Law 33/2011 of 4 October, General of Public Health.



JUAN CARLOS I


KING OF SPAIN


To all who see and understand this


You know: 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. The object and scope of the law.


Chapter II. General principles of public health.


Title I. Rights, duties and obligations in public health


Chapter I. Rights of citizens.


Chapter II. Duties of citizens.


Chapter III. Obligations of the 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.   Health management as public health action.


Chapter VI.   Protection of the population's health.


Chapter VII.  Health impact assessment of other policies.


Chapter VIII. Foreign health and international health.


Chapter IX. Public health information system.


Title III. Planning and coordination of public health.


Title IV. The professional staff and research in public health.


Chapter I. Training and Professional Development in Public Health.


Chapter II. Research in Public Health Policy Development


Title V. The State Health Authority, Surveillance and Control.


Chapter I. State health authority.


Chapter II. Special and precautionary measures.


Title VI. Infractions and sanctions.


First additional provision. Specialization in public health of the health professions.


Second additional provision. Public health in the Armed Forces.


Third additional provision. Public health in penal institutions.


Fourth additional provision. From the State Public Health Center.


Fifth additional provision. Benefits.


Sixth additional provision. Extension of the right to public health care.


Seventh additional provision. Regulation of psychology in the health field.


Single derogatory provision. Regulatory repeal.


First final provision. Modification of Law 14/1986, of 25 April, General Health.


Second final provision. Amendment of Law 16/2003, of 28 May, on the Cohesion and quality of the National Health System.


Third final provision. Modification of Law 41/2002, of 14 November, basic regulation of patient autonomy and rights and obligations in the area of clinical information and documentation.


Fourth final provision. Competence title.


Fifth final provision. Authorisation for the development of regulations.


Sixth final provision. Entry into force.


PREAMBLE


Health services are essential to respond to the health problems of the community, since they manage to mitigate the damage of diseases and allow the recovery of lost health and improve the quality of life of sick people. However, the health care system is not the main condition for our level of health; health is gained and lost in other areas: before birth there can be exposure to different factors that indelibly determine future health, and from birth to death there is an accumulation of positive or negative life experiences that shape health. The family environment, education, material goods, social and economic inequalities, access to and quality of work, the design and services of cities and neighbourhoods, the quality of the air we breathe, the water we drink, the food we eat, the animals we live with, the physical exercise we take, the social and environmental surroundings of people, all these determine health. Government actions, at any level, public or private interventions, have a greater or lesser impact on health. This is why the current public health approach is aimed at shaping actions that go beyond the scope of health services and therefore require new forms of organisation.


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


The right to health protection recognized in the Constitution was usually interpreted as the right to health care in the face of illness. For this reason, Law 14/1986, of 25 April, General Health Law, one of the fundamental milestones in our organized effort to make the right to health protection effective, established as one of the general principles in its article 3 that the health system should be oriented as a priority to prevention and health promotion.


Act No. 16/2003 of 28 May 2003 on the cohesion and quality of the National Health System laid the foundations for the provision of quality care by the health services. This essential legislative development was fundamentally oriented towards the important task of ordering and coordinating health care activities; however, the efforts that society as a whole must make to ensure a good state of health through disease prevention and health promotion have not been developed in the same way.


The public authorities must ensure and improve the health of the population, both present and future, understanding investment in health as a decisive contribution to social well-being, both because of the net effect of gains in health and because of the contribution to the sustainability of health and social services, without forgetting the contribution to general sustainability through the increase in productivity associated with health and the positive effect that environmental care policies have on the environment and on human health. The excellent response that we have given to the constitutional requirement of health protection from the perspective of caring for the sick must now be complemented by the preventive aspect and the protection and promotion of health.


The health of the Spanish population has not only benefited from quality health services and the excellence of the professionals who work in them, but also from their environment, their climate, their social and family network, their diet and many other factors that have contributed to placing them among the countries with the best health indicators in the world. But there are new realities to be addressed that remind us that an advanced society must think about the population of the future, without waiting to solve problems when its social and health services can no longer provide answers. The growing ageing of the population, the increase in single-parent families, the weakening of family and social networks accentuated by dispersed urbanism, globalisation and its emerging risks, consumerism, the growing use of 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 are not so old are completely resolved, such as intellectual disability, mental health, the full integration of minority ethnic groups, prison confinement or different situations of social exclusion. Health and social services will only be sustainable if we ensure the best possible levels of health and autonomy for our population at all stages of life and with the guarantee of maximum equality.


The search for health must be a joint and shared task that does not recognise borders. This aspect takes on particular importance in the globalized world of the twenty-first century, marked by profound inequalities that follow a social pattern between countries and within countries themselves, and makes the aspiration to equity not only an end, but a means of achieving better health for all people. Equity is, after all, inherent in health, and only societies that strive for equality achieve good health outcomes. Today, threats to public health in the international arena cannot be stopped or prevented by borderline, containment health. Cooperation and solidarity are the main preventive actions, so public health in 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 provide a complete and current response to the requirement contained in Article 43 of the Spanish Constitution and, consequently, to try to achieve and maintain the highest possible level of health of the population. Health, defined as a way of living autonomously, in solidarity and joy, provides, together with education, the best opportunities for a society to have well-being. Because it is autonomous, health recognizes the freedom to choose, being aware of the consequences, for which it is necessary to 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 supports a democratic society. Both are intimately related and facilitate the desirable social welfare and the necessary sustainable economic development. There is sufficient scientific knowledge to be able to ensure that a high level of health improves productivity in all the areas analyzed, which is why investment in health, including investment in the structures that ensure the population's health, is one of the most profitable public policies and, if it also respects effective equity, it is essentially fair.


Achieving the greatest health gains, the object of this law, requires that society be organized in such a way as to encourage, protect and promote people's health, both in their individual and collective spheres, and that this be done on the basis of rigorous scientific knowledge and with the necessary anticipation. This organisation of society requires a public health system that brings together, coordinates and mediates in three areas of action: (1) public health systems; (2) prevention and health promotion actions in health services; and (3) actions and programmes which, without being health-related, have an effect on health and which, properly managed, can achieve their primary objectives while ensuring the best health outcomes.


Public health systems, specialised in community health, monitor the health status of the population and its determinants, warning of potential health gains from different policies or interventions; they respond to threats to the health of the population and to health crises; They implement actions in the areas of health protection, by preventing the negative effects of various elements of the environment, such as environmental health, occupational health, food safety or foreign health; in the area of health promotion, they contribute to empowering citizens to make informed and free decisions that best serve their health and well-being; and in the area of disease and injury prevention, through vaccinations and other population-based interventions. These actions require a common basis for implementation in Spain that includes guarantees of maximum quality, human cohesion that allows the best public health intelligence in our society to be available wherever it is needed, and an organization that responds to the challenges of today's public health.


The health services within the National Health System carry out some preventive actions in addition to curative, care and rehabilitation actions. However, the health services, and especially primary health care, must assume a more relevant role in preventive action and community health. The effectiveness of these preventive activities is ensured by adequate coordination with public health actions and by an organization that makes it possible to provide health services with the best preventive recommendations, giving priority to the most efficient actions, thus optimizing resources and avoiding unnecessary damage from ineffective preventive actions.


Instruments are essential 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 of government. The health of the population is determined by policies and interventions in other areas, so it is necessary for public administrations to ensure a regulatory framework that maximizes the level of health without detriment to other social goods that contribute to the welfare of society. The great challenges of health today can only be tackled with guarantees of success if society as a whole is governed by taking into account and maximising the results that the various actions and regulations have on health. Putting health and equity in all policies requires an organization that allows for adequate coordination between the health sector and other sectors, seeking synergies in their policies or the necessary protection of health when these are not possible.


This description of the areas of action already advances some of the criteria that justify and support the reform of the organization of public health that this law addresses. Spain, due to the characteristics of its economic and social development, must be oriented towards guaranteeing health security. This means that the capacity to influence internationally is necessary to act on those decisions that affect public health and that everything related to the international traffic of goods, services and persons that concerns Spain must be especially taken care of from the public health perspective, requiring adequate structures. Similarly, the policies and interventions developed in Spain in any area must be recognised for taking care not only of the environment but also of health, requiring a regulatory provision to this end. Spain's commitment to health safety is linked to economic interests in trade and tourism, but also to the capacity to influence decisions in international areas that affect people's health. These challenges can be met successfully and the present law introduces the appropriate provisions to do so.


Health security itself is based on adequate public health information services with a network of well-coordinated centres. The current situation can take a significant step forward in quality and operation if the issuing centres for public health surveillance information are organised.


Global scientific development on public health actions and policies must be enhanced in order to be able to make scientifically based recommendations, as is the case in health care settings. In Spain, there is sufficient scientific development to be able to provide solid recommendations in public health and, if the appropriate organization is in place, to make considerable progress in the development of knowledge-based actions.


Many of the actions that shape 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 that can only be modified on a national or supranational level. Likewise, there are public health actions whose effectiveness and social efficiency are multiplied when they are implemented or carried out in a coordinated manner on a state or international level. In addition, the development of the territorial structure is heterogeneous, as are capacities. It is not a question of harmonizing actions to complement activities carried out by the autonomous and local administrations, which is already provided for in the regulations. What is required is an organization that effectively achieves human cohesion in terms 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 by contributing to global health. Public health intelligence, understood as the set of people with professional and scientific capacity to address public health problems, is of a high level in Spain, but an organization that efficiently uses these resources to achieve the essential human cohesion has not yet been established.


This General Law on Public Health responds to the needs and challenges listed and others that are specified in the description of the content that follows.


The law, which establishes the legal basis for the coordination and cooperation actions of public administrations in the area of public health, is structured into a preliminary title, six titles, three additional provisions, one repealing provision, and five final provisions.


Chapter I of the Preliminary Title establishes the object and scope of the law. Chapter II sets out the general principles of public health, which must be guaranteed in public health actions. Among others, it highlights the requirement that equity and health should guide all government policies.


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


Chapter I develops citizens' rights 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 addresses 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 unrelated to the health of the population and the public good, and are independent. This strengthens public confidence in the health authority and its public health recommendations.


Title II describes public health actions. Chapters I and II are devoted to the regulation of health surveillance and promotion. Building on the experience already developed in the field, particularly in surveillance of communicable diseases, it now extends to the determinants of health problems which are the subject of policies to improve health. This Act provides the basis for comprehensive public health surveillance covering all health determinants and health status itself. Similarly, the public health information system complements the work of the Health Information Institute whose functions were established by Law 16/2003, of 28 May, on the cohesion and quality of the National Health System in the area of health information systems and are developed considering the competencies that Law 12/1989, of 9 May, on the Public Statistical Function assigns to the National Statistics Institute in the coordination of the statistical activity of the General State Administration. Currently, advanced indicators are available on illness, on health care and on some health-related behaviours, but they are not integrated with information from other social, environmental or other fields that are essential for assessing the evolution of public health and related policies. With this integral vision, the core of coordination is the Ministry of Health, Social Policy and Equality with the surveillance and information networks of the Autonomous Administrations. The Public Health Surveillance Network is articulated to coordinate the surveillance system of conditioning factors, health problems and early warning and rapid response systems.


Chapter III establishes the general lines that should be followed by the policies in matters of 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 to mitigate their negative consequences through policies of a health, environmental, economic, labour, food or physical activity promotion nature, among others; it also regulates the specific actions on screening, with the health authorities being responsible for promoting that these be implemented with the maximum possible quality and the greatest possible accessibility for the population by carrying out the appropriate campaigns. This law should be a key instrument to avoid the implementation of supposedly preventive actions whose benefit has not been scientifically proven and which may cause harm.


Chapter IV, devoted 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 implemented in the health services in a way that is coordinated with the actions of the public health structures.


The importance of health management adapted to public health is discussed in Chapter V. In order to achieve the objectives described in this law, it is essential that at all levels and levels of care, disease prevention and health promotion are appropriately coordinated, 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 World Health Organization report "World Health Report 2000 - Improving the Performance of Health Systems" and subsequent developments in the international sphere, which advocate a direction of care services aimed at improving the health of the population.


Chapter IV, devoted to the coordination of health promotion and prevention of diseases and injuries in the National Health System, provides the basis for their implementation in the health services in a coordinated way with the actions of the public health structures.


The importance of health management adapted to public health is discussed in Chapter V. In order to achieve the objectives described in this law, it is essential that at all levels and levels of care, disease prevention and health promotion are appropriately coordinated, 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 World Health Organization report "World Health Report 2000 - Improving the Performance of Health Systems" and subsequent developments in the international sphere, which advocate a direction of care services aimed at improving the health of the population.


Chapter VI deals with public health actions in health protection that are aimed at preventing the negative effects that various elements of the environment can have on people's health and well-being. It includes the most relevant aspects on which the action of the environmental health government is based, which takes on its own defined space in the field of public health. Human health depends to a great extent on the environment in which life develops and therefore the healthiness of food, water and air is essential. However, the environment in which human life develops is not made up exclusively of the natural environment, but we must also consider the socially constructed environment made up of the home, the workplace, the school, the places of leisure, the city as a whole and lifestyles. Actions in the area of occupational health are also established to achieve the best risk prevention in the workplace, and in line with the provisions of Law 31/1995, of 8 November, on the Prevention of Occupational Risks, and complementing it, the promotion of health in this same area is facilitated. The promotion and protection of occupational health, as well as the prevention of risk factors in this area, must be contemplated in the public health services portfolio.


Chapter VII determines the application in Spain of health impact assessment, i.e. the combination of procedures, methods and tools by which a programme or regulation can be evaluated in relation to its effects and the distribution of these effects on the health of the population. The need to advance in health safety makes it advisable for Spain to be one of the leading countries in guaranteeing and promoting health in its government actions, including, as established in this chapter, the actions necessary for the impact on human health of the various public actions to be assessed. The inclusion of health impact assessment in our legal system can place us in the group of the most advanced countries, encouraging innovation in the development of reforms related to sustainable economy which in turn guarantee health safety.


Chapter VIII is dedicated to foreign and international health, an essential part of public health and an exclusive competence of the State, as established by the Spanish Constitution. One of the opportunities opened up by this law is to adapt the services and mechanisms of the Spanish government to the needs of a globalised world. The foreign health paradigm is modified, understanding that in addition to health at borders, international health must be developed in the sense of considering Spain as a relevant health agent on an international scale. This is not only a matter of avoiding the importation of communicable diseases, but also of contributing to a healthier world.


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


Title III regulates the planning and coordination of public health, with the objective of contributing to maintaining and improving the health of the population through an organization that allows the coordination of existing resources in an efficient manner.


It provides for the articulation of public health in Spain through the Public Health Strategy, which defines the actions aimed at the main determinants of health and identifies synergies with policies of other departments and administrations.


The Public Health Advisory Council was also created as a collegiate consultation and participation body, attached to the Ministry of Health, Social Policy and Equality, in which the departments of the General State Administration whose policies affect health and those other administrations, bodies and organizations that ensure adequate governance of the system are represented.


Title IV deals with professional and research staff in public health, and is divided into two chapters. The first chapter deals with training and professional development, and the second with 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, fulfils its obligations to defend health. Given the diversity of health determinants, public health professional staff must be able to apply a wide range of knowledge and skills, which makes it necessary to integrate people with different academic profiles, thus recognizing the multidisciplinary nature of public health. This implies that public health professionals are not necessarily health professionals as established in Law 44/2003, of 21 November, on the organization of the health professions; however, their specific and principal professional performance must consist of the development of the actions described in Title II and limited to public health. Moreover, if public health is to be scientifically oriented, based on scientific evidence, it is essential to include the research work of public health professional staff. To improve the quality of public health actions, these must be closely linked to a type of research activity that promotes channels for disseminating the knowledge generated and good practices.


