[Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014].

This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts' opinions are divided on the need for some preventive activities. Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions.