy or by another person subject, in addition, to an equivalent obligation of secrecy, on the grounds that the administration has requested the access to data. "

Final disposition fourth. Competence title.

1. This law has the character of a basic rule, in accordance with the provisions of article 149.1.16. of the Constitution, which attributes to the State exclusive competence on the basis and general coordination of health. Chapter VIII of Title II falls within the exclusive competence of the State in the field of external health as provided for in the same clause. Chapter II of Title IV is issued under Article 149.1.15 of the Constitution, which gives the State exclusive competence in the field of general promotion and coordination of scientific and technical research.

2. Articles 45 and 53 are not of a basic character and apply exclusively to the General Administration of the State.

Final disposition fifth. Enabling regulatory development.

The Government and the titular person of the Ministry of Health, Social Policy and Equality, within the scope of their respective competences, will dictate the provisions necessary for the development and implementation of this law.

Final disposition sixth. Entry into force.

This law shall enter into force on the day following that of its publication in the Official Gazette of the State, with the exception of Article 48 (4), which shall enter into force 12 months after its publication in the Official Journal of the European Communities. "Official State Gazette".

Therefore,

I command all Spaniards, individuals and authorities, to keep and keep this law.

Madrid, 4 October 2011.

JOHN CARLOS R.

The President of the Government,

JOSE LUIS RODRIGUEZ ZAPATERO