Title V regulates the state health authority and its agents. Thus, this authority, in the exercise of its responsibility and in accordance with the competencies that correspond to it in matters of public health, will dictate provisions and will have powers to act, through 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 Act is supplemented by Title VI, which sets out offences and penalties, followed by additional, derogatory 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.


The purpose of this law is to establish the basis for the population to achieve and maintain the highest possible level of health through the policies, programmes, services and, in general, actions of all kinds carried out by the public authorities, companies and citizens' organizations with the aim of acting on the processes and factors that most influence health, and thus prevent disease and protect and promote people's health, both in the individual and collective sphere.


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

Article 2. Scope of the law.


The provisions of this law shall apply to public administrations in general and to private subjects when specifically provided for.


CHAPTER II

General principles of public health

Article 3. General principles of action in public health.


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


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


(b) Principle of health in all policies Public health actions shall take into account non-health policies that influence the health of the population, promoting those that favour healthy environments and discouraging, when appropriate, those that pose risks to health.



Likewise, public policies that affect health will value this circumstance by reconciling their objectives with the protection and improvement of health.


c) Principle of relevance. Public health actions shall take into account the magnitude 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 well-founded indications of a possible serious effect on the health of the population, even where there is scientific uncertainty as to the nature of the risk, shall result in the cessation, prohibition or limitation of the activity in question.


e) Principle of assessment. Public health actions must be evaluated in terms of their operation and results, with a frequency appropriate to the nature of the action taken.


f) Principle of transparency. Public health actions must be transparent. Information on them must be clear, simple and understandable to all citizens.


g) Principle of completeness. Public health activities must be organized and developed within the overall concept of the health system.


h) Principle of safety. Public health actions shall be carried out after verification of their safety in terms of health.


TITLE I

Rights, duties and obligations in public health


CHAPTER I

Citizens' Rights

Article 4. Right to information.


Citizens, directly or through the organizations in which they are grouped or which represent them, have the right to be informed, with the limitations provided for in the regulations in force, on public health matters by the competent administrations. This right includes, in any case, the following


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


(b) To receive information on public health actions and benefits, their content and the way to access them.


(c) To receive information on health determinants as factors influencing the level of health of the population and, in particular, on biological, chemical, physical, environmental, climatic or other risks relevant to the health of the population and on their impact If the risk is immediate, the information shall be provided as a matter of urgency.


(d) All information shall be provided in a disaggregated form, so that it can be understood by the group concerned, and shall be available under conditions and in a format which make it fully accessible to persons with disabilities of all kinds.

Article 5. Right to participate.


1. Citizens, directly or through the organisations in which they are grouped or which represent them, have the right to effective participation in public health actions. The competent public administrations shall establish the specific channels through which this right can be made effective.


Without prejudice to the duty to collaborate, participation in public health actions shall be voluntary, except as provided for in Organic Law 3/1986, of 14 April, on special measures in the field of public health.

Article 6. Right to equality.


1. All persons have the right to have public health activities carried out under conditions of equality, without discrimination on the grounds of birth, racial or ethnic origin, sex, religion, conviction or opinion, age, disability, sexual orientation or identity, illness 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 Organic Law 3/2007, of 22 March, for the effective equality of women and men, as well as other existing regulations in this area.


3. The disease may not cover differences in treatment other than those arising from the treatment process itself, from objective limitations imposed on the exercise of certain activities or from those required for public health reasons.


4. This right shall take the form of a common basic service portfolio in the field of public health, with a set of actions and programmes. This portfolio of services shall include a single vaccination schedule and a single offer of population-based screening.

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


Everyone has the right to respect for his or her personal and family dignity and privacy in connection with his or her participation in public health activities.


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


2. The personal information used in public health activities will be governed by the provisions of Law 15/1999, of December 13, Protection of Personal Data and Law 41/2002 of November 14, basic regulation of patient autonomy and rights and obligations in the field of information and clinical documentation.

CHAPTER II

Duties of citizens

Article 8. Duty to cooperate.


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

Article 9. Duty of communication.


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


2. The provisions of the previous paragraph are without prejudice to the communication and information obligations that the laws impose on health professionals.

CHAPTER III

Obligations of the public administrations

Article 10. Public information on health risks to the population


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

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


Health administrations shall require transparency and impartiality from scientific and professional organisations and experts with whom they collaborate in public health activities, including training and research, as well as from persons and organisations receiving grants or with whom they conclude contracts, agreements, arrangements or other arrangements.


To this end, the composition of the committees or groups that evaluate actions or make recommendations on public health, the selection procedures, the declaration of interests of the participants, as well as the relevant opinions and documents, shall be made public, except for the limitations established by the regulations in force.


The requirements for the declaration of conflicts of interest by the experts and representatives of scientific and professional organisations that make up the committees or groups evaluating actions or making recommendations in the field of public health will be developed in the regulations.

TITLE II

Public health actions

CHAPTER I

Public health surveillance

Article 12. Public health surveillance.


1. Public health surveillance is the set of activities aimed at collecting, analysing, interpreting and disseminating information related to the state of health of the population and the factors that condition it, with the aim of providing a basis for public health actions.


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


1.º The social conditioning factors and inequalities that affect health with measurements at the individual and population level.


Environmental risks and their effects on health, including the presence of pollutants in the environment and in people, as well as the potential impact on health of exposure to electromagnetic emissions.


3.º Food safety, including food risks.


4.º Work related risks and their effects on health.


Non-communicable diseases.


Communicable diseases, including zoonoses and emerging diseases.


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


8.º Injuries and violence.


9. Other public health problems that are known to exist


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


4. The Autonomous Communities, the cities of Ceuta and Melilla and the local entities shall ensure, within the scope of their competencies, that the respective public health surveillance systems comply at all times with the provisions of this law. Likewise, they shall provide the information established by national and international regulations, with the periodicity and disaggregation determined in each case.

Article 13. Coordination of public health surveillance.


1. The General State Administration, the Autonomous Communities, the cities of Ceuta and Melilla and the local Administration, within the scope of their competencies, are responsible for the organisation and management of public health surveillance.


2. The Interterritorial Council of the National Health System, through the Public Health Commission, is responsible for ensuring cohesion and quality in the management of public health surveillance systems.


3. In order to coordinate the different surveillance systems, the Public Health Surveillance Network shall be created, which shall include among its systems the early warning and rapid response system. This system shall operate continuously and without interruption on a 24-hour basis. The configuration and operation of the Public Health Surveillance Network will be determined by regulation.

Article 14. The competences of the Ministry of Health, Social Policy and Equality in Public Health Surveillance.


The Ministry of Health, Social Policy and Equality is responsible for the following functions in the area of public health surveillance


a) The management of alerts of a supra-autonomic nature or which may extend beyond the territory of an Autonomous Community.


b) The management of alerts that come from the European Union, the World Health Organization and other international organizations and, especially, those alerts contemplated in the International Health Regulations (2005), if applicable, 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, on the cohesion and quality of the National Health System.


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


e) Ensuring that the criteria used in surveillance are homogeneous, are standardized and that the information is timely, relevant and of high quality.


f) The design and execution of a periodic public health survey in coordination with the Autonomous Communities and cities of Ceuta and Melilla.


g) The coordination and management of the exchanges of information corresponding to surveillance both on a national level and on a European Union level, as well as on the level of the World Health Organisation and other international organisations related to public health.


h) The coordination of the messages addressed to the population in the event that the Health Authorities issue communications or recommendations in contexts of health alerts or crises or that affect uncertain risks that could affect more than one Autonomous Community. For this purpose, the Health Authorities will inform the Ministry.

