Skip to navigation – Site map
Sociocultural and economic development

The health of the Portuguese over the last four decades

Comments on the course taken
La santé des Portugais au cours des quatre dernières décennies. Commentaires sur la direction adoptée
Paula Santana and Ricardo Almendra

Abstracts

The objective of this paper is to present the health gains in Portugal from the 1970s onward, and how this evolution responds to Portugal’s 40 years of democracy, the country’s inclusion in the EEC/EU, the public investment made in health, and the generalized improvements experienced in the daily lives of the population (housing, education, and access to public services).
Currently, Portugal is at the end of an epidemiological transition. Health indicators linked to communicable disease, infant mortality, maternal mortality, perinatal mortality and mortality in children from 1 to 4 years of age have decreased sharply and are in line with those seen in other countries of the European Union, and in some cases Portugal shows more favorable values.
The impact of these gains has translated into an increase in life expectancy at birth of 14.0 years for men and 14.4 years for women for the 45 years of observations made (1974-2014). Despite the gains in Portugal verified by this indicator, the difference in life expectancy with regard to the EU continues to be quite evident given the increase in mortality associated with certain diseases
The gains in health are the result of the implementation of public policies that have allowed for increased public access to a wide range of goods and services (e.g. housing sanitation, transport, education), with particular note going to the organized health care initiatives regarding the Portuguese National Health Service.

Top of page

Full text

Introduction

1The generalized improvement seen in health indicators in Portugal over the last four decades is mostly due to two groups of factors: 1) the promotion of conditions conducive to a healthy lifestyle, and 2) the increase in both access to and quality of health care (Barros et al., 2011). The first is due in great part to the municipalization (decentralization and competences in terms of the management and administration of municipalities) which occurred following the political regime change in 1974. The second stems from the health care system established by the Portuguese National Health Service, whose coverage rate increased significantly since its creation in 1979 (following the Constitution of Portugal of 1976) (Oliveira, 2005).

2The objective of this paper is to present the health gains in Portugal since the 1970s and to address how this evolution reflects the 40 years of Portuguese democracy, the country’s inclusion in the EEC/EU, the public investment made in health, and the generalized improvements experienced in the daily lives of people.

3The text will be divided into two parts. In the first part, the Portuguese Health System, which was established in 1971, will be presented and its features identified, and the decisive landmarks in terms of all citizens’ right to health protection will be indicated. Highlighted next will be the Constitution of 1976, and the rights included in it which found expression in the social movements subsequent to the 1974 Revolution, and the creation of the National Health Service (NHS) in 1979. The second part will begin with a retrospective analysis of the last 40 years with respect to demographic indicators (e.g. ageing and the natural balance) and health indicators (e.g. infant mortality and maternal mortality). Following will be an assessment of the course of the principal causes of mortality and the number of Potential Years of Life Lost. Finally, gains in health and Portugal’s position within a group of 15 European countries will be shown.

1 - Data and Sources

4To analyze the evolution of demographic and health indicators since the establishment of democracy in Portugal, a wide range of indicators have been collected from 1975 to the most recent year available (Table 1). In order to compare Portugal’s progress with that of the European Union average (the option was made to compare Portugal with the 15 countries which comprised the European Union in 2004), a set of indicators relative to health results was selected.

5The data were collected from a variety of national and international sources: Statistics Portugal – INE; European Health for All Database; Eurostat; and OECD Health Statistics.

Table 1 - Identification of the indicators and their respective sources

Table 1 - Identification of the indicators and their respective sources

Note: SDR = Standardized Death Rate; PYLL = Potential Years of Life Lost.

2 - Evolution and Characterization
of the Portuguese Health System

6The Portuguese Health System (PHS) is comprised of three complementary sectors: 1) the National Health Service (NHS) whose functions are financing, regulation, service management, and providing health care; 2) the social sector and the private sector, which provides health care; and 3) subsystems of public and private insurance, which deal with financing and providing health care (Simões et al., 2017).

7The design of the PHS had its start in 1971 and was the responsibility of Professor Gonçalves Ferreira (Simões et al., 2004). The Constitution of 1976 incorporated many of the demands that the social movements of the 1974 Revolution espoused and created the political conditions for the development of the NHS. The NHS was created in 1979 (Decree-Law 56/79 of September 15) as part of the Secretariat of State for Health in the Ministry of Social Affairs, encompassing all health care related to the prevention of disease and the diagnosis and treatment of the ill and of those in rehabilitation. It is made up of organs articulating on three levels – central, regional and local – with each dimension possessing different characteristics (Ferreira, 1990). The NHS is the guarantee of the right to health protection for all citizens.

