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The paper is aimed to analyze if religion plays a relevant role in health promotion and, thus, if it can be included in the interpretations on the positive role of religions in the public sphere. In this regard, Habermas refers to a crisis of meaning in secular societies that has been caused, among other reasons, by individualistic and selfish lifestyles that fail to encourage a moral action when it goes beyond the law. In contrast, it seems that the strong social ties of religious communities foster solidarity and altruistic attitudes, which could be interpreted as a sign of greater social cohesion; but is it really like that? Pandemic and its consequences help to assess whether the religious element (analyzed as belief, belonging, bonding and behavior) has created positive attitudes in the face of the health challenges (i.e., compliance with rules of social distance, vaccination) or, on the contrary, the motivational deficits of some societies have to do with other factors not related to the religious/secular dichotomy., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

In behavioral science, the term nudge refers to any aspect of decision architecture that predictably alters people's behavior to improve the chooser's own welfare without forbidding or significantly restricting their choices. Its promoters invoke libertarian paternalism, which means, on the one hand, that the behavior of the individual is guided without counting on his autonomy, but, on the other hand, that this form of influence does not reach the point of restricting freedom of choice when it is manifest. This paper analyzes the role of nudges in the field of health policies. A cognitive analysis of these nudges is carried out and are distinguished the clinical nudges (those that take place within the healthcare professional and patient relationship) from the public health nudges (specific to public health policies). The ethical aspects of both categories of nudge will be analyzed to point out some of their virtues and the ethical challenges they face. This study focuses in particular on public health nudges, to consider whether it is reasonable, and with what limits, their implementation in health crises (for example, pandemics). Analyzing that public policies face the dilemma between preserving freedom at the expense of health or, on the contrary, prioritize health to the point of limiting freedom. It is raised whether in this context greater restrictions on individual freedoms should be allowed (for example, through mandatory lockdowns and quarantines, imposed vaccinations, forced tests) or whether to use nudges as an intermediate solution and less harmful to individual rights to promote health measures., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The creation of a national centre for public health, with adequate resources, will make it possible to face the public health challenges of the present and the future in our country. To this end, the proposed state agency, should hold functions based on advanced public health organizational schemes, while linking with the sustainable development goals. The coordination of a national public health strategy built on a collaborative network of networks would also be essential, as developing an innovative, benchmarked and prioritised public health communication strategy, among other tasks. The lack of resources, the current relative disconnection of essential public health functions at the state level, and the inequity in their development of these functions at the regional and municipal levels, favour the development of the agency project as a network of networks. In this paper we give ideas for a process that seems decisive for Spanish public health in the 21st century., (Copyright © 2021 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: The COVID-19 pandemic has been a time where social media allows increased conversations about it. These conversations have spread various conspiracies about vaccines against COVID-19. It is, therefore, necessary to develop communication strategies, led by official accounts, that offer accessible information on vaccination as a preventive public health strategy. The aim of this study was to analyze the role of public institutions on Twitter campaign #yomevacuno to deal with misinformation about vaccination against COVID-19., Methods: This paper performs a social network analysis and content analysis of Twitter data, using NodeXL software, from December 8 th to 23 rd , 2020. Tweets included content #yomevacuno hashtag., Results: A total of 6,080 interactions were collected, 82% were tweets. Data shows that public institutions generate 53.36% of traffic information, the most important was the Ministerio de Sanidad from Spain. Content analysis revealed that 48% of a sample of 50 Tweets the message was focused on vaccination as a social responsibility to defeat COVID-19 pandemic., Conclusions: The communication strategy of #yomevacuno hashtag, has been led by the Ministerio de Sanidad of Spain, by comparison to other campaigns in which there was no large presence of public institutions. This case represents the importance of social media as a way to spread information and prevention, even in public health and the need for them to be led by public organizations rather than by individual users., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

This paper intends to raise the potential interest that the principles and experiences of the so-called behavioral economy have in the field of public health and, more specifically, in behavioral changes, thus substituting harmful behaviors to health for salutogenic behaviors while respecting the final freedom of choice of the person. In this article, we review the foundations of behavioral economics, emphasizing the work of Tversky and Kahneman and their approach to prospective theory and the role of brain activity levels 1 (automatic) and 2 (reflective) in decision making process. On the basis of these approaches, Thaler and Sustein identify a series of biases that will be used as tools to facilitate behavioral changes through a set of actions "that modify people's behavior in a predictable way without prohibiting any option or significantly changing their economic incentives" based on the so-called libertarian paternalism. We review its interest in public health, citing some empirical studies that demonstrate its high level of effectiveness and efficiency, reflected in the creation of Nudge Units in various countries, and concluding that this can be an interesting tool to add (not to replace) the classical techniques of health promotion and disease prevention.

