[Once upon a time there was a place where we learned to listen. The Other Front line_voices for social justice]. / Había una vez un lugar donde aprendimos a escuchar. The Other Front line_voces por la justicia social.

Government responses to the COVID-19 pandemic generated a new wave of social inequalities for communities around the world living in unjust circumstances . Lockdowns and health measures overlooked housing conditions, transitions to virtual schooling, ignoring homes and families without the technological infrastructure and skills to access education, as well as overlooking the availability of an economic remainder. informal employment. The experiences of various communities around the world, from racialized/ethnic communities, homeless, migrants, elderly to young populations, were not reflected in the knowledge that guided the Government's responses; in fact, their experiences were involuntarily silenced . As a result of all this, it was necessary to create alliances with communities that lived in vulnerable conditions and that bore the great burden of the pandemic, to ensure that their voices were included in Public Health policies and practices.

Las respuestas de los gobiernos a la pandemia de la COVID-19 generaron una nueva ola de desigualdades sociales para las comunidades de todo el mundo que vivían en circunstancias injustas . Los confinamientos y las medidas sanitarias pasaron por alto las condiciones de vivienda, las transiciones a la escolarización virtual, ignorando los hogares y las familias sin las infraestructuras tecnológicas y habilidades para acceder a la educación, así como la disponibilidad de un remanente económico pasó por alto el empleo informal. Las experiencias de varias comunidades en todo el mundo, desde comunidades racializadas/étnicas, personas sin hogar, migrantes, ancianos hasta poblaciones jóvenes, no se reflejaron en el conocimiento que orientó las respuestas del Gobierno; de hecho, sus experiencias fueron silenciadas involuntariamente . A consecuencia de todo ello, fue necesario generar alianzas con las comunidades que vivían en condiciones de vulnerabilidad y que soportaban la gran carga de la pandemia, para garantizar así que sus voces se incluyeran en las políticas y prácticas de Salud Pública.

[Climate change and vector-borne diseases. From knowledge to action]. / Cambio climático y enfermedades transmitidas por vectores. Convertir el conocimiento en acción.

Andalusia is particularly sensitive to climate change, not only because of extreme weather events, but also because of the impact on the population dynamics of vectors, pathogens, reservoirs and hosts, which has led to a change in the epidemiological patterns of vector-borne diseases. In order to achieve an integrated vector management for disease control, public action is necessary. This study describes the design of the initial phase of a strategy for knowledge translation about climate change and vector-borne diseases to the public, using transdisciplinary co-creation and the World Café participatory method with three discussion rounds to address strategies for three age groups (adults, adolescents and schoolchildren). The aim is to drive knowledge into action and for this purpose the underlying messages for action (strategic and instrumental) have been identified, as well as the formats of the knowledge products and the potential implementers of the strategies.

Cambio climático y enfermedades transmitidas por vectores. Convertir el conocimiento en acción / Climate change and vector-borne diseases. From knowledge to action

Andalucía es un territorio especialmente sensible al cambio climático, por el impacto de los fenómenos meteorológicos extremos, así como por la dinámica poblacional de vectores, patógenos, reservorios y hospedadores, que ha ocasionado ya una modificación en los patrones epidemiológicos de enfermedades de transmisión por vectores. Para conseguir una gestión integral de los vectores y el control de las enfermedades que transmiten es necesaria la acción de la ciudadanía. Se describe el diseño de la fase inicial de una estrategia de transferencia de conocimientos sobre cambio climático y enfermedades de transmisión por vectores a la ciudadanía, mediante cocreación transdisciplinaria con la técnica de World café en tres rondas para la definición de estrategias dirigidas a diferentes audiencias (adultos, adolescentes y escolares). El objetivo es convertir el conocimiento en acción, y para ello se han identificado los mensajes de acción de fondo (estratégicos e instrumentales), así como los formatos de los productos de conocimiento y los posibles implementadores de las estrategias. (AU)