8In the 1980s and 1990s, the geographic coverage of the public health services grew steadily (medical appointments in primary care registered a 36.4% increase between 1985 and 2001 [Santana, 2005]), and the Government’s responsibility in terms of individual and collective health protection became increasingly effective.

9As a result of the Arnaut Law, the NHS now came under a regionalized structure (Regional Health Administration: Decree-Law 254/82 of June 29; Inter-Hospital Commissions: Decree-Law no. 43853 of August 10, 1961; and Local Commissions: Legislative Order no. 97/83 of April 22) with the intention of improving community health care (KOIVUSALO et al., 2007 (Koivusalo et al. 2007). This structure was changed in 1990 with the creation of five Regional Health Administrations (RHA) (Law 48/90, of August 24), with their scope broadened in 1993 (Decree-Law 11/93 of January 15) when new geographical borders (Decree-Law 11/93 of January 15; however this was never implemented) were defined so that “in each Portuguese region there should be a Regional Health Administration.”

10The legislation mentions that the growing demands of the population in terms of quality and rapid response of the health care concerns and needs points to the management of resources that is done as close to the recipients as possible. For that reason, the regions were created in terms of health care, managed by Administrations that had additional competences and attributes. The RHAs are legally distinct entities with administrative and financial autonomy and their own assets; they execute their own functions of planning, distribution of resources, direction and coordination of activities, human resource management, technical and administrative support, and assessment of operations of the health-care institutions and service providers (Decree-Law 11/93 of January 15). Only the Autonomous Regions of the Azores and Madeira, whose special geographical characteristics, which have allowed them to be administered under a special political regime, have their own regulatory system with respect to the organization, operation, and regionalization of health care services with their policies defined and carried out by the organs of their own government (Decree-Law 11/93 of January 15).

11In 1990, the Health Basis Law (Lei de Bases da Saúde) restructured the NHS with its objectives being (Law 48/90, of August 24) to be universal in terms of the target population; to provide adequate global health care or to guarantee its provision; to tend toward being free of charge for users given the economic and social conditions of the citizens; to guarantee equity of access for users with the objective of attenuating the effects of economic, geographical and any other inequality with regard to access to health care; to have a regionalized organization and decentralized and participatory management. Beneficiaries of the NHS shall be Portuguese citizens (…) or foreign citizens with residency in Portugal under conditions of reciprocity, and stateless citizens residing in Portugal. In Law II with regard to Health Policy, the fundamental objective is to take special measures relative to those groups which are subject to the greatest risk, such as children, adolescents, pregnant women, the handicapped, drug abusers, and workers whose professions so justify.

12In 1996, the Agencies for Outsourcing Health Services were created (Decree-Law 42/99 of February 10) which sought to guarantee the best utilization of public resources through the establishment of objectives, the monitoring and final assessment expressed in program-budgets.

13In 2003, a substantial number of public hospitals were transformed into corporate enterprises funded with exclusively public capital – Hospitais, SA (approximately 45% of existing capacity) supported by a new management model (corporatization of public hospitals).

14Other forms of innovative management are related to the construction and management of new hospitals in the NHS by private entities in a combined regime of a Private Finance Initiative (PFI) for the construction and maintenance of hospital facilities and the concession of public service to the management of hospital facilities (via Public-Private Partnerships [PPP]) which began in 2003. There are four PPP hospitals presently operating (Braga, Cascais, Loures and Vila Franca de Xira). The model had been previously attempted (1996) with the Amadora/Sintra Hospital but only in the area of hospital management.

15More recently, the Health Regulatory Agency was created, whose role is to assure the primacy of “the broadest interests of the users in particular, and of the citizens, in general.” (Decree-Law 309/03 of December 10).

16Primary Health Care has become the principal undertaking of the NHS. In recent decades, reforms have been carried out that have brought about great organizational changes. After 2006, Family Health Units (FHU) were created, small multi-professional and self-organized teams, having their own operational and technical autonomy and subject to a contract system for basic employment, with decentralized diagnostic means and a benefits system to facilitate great productivity, accessibility and quality. Also created were Health Center Groups (HCG), organizational and management entities above the FHUs which also included the former primary health care structures, now designated as Personalised Health Care Units (PHCU). Distribution is very asymmetric, revealing geographical inequalities in terms of access to these services with an eventual impact on the level of health equity (Figure 1) (SANTANA and FERREIRA, 2016).

