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Spain has made relevant progress in the planning, visibility and organisation of palliative care, but territorial inequalities, differences in access and still insufficient guarantees for patients and families persist. In this context, a national palliative care law should be understood not as an ideological gesture or a reactive response to other debates, but as a tool for equity, public health and cohesion within the National Health System. The World Health Organization considers the existence of a legal framework that guarantees access to and regulates palliative care to be an indicator of development, and the European experience shows that the most useful laws are those that, beyond formal recognition, incorporate concrete mechanisms for implementation, financing, governance and evaluation. In light of these lessons, a future Spanish law should establish common minimum standards of access across the country, promote early and integrated care, strengthen professional training, support families and caregivers, ensure access to essential medicines and establish public monitoring indicators. The aim would not be to add one more regulation, but to reinforce a basic guarantee of the health system.

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The quality, equity, and sustainability of health systems depend in part on effective health care coordination, which raises ethical and legal challenges that go beyond purely operational concerns. In decentralized systems such as the Spanish one, inadequate coordination is associated with fragmented care, increased risk of iatrogenesis, inefficient use of resources, rising costs, and loss of public trust, placing fundamental ethical values such as justice, responsibility, transparency, and beneficence under strain. This article presents a narrative review of a conceptual and normative nature that examines the ethical and legal aspects of health care coordination in Spain, distinguishing between interorganizational coordination within the National Health System and intraorganizational coordination within health care organizations. The analysis shows that although the legal framework provides formal coordination mechanisms, their effectiveness largely depends on ethical governance practices, responsible leadership, and deliberation among actors with diverse interests and values. From an ethical perspective, the article argues that health care coordination involves principles of distributive justice, equity, efficiency, and transparency, and that health care organizations should be recognized as moral agents responsible for the consequences of their decisions. As a result, an ethical framework for decision-making in health care coordination is proposed, highlighting the role of organizational ethics committees as deliberative spaces, with implications for health care management, clinical practice, and public policy aimed at reducing inequities and improving system quality.

Embedded in Spanish neighborhoods and towns, there are hundreds of thousands of self-employed healthcare professionals who provide services within the private sector. In the absence of an official term, they are referred to here as "self-employed community healthcare professionals", as they practice within a community setting with a high degree of proximity to patients, participate to varying extents in health promotion activities, and operate independently from large organizations. Healthcare provision, whether public or private, has an impact on patients. It would therefore be reasonable for a regulated exchange of information to exist, allowing, when necessary and in accordance with the legal framework, collaboration for their benefit. In this context, it is important to better understand the reality of healthcare services delivered by self-employed professionals and the extent to which coordination with public healthcare exists, if any. Although the available knowledge about these services is limited, in most cases there is a low degree of coordination and/or collaboration with other healthcare professionals, both public and private. Despite the millions of interventions carried out, very few are captured within the electronic health record of the Spanish National Health System, resulting in two parallel and largely disconnected systems coexisting within the same territory, with minimal coordination as patients move between them. Pilot initiatives and statements from some professional groups suggest the need to integrate communication and collaboration systems to optimize patient care.

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Mexican health system is organized around social security (SS) entitlement, dividing the population into insured and uninsured groups, which represents a potential source of health inequity. The objective is to analyze life expectancy (LE) and healthy-adjusted life expectancy (HALE) between both populations. Ecological study was conducted at national and state levels for 2020, disaggregated by sex. LE and HALE for both populations were estimated. Statistical differences between them were assessed using Student's t-test or Wilcoxon rank-sum test, depending on the normality of the distributions. LE was higher in younger groups for population with SS when men and women were analyzed together, as well as for men independently. This pattern reversed at ages 30-34, after which the group without SS exhibited higher LE. However, these differences were not statistically significant. For HALE, the group without SS showed lower values across all age groups. These differences were statistically significant. Findings at state level were consistent with those observed at national level. LE didn't differ significantly between both populations. Nevertheless, the population with SS exhibited higher HALE, suggesting closer contact with health services. Therefore, the organization of the Mexican health system around SS may be a determinant in the generation of health inequities by segregating the Mexican population.

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The Argentine health system is one of the most accessible in the region of the Americas, but this accessibility is not equitable in terms of quality and time, and its results in terms of indicators do not match its investment levels. There is an absence in the definition of policies regarding the financing and care model, but especially in the values that support it. During the last twenty years, all the countries in the region initiated reforms with different proposals, and even when the systems were different, they ended up in very homogeneous proposals, centered on the pooling of funds, care models based on primary care and integrated networks of health services, with public-private participation. Argentina, in the more than 40 years since the recovery of democracy, has not made progress in that regard; it has not been able to formulate policies that decide what role the State plays in health.

