The defence of health : the debates on health reform in 1970s Spain

This paper analyses the discourses that addressed healthcare reform projects discussed in Spain during the 1970s, before the death of the dictator General Franco, and up to the declaration of healthcare as a right in the Spanish Constitution of 1978. The Spanish health system, which developed from the Compulsory Sickness Insurance launched in 1944, focused only on disease and made no provision for preventive activities. This  shortcoming was one of the main aspects that required reform in the 1970s. We analyse the characteristics of the proposals to replace a treatment-centred health system with a new one based on a more holistic view and the defence of health. To contextualise these proposals, we review the development of the Francoist health system and regulations and plans that attempted to reform it before the death of Franco. The most interesting Spanish health system reform projects were written at the end of Francoism and the beginning of the Democratic Transition and were mainly drafted by medical doctors committed to the illegal left-wing parties. All shared the aim of universal healthcare financed by the State and the goal of placing the protection of health at the core of the health system by integrating preventive medicine and healthcare. Some proposals encouraged the study of social determinants of health and disease and emphasised the role of health education. Others were more concerned with the re-organisation of healthcare through planning and decentralisation, retaining the hospital for the treatment of diseases as the main goal.