Fig. 1 - Municipalities with Family Health Units and other Personalized Health Care Units

Fig. 1 - Municipalities with Family Health Units and other Personalized Health Care Units

Source: SANTANA and FERREIRA, 2016, p. 407.

3 - Health Gains after 1974

17The indicators allowing for the population health assessment have been improved over the last four decades, making them more reliable and sensitive, and thus more useful in the definition of strategies and policies. Some of these indicators stem from deepening the level of detail of the traditional mortality indicators, as in the case of premature mortality and Potential Years of Life Lost from early death. Knowledge of these indicators allows for the identification of which cause of death could have been “avoided” if there had been timely access to health services (medical and other), and healthy behaviors and/or attitudes, allowing for the assessment of health gains. The following text is an updating of a work published in 2014 (SANTANA, 2014).

3.1 - Socio-Demographic and Health Indicators

18In 2016, Portugal has about 10 million inhabitants, 70% of whom reside in urban spaces, which is quite a different context from the one seen in 1974, when the population was about 8.8 million with only 40% living in urban spaces (INE, 2016). The population growth and urbanization process occurred in different phases and at different paces, even registering significant decreases at certain points in time. Along with these phenomena, there were significant improvements in social conditions: the illiteracy rate decreased from 25.7% in 1970 to 5.2% in 2011 (INE, 2016); the percentage of the population connected to urban wastewater collecting system increased from 34% in 1975 to 81% in 2009 (OECD, 2016) and the percentage of dwellings with public water supply (47% in 1970 to 99% in 2011) and showers (32% in 1970 to 98% in 2011) also increased significantly (INE, 2016).

19Despite the significant improvements in social conditions its evolution had some setbacks, being marked by the three International Monetary Fund (IMF) interventions, two of them in the aftermath of the democratic transition (1977-78 and 1983-85) and the last in 2011 (DOS SANTOS, TAVARES, and BARROS, 2016).

20The ageing of the population, at both the top and the bottom of the pyramid, verified between 1974 and 2015, is one of the most visible consequences of Portugal’s demographic evolution: the population with 65 and over has grown (from 9.8% to 20.7%) and the 0 to 14 age group has shrunk, from 27.7% to 14.1% (Figure 2). The municipalities with higher proportion of the resident population with 65 years old or more tend to be located in the peripheral regions of the north-east and central-east regions (Figure 3).

Fig. 2 - Age pyramid of the resident population

Fig. 2 - Age pyramid of the resident population

Source: Adapted from INE, 2016.

Fig. 3 - Proportion of the resident population with 65 years old or more in 1991 and 2015

Fig. 3 - Proportion of the resident population with 65 years old or more in 1991 and 2015

Source: Adapted from INE, 2017.

21One of the causes of the decrease in the infant and youth population is the evolution of fertility rates. Between 1974 and 2015 the number of live births per woman of childbearing age dropped from 2.7 to 1.3, and since 1983 this figure has stayed under the minimum level (2.1) needed to assure replacement of the population over generations. This decrease seems to be proportional to the increase in the average age of the mother at the birth of the first child, which has gone from 24 to 30.2 between 1974 and 2015.

22The decreasing trend in the crude birth rate is common to almost all municipalities (93%) (Figure 4).

Fig. 4 - Crude birth rate (number of live births by 1000 inhabitants) in 1992 and 2015

Fig. 4 - Crude birth rate (number of live births by 1000 inhabitants) in 1992 and 2015

Source: Adapted from INE, 2017.

23The increase in life expectancy (LE) is another of the relevant aspects in the recent evolution of the Portuguese population (Table 2). In 40 years, the LE at birth was up 13.2 years, with greater gains for the male population (14.2 years) than for the female population (13.0 years); however, despite this fact, the difference between men and women remains high (going from 6.6 to 6.4 years).

Table 2 – Evolution of Life Expectancy (in years) at Birth, at 40, 65 and 80 years of age.

Table 2 – Evolution of Life Expectancy (in years) at Birth, at 40, 65 and 80 years of age.

Source: Adapted from OECD Health data, 2016.

