The Republic of Portugal is situated in the southwest of Europe, and has a population of around 10.3 million people. Portugal joined the EU in 1986 and the Eurozone in 1999. Although the country has a quite developed economy, Portugal currently belongs to the poorest European countries. Portugal is divided into 308 administrative municipalities, which are subdivided into 4260 civil parishes.
The Portuguese health system is made up of three coexisting systems: the National Health Service, special social health insurance schemes for certain professions, as well as voluntary private health insurance. The Ministry of Health manages the National Health Service, which is primarily funded through general taxation. Furthermore, the Ministry is responsible for developing health policy, which are implemented by five regional health administrations. Decentralization efforts have sought to shift financial and management responsibility to the regional level, but in practice this has so far been restricted to primary care. Health expenditure is below that in many other EU countries, with Portugal spending EUR 1989 per head on health care in 2015. In 2015 life expectancy reached 81.3 years.
Health inequalities have been on the Portuguese political agenda for many years. In the last part of the 20th century the development of the primary care network especially targeted immigrant populations, deprived neighborhoods, and the homeless, and included more structured and sustained interventions with legislative and financial support. Both the national and regional level are involved in tackling health inequalities, with policies mainly developed at the national level, and implementation carried out by local actors. The role of local public organisms is supplemented by other actors, mainly local NGOs and those linked with the Catholic Church, who have always directed a great deal of attention to differences in health care of the deprived groups.
The Ministry of Health and the Ministry of Social Affairs take the lead in policy response to health inequalities. The National Health Plan extension to 2020 gives continuity to the vision established in the previous plans, being “to maximize the health gains through the integration of sustained efforts in all sectors of society, and the use of strategies based on citizenship, equity and access, quality and healthy policies.” The NHP is focused around four strategic axes: 1) Citizens in health; 2) Equity in access to health care; 3) Quality in health; and 4) Healthy policies.
The Ministry of Finances also plays a central role in ensuring redistributive mechanisms. Yet, the policy response to health inequalities can be defined as mainly implicit. Moreover, the decisions taken in the policy documents are not always strongly implemented, and the lack of a well-structured and systematic monitoring and evaluation system makes it difficult to assess their impacts on the health equity situation in the country. Monitoring of health policies is limited and generally takes up data from administrative sources used for monitoring the attainment of specific goals and objectives in specific programmes, and not population based studies that could reflect and detail the impact of policies. Health impact assessment is practically inexistent. The present economic situation in Portugal demands increased attention to health inequalities and innovative approaches to tackle the foreseen increase of this issue in Portugal. The economic crisis had a major impact in Portugal, which resulted in the implementation of several policies to rationalise health sector costs, as part of its agreed Economic Adjustment Programme from 2011 to 2014.
An overview of policy responses addressing health inequalities in can be found in our Policy Database.
An overview of projects and initiatives that are currently taking place or that have successfully been finalized, and that are addressing health inequality issues, can be found in our Project Database.
Please find below an overview of key actors in Portugal working on health inequality issues:
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Please find below an overview of relevant documents addressing health inequality issues in Portugal. Further publications can be found in our Publications Database.
- Diagnóstico da infecção VIH/sida: representações e efeitos nas condições laborais (2011) (Diagnosis of HIV/AIDS: representations and effects on the working conditions)
- Distribuição da Mortalidade e dos Internamentos Hospitalares por Doenças do Aparelho Circulatório em Portugal Continental: Agregação Geográfica e Determinantes (2007 -2010) This second publication of the GeoFASES project (Geographical analysis of environmental factors and Socio-economic in health) analyses spatial patterns of mortality and hospitalization rates for circulatory diseases and their association with the spatial distribution of some plausible determinants that could justify, even partially, the unequal geographical distribution of those rates.
- Análise da mortalidade e dos internamentos hospitalares por concelhos de Portugal Continental (2000-2004) (Analysis of mortality and hospitalization in the counties of Continental Portugal)
- Presentation: Social Determinants and Health (2007) Presentation by José Robalo, Deputy Director of Directorate General of Health, for the EU Expert Group on Social Determinants and Health Inequalities.
- A Saúde dos imigrantes. Inquérito Nacional de Saúde 2005-2006 (Immigrants’ Health. National Health Survey 2005- 2006)
- Presentation: Health and Migration. Portuguese Policies after the Lisbon Conference Presentation by José Robalo, Deputy Director of Directorate General of Health.
Are you aware of any other key resources that should be added to this list?