Andalusia is particularly sensitive to climate change, not only because of extreme weather events, but also because of the impact on the population dynamics of vectors, pathogens, reservoirs and hosts, which has led to a change in the epidemiological patterns of vector-borne diseases. In order to achieve an integrated vector management for disease control, public action is necessary. This study describes the design of the initial phase of a strategy for knowledge translation about climate change and vector-borne diseases to the public, using transdisciplinary co-creation and the World Café participatory method with three discussion rounds to address strategies for three age groups (adults, adolescents and schoolchildren). The aim is to drive knowledge into action and for this purpose the underlying messages for action (strategic and instrumental) have been identified, as well as the formats of the knowledge products and the potential implementers of the strategies. (AU)

Cómo adaptar una investigación cualitativa a contextos de confinamiento / How to adapt qualitative research to confinement contexts

El confinamiento de la población, incluidas las personas investigadoras, pone de manifiesto la necesidad de adaptar la metodología cualitativa, sus técnicas y herramientas, al contexto actual generado por la COVID-19. Internet y los medios o redes sociales posibilitan la recogida de datos textuales, secuencias, imágenes o narrativas sobre una realidad limitada para el acceso a ella de forma presencial. Entramos en la era de la e-investigación, matizando y reorientando la observación, la conversación, la recogida y el análisis de la información. En la actualidad se trabaja en técnicas y modelos de buena práctica en esta materia. Esta nota incluye métodos de obtención de datos empleados en las investigaciones cualitativas en ciencias de la salud; se hace una selección de técnicas para una investigación cualitativa en línea y se aportan 10 reglas para el diseño de una e-investigación de este tipo. (AU)

The confinement of the population, researchers, shows the need to adapt the qualitative methodology, techniques and tools, to the current context generated by COVID-19. The Internet and the social media allow the collection of textual data, sequences, images or narratives about a limited reality for access to it in person. We enter the era of e-research, nuancing and reorienting the observation, conversation, collection and analysis of information. Currently, we are working on techniques and models of good practice in this area. This note includes data collection tools used in qualitative research in health sciences, a selection of techniques for qualitative online research is made, and 10 rules for the design of an e-research of this type are provided. (AU)

[COVID-19 on migrants and ethnic minorities]. / COVID-19 en migrantes y minorías étnicas.

There are still few publications that analyse the effects on migrants or ethnic minorities of COVID-19 or of measures taken to curb this pandemic, although early studies point to a greater impact on black, asian and ethnic minority populations in the UK or on migrants in Mexico. In addition to barriers to access to information and health services, we consider it a priority to focus on their living conditions, particularly those in situations of vulnerability or social exclusion. People who are unemployed or with precarious jobs, without social benefits, in overcrowded conditions, may be more at risk of infection and not receiving adequate treatment. Confinement has predictably more negative impact on migrants in irregular administrative situations, victims of gender-based violence and those unable to comply with physical estrangement measures, such as refugees in camps or migrants under-living and settlements, without adequate hygienic conditions. Recommendations such as suspending deportations, extending or facilitating residence and work permits, closing detention centres for foreign persons, evacuating those in prisons and refugee camps or settlements have been applied unequally in different countries. Only a strong political commitment to global health equity can ensure the health of migrant populations and ethnic minorities, as well as their access to protection measures, information, medical testing and health services.Keywords: Migrants, COVID-19, Minority Groups, Vulnerable Populations, Social Determinants of Health.

[How to adapt qualitative research to confinement contexts]. / Cómo adaptar una investigación cualitativa a contextos de confinamiento.

The confinement of the population, researchers, shows the need to adapt the qualitative methodology, techniques and tools, to the current context generated by COVID-19. The Internet and the social media allow the collection of textual data, sequences, images or narratives about a limited reality for access to it in person. We enter the era of e-research, nuancing and reorienting the observation, conversation, collection and analysis of information. Currently, we are working on techniques and models of good practice in this area. This note includes data collection tools used in qualitative research in health sciences, a selection of techniques for qualitative online research is made, and 10 rules for the design of an e-research of this type are provided.