24The improvements introduced into the preventive and therapeutic systems–namely through the development of vertical programs of mother-child health or the immunization programs occurring at the same time as economic and social transformations that sustained the continued improvements in food/diet, basic sanitation, hygiene, housing and overall quality of life issues–certainly played a decisive role in the drop in maternal mortality, infant mortality, neonatal mortality and perinatal mortality rates. Campos (1983) mentions that the health promotion and disease prevention measures significantly contributed to the population health improvement as well as to decreases the disparities between the more developed and the less developed regions.

25The variation on infant mortality was quite relevant, plunging from 37.9‰ to 2.9‰ in the period from 1974 to 2015. Steep declines were verified as well in the neonatal and perinatal mortality rates, falling from 20.9% and 32.3% in 1974, to 2.0% and 3.7% in 2015, respectively (Figure 5).

26A significant decrease in the maternal mortality rate has also been noted. In 1974, 47.7 women per 100,000 live births would die due to pregnancy-related complications. Today there are hardly any maternal deaths on record. Contributing to this are the actions undertaken within the scope of the NHS, with special mention to the Mother-Child Health Program, the increased number of births assisted by specialized professionals, and the fewer complications resulting from having an abortion, following the decriminalization of abortion in 2007.

Fig5 – Evolution of the infant mortality rate, neonatal, and perinatal

Fig. 5 – Evolution of the infant mortality rate, neonatal, and perinatal

Infant deaths by 1,000 live births, neonatal deaths by 1,000 live births, perinatal deaths by 1,000 births

Source: Adapted from Eurostat, 2016; INE, 2016.

3.2 - Principal Causes of Death and Years of Life Lost

27The fall in infant mortality had an impact on the increase in life expectancy at birth, but the gains obtained from 1974 to 2014 would have been even greater without the persistence or increase in other causes of death in adult age groups, mainly those associated with behaviors and lifestyles that young adults are prone to follow.

28In order to offer a frame of reference with regard to the evolution of health issues, the principal causes of death from 1974 to 2015 are presented in Figure 6. Competing with the significant decline in the number of deaths caused by diseases of the circulatory system and external causes is the re-emergence or worsening of the impact of other causes of death, notably those from malignant tumours or endocrine, nutritional, and metabolic disorders, which include diabetes, as they are related to human habits and lifestyle.

Fig. 6 - Standardized death rates due to some selected causes of death by 100,000 inhabitants

Fig. 6 - Standardized death rates due to some selected causes of death by 100,000 inhabitants

Source: Adapted from Health for All database, 2016; INE, 2016.

29The pattern for mortality per age group and sex also underwent substantial changes in the last 40 years. In 1974, infant mortality was mainly caused by pneumonia (Table 3). Similarly, for children from 1 to 4 years of age, mortality was mostly attributable to diseases of the respiratory system. This cause contributed to the greatest number of deaths in young children of both sexes. As for adults (younger and older adults) cerebrovascular diseases were the principal causes for mortality.

30The pattern changed in 2014: a) infant mortality is mainly caused by disorders occurring during the perinatal period; b) the most frequent cause of death for both sexes of children aged 1-4 is congenital malformations; c) from the ages 5 to 19, transport accidents are the leading cause of death for both genders; d) between the ages 20 and 59, ischaemic heart disease for men and breast cancer for women are of the greatest concern; e) from 60 years old onwards, death occurs most frequently due to cerebrovascular disease.

Table 3 – Comparison of the principal causes of mortality between 1974 and 2014

Table 3 – Comparison of the principal causes of mortality between 1974 and 2014

Source: Adapted from Eurostat, 2016; INE, 1975.

31In 1974 43,750 deaths for persons under age 70 were registered, representing 45% of all mortality. In 2014, this number fell, with the registry of 23,251 deaths for persons under age 70 (corresponding to 22% of all mortality). During this 40-year period, a significant drop in the Potential Years of Life Lost (PYLL) per 100,000 inhabitants has been observed, both for men (from 14,089 to 4,057) or for women (from 8,188 to 1,851).

32In 1974, the greatest number of PYLL per 100,000 inhabitants for men was registered for accidents, followed by diseases of the circulatory system; for women, at the top of the list were diseases of the respiratory system followed by diseases of the circulatory system. In 2014, there is no variation between the sexes: malignant tumours constitute the cause death that affects the under-70 population the most, followed by diseases of the circulatory system, for both men and women (Table 4).