To analyse the association between patients' contact with the private sector to undergo a diagnostic test and the probability that subsequent hospital treatment, if needed, will be provided by the public healthcare system, assessing whether this pattern may imply a dualisation of access to public treatment and its relationship with per-individual expenditure. Individual-level data from the Minimum Basic Data Set for Acute Hospitalisation in Catalonia (2018-2023) were used to identify patients with diagnostic contact in private centres, defining two samples: 1) private visits with an explicit record of a diagnostic test (n=9080) and 2) a proxy based on short-stay (≤2 days), non-surgical contacts in private centres (n=584,835). Care trajectories were reconstructed using the Morbidity and Use of Health Services Registry of Catalonia, calculating monthly rates of public healthcare resource use in the 12 months before and after private contact. Based on these rates and the registry of tariffs by resource, public healthcare expenditure per individual was estimated. The rate of public hospital admissions increased after discharge from the private sector, especially in the first month and in the sample with an explicit diagnostic test. The relative increase in public expenditure exceeded that of admission rates, suggesting that cases referred to the public sector after private diagnosis may be more complex and costly. The results are consistent with the hypothesis of a possible mechanism of dualisation of access to public treatment, although the descriptive design does not allow causal inference or determination of its net effect on equity or waiting lists.

To describe the evolution of individually notifiable sexually transmitted infections diagnoses in the city of Barcelona between 2007 and 2024, and to analyse their association with sociodemographic variables and the type of reporting centre. Temporal trend analysis based on population-level data on cases of syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum in the city of Barcelona. Annual incidence rates and adjusted incidence rate ratios were estimated using robust Poisson regression, adjusting for sociodemographic variables and stratifying by type of centre. Overall, 44.3% of diagnoses were made in community-based services, 30.6% in primary care and 24.9% in hospital-based care. Men accounted for 78.6% of cases and were predominantly diagnosed in community settings, whereas women were mainly diagnosed in primary care. Compared with the 25-34-year age group, the probability of being diagnosed in any type of care setting decreased with increasing age. Being born in Central or South America was associated with a 112% higher probability of diagnosis in primary care and a 144% higher probability in hospital care. Low socioeconomic status was associated with a 238% higher probability of diagnosis in primary care. Sexually transmitted infections diagnoses in Barcelona show potential inequalities by sex, country of birth and socioeconomic level, which are reflected in the type of healthcare setting where diagnoses are made. The COVID-19 pandemic appears to have accentuated these patterns, with a relative shift in diagnostic activity towards community-based services. Strengthening primary care and improving coordination between healthcare settings are needed to move towards a more equitable model of sexual health care.

The long-standing delay in the institutionalization of public health in Spain is directly related, both as a cause or effect, to its academic and professional weaknesses. This second part examines the necessary, yet challenging, relationship between academia and administration, describing how public health research and training have developed in the country, primarily since the transition to democracy. One of the keys to consolidating the progress already made is connecting the day-to-day work of research with professional practice. That is linking the knowledge generated through research and innovation with the implementation of policies and programs. Investing in research and professional training, with sufficient and sustained resources, is the best way to prepare ourselves to face the present and future challenges of public health. Scientific societies play a unique role in connecting academia and administration.

A practical, guiding and non-linear pathway is proposed to help nursing teams within Spain's National Health System transform clinical needs into transferable medical devices, integrating responsible research and innovation principles (anticipation, reflexivity, inclusion and responsiveness) and the requirements of Regulation (EU) 2017/745 and related standards (risk management and usability). The pathway brings together definition of real-world use, review of evidence and the technology landscape, prototyping and co-creation, regulatory alignment, an intellectual property protection and transfer strategy, and proportionate evaluation (formative/summative usability and clinical evidence). As a demonstrator, ERGOMIC -a non-invasive voiding device for women in the supine position- is presented, addressing a design gap with a gender equity dimension, a usability plan and a life cycle assessment. This approach supports solutions that are safe, acceptable and adoptable.

