State and Health (1900–2013): Political Stability, Resources and Welfare

Abstract

Throughout the twentieth century, Portugal has undergone major social, political, cultural and economic changes. The same happened in healthcare provision issues, even if the most relevant changes in the way Portuguese governments perceived the need and urgency of a real and effective health policy happened in the mid 1970’s. Swiftly Portugal progressed from a narrow understanding of healthcare provision still linked to charitable assistance, to an inclusive approach, based on prevention and on the implementation of other needs, such as the provision of continued care. In the first decades of the last century, the appearance of Ministries of Health throughout Europe was a sign of a full awareness assigned by the central governments to population’s collective health. But in Portugal public health policies do not surpass 60 to 80 years of concerted decision-making, and it is inappropriate to speak of a national health policy before the second half of the century.. In this article we will analyse official legislation to describe the pathway of policymaking in the period 1900-2013, concerning the emergence of the Portuguese Welfare State. In methodological terms, we adopted a descriptive and chronological approach, based on the available national studies on the topic, which allow us to identify different health reforms, and each of their main constraints. Our aim is to answer the following questions: Which was the route of health policy in Portugal, and which was the role performed by the State, as the main actor in this field? How did policy options on public health look like in Portugal, and how might they have influenced morbidity and mortality levels? The text is divided in two parts. The first systematises the main stages of the Portuguese health policies in the twentieth century, highlighting the relationship between political stability, resources and the State’s intervention, strongly related to the emergence of the Welfare State. The second part summarises the milestones of health policy decisions and describes each of them. It starts in 1910, with the establishment of the republic, goes through the military dictatorship and the Estado Novo, giving a more extensive presentation of changes after the democratic regime and the origins of the Welfare State, embodied in the creation of the National Health Service. It finishes in 2013, emphasising the process of epidemiological transition, the decline of infant mortality rate and the growth of average life expectancy levels. The article ends with major remarks, and the answer to the initial questions.