There is broad consensus on the health benefits that neonatal screening has provided in Spain, since Professor Mayor Zaragoza began his research project for the early detection of phenylketonuria and other aminoacidopathies in 1968, to date. In these decades there has been a great evolution and development of Neonatal Screening Programs (NSP) in Spain. This paper presents the effect on the development of the NSPs of the decentralization of Public Health responsibilities in the Autonomous Communities, creating differences among them by atomizing the decisions on the expansion of the diseases to be screened. The availability of effective detection and treatment methods was the justification, often unique, for the inclusion of new diseases in an NSP. On rare occasions, neonatal screening was assumed as a public health program that should offer guarantees of effectiveness, from information for informed consent to the correct treatment and follow-up of detected cases. This situation of enormous inequality in access to neonatal screening has changed with the introduction of appropriate legislation to guaranty the correct development of NSP within the National Health System. Forums coordinated by the Ministry of Health with the participation of those responsible for public health from the Autonomous Communities and scientific societies have been fundamental. An example of the convergence of research and science for the benefit of a basic Public Health program.

This paper aims to share the reflections related to the community actions in which the Agència de Salut Pública de Barcelona has been involved during the emergency of COVID-19. The tasks carried out can be arranged in three stages, frequently overlapping: detection of needs and problems; contact with key stakeholders to assess what to do and how to do it; adaptation of the interventions to the "new normal" and generation of new responses. The emerging problems included: not being able to do the confinement (due to homelessness, material conditions, living in a situation of violence); digital gap (lack of knowledge, devices, access to Wifi); greater exposure to COVID-19 in the essential but precarious, feminized and racialized jobs (care, cleaning, food shops) that are the most frequent in the neighborhoods in where we work; language and cultural barriers that preclude to follow recommendations; to lose employment; insufficient income to cover basic needs; social isolation; and the deterioration of emotional health caused by the situation. During the process, some interventions were adapted to be delivered on-line. Solidarity networks and local resources were key to meet basic needs, but also other needs related to lack of digital knowledge or device. Community action in health, from a critical, intersectional and local perspective, and with intersectoral work and community participation, can contribute to: facilitate a contextualized response in the event of a health crisis; mitigate the effects derived from its economic and social crisis.

Objective: Gambling may cause a variety of problems, both health and social, to the player, his family and his environment; Problems can be more serious for those who gamble more frequently or bet more money. Beyond the mental health gambling disorder and considering other harms derived from gambling, it is possible to develop a public health approach to the issue, including both prevention and harm reduction aspects. In recent decades gambling availability has expanded, with attempts at regulation. The objective of this paper is to provide basic information about gambling in Spain, stratifying data by Autonomous Communities (AC), from a public health perspective., Methods: A descriptive study of some aspects of gambling in Spain was carried out. The data for amounts gambled by participants, gross gaming revenue of the industry, and establishments or machines licensed for the year 2017 were extracted from the available systematic sources. Aggregated data were tabulated and stratified by AC for those presential gambling categories with the greatest compulsive gambling potential and relevant business volume. Crude results and ratios per 100,000 inhabitants were calculated., Results: Up to 41,826.8 million euros were spent gambling throughout Spain in 2017, a figure that exceeds 3.5% of the Gross Domestic Product, and the largest segment was online gambling in its various modalities (32%), followed by the national lottery and similar traditional games (27%). The supply of gambling venues (74.9 establishments per million inhabitants) was assessed by AC, showing large differences among them: their density in the region of Murcia is tenfold that of Catalonia. Gambling machines that can be installed in hospitality establishments (B machines) showed a density of 43.4 per 1,000 inhabitants, with greater homogeneity across AC than gambling premises. Regional data on the amounts spent in casinos, bingo cards, and sports betting show no homogeneous patterns., Conclusions: The volume of money spent on gambling in Spain is very important, and online gambling has become the largest business segment. The most traditional game modes and probably with less addictive potential such as lotteries and draws continue to have a relevant presence. The availability of presential gambling shows wide heterogeneity among AC, especially for licensed gambling establishments, whose density is ten times greater in the community with more supply compared to the one with less. The data by AC of some game modalities suggest that availability may be a relevant factor for gambling, but not the only one., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

In this paper present, from a bioethical perspective, a reflection on how to reconcile efforts to combat the COVID-19 pandemic with the safeguard of human rights. To do this, I develop three points. First, the regulatory framework that justifies the restriction or suspension of rights in the face of serious threats to public health. Second, the declarations of the international bioethics committees on the way in which human rights should be protected during public health crisis. And third, a review of the main rights threatened both by the public health crisis and by the means adopted to combat it. Before going into each of these points, I offer a preliminary note to clarify certain legal concepts and underline the need to overcome disjunctive approaches in considering human rights.