Article 15. Resources for public health.


The Public Health Authorities shall promote the existence of adequate infrastructures for public health activities, including laboratories and other physical (public employees) and virtual facilities and resources of the public health services, which cover the specific needs in the field of public health and ensure the quality of services.


Likewise, the public health administrations shall develop the specific regime of incentives and public aid in the field of public health, which promotes the training and cooperation of individuals and legal entities with the subject matter, based on principles of publicity, efficiency, transparency and control, in accordance with the objectives of this law.

CHAPTER II

Health Promotion

Article 16. Health promotion.


1. Health promotion shall include actions aimed at increasing the knowledge and skills of individuals, as well as changing social, working, environmental and economic conditions, in order to promote their positive impact on individual and collective health.


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


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

4.Social organizations may participate in the development of health promotion activities. The competent public administrations shall promote effective participation in the health promotion activities of citizens, directly or through the organisations in which they are grouped or which represent them.

Article 17. Promotion measures.


1. The public administrations shall support and collaborate with the entities and organisations that carry out public health activities, especially in relation to the most disadvantaged or discriminated groups in public health matters.


2. Public administrations shall promote the incorporation of public health as an integral element of corporate social responsibility.

Article 18. Communication in public health.


1. Health administrations shall ensure that health information addressed to the public is accurate and complies with the provisions of this law, especially when it is disseminated through the mass media.


2. The Ministry of Health, Social Policy and Equality shall make available to the media and other social organizations the criteria of good practice referred to in Article 16.3, so that they may achieve maximum dissemination.


3. The public authorities, within the scope of their powers, shall monitor commercial advertising to ensure that it complies with truthfulness criteria with regard to health, as well as public recommendations on health.


4. Public health administrations shall count on the collaboration of the media to disseminate recommendations on public health.


5. The public administrations that develop actions in the field of health communication shall ensure that the information is socially, culturally and linguistically adapted to those sectors of the population to which it is addressed.

CHAPTER III

Prevention of health problems and their determinants

Article 19. Prevention of health problems.


1. Prevention aims 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 consistent with the objectives of this Act.


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


a) Direct the actions and preventive policies on the determinants of health, understanding as such the social, economic, labour, cultural, food, biological and environmental factors that influence the health of persons.


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


(c) Promote other primary prevention actions, such as vaccination, which shall be complemented by secondary prevention actions such as early detection programmes.


d) They will develop prevention programmes aimed at all stages of people's lives, with special emphasis on childhood and old age.


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


f) They may require, in accordance with the procedure established by regulation, the cessation of those preventive health practices that have been proven to be ineffective or unnecessary.


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


a) A single calendar of vaccines 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) The common preventive actions that meet the criteria to be implemented in the whole territory.


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


4. Social organisations may participate in the development of activities for the prevention of health problems. The competent public administrations shall promote effective participation in actions to prevent citizens' health problems, either directly or through the organisations in which they are grouped or which represent them.

Article 20. Specific actions on screening


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 suffering from the disease, even if they do not have symptoms or have not requested medical help.



2. The Health Authorities shall promote that screening is implemented with the highest quality and the greatest accessibility for the population, carrying out the appropriate campaigns.


3. The use of diagnostic tests for screening purposes should be carried out according to the principles established in Chapter II of the Preliminary Title and the scientific criteria on which the screening is based, excluding indiscriminate diagnostic tests or those lacking an express justification for the health objectives.


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

Article 21. Prior health examinations.


1. Health examinations may only be carried out prior to employment when so provided for in the regulations in force. When the practice of tests for early detection of disease is required, this must be explicitly justified on the basis of the specific occupational risks and must comply with the principles established in Chapter II of the Preliminary Title of this law and the scientific criteria on which the screening is based.


2. Health examinations may only be carried out prior to the practice of sport, when so provided by the sectorial regulations in force. These must be based on tests in accordance with the principles established in Chapter II of the Preliminary Title of this law and the scientific criteria on which the screening is based.

CHAPTER IV

The coordination of health promotion and disease and injury prevention in the National Health System

Article 22. Disease prevention and health promotion in health services


1. All the care services of the National Health System shall contribute to the comprehensive development of prevention and promotion programmes, in coordination with public health structures.


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


3. The health administrations will establish public health surveillance procedures that allow for the evaluation of prevention and health promotion actions in the area of care, maintaining the correspondence between the populations served by primary care teams, specialised care and the public health services of a given area, complying with the provisions on health areas in article 56 of Law 14/1986, of 25 April, General Health.

Article 23. Collaboration between care services and public health services.


1. The health administrations will adopt the necessary measures so that the assistance services and the public health services establish an effective coordination to develop the following actions:


a) Exchange the necessary information for public health surveillance and on the health situation and its social determining factors for better care action by the assigned community.


b) Carry out clinical tasks derived from the detection of public health risks.


c) To carry out diagnostic examinations derived from health protection actions in the field of food and environmental safety.


d) To carry out prevention programmes in accordance with the priorities established by each health administration, facilitating their evaluation by the population.


e) To develop family and community care by collaborating with health promotion actions in its area of action.


f) To develop preventive actions in the living environment of people, including the home.


g) To provide care services with updated scientific information for the best effectiveness of prevention and promotion actions.


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


i) To develop the necessary coordination mechanisms between primary care and specialized care with the occupational risk prevention devices of the Health Areas.


j) To establish the mechanisms to communicate the suspicion of diseases that could be qualified as professional among the doctors of the National Health System, the managing and collaborating entities of the Social Security and the prevention services that carry out the health surveillance.



2.The actions described in the previous section shall be applicable at the local level when it has municipal public health services.

Article 24. On the collaboration of other health centres and establishments with public health


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


2. The administrations may enable these services to carry out the following actions, where appropriate:


a) Participate in the public health programs and strategies designed by the public health services at the local, regional and state levels.


b) Carry out 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

Health management as public health action

Article 25. Nature and objectives of health management


The main objective of health management will be the improvement of the population's health and the reduction of social and territorial imbalances, in accordance with articles 3, 6, 8 and 12 of Law 14/1986, of 25 April, the General Health Law, and as established in this law.

Article 26. Health management in the Health Area.


1. The bodies that make up the Health Areas shall in all cases take into account the actions aimed at improving community care, disease prevention, protection and promotion of health.


2. Health management shall be guided by health outcomes that shall be made explicit at least every five years and presented in the area's health councils.


3. The public health services will adopt all those measures aimed at making health centres "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 management unit for public health in the autonomous community or city.

CHAPTER VI

Protecting the health of the population

Article 27. Actions for the protection of health.


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


2. Public administrations, within the scope of their competences, shall protect the health of the population through activities and services that act on the risks present in the environment and in food, to which end they shall develop the services and activities that allow the management of the health risks that may affect the population.


3. Health protection actions shall be governed by the principles of proportionality and precaution, and shall be carried out in accordance with the principles of inter-administrative collaboration and coordination and joint management to ensure maximum effectiveness and efficiency.


4. Social organizations may participate in the development of health protection activities. The competent public administrations shall promote effective participation in citizens' health protection activities, either directly or through the organisations in which they are grouped or which represent them.

Article 28. Characteristics of health protection actions.


1. Health protection shall include the analysis of risks to health, including their assessment, management and communication. To this end, action shall be taken on risk triggers and, where appropriate, in accordance with specific rules through official control procedures.


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

Article 29. Health authorisation and records.


1. In the case that according to the laws is required previous sanitary authorization or the obligatory inscription in a registry, it will be to what they are anticipated.


2. The health administrations may establish the obligation of a responsible declaration or prior communication of the commencement of activities for those facilities, establishments, services and industries that carry out activities that may affect health, in accordance with the applicable sectorial regulations and taking into account the provisions of Law 17/2009, of 23 November, on free access to service activities and their exercise.