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To advance towards a more responsive, equitable and sustainable model of primary care, it is necessary, among other actions, to move beyond the traditional structure centred on the roles of nurses and physicians. The existence of the primary care team is grounded in the principles established in the Declaration of Alma-Ata (1978). This article analyses the factors that currently hinder its effectiveness, based on the needs it is expected to address, and proposes criteria that may contribute to its improvement and further development, focusing efforts on providing comprehensive care to individuals from an individual, family and community perspective. Such development is possible by giving greater prominence to collaborative clinical management processes, as well as to training, communication and intra-team coordination, together with the assumption by all team members of new professional profiles and competencies, so that each activity is carried out by the professional most competent to do so. This transformation redefines professional roles, resulting in an interdisciplinary and multiprofessional team that brings together nurses, physicians and administrative staff with other professional roles -established roles that are not yet fully integrated into primary care teams-, such as physiotherapists, pharmacists, dentists, psychologists and nursing assistants. The aim is to jointly address diagnoses, treatments and care, as well as complex care processes, thereby enhancing problem-solving capacity and expanding care delivery beyond the physical structure of the health centre.

To describe the design process, through participatory diagnosis and community validation, of a municipal digital well-being strategy with a preventive approach focused on families with children under 16 years of age. A community-based participatory action research study with a longitudinal design (November 2023-November 2025) was conducted in El Prat de Llobregat, framed within the Local Plan for Childhood and Adolescence. It was structured into three phases: 1) participatory diagnosis through a questionnaire administered to 1583 guardians and four focus groups; 2) collaborative desing inolving plenary sessions and age- stratified working groups; and 3) community, institutional, and political validation. The theory of change and qualitative-quantitative methodological triangulation were applied. The diagnosis identified five thematic categories: parental overwhelm, normative inconsistency, impact on free play and physical activity, demand for practical age-adapted tools, and the tension between protection and autonomy in adolescence. The collaborative design culminated in an action plan comprising four strategic lines. Community validation demonstrated an acceptance rate exceeding 85%, with unanimous institutional and political support. The materials are publicly available (www.elprat.cat/benestardigital). A process that incorporated participatory diagnosis, intersectoral leadership, community validation, application of the Theory of Change, and the production of accessible materials enabled the design of a municipal strategy for the digital well-being of families with children under 16 that was widely accepted and theoretically reproducible. The impact evaluation of the strategy, scheduled for 2026-2027, is expected to provide evidence on the effectiveness of the interventions in real-world implementation contexts.

The objective of this paper is to describe and analyse the healthcare reform project in Chile following the 2019 social uprising. It outlines the progress, obstacles, and challenges within its historical context. Chile presents very positive health indicators, but also marked inequities stemming from the existing inequality in the country. The Chilean healthcare system has experienced a pendulum swing throughout its history, going from being one of the first integrated healthcare services in Latin America to becoming one of the best examples of the neoliberal model, before attempting to transition once again toward a social protection system with universal access and coverage. The arrival of President Boric to power in 2022 was accompanied by a program that established a conception of health as a social right, generating an agenda of transformations in the sector, consistent with the principles of universal healthcare. Although significant progress has been made (zero co-payments, universal Primary Health Care), the inability to pass the tax reform that would guarantee the structural financing of these changes, along with the difficulties in creating a Universal Health Fund and advancing the transformation of private health insurers (Isapres) into supplementary insurance providers, has significantly limited the scope of these transformations. The difficulties observed in Chile in moving towards a single insurance model demonstrate that the dismantling of welfare states proceeds much more easily than the strengthening of social protection.

Misinformation is one of the main global risks threatening public health. During public health crises, which often involve a high degree of scientific uncertainty and a high social demand for information, the infodemic contributes to misinformation. The objective of this article is to analyze how to communicate effectively to contribute to the fulfillment of the public health mission while avoiding misinformation. Strategic communication, one of the essential functions of public health, involves not only providing the right message at the right time, delivering it to the right messenger, and disseminating it through the appropriate channels (mass, community, and interpersonal media), but also defending against the corporate capture of public health. In public health crises, the goal of communication is to enable people to make informed decisions to reduce risk and mitigate the impact of the crisis, recognizing and addressing community concerns and emotions, providing clear and truthful information, without hiding the uncertainties. Traditional media and social media are the primary sources of public health information for the population, especially during crises, so the active presence of public health institutions and professionals in these media is essential. Interinstitutional collaboration between levels of government with expertise in public health, including primary care professionals, and community leaders increases the coherence and effectiveness of messages, avoiding confusion and promoting public trust.