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1. Governance

2. Cross-sectorial cooperation

Governance

Public Administration in Spain consists of three levels among which powers are distributed: State Administration (Government), Regional Administrations (Autonomous Communities) and Local Administrations (Municipalities and Provinces) (Articles 148, 149 and 150 of the Spanish Constitution).

Main actors

Ministry of Health

The Ministry of Health (Ministerio de Sanidad) is responsible for proposing and implementing government policy  in areas such as public health, health care planning and assistance, pharmacy, nutrition and assisted reproduction. It is also responsible for the management of health-related data, technologies and health professions and oversee the National Plan on Drugs. The Ministry ensures the right to health protection through the General State.

It presides over the State Foundation for Health, Childhood and Social Welfare (Fundación Estatal de Salud, Infancia y Bienestar Social, CSAI) which coordinates policies on social cohesion and inclusion, family, child protection and care for dependent or disabled persons and equality. CSAI also leads efforts against all forms of discrimination and gender-based violence.

The Ministry’s structure is regulated by Royal Decree 718/2024, which defines its basic organizational framework. More information on the structure available on the Ministry website. 

Ministry of Social Rights, Consumers and Agenda 2030 

The Ministry of Social Rights, Consumers and Agenda 2030 is responsible for proposing and executing the Government's policy on social rights and welfare, family and child protection, disability, youth, the promotion of the United Nations Agenda 2030 and consumers.

The Ministry does not hold direct responsibilities for health policy, which remain under the Ministry of Health. However, it continues to play a key role in coordinating social programmes that intersect with health-related issues, such as care for dependent persons and vulnerable youth.

Ministry of Education, Vocational Training and Sports

The Ministry of Education, Vocational Training and Sports (Ministerio de Educación, Formación Profesional y Deportes) is responsible for proposing and executing the Government's policy on sports matters. 

The High Council of Sports ( Consejo Superior de Deportes, CSD) is an autonomous body attached to this Ministry. It exercised the functions of the General State Administration in sports, including the coordination, programming, technical direction and execution of national and international competitions. The CSD also oversees the implementation of the Sports Law 39/2022 and the Anti-Doping Law 11/2021, and its president holds the rank of Secretary of State

The Ministry’s structure is regulated by Royal Decree  274/2024, which defines its basic organizational framework.

General distribution of responsibilities

There is a shared competency model, where the State sets overarching policy and guarantees equity, while regional and local authorities implement and adapt programs to local needs.

Health

• The State Administration, through the Ministry of Health, is responsible for setting national health policy, coordinating public health strategies, and ensuring equity across the system. It also manages the National Plan on Drugs, regulates health professions, and oversees pharmaceutical policy.
• The Autonomous Communities hold legislative and executive powers in health matters, including:
  • Health promotion and disease prevention
  • Hospital and primary care management
  • Public health surveillance and hygiene
  • Coordination of health services within their territories
• The Autonomous Communities hold legislative and executive powers in health matters, including:
  • Health promotion and disease prevention
  • Hospital and primary care management
  • Public health surveillance and hygiene
  • Coordination of health services within their territories.
• The Interterritorial Council of the National Health System (CISNS) is the permanent coordination body between the State and the Autonomous Communities, ensuring consistency, cooperation and communication across regions.
• Local Administrations are responsible for:
  • Sanitation and community hygiene
  • Oversight of public buildings and spaces
  • Health inspections and control of public of consumer goods
  • Local health promotion initiatives. 

Sport

• The State Administration, through the Ministry of Education, Vocational Training and Sports and its autonomous body, the Higher Council of Sports (Consejo Superior de Deportes, CSD, is responsible for:
  • National and international sports policy
  • Regulation of elite and professional sports
  • Coordination of national competitions and anti-doping policy
  • Promotion of inclusive and grassroots sports
• The Autonomous Communities have exclusive competences in:
  • Promotion of sport and physical activity
  • Management of regional sports programmes ad school competitions
  • Support for local sports associations and clubs
  • Development of sports infrastructure and funding mechanisms
  • Coordinating with the Local Administrations.
• Local Administrations (municipalities, regions, etc.) play a key role in:
  • Providing access to sports facilities and services
  • Organizing community-level sports activities
  • Supporting youth participation in sport
  • Maintaining and upgrading municipal sports infrastructure.

Cross-sectorial cooperation

Each of these Ministries has an Inter-territorial Commission that allows for coordinated cooperation between the Autonomous Communities and the General State Administration. There is also an Institutional Cooperation Agency in charge of coordinating cooperation between the Public Administrations with competencies in food safety and nutrition. The Youth Institute also collaborates closely with other bodies such as the Interministerial Commission for Youth (Ministry of Equality), the Spanish Federation of Municipalities and Provinces (municipal level), the Interterritorial Youth Council or the Spanish Youth Council (CJE) (currently private). The State Foundation for Health, Childhood and Social Welfare (CSAI). It is also made up of five departments: Health; Presidency; Social Rights and Agenda 2030; Foreign Affairs; European Union and Cooperation; and Science and Innovation.

In addition, taking into account that both health and youth are considered cross-cutting elements, there are inter-ministerial collaborations and collaborations with other agencies to address these issues. As a result of a participatory process in which 19 ministries, 6 scientific societies and associations, the 17 Autonomous Communities of the State and the Spanish Federation of Municipalities and Provinces have collaborated, the first national Public Health Strategy for the year 2022 has been developed. It has a cross-cutting and integrative approach that focuses on working on the determinants of health in all public policies unifying its governance and aligns with the 2030 Sustainable Development Goals. Its lines of action include promoting healthy, safe and sustainable educational environments and promoting active childhood and adolescence.