Article 30. Environmental health.


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


2. Public administrations shall implement environmental health programmes, coordinated by the health administrations, to raise the level of health protection against risks derived from environmental conditions.

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


1. The Ministry of Health, Social Policy and Equality is responsible for coordinating the State with the public administrations and competent bodies in the exercise of actions aimed at the prevention and protection against environmental health risks.


2. The Ministry of Health, Social Policy and Equality shall promote that the State-level services exercising functions in the areas of identification, assessment, management and communication of environmental risks to the health of the population, including at least risks related to chemical products and health and climate change, may act as a national reference centre in these areas.


The Ministry of Health, Social Policy and Equality, subject to the agreement of the Interterritorial Council of the National Health System, will accredit services that will act as a national reference centre in the aspects of identification, evaluation and management and communication of the risks to the health of the population derived 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.


The objective of occupational health is to achieve the highest degree of physical, mental and social well-being of workers in relation to the characteristics and risks derived from the workplace, the working environment and the influence of the latter on their surroundings, promoting aspects of prevention, diagnosis, treatment, adaptation and rehabilitation 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 developed in coordination with employers and workers' representatives and shall include the following aspects:


(a) promotion, in general, of the overall health of workers


(b) Surveillance of workers' health, both individually and collectively, to detect early the effects of 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 occupational health.


2. The health authority, in coordination with the labour authority, shall carry out the following actions in addition to those already established by law


a) Develop a health information system in occupational health that, integrated into the public health information system, supports the surveillance of work-related health risks


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


c) To promote surveillance of workers' health, through the preparation of protocols and guides for specific health surveillance in response to the risks to which they are exposed.


d) To develop post-occupational health surveillance programmes.


e) To authorize, evaluate, control and advise on the health activity of the occupational risk prevention services.


f) To establish mechanisms for the integration into the public information systems of the National Health System of the information generated by the health activities carried out by the occupational risk prevention services and by the mutual insurance companies for occupational accidents and diseases of the Social Security in relation to the health of the workers.


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


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



(i) Any others which promote improvements in the surveillance, promotion and protection of the health of workers and the prevention of health problems arising from work.


(j) To promote training in occupational health for health professionals in public health systems.

Article 34. Participation in occupational health.


Employers and workers, through their representative organisations, will participate in the planning, programming, organisation and control of management related to occupational health, at the different territorial levels.

CHAPTER VII

Health impact assessment of other policies

Article 35. Health impact assessment.


1. The public administrations shall submit to a health impact assessment the standards, plans, programmes and projects that they select as having a significant impact on health, in the terms provided for in this law.


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


3. Health impact assessment shall anticipate the direct and indirect effects of health and non-health policies on the health of the population and social inequalities in health with the aim of improving actions.


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

CHAPTER VIII

Foreign health and international health

Article 36. Purpose of external health.


1. The Ministry of Health, Social Policy and Equality is responsible for the exercise of State competence in the field of foreign health:


a) Organizing and guaranteeing the provision and quality of health controls of goods on their import or export in the facilities at the Spanish borders and in international means of transport, as well as those transported by travelers in international transit.


b) Organize and guarantee the provision of health care for international travelers, the prevention of illness and injury of the traveler and international vaccination services. To this end, collaboration may be established with the Autonomous Communities by means of management contracts or other forms of collaboration provided for in the legal system so that vaccination is more accessible to citizens who must comply with this requirement.


c) To coordinate foreign health surveillance.


2. The provisions of this chapter are understood to be without prejudice to the competences that correspond to the Ministry of Foreign Affairs and Cooperation in matters of international relations, with which the appropriate coordination will be established.

Article 37. Foreign health functions.


These are foreign health functions:


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


b) The control and surveillance of the hygienic-sanitary conditions in the international traffic of persons, corpses and human remains, animals and goods, including both foodstuffs and foodstuffs as well as other goods susceptible to put at risk the health of the population, such as international means of transport, without prejudice to the competences of the Ministries of Economy and Finance, of the Environment, of the Rural and Marine Environment, as well as the competences of the Autonomous Communities and the cities of Ceuta and Melilla in the matter of verification of the conditions of foodstuffs in the exporting establishments.


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


d) All those concordant activities that are determined in the future.

Article 38. Foreign health activities.


1. The foreign health services may act ex officio or at the request of a party, as appropriate and duly accredited and identified.


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


3. They may require the presentation of the authorizations and certifications that are required by the applicable provisions, in everything related to their actions.

4. Where non-compliance with the health and hygiene rules is detected, they shall act accordingly and, depending on the seriousness of the shortcomings detected, take appropriate action. If the seriousness of the health risks so requires, they may halt the activities of the installation or the means of transport inspected, in accordance with the national and international rules in force.

Article 39. Action on international health.


1. In the area of international health, the Ministry of Health, Social Policy and Equality shall carry out the following actions:


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


b) Collect information on health risks of an international nature and inform the General State Administration bodies responsible for coordinating emergencies and civil protection.


c) To draw up periodic reports on the evolution and determining factors of international health and its implications for Spain.


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


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


f) To propose the appointment of experts in public health in the Permanent Representations of Spain to international organisations and institutions in coordination with the competent Ministries.


2. The Ministry of Health, Social Policy and Equality shall be the National Liaison Centre for continuous communication with the World Health Organization and other international alert networks, and shall be responsible for the application of the International Health Regulations (2005), maintaining for this purpose the essential national capacity to comply with the provisions of the said Regulations 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 on public health or whose information is relevant to decision-making in this field, regardless of their ownership, shall form part of the Public Health Information System.


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


3. The Public Health Information System will integrate at least the following:


a) The statistics, registers and surveys that measure the conditioning factors of health: education, social situation, labour situation, physical and environmental surroundings, including changes in climate, security, demography, economy, services, health resources, presence of pollutants in people and any other variable that scientific knowledge and the needs of the health administration make necessary.


(b) Statistics, registers and surveys which measure the health, quality of life and well-being of the population


(c) Information on public health policies and actions in all fields of action


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

Article 41. Organisation of information systems


1. In order to ensure the best possible protection of the health of the population, health authorities may, under the terms set out in this Article, request reports, protocols or other documents from health services and professionals for health information purposes.


2. The health administrations will not need to obtain the consent of the persons concerned for the processing of personal data related to health, as well as their transfer to other public health administrations, when this is strictly necessary for the protection of the health of the population.


3. For the purposes indicated in the two previous sections, public or private persons will cede to the health authority, when so required, personal data that is essential for making decisions in public health, in accordance with the provisions of Organic Law 15/1999, of 13 December, on the Protection of Personal Data.

In any case, access to clinical records for epidemiological and public health reasons will be subject to the provisions of section 3 of article 16 of Law 41/2002, of November 14, which is the basic law regulating Patient Autonomy and Rights and Obligations in terms of Information and Clinical Documentation.

Article 42. Basic data and communication of information.


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


2. Access to the information by users of the system will be carried out under the terms established in this law and its implementing provisions.

Article 43. Information security.


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


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

TITLE III

Public health planning and coordination

Article 44. Public health strategy.


1. The purpose of the Public Health Strategy, without prejudice to those that may be approved by the Autonomous Communities, is to ensure that health and equity in health are considered in all public policies and to facilitate intersectoral action in this area.


2. The Strategy shall define the areas of action on health determinants and shall incorporate the public health research actions set forth in articles 47, 48 and 49 of this Act.


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 every two years.

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


The Advisory Council on Public Health is created as a collegiate consultation and participation body, attached to the Ministry of Health, Social Policy and Equality, in which the Departments of the General State Administration whose policies affect health, the Autonomous Communities, and those other bodies and organizations related to public health that ensure adequate governance of the system are represented.