La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía / The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)

OBJETIVO: Conocer la valoración de personas migrantes sobre su acceso al sistema sanitario tras la entrada en vigor del Real Decreto-Ley16/2012 y sobre el efecto que han podido producir los recortes económicos en dicho acceso. MÉTODO: Estudio cualitativo fenomenológico con entrevistas semiestructuradas, realizado en Andalucía, en dos fases (2009-2010 y 2012-2013), con 36 participantes. Se segmentó la muestra por tiempo de estancia, nacionalidad y ámbito de residencia. Las nacionalidades de las personas migrantes son Bolivia, Marruecos y Rumanía. RESULTADOS: Como elementos facilitadores del acceso en ambas fases se identifican la situación administrativa regular, la posesión de tarjeta sanitaria individual, el conocimiento del idioma, las redes sociales y la información. Los resultados muestran diferencias en el acceso a la atención sanitaria de las personas migrantes antes y después de la aplicación del RDL 16/2012, en el marco de las políticas de austeridad. En la segunda fase se agravan algunas barreras de acceso, como los tiempos de espera y la incompatibilidad de horarios, y empeoran las condiciones socioeconómicas y administrativas de las personas participantes. CONCLUSIONES: El diseño de políticas económicas y de regulación de la atención sanitaria debería tener en cuenta las barreras y los facilitadores de acceso como ejes fundamentales de la protección de la salud de las personas migrantes y, por ende, de la población general

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population

[The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. / La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía.

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.

[Participatory tools and methods for community action. SESPAS Report 2018]. / Herramientas y métodos participativos para la acción comunitaria. Informe SESPAS 2018.

Participation is a process that requires the involvement of the policy makers, managers, technicians and staff of the institutions, and of citizens, as well as intersectoral and interdisciplinary action. To generate transformative changes, an infrastructure that encourages participation and planned action is required, and that recognises all the actors in the process. It takes time and commitment to ensure continuity through the joint production of actions, hence the importance of consolidating participatory projects that continue beyond political changes making public services sustainable. Training, the appropriate use of participation tools and a horizontal policy of delegated power are essential to ensure participation. Surveys, sociograms, flowcharts, health assets mapping, participatory budgets and participatory evaluation matrices are some of the tools that can be chosen, depending on the type of subjects addressed, the time and resources available, the characteristics of the participating population and territory, as well as determining the use that will be made of the information generated for the next phase. Participation tools are useful for citizens and professionals to analyze, understand, debate and decide collectively how to improve living conditions and environments. Over the past decade, social networks in the virtual environment have generated new trends in mass participation, which are self-managed by citizens.

Herramientas y métodos participativos para la acción comunitaria. Informe SESPAS 2018 / Participatory tools and methods for community action. SESPAS Report 2018

La participación es un proceso que requiere la implicación de responsables de la política, del personal directivo y técnico de las instituciones, y de la ciudadanía, así como de la acción intersectorial e interdisciplinaria. Para generar cambios transformadores es necesaria una infraestructura que favorezca la participación y la acción planificada, reconociendo a todos los actores del proceso. Se precisan tiempo y compromiso para su continuidad a través de la producción conjunta de acciones, y de ahí la importancia de consolidar proyectos participativos que continúen más allá de los cambios políticos para que los servicios públicos sean sostenibles. La formación, el uso adecuado de las herramientas de participación y una política horizontal de poder delegado son imprescindibles para el desarrollo de la participación. Herramientas como sondeos, sociogramas, flujogramas, mapeos de activos para la salud, presupuestos participativos o matrices de evaluación participativa son algunas de las que pueden elegirse, en función del tipo de materias abordadas, el tiempo y los recursos disponibles, las características de la población participante y del territorio, así como del uso que se va a hacer de la información generada para la siguiente fase. Las herramientas de participación son útiles para que la ciudadanía profesionales analicen, comprendan, debatan y decidan colectivamente con el fin de mejorar las condiciones de vida y los entornos. En la última década, las redes sociales en el entorno virtual han generado nuevas tendencias de participación masiva y autogestionada por la ciudadanía