This paper describes the beginning of the implementation process of the health impact assessment in the Valencian Community (Spain), as an instrument to incorporate the framework of social determinants and health inequalities in the policies issued by the different departments of the Valencian government. The proposal involves: 1) political commitment, with legislative and strategic planning actions; 2) the creation of structures to allow intersectoral collaboration, with the establishment of the health impact assessment commission and the intersectoral technical committee; and 3) the design and validation of a tool for the simplified health impact assessment of non-health policies adapted to the Valencian Community. We highlight the importance of the participatory methodology used in the whole process and the potential of the health impact assessment for the development of public policies oriented to improve health and equity., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

It is essential to develop a comprehensive approach to institutionally promoted interventions to assess their impact on health from the perspective of the social determinants of health and equity. Simple, adapted tools must be developed to carry out these assessments. The aim of this paper is to present two tools to assess the impact of programmes and community-based interventions on the social determinants of health. The first tool is intended to assess health programmes through interviews and analysis of information provided by the assessment team. The second tool, by means of online assessments of community-based interventions, also enables a report on inequality issues that includes recommendations for improvement. In addition to reducing health-related social inequities, the implementation of these tools can also help to improve the efficiency of public health interventions., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

During the second half of the 19th century, Spanish authorities began developing specific programs on the safety of certain foods intended for human consumption. This paper analyses the key features that gave rise to the inclusion of the veterinarian in the administrative structure responsible for safeguarding public health. Among the aspects covered, special focus is put on the relationship between human and animal medicine at a time when growing public alarm in relation to certain zoonoses contributed to shaping the notion of veterinary public health. The appearance of a disease in pigs that was transmissible through the consumption of parasitized meat set the scene for veterinary inspection to be associated with the protection of public health. The outbreaks of trichinosis all over Spain in the 1870's proved the existence of contagium animatum in a pre-bacteriology era, and this led to the introduction of improvements in food inspection. In this sense, microscopic examination of pork products encouraged the modernization of inspection tasks undertaken by veterinarians, which had previously focused on the organoleptic evaluation of meat and fish and on unveiling fraud. The introduction of microscopes was widely accepted and established a watershed between acceptable and unacceptable methods of carrying out the examination of meat. Furthermore, this "technological" method of diagnosis brought veterinary medicine closer to other more prestigious health professions, at least in theory. Among other aspects, the acceptance of trichinae as an exogenous cause of disease contributed to 19th century doctors learning about the idea of pathogenic microorganisms from veterinarians. At a social level, the use of the microscope was seen as a way of preventing the transmission to people of an animal disease that was very much in the public eye at the time. From the political point of view, the process -analysed in this paper from the perspective of veterinarians in Barcelona- allows a glimpse of the contrast between the desire of some Catalan veterinarians to modernize their profession and what was happening in others parts of Spain.

Gregorio Marañón y Posadillo (1887-1960), played a leading role in the birth of endocrinology in Spain as is well known. However, his medical work included other important and significant fields. Thus, it was especially in the 1910s and 1920s, when Marañón dealt with the social-sanitary situation in madrid probably due to his professional attachment to the treatment of several infectious diseases and epidemic outbreaks. Actually, since 1911 onwards, he was in charge of the wards of infectious diseases in the Hospital General de Madrid where he had the opportunity of treating an important number of patients suffering from this type of pathology and, as a consequence, in the following years he published several articles in medical journals and presented in the Royal Academy of Medicine in Spain, some reports on infectious diseases and the Spanish health and social conditions at the time. This paper try to analyze this field of Marañón's social and scientific activity.

This paper concentrates on the port folio of public health services in the National Health System, with an inventory of those provided by the central level of government in the currently decentralized context of Spain. There is an important activity in public health, with some dispersion among different bodies and organisations. Most of the current activities of the central level of government concentrate in monitoring health levels and their determinants, managing information systems and health alerts and warnings, but with an involvement in policy development, both as a counterpart of the European Union and as an active agent with both regional levels of government and other organisations influencing public health. Besides, this level of government assures some essential services with little visibility for the general population as they are mostly delivered to other public administrations or to professional groups.

