• health inequalities
• public health policy
• social inequalities
• socio-economic

Social protection systems are related to each community’s culture. In most of the developed countries with welfare systems, healthcare provides universal access to their population. Despite its achievements, the main concern today of public health systems is financial sustainability. The challenge results from the fact that most of the health systems are very set in their ways and do not seem much prepared to answer the upcoming challenges in healthcare. Specifically, health systems might be ill-pepared to implement the interventions likely to be required to fight against the inequity that will result from those future developments. This forces to rethink our systems and to direct universalism to a greater extent towards the most needy, fragile population that have been left behind by the economic crisis and may suffer loss of access to some innovations in healthcare.

This is particularly the case of the Spanish system. This does not seem prepared to prioritise services and set proper population targets to show resilience to the consequences of future technological and economic changes. In Catalonia, a wealthy region in Spain,1 despite rather good health outcomes for a reasonable healthcare expenditure, in terms of equality, the gap in socioeconomic inequalities has already increased during the last decades, first by immigration, driven by the economic boom, followed by unemployment caused by the economic crisis. They have generated new vulnerable groups (unemployed, children and elderly). In addition, some proposals from the former Spanish conservative government to change the terms of access to universal health services to pursue fiscal deficit control2 may make things worse.

The economic consequences of the past crisis overlap with problems related to technological innovation and pressures on utilisation of the health system, emerging further issues on equity. We know that in order to face them, the old universalism of the …