Participation is a process that requires the involvement of the policy makers, managers, technicians and staff of the institutions, and of citizens, as well as intersectoral and interdisciplinary action. To generate transformative changes, an infrastructure that encourages participation and planned action is required, and that recognises all the actors in the process. It takes time and commitment to ensure continuity through the joint production of actions, hence the importance of consolidating participatory projects that continue beyond political changes making public services sustainable. Training, the appropriate use of participation tools and a horizontal policy of delegated power are essential to ensure participation. Surveys, sociograms, flowcharts, health assets mapping, participatory budgets and participatory evaluation matrices are some of the tools that can be chosen, depending on the type of subjects addressed, the time and resources available, the characteristics of the participating population and territory, as well as determining the use that will be made of the information generated for the next phase. Participation tools are useful for citizens and professionals to analyze, understand, debate and decide collectively how to improve living conditions and environments. Over the past decade, social networks in the virtual environment have generated new trends in mass participation, which are self-managed by citizens

Salud Pública (también) para las personas migrantes y refugiadas en Europa / Public Health for migrants and refugees in Europe (as well)

No disponible

El derecho de acceso sanitario en el contexto del Real Decreto-ley 16/2012: la perspectiva de organizaciones de la sociedad civil y asociaciones profesionales / Right of access to healthcare in the context of the Royal Decree-Law 16/2012: the perspective of civil society organizations and professional associations

Objetivo. La publicación del Real Decreto-ley 16/2012 (RDL 16/2012), que introduce cambios estructurales en el Sistema Sanitario Público Español, puede situarse en el contexto más amplio de políticas de ajuste en el momento actual de crisis económica. En el análisis de la interrelación de crisis económica, políticas sanitarias y salud, la participación ciudadana se nombra entre las potenciales estrategias para mitigar un impacto de la situación en la población. Desde esta valoración, se plantea el interés de un conocimiento de la perspectiva de la ciudadanía sobre las modificaciones introducidas por el RDL 16/2012. Métodos. Revisión narrativa de publicaciones de organizaciones de la sociedad civil y asociaciones profesionales relacionadas con el RDL 16/2012 en el contexto español. Resultados. Se observa una amplia respuesta ciudadana a la introducción del RDL 16/2012. Los documentos revisados incluyen un análisis del cambio del modelo sanitario inherente al RDL 16/2012, así como la previsión de su impacto en el acceso sanitario, la calidad asistencial y la salud. Las organizaciones de la sociedad civil y las asociaciones profesionales aportan recomendaciones y propuestas, además de ofrecer su colaboración en la elaboración de estrategias alternativas de ahorro. Conclusiones. La respuesta al RDL 16/2012 por parte de organizaciones de la sociedad civil y asociaciones profesionales indica el interés de fomentar canales de participación ciudadana para el desarrollo de políticas sanitarias basadas en el objetivo de mantener el carácter universal y la sostenibilidad del Sistema Sanitario Público Español en el momento actual de crisis económica y sistémica (AU)

Objective. The recent publication of the Royal Decree-Law 16/2012 (RDL 16/2012), which introduces structural changes in the Spanish Public Healthcare System, can be placed in the broader context of budgetary adjustments in response to the current economic crisis. An analysis of the interrelationships among economic crisis, healthcare policies, and health reveals that citizen participation is one of several potential strategies for reducing the impact of this situation on the population. This observation raises the interest to know the citizens’ perspectives on the modifications introduced by the RDL 16/2012. Methods. Narrative review of documents related to the RDL 16/2012 published by civil society organizations and professional associations in the Spanish context. Results. A broad citizen response can be observed to the introduction of RDL 16/2012. The documents reviewed include an analysis of changes in the healthcare model inherent to the RDL 16/2012, as well as predictions on its impact on access to healthcare, healthcare quality, and health. The civil society organizations and professional associations offer recommendations and proposals, as well as collaboration in elaborating alternative strategies to reduce costs. Conclusions. The response of civil society organizations and professional associations underscores the importance of strengthening citizen participation in the development of healthcare policies aimed at maintaining the universal character and sustainability of the Spanish Public Healthcare System in the current moment of economic and systemic crisis (AU)