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


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


The composition of this Advisory Board should ensure adequate 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 shall act as a specialized, collegiate and permanent body for consultation and social participation in public health policies, so as to ensure adequate governance of the system.

Article 47. State Public Health Centre.


1. The State Centre for Public Health is attached to the Ministry of Health, Social Policy and Equality, acting under the guidelines of the management centre responsible for public health. Its functions will be established in the corresponding Royal Decree on organizational structure.


2. The objective of the State Centre for Public Health is to provide technical advice on public health matters and to evaluate public health interventions within the scope of the General State Administration. Likewise, it will carry out technical and scientific advice tasks and the evaluation of public health interventions in the scope of other Administrations.


3. The State Public Health Centre shall monitor and evaluate the Public Health Strategy and coordinate the actions carried out by the national public health centres.

TITLE IV

Professional staff and public health research

CHAPTER I

Training and professional development in public health

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



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


2. Public health is multidisciplinary in nature, and public health professional personnel have the duty to follow continuing education throughout their lives, which should also be appropriate to their level of responsibility and competence in order to guarantee proper professional practice.


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


4. The provisions of Title III, on professional development and its recognition of Law 44/2003, of 21 November, on the organisation of health professions, shall be applied to public health professionals, necessarily defining the corresponding professional career.

CHAPTER II

Research in public health policy development

Article 49. Priorities for public health research


The Public Health Strategy shall identify those areas of public health and its social determinants where, because of their particular impact on the population as a whole, the promotion of research is of particular interest.

Article 50. Promotion of research in public health


Health administrations shall promote research and the communication of its results in the activity of public health professionals. To this end, they shall adopt the following actions:


a) Facilitate research on the health problems of the population with the appropriate means and quality.


(b) Fostering the relationship between research groups of excellence and the professional public health staff.


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

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


Regardless of the obligations to disseminate the results of research, as provided for in the Law on Science, Technology and Innovation, the public administrations responsible for health-related research shall establish appropriate mechanisms so that the results of publicly funded projects that can be immediately applied in health policy decision-making, especially in the treatment of diseases with a high impact on the population, are immediately communicated to the health administrations. In any case, the defence of the corresponding intellectual and industrial property rights will be guaranteed.


2. Health administrations shall jointly evaluate the impact on the health of the population of the results of publicly funded research.


3. In establishing agreements with research groups, the competent authorities shall give preference to those groups whose results have given rise to effective applications and uses by health administrations.

TITLE V

The state health authority, surveillance and control

CHAPTER I

State Health Authority

Article 52. The State Health Authority.


The holder of the Ministry of Health, Social Policy and Equality and, within the framework of their respective functions, the holders of the higher bodies and management bodies with responsibilities in public health of the said ministerial department with a rank equal to or higher than that of Director-General, shall be considered as the State Health Authority.


2. The State health authority, in the exercise of its responsibility and in accordance with its powers in the field of public health, shall make arrangements and have the power to act, through the competent bodies in each case, in public or private activities to protect the health of the population.


3. Within the scope of its powers, the State health authority shall be responsible for adopting measures on the coordination and execution of the public health actions considered in this law, as well as for adopting any special intervention measures, in accordance with article 52, in the field of public health that may be necessary for urgent or necessary health reasons or in the face of extraordinary circumstances that represent a clear risk to the health of the population, provided that the available scientific evidence so demonstrates.

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

Article 53. Agents of the State Health Authority.


The personnel in the service of the General State Administration linked to the exercise of the competencies contemplated in this law, shall have the status of agents of the health authority and shall be empowered to carry out inspection tasks. To this end, they may take samples and carry out the tests, investigations or examinations necessary to verify compliance with the health regulations, following the established procedures.

CHAPTER II

Special and precautionary measures

Article 54. Special and precautionary measures.


1. Without prejudice to the measures provided for in Organic Law 3/1986, of 14 April, on Special Measures in the Field of Public Health, on an exceptional basis and when so required for reasons of extraordinary gravity or urgency, the General State Administration and those of the Autonomous Communities and cities of Ceuta and Melilla, within the scope of their respective competences, may adopt any measures necessary to ensure compliance with the law.


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


(a) The freezing and, where appropriate, confiscation of products and substances


(b) The intervention of material or personal means.


(c) Preventive closure of installations, establishments, services and industries.


(d) The suspension of activities.


e) The determination of prior conditions at any stage of the manufacture or marketing of products and substances, as well as the operation of the facilities, establishments, services and industries referred to in this law, with the aim of correcting the deficiencies detected.


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


3. The measures shall be adopted after a hearing of the interested parties, except in the case of imminent and extraordinary risk to the health of the population, and their duration shall not exceed the time required by the risk situation that motivated them. The costs incurred in taking the precautionary measures referred to in this Article shall be borne by the person or undertaking responsible.


The measures taken shall, in any event, respect the principle of proportionality.

TITLE VI

Infringements and sanctions

Article 55. Subjects responsible for infringements.


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

Article 56. Infractions and sanctioning regime.


Administrative infractions in public health are the actions and omissions that are typified in the following articles, as well as those that may be established by regional or local legislation.


2. If the same action or omission constitutes two or more offences, only the one that carries the highest penalty shall be taken into consideration.


3. Facts that have been criminally or administratively sanctioned may not be sanctioned in cases where the identity of the subject, the fact and the basis are established. In cases where the offences may constitute a crime or misdemeanour, the competent authority shall pass on the blame to the competent jurisdiction and shall refrain from pursuing the sanctioning procedure until the judicial authority has ruled.


If the existence of a criminal offence has not been established, or if a decision has been taken that terminates the criminal proceedings, the disciplinary proceedings shall be continued, taking into account, where appropriate, the facts that the courts have deemed to be proven.


4. The processing of a sanctioning procedure for the infractions regulated in this Title shall not postpone the requirement for the adoption of preventive measures, the avoidance of further damage or reparation, as provided in this law, which shall be independent of the sanction that may be imposed.

Article 57. Classification of infringements.


. The offences classified in this law are classified as very serious, serious and slight, taking into account the criteria of risk to the health of the population, seriousness of the health or social disturbance produced, the amount of any benefit obtained, the degree of intentionality and recidivism.


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


a) They are very serious infringements:


1.º The carrying out of conduct or omissions that produce a very serious risk or harm to the health of the population.


Repeated failure to comply with the instructions received from the competent authority, or failure to comply with a requirement of the latter, if this involves serious damage to health.


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


4.º Recidivism in the commission of serious offences in the last five years.


b) These are serious infractions:


The carrying out of conduct or omissions that may produce a risk or serious damage to the health of the population, when this does not constitute a very serious infringement.


The refusal to support, assist or collaborate with the agents of the health authority.


Failure to comply with the instructions received from the competent authority, if it involves damage to health, when it does not constitute a very serious infringement.


The resistance or obstruction of those actions that were required, in accordance with the provisions of this law.


Failure to communicate information and other obligations in accordance with the provisions of Title I of this law, when it is of a serious nature.


Recidivism in the commission of minor infractions in the last twelve months.


c) These are minor infringements:


Failure to comply with current health regulations, if the repercussions produced have had little or no direct impact on the health of the population.


2.º Those infringements which, in accordance with the provisions of this article, are not classified as serious or very serious.

Article 58. Penalties.


1. The commission of infringements in the area of public health will give rise to the imposition of the following sanctions, without prejudice to those that may be established by the Autonomous Communities and Local Entities within the scope of their competences:


a) In the case of a very serious infringement: A fine of 60,001 up to 600,000 euros, which may exceed this amount up to five times the market value of the products or services subject to the infringement.


(b) For serious infringements: A fine of EUR 3,001 to EUR 60,000.


(c) For minor infringements: fine of up to


These amounts may be updated by the Government in accordance with regulations.


Without prejudice to the financial penalty that may correspond, in the case of very serious infringements, the competent authority may agree to the temporary closure of establishments or services for a maximum period of five years.