This paper reviews the meaning of the Rural Health Bureau (1910-1918) for the history of Spanish public health, thanks to a wealth of previously unknown sources found through a systematic search through medical journals of the time and the Bulletin of the national department of Agriculture. The Bureau was dependent of the Ministry of Development, in the same way as the competences on animal health. It aimed to provide a public health rationale for a plan of agrarian infrastructures, a goal resolved into a huge task of surveillance on hookworm disease, malaria, water supplies, and diet. Thus it becomes a perfect paradigm of the Spanish Liberal tradition of promoting information instead than actual changes into society, as well as a needed complement to the hydraulic policy sponsored by Rafael Gasset.

Today the terrorism is a problem of global distribution and increasing interest for the international public health. The terrorism related violence affects the public health and the health care services in an important way and in different scopes, among them, increase mortality, morbidity and disability, generates a context of fear and anxiety that makes the psychopathological diseases very frequent, seriously alters the operation of the health care services and produces important social, political and economic damages. These effects are, in addition, especially intense when the phenomenon takes place on a chronic way in a community. The objective of this paper is to examine the relation between terrorism and public health, focusing on its effects on public health and the health care services, as well as to examine the possible frames to face the terrorism as a public health concern, with special reference to the situation in Spain. To face this problem, both the public health systems and the health care services, would have to especially adapt their approaches and operational methods in six high-priority areas related to: (1) the coordination between the different health and non health emergency response agencies; (2) the reinforcement of the epidemiological surveillance systems; (3) the improvement of the capacities of the public health laboratories and response emergency care systems to specific types of terrorism as the chemical or biological terrorism; (3) the mental health services; (4) the planning and coordination of the emergency response of the health services; (5) the relations with the population and mass media and, finally; (6) a greater transparency in the diffusion of the information and a greater degree of analysis of the carried out health actions in the scope of the emergency response.

Interventions implemented by governments are very frequently related to the determinants of health. Health impact assessment (HIA) is used as a predictive tool to include health in nonhealth policymaking. This paper defines HIA, describes its methods, procedures and applications, and discusses opportunities and challenges associated with HIA. Doing a HIA implies studying the intervention, profiling the target population, and estimating its impacts on health by means of combining quantitative and qualitative evidence. HIA has been used in different kinds of policies (transports, urban regeneration, culture, energy development etc.), at different levels (local, national, European) and in many countries. Despite its scarce use in Spain, HIA allows to consider health in sectorial policymaking, taking into account social inequalities in health, so that healthier public policies can be designed. On the other hand, HIA is a tool under methodological development which use is hindered due to the existing narrow biomedical perspective on the determinants of health, and to the difficulties in working in public policy-making with multisectorial and participative perspectives.

Against the background of the renewed interest aroused in recent years by the influenza pandemic of 1918-1919, and the leading role now played by research analysing the process of innovation in medicine, this paper assesses the role played by serums and vaccines - the new resources of the medical science of the time 0 in the fight against the influenza outbreak of 1918-1919. The paper highlights the dependence on combined scientific, social, economic and professional factors, and also shows the main consequences arising from the fine-tuning and implementation of these therapeutic and prophylactic resources.

The paper comments on present and future scenarios for the pharmaceutical sector in Spain, framed a highly regulated system. So far the drug industry has evolved under the short term public financial constraints for additional health care spending and the long term efforts to innovate. This has not proved to offer a stable setting for the relationship between the industry and Health Authorities. The author offers from the economic analysis and a subjective appraisal from his experience some recommendations for regulatory changes in order to better align the incentives of the parts for improving the health system as a whole. The basic point is that 'consumption levels' (quantities) and not <> (unit costs) are the main challenge to tackle today in our Public Health Care system, and for this the decentralisation of financial responsibility is not in itself 'the' problem but it may well be a part of the solution.