[Right of access to healthcare in the context of the Royal Decree-Law 16/2012: the perspective of civil society organizations and professional associations]. / El derecho de acceso sanitario en el contexto del Real Decreto-ley 16/2012: la perspectiva de organizaciones de la sociedad civil y asociaciones profesionales.

OBJECTIVE: The recent publication of the Royal Decree-Law 16/2012 (RDL 16/2012), which introduces structural changes in the Spanish Public Healthcare System, can be placed in the broader context of budgetary adjustments in response to the current economic crisis. An analysis of the interrelationships among economic crisis, healthcare policies, and health reveals that citizen participation is one of several potential strategies for reducing the impact of this situation on the population. This observation raises the interest to know the citizens' perspectives on the modifications introduced by the RDL 16/2012. METHODS: Narrative review of documents related to the RDL 16/2012 published by civil society organizations and professional associations in the Spanish context. RESULTS: A broad citizen response can be observed to the introduction of RDL 16/2012. The documents reviewed include an analysis of changes in the healthcare model inherent to the RDL 16/2012, as well as predictions on its impact on access to healthcare, healthcare quality, and health. The civil society organizations and professional associations offer recommendations and proposals, as well as collaboration in elaborating alternative strategies to reduce costs. CONCLUSIONS: The response of civil society organizations and professional associations underscores the importance of strengthening citizen participation in the development of healthcare policies aimed at maintaining the universal character and sustainability of the Spanish Public Healthcare System in the current moment of economic and systemic crisis.

The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context.

BACKGROUND: The recent introduction of adjustment measures in the Spanish context by means of the Royal Decree-law 16/2012 (RDL 16/2012), which limits access to health care for undocumented migrants, raises the question about the state of the matter in different European Union member states. METHODS: Narrative review of comparative studies published between 2009 and 2012 that analyzes the right to health care for undocumented migrants in the European context. RESULTS: The review shows a high degree of variability regarding health care entitlements of undocumented migrants in different European countries, a frequent legal restriction of access to health care, as well as barriers in the effective access to health care. The studies coincide in recommending access at all health care levels, regardless of the administrative status of the person seeking treatment. The analysis of the impact of the current economic crisis on access and quality of the health care directed to undocumented migrants, as well as the knowledge of the migrants' perspective are identified as future research areas. CONCLUSIONS: Compared with other European countries, the introduction of the measures established in the RDL 16/2012 modifies the place of the Spanish Public Health Care System from being situated in the group of countries that permit undocumented migrants access to all health care levels, towards the category of highest restriction.

Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía / Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)

Objetivo Identificar los atributos con los cuales los/las pacientes crónicos/as atendidos/as en el Sistema Sanitario Público de Andalucía (SSPA) describen la competencia profesional del personal facultativo que les atiende a lo largo de su proceso asistencial. Métodos 147 pacientes crónicos de diferentes procesos asistenciales y sus familiares. Investigación cualitativa con grupos focales y entrevistas en profundidad, realizadas en centros de salud y consultas externas de Granada, Málaga, Sevilla, Cádiz y Córdoba, entre 2007 y 2008. Análisis de contenido con Nudist Vivo. Resultados Las personas participantes definen la competencia médica enlazando elementos de habilidad y conocimientos técnicos (tener conocimientos e interés por la enfermedad, mantener una continuidad en la atención mediante seguimientos correctos o solicitar las pruebas precisas) con otros relacionales, tanto sobre comunicación e información (informar, escuchar, confiar, estimular las preguntas) como sobre trato (humanidad, amabilidad, respeto, interés, cercanía). En la valoración de la asistencia en atención primaria, las expectativas incluyen relación cercana, trato personalizado, información, gestión de recetas y baja laboral, y derivación al/a la especialista. Sobre las consultas de especialidad destaca acertar diagnóstico y tratamiento, informar y hacer un seguimiento del/de la paciente. En el servicio de urgencias se valoran especialmente el alivio de los síntomas, acertar el diagnóstico, ser derivado al/a la especialista y recibir un trato humano. Conclusiones Las necesidades y las expectativas de los/as pacientes crónicos/as hacia la competencia médica se organizan en torno a habilidades técnicas y relacionales (AU)