3. When imposing sanctions, the public authorities must ensure that the seriousness of the event constituting the infringement is in keeping with the sanction applied, taking into account the criteria established in Article 131 of Law 30/1992, of 26 November, on the Legal System of Public Administrations and Common Administrative Procedure.

Article 59. Prescription of infringements and sanctions.


1. Minor infringements will expire after one year, serious infringements after three years and very serious infringements after five years.


The period of limitation for infringements shall begin on the day following that on which the infringement was committed.


In the case of continuing infringements, the limitation period shall start to run from the time when the activity is completed or the last act with which the infringement is completed. In the event that the facts or activities constituting the infringement are unknown because they lack external signs, the said period shall be counted from the time when they become apparent.


The prescription period shall be interrupted by the initiation, with the knowledge of the interested party, of the sanctioning procedure, and the prescription period shall be resumed if the sanctioning procedure is paralyzed for more than one month for reasons not attributable to the presumed responsible party.


2. Sanctions imposed for minor offences shall be time-barred after one year, those imposed for serious offences after three years and those imposed for very serious offences after five years.


The limitation period for penalties shall start to run on the day following that on which the decision imposing the penalty becomes final.



The limitation period shall be interrupted by the initiation, with the knowledge of the interested party, of the enforcement procedure, and the period shall be resumed if the interested party is paralyzed for more than one month for reasons not attributable to the offender.

Article 60. Penalty procedure.


1. The sanctioning procedure, in matters of public health, will be developed in accordance with the provisions of this law and Title IX of Law 30/1992 of 26 November, on the Legal System of Public Administrations and Common Administrative Procedure.


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

Article 61. Bodies competent to impose sanctions in public health matters.


1. The initiation, processing and resolution of disciplinary proceedings shall be the responsibility of the competent administration by reason of the territory and the subject matter.


2. Within the scope of the General State Administration, the initiation of the file will correspond to the General Directorate competent in public health matters and the resolution to the head of this General Directorate, in the case of minor infractions, to the head of the General Secretariat of Health, in the case of serious infractions, and to the head of the Ministry of Health, Social Policy and Equality, for very serious infractions.


3. The competent authorities may publish, once they have made a final decision, the penalties imposed for the infringements committed, the facts constituting such infringements and the identity of the offender.

First additional provision. The specialisation of the health professions in public health


The Government shall amend Royal Decree 183/2008, of 8 February, which determines and classifies the specialities in health sciences and develops certain aspects of the system of specialised health training, in order to extend specialisation in public health to the other health professions.

Second additional provision. Public Health in the Armed Forces.


Within the scope of the Armed Forces, the General Defence Health Inspectorate, as the health authority of the department, shall coordinate with the other health authorities the actions aimed at fulfilling the objectives of this law, and shall carry out, within the Armed Forces, the necessary actions for the fulfilment of its provisions and those that are concordant, reporting them to the Ministry of Health, Social Policy and Equality.

Third additional provision. Public health in penal institutions.


Within the scope of the Penitentiary Institutions, the penitentiary authority shall coordinate with the health authorities the actions aimed at fulfilling the objectives of this law, and shall carry out the necessary actions to comply with its provisions and those that are concordant in those health services dependent on Penitentiary Institutions that have not been transferred to the Autonomous Communities, reporting them to the Ministry of Health, Social Policy and Equality.

Fourth additional provision. From the State Public Health Centre.


The creation of the State Public Health Centre, provided for in article 47, shall be carried out through the restructuring of the existing units contemplated in the Royal Decree implementing the basic organizational structure of the Ministry of Health, Social Policy and Equality, and may not entail an increase in budgetary appropriations.


This centre will coordinate its activity with the national centres of Epidemiology, Microbiology, Environmental Health, Tropical Medicine, the National School of Health and the National School of Occupational Medicine, and other state-owned units, centres and bodies whose responsibilities include the development of public health functions in connection with the development of research activities.

Fifth additional provision. Benefits.


The benefits established by this Act shall be financed in accordance with the provisions of article 10 of Act 16/2003, of 28 May, on the cohesion and quality of the National Health System.

Sixth additional provision. Extension of the right to public health care.


The right to access public health care is extended to all Spaniards resident in national territory, to whom it cannot be recognised under other legal provisions.


This extension, which will have at least the scope foreseen in the portfolio of common services of the National Health System, is made without prejudice to what is expressed in the following sections and to the requirement of the corresponding obligations to those third parties legally obliged to pay for this assistance in accordance with what is established in the General Health Law, in the rewritten text of the General Social Security Law and of what is established in the European Community regulations and international conventions on the matter.


The extension provided for in this section will be effective for those persons who have exhausted their unemployment benefit or subsidy as of 1 January 2012. For the rest of the groups affected, it will be carried out, taking into account the evolution of public accounts, under the terms provided for in paragraph 3.


2. The provisions of the previous section do not modify the health care regime of the persons who are holders or beneficiaries of the special social security regimes managed by MUFACE, MUGEJU or ISFAS, which will maintain their specific legal regime. In this regard, the persons included in said mutual insurance companies who have opted to receive health care through the insurance entities shall be treated in the health care centres arranged by these entities. In the event of receiving care in public health centres, the cost corresponding to the care provided will be claimed from the obligated third party, in accordance with the regulations in force.


3. Within a period of six months, the Government shall determine the regulatory terms and conditions of the extension of the right for those who are self-employed.

Seventh additional provision. Regulation of psychology in the health field.


1. Graduates in Psychology shall be considered as a qualified and regulated health profession under the name of General Health Psychologist at degree level, under the terms provided for in Article 2 of Law 44/2003, of 21 November, on the Regulation of Health Professions, when they carry out their professional activity on their own account or on behalf of others in the health sector, provided that, in addition to the aforementioned university degree, they hold the official Master's degree in General Health Psychology, the study plans for which shall conform, regardless of the university teaching them, to the general conditions established by the Government under the provisions of Article 15. 4 of Royal Decree 1393/2007, of 29 October, which establishes the organisation of official university education.


In accordance with the provisions of article 6.4 of Law 44/2003, of 21 November, the General Health Psychologist is responsible for carrying out research, evaluations and psychological interventions on those aspects of the behaviour and activity of people that influence the promotion and improvement of the general state of their health, provided that these activities do not require specialised attention from other health professionals.


2. In accordance with the provisions of Article 15.4 of Royal Decree 1393/2007, of 29 October, the Government shall, within a period of six months, establish the general conditions to which the curricula for the official degree of Master's in General Health Psychology shall conform, authorising the Ministry of Education to specify, subject to the provisions of the aforementioned Royal Decree, the requirements of the aforementioned Master's and the planning of its teaching throughout the State, subject to the following criteria


a) The curricula corresponding to the official Master's degree in General Health Psychology will guarantee the acquisition of the necessary skills to carry out the activities of the health profession of General Health Psychologist as specified in section 1. To this end, the qualifying degree for the profession of General Health Psychologist must accredit the completion of at least 180 ECTS credits of specific health content in the set of Bachelor's and Master's courses, in accordance with the specification determined by regulation.


b) The universities that offer Master's degree courses in General Health Psychology will regulate the procedure that will allow the recognition of the Psychology graduates who have completed these studies before the entry into force of this law, the European credits of this Master's degree that correspond in each case, after evaluating the degree of equivalence accredited through the professional experience and training acquired by the interested party in Health Psychology.