The evaluation of interventions in Public Health is a key element through the process of developing health policies, but it is not free of controversy. For doing this purpose it is essential the use of research outcomes, although there are sticking points related to the traditional approach of Evidence Based Medicine, dominated by the randomized clinical trial as the gold standard. Not always it is possible to develop randomized and controlled studies in Public Health (sometimes due to ethical limitations, or because of the technical impossibility for performing the trial or because conceptual incompatibility) and the interventions are mostly multifaceted, therefore, the interpretation of the results is a complex task. In other hand, the usual criteria for research appraisal underestimates systematically the observational studies which, frequently, are the indicated in Public Health scenarios. Nevertheless, a great advance has been implemented with the generation of strategies as TREND (Transparent Reporting of Evaluations with Non randomized Designs), as well as other instruments like STROBE (STrenghtening the Reporting of OBservational studies in Epidemiology) or MOOSE (Meta-analysis Of Observational Studies in Epidemiology). But regardless of the existence of more or less consolidated critical appraisal tools, we all need a solvent and rigorous way of knowing the outcomes of Public Health interventions. This would make more dynamic the review, design or planning phases, and it would contribute to facilitate the decision-making process when a well grounded knowledge be available. In this paper all the methodological process about searching evidence in Public Health interventions is reviewed, as well as the main sources providing this information, in order to facilitate this task to the Public health professionals.

This paper deals with prenatal diagnosis practices in Spain. For pursuing this aim it reviews both literature on the origins of these practices in foreign countries as well as some of the early publications by Spanish practitioners. Those publications appeared to be connected to previous genetic testing in children such as the case of Down syndrome. Socio-political norms and values of Franco's regime together with clinicians' interests on introducing new testing techniques resulted in the stabilization of these practices associated to a reconceptualisation of pregnancy. Although prenatal diagnosis techniques made the body of pregnant women invisible, women's bodies remained at the core of the technicalisation of contemporary reproductive options.

Due to the strict selection process applied to its indexed journals, Medline is the most prestigious database in the Health and medicine field. The aim of this paper is both to analyze its selection criteria and translate into indicators that can be applied to Spanish medical journals willing to enter the Index Medicus. Analysis samples and methodology to apply obtained from the five groups of criteria considered by Medline (namely, Scope and coverage, Quality of contents, Quality of editorial work, Production quality and Audience) are proposed. A list of qualitative and quantitative indicators related to the five groups of criteria used by Medline is presented; namely, journal scientific output in the national and international context of the discipline, citation, analysis of the editorial committees, the editorial process and the peer-review system, indicators on compliance with the Vancouver guidelines, journal layout and informational quality, attractiveness, audience, journal visibility and interest as regards Medline goals.

In the year 2004 the government of Catalonia undertook a process to reform its public health services. In this context, it created a working groupinvolving experts from diverse backgrounds to analyse the reforms to be undertaken, the Scientific Committee for the Reform of Public Health in Catalonia. Its members produced eight documents on specific aspects of public health, from which a global report of the Committee was compiled by the end of 2005. This paper makes a synthesis of their production, and includes as an annex their recommendations and proposals. Public health policies should be structured around three main goal: the reduction of health inequalities, the control and removal of social and environmental risks, and effective improvements in quality of life. To reach them, common criteria are defined as main directions. These are based in favouring decentralization of public health services and their administration, linking public health activities with health care services, designing interventions with a population perspective, and reinforcing cross-sectional implications of public health. The work of this Committee is produced in the context of an international debate on the future of public health services and the disproportion between its contribution to health and well being and its resources and visibility. The Committee produced proposals and recommendations which can he grouped in five facets: consolidating a solid and coherent system, developing an organizational reform, defining a port-folio of services, adopting improvements in management, and taking into account cross sectional aspects relating to public health.

Objective: To measure the mediatic effect of different communication strategies used in public health advocacy. More specifically, to compare the effectiveness of the World Wide Web as a tool to attract the attention of journalists, with other more traditional formulas., Methods: For the Spanish Public Health Association (SESPAS) Report 2000, two types of media strategies to communicate the report contents were programmed: a) traditional and passive strategies, centred in approaching journalists through press releases and press conferences around the SESPAS meeting (November 15-20 1999); b) interactive strategies, since August 15 to December 30, focused towards attracting health journalists to the non-embargoed, full text SESPAS report launched in a web site. To facilitate the web page use, we wrote a letter, in the first week of August, to all the members of the Spanish Health Communicators Association giving them the URL and the website map. In parallel, a monitoring system of the media impact was established from August to December 99, covering 250 magazines and 70 newspapers, in order to locate and recover all the stories about the SESPAS report for further analysis., Results: Sixty-six stories were recovered; they were published in 32 press media from 24 provinces with an advertising value of 18,243,873 Ptas. As a whole, smaller circulation rate papers published more stories than larger ones. During five months, the SESPAS report was present in the press agenda, even though stories were not distributed homogeneously over time. Information concentrated around three moments: the first one, a week after our summer mailing; the second one, in the occasion of the publication of a story about the increase in traffic accidents in El País, and the third one during the SESPAS meeting. There were significant differences among those stories published from the traditional strategies of communication and those published from the interactive ones, the latter being more diverse, with more contributions of the journalists and tackling a wider range of issues., Conclusions: The combination of traditional and alternative communication strategies was a effective option. Unlike previous experiences in this occasion, with the network aid, the presence of SESPAS in media was not punctual around the Congress, but maintained during five months. The results and the obtained experience of this research can be useful for future public health advocacy interventions in Spain.