Objective To identify the attributes used by chronically-ill patients to describe physicians’ competence in the public healthcare system in Andalucia. Methods A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. Results The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. Conclusions Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills (AU)

[Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)]. / Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía.

OBJECTIVE: To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. METHODS: A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. RESULTS: The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. CONCLUSIONS: Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills.

Participación ciudadana en salud: formación y toma de decisiones compartida. Informe SESPAS 2012 / Citizens’ participation in health: education and shared decision-making. SESPAS Report 2012

Durante las últimas décadas, la participación ciudadana adquiere relevancia en el ámbito de la salud pública, y son el nuevo rol del paciente, como agente activo, gestor y generador de su salud, y el paradigma de la atención centrada en el paciente, algunos de los hitos más importantes en la mejora continua de la atención sanitaria. La participación de los pacientes supone un nuevo modo de entender la relación entre éstos, los profesionales y sistemas de salud, no sólo desde el prisma del conocimiento, el manejo y el control de la propia salud, de manera individual o colectiva, sino también desde la influencia que puede llegar a tener en la planificación de políticas sanitarias. El aumento de la esperanza de vida y la consecuente prevalencia de enfermedades crónicas, que suponen ya un 80% de las consultas de atención primaria, son factores fundamentales del cambio de papel en los pacientes. El lugar que ocupaban tradicionalmente la consulta y el profesional sanitario ante cualquier síntoma o signo de alarma, lo comienza a tener hoy día el autocuidado y otros recursos de información y formación sanitaria al alcance de los pacientes y la ciudadanía. El acceso a Internet se constituye como fuente inagotable de recursos de información sanitaria dirigida a pacientes y de herramientas de participación, con las redes sociales como enclave de intercambio de información y consejos prácticos entre pacientes, familiares y profesionales sanitarios. La consideración de que los pacientes pueden ser expertos en su propia enfermedad posibilita una opción de participación real en salud, y de esta manera se acepta que adopten un papel más activo en las decisiones sobre su salud, como ocurre en la toma de decisiones compartida, así como formando parte de iniciativas y de evaluaciones de acciones en salud pública y servicios sanitarios (AU)

In recent decades, citizen’s participation has become increasingly important in the field of public health,with the new role of the patient as an active agent, manager and producer of his or her own health,and the paradigm of patient-centered care. These changes have represented some of the most importantmilestones in the continuous improvement of healthcare. The involvement of patients is a new way ofunderstanding the relationship between patients, health professionals and health systems, not only interms of knowledge management and patients’ control of their own health, individually or collectively,but also in terms of the influence that patients may have in health policy planning. Increased life expectancy and the consequent rise in the prevalence of chronic diseases, which already account for 80% ofprimary care consultations, is one of the key factors changing the role of patients. The place traditionallyoccupied by professional consultations given any symptoms or signs of alarm is beginning to be occupiedby self-care and information and health education resources within the reach of patients and citizens.Internet access is an inexhaustible source of health information resources aimed at patients and provides participation tools. Social networks are places to exchange information and practical advice amongpatients, families and health professionals. Patients may be experts in their own illnesses and may thustake a more active role in decisions about their health, such as in shared decision making, as part ofinitiatives, and as part of evaluation of public health activities and health services (AU)