3. In accordance with the provisions of article 12.9 of Royal Decree 1393/2007, of 29 October, the Government shall, within a period of one year, regulate the general conditions to which the curricula of the Degree in Psychology shall conform, and the Ministry of Education shall regulate, within the aforementioned period and subject to the provisions of the aforementioned Royal Decree, the requirements of the degree and planning of the education to which the curricula of the Degree shall conform throughout the State, subject to the following criteria


a) The Degree in Psychology, which in itself does not qualify for 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 who intend to access the Master's Degree in General Health Psychology shall design the Degree in Psychology providing, at least, a specific path linked to health psychology. This course will be expressly mentioned in the corresponding Degree in Psychology.


c) The universities will proceed to adapt the curricula of the Degree in Psychology already approved to the general conditions mentioned above, requesting its verification in the terms provided by the legislation in force. The aforementioned adaptation will be carried out within five years from the time the Government approves the general conditions to which the curricula of the Degree in Psychology will adjust.


4. Psychologists who work in centres, establishments and services of the National Health System or in conjunction with it, in order to provide the health benefits derived from the portfolio of common services of the same that correspond to these professionals, must hold the official title of Specialist Psychologist in Clinical Psychology referred to in section 3 of annex I of Royal Decree 183/2008, of 8 February, which determines and classifies the specialities in Health Sciences and develops certain aspects of the specialised health training system.


The provisions of the previous paragraph are without prejudice to the competencies of other health specialists and, where appropriate, the multi-professional nature of the corresponding work teams in the field of mental health.


5. The Health Administrations of the different Autonomous Communities, in order to register the psychology assistance/consultation units in the corresponding General Register of Health Centres, Services and Establishments, shall require that the interested party has obtained the Master's degree in Health Psychology or the degree of Psychologist specialising in Clinical Psychology.


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

Single derogating provision. Regulatory repeal.


Article 19(1) and Articles 21 and 22 of Law 14/1986 of 25 April 1986 on the General Health System are hereby repealed.


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


3. Likewise, any provisions of equal or lower rank that are contrary to the provisions of this law are hereby repealed.

First final provision. Amendment of Law 14/1986, of 25 April, General Health.


Section 1 of Article 25 of Law 14/1986, of 25 April, General Health, shall read as follows


"1. The requirement for health authorizations, as well as the obligation to submit companies or products to registration for health reasons, shall be established by regulation, based on the provisions of this Law, as well as on the provisions of the General Law on Public Health".


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


"The Public Administrations, within the scope of their competencies, will control commercial advertising and propaganda so that they conform to criteria of veracity with respect to health and to limit everything that could constitute a damage to it, with special attention to the protection of the health of the most vulnerable population".

Second final provision. Amendment of Law 16/2003, of 28 May, on the Cohesion and Quality of the National Health System.


Law 16/2003, of 28 May, on the Cohesion and Quality of the National Health System, is modified in the following terms:


First. Article 2(c) of Law 16/2003, of 28 May, on the 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, under the terms of this Act and the General Public Health Act.


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


"(d) The provision of comprehensive health care, including both promotion and prevention of disease, care and rehabilitation, ensuring a high level of quality, under the terms of this Act and the General Public Health Act".


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


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


(a) Public health information and surveillance and epidemiological alert and rapid response systems for public health emergencies


(b) Advocacy for public health goals and objectives which is the combination of individual and societal actions aimed at obtaining political commitment, support for health policies, social acceptance and endorsement for specific health objectives or programmes.


(c) Health promotion, through intersectoral and cross-cutting programmes.


d) The prevention of disease, disability and injury.


e) The protection of health, avoiding the negative effects that various elements of the environment can have on the health and well-being of individuals.


f) The protection and promotion of environmental health


g) The protection and promotion of food safety.


h) The protection and promotion of occupational health


i) Health impact assessment.


j) Monitoring and control of possible health risks arising from the import, export or transit of goods and the international transit of travellers.


k) Prevention and early detection of rare diseases, as well as support to persons presenting them and their families


The provision of public health care shall also include all those unique actions or special measures which, in the field of public health, need to be taken by the health authorities of the various public administrations, within the scope of their powers, when extraordinary health circumstances or situations of special urgency or need so require and the available scientific evidence justifies them".


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


"1. The health services shall inform citizens of their rights and duties, of the benefits and the portfolio of services of the National Health System, of the requirements necessary for access to these and of the other rights set out in the basic law regulating patient autonomy and of the rights and obligations in the field of clinical information and documentation, as well as the rights and obligations set out in the General Law on Public Health and in the corresponding regional regulations, where applicable".


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


"Fourth additional provision. Extension of the content of the portfolio of services of the National Health System


1. The Mutualidad General de Funcionarios Civiles del Estado (MUFACE), the Instituto Social de las Fuerzas Armadas (ISFAS) and the Mutualidad General Judicial (MUGEJU), as members of the National Health System in their capacity as managing entities of the Special Social Security Regimes for State Civil Servants, of the Armed Forces and of the Personnel at the Service of the Administration of Justice, respectively, will have to guarantee the content of the service portfolio of the National Health System, as well as the guarantees on accessibility, mobility, quality, security, information and time contained in this law, in accordance with the provisions of its specific regulations.


In the area of public health, the following are excluded from the National Health System's service portfolio within the scope of these Mutual Funds: epidemiological surveillance, protection and promotion of food safety, protection and promotion of environmental health, surveillance and control of risks arising from the import and transit of goods and travelers, and general health protection and promotion actions related to the prevention and handling of epidemics and disasters.





In any case, the health professionals and centres that provide services to the group protected by the Mutual Insurance Societies of civil servants by virtue of the agreements subscribed by the latter 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 the provisions of article 6, the collaborating entities and mutual insurance companies with responsibilities for public health care coverage will have to guarantee, in accordance with the provisions of their specific regulations, the content of the service portfolio of the National Health System, as well as the guarantees on accessibility, mobility, quality, security, information and time set out in this law".

Third final provision. Modification of Law 41/2002, of 14 November, basic regulation of patient autonomy and rights and obligations in the area of clinical information and documentation.


Section 3 of article 16 of Law 41/2002, of 14 November, basic regulation of patient autonomy and of rights and obligations in matters of clinical information and documentation, is worded as follows


"3. Access to clinical records for judicial, epidemiological, public health, research or teaching purposes is governed by the provisions of Organic Law 15/1999, of 13 December, on the Protection of Personal Data, and Law 14/1986, of 25 April, General Health, and other regulations applicable in each case. Access to the clinical history for these purposes requires the preservation of the patient's personal identification data, separated from those of a clinical-assistential nature, so that, as a general rule, anonymity is ensured, unless the patient himself has given his consent not to separate them.


Exceptions are made for cases of investigation by the judicial authority in which it is considered essential to unify the identification data with the clinical care data, in which case the judges and courts will have the corresponding process. Access to the data and documents of the clinical history is strictly limited to the specific purposes of each case.


When it 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 of Public Health, may access the data identifying patients for epidemiological reasons or for the protection of public health. The access must be carried out, in any case, by a health professional subject to professional secrecy or by another person also subject to an equivalent obligation of secrecy, prior motivation by the Administration that requested the access to the data".

Fourth final provision. Title of competence.


1. This law has the character of a basic rule, under the provisions of article 149.1.16 of the Constitution, which gives the State exclusive competence over the bases and general coordination of health. Chapter VIII of Title II is covered by the exclusive competence of the State in foreign health matters by virtue of the provisions of this same clause. Chapter II of Title IV is dictated under article 149.1.15 of the Constitution, which confers exclusive competence on the State for the promotion and general coordination of scientific and technical research.


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

Fifth final provision. Empowerment for regulatory development.


The Government and the head of the Ministry of Health, Social Policy and Equality, within the scope of their respective competencies, will dictate the provisions that are necessary for the development and application of this law.

Sixth final provision. Entry into force.


This Act shall enter into force on the day following its publication in the "Official State Gazette", with the exception of the provisions of Article 48(4), which shall enter into force twelve months after its publication in the "Official State Gazette".


Therefore,


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


Madrid, October 4, 2011.


JUAN CARLOS R.


The President of the Government,


JOSÉ LUIS RODRÍGUEZ ZAPATERO

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