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. One of the differential traits of the practice of public health when compared to clinical medicine is that it does not concentrate in individual patients, but rather in the health problems of the population in a given time. In public health interventions, besides the importance of efficacy, aspects related to the process of implementation become also crucial. This paper develops some principles for evidence-based public health, which are then applied to a given problem: tuberculosis control in our context. Tuberculosis control poses challenges which go beyond clinical practice, and require a collective organized effort. This is precisely what makes it a public health issue and not only a clinical problem, as it requires not only health care dimensions but also public health dimensions, which require policies that are feasible, have high efficacy, and a moderate cost. To illustrate the problem and the results of public health policies, available data and indicators are used, with special reference to the authors experience in the program for the prevention and control of tuberculosis in Barcelona (Catalonia, Spain).

Majorca's mortality rates in the turn of the century were the lowest of Spain and nearer to those of the northern European countries than to Mediterranean ones and therefore their amazing quality. This paper seeks to contribute to solve that riddle and, as a first step, it reviews the island's demographic conditions and its economic, political and social and cultural context, including the analysis of the development of medical sciences and the sanitary reform of the city of Palma proposed by Eusebio Estada.

The paper explores how, through a process that began in the last decades of the nineteenth century and continued during the first part of the present century, especially in the 1920's infancy and infant health were regarded as objects of great value and as a social problem. The child's body was studied and analyzed by doctors, a situation that had important repercussions in other spheres of social life. Children were considered to have a series of characteristics which formed, as a whole, an ideal model within the family and home setting. Care, protection and intervention are the three components underlying the sanitary reform process that supported the health and welfare of children in Spain during this period.

From the 17th century until the 19th century, the world's most important mercury mine was the one at Almadén in the Spanish province of Ciudad Real. This state-owned mine rapidly achieved extraordinary importance, since mercury played a key role in the processing of silver from the Americas. However, efforts to reach target levels of production were hindered by the extreme toxicity of quicksilver. Nearly all the mining and metallurgical processes involved in the processes used to obtain mercury exposed workers to health risk. The extent and seriousness of the health problems suffered by workers at the mine (mainly hydragyrism) led to repeated labour shortages, a problem which reached its peak in the second half of the 18th century. The aim of this paper has been to study the strategies chosen by the managers of the establishment in their efforts to solve the problem and their evolution along the 18th and 19th centuries. Special attention is paid to health strategies engaged in the speedy return to health of the affected workers. Active intervention took various forms, from a patient-specific health centre, the Royal Miners' Hospital, to mechanisms of economic transference to the sick miners. The hospital, founded in 1752 and functioning from 1774, was intended for the free treatment of miners and their families. The most frequent users of the wards were the "temporeros" - peasants from outlying areas who were taken on at the mine for varying lengths of time in the winter and spring, returning to their places of origin for the summer harvest. Treatment was extended to homecare via home visits, the concession of alms-giving and the supply of medicines under advantageous conditions, which specially benefitted miners from the neighbouring town of Almadén. The analysis of the evolution of mine's healthcare system throughout the 18th and 19th centuries confirmed the utilitarian character that its managers intended. Thus, during the mid-19th century, economic and technical changes were implemented which drastically reduced the workforce required. With the shortage of labour no longer a problem, the healthcare system lost a good deal of its usefulness.

The growing interest which the daily press in Spain has been showing in recent years on medical matters, health and public health in general is revealed when you study the number of articles which the daily newspaper El País has published on these subjects since its foundation in 1976 up until the end of 1990. During this time, the number of articles on this topic which have appeared have nearly quadrupled, rising from 1.8 in 1977 to 6.9 in 1990. The toxic syndrome and Aids seem to have been the main subjects which have fostered, at least quantitively, medical journalism and are topics on which El País has written several editorials. This study is in three sections: the first is a methodological introduction to the study of the "health" value via the daily press; the second classifies and quantifies the articles published en El País during the period in question; and the last studies, via the editorials, the position of this paper, which is in favour of individual freedoms as opposed to those of the state medical system.