Table 4 – Potential years of life lost due to selected causes of death by sex and 100,000 inhabitants

Table 4 – Potential years of life lost due to selected causes of death by sex and 100,000 inhabitants

Source: Adapted from OECD Health data, 2016.

3.3 - Portugal in Europe

33Portugal is at the end of an epidemiological transition. Several health indicators show an accentuated decrease and a harmonization with other European Union countries (EU-15), where in some cases Portugal presents more favorable figures. Four indicators decreased in an exemplary way: Infant Mortality (92%) (Figure 7), Maternal Mortality (83%), Perinatal Mortality (84%), and Neonatal Mortality (87%). The impact of these gains on Life Expectancy (LE) at birth resulted into an increase of 12.7 years in about 40 years of observation (1974-2014) (Figure 8).

Fig. 7 - Infant mortality (‰) in the European Union (EU-15) in 1974 and 2014

Fig. 7 - Infant mortality (‰) in the European Union (EU-15) in 1974 and 2014

Source: Adapted from the Health for All database, 2016, Eurostat, 2016.

Fig. 8 - Life Expectancy in European Countries (EU-15) in 1974 and 2010

Fig. 8 - Life Expectancy in European Countries (EU-15) in 1974 and 2010

Source: Adapted from Health for All database, 2014; Eurostat, 2016.

34Although malignant tumours are the primary cause of death in Portugal and have increased by 0.2% between 1974 and 2104, Portugal is part of the group of countries with a lower mortality rate in this area. Portugal’s figures for mortality are near the European average; in 2014 Portugal registered 5.7 deaths per 100,000 inhabitants in the EU-15 whereas in 1974 the figure stood at 48 deaths per 100,000 inhabitants (Table 5).

35With the consumption of tobacco on the rise (18.7% over the past 15 years), it would be expected an increase in diseases of the respiratory system as well as cancers located elsewhere in the body (mainly for women), caused by this harmful substance (SANTANA, 2014). In 1974, Portugal registered 23 fewer deaths per 100,000 inhabitants from lung cancer as compared to the EU-15 average. Between 1974 and 2014, this cause of death increased by 114% in Portugal whereas the EU-15 average was unchanged. Despite this evolution, in 2014 Portugal registered 5.7 fewer deaths per 100,000 inhabitants than the EU-15 average.

36Diseases of the liver are one of the causes of death with higher rates, and alcohol consumption is one of the main causes. In 2014, Portugal presented approximately 8.5 deaths per 100,000 inhabitants, a figure slightly below that of the EU-15, with 9.1%. In 2011, the consumption of alcohol was at 10.3 liters/people/year, having fallen by 43% compared to the 1974 figures (18.3 liters/person/year).

Table 5 – Evolution (1974-2015) of some indicators and gains in health (EU-15 and Portugal)

Table 5 – Evolution (1974-2015) of some indicators and gains in health (EU-15 and Portugal)

1 Values of 1980; 2 Values of 2013; 3 Values of 2014; EU-15 Countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom

Source: Adapted from Health for all database, 2016; INE, 2016; OCDE Health data, 2016

Conclusions

37Portugal has a Health System with a strong public component after 1971. From this point a movement toward centralization took place, with the State having increasing responsibility for the management and provision of a hierarchical network of services. Five years later, the Constitution of 1976 called for the creation of the National Health Service. From 1979, health protection for all citizens via a quality NHS system became a guaranteed right. However, the NHS is presently suffering from pressures and must address adjustments to make health service more efficient, ones which are urgent and can no longer be postponed. In other words, given that the battle for quality has been won, the battle for greater efficiency must now be tackled.

38It bears noting that the positive evolution in terms of health results over the last 40 years (e.g. infant mortality, life expectancy at birth) is due not only to the public policies which have promoted access to public (and private) health services but also, and more fundamentally, to the improvement in quality of life (e.g. the population’s access to the water supply system, electricity, sanitation, educational establishments and better-paying jobs), which are clear outcomes of the regime change which took place in 1974.

39In conclusion, Portugal finds itself in 2014 at the end of an epidemiological transition. The health indicators associated with communicable diseases, infant mortality, maternal mortality, perinatal mortality, and mortality in children aged 1 to 4 are in sharp decline and in line with those of other European Union countries, and in some cases Portugal presents more favorable figures. The impact of these gains has translated into an increase in life expectancy at birth of 14.0 years for men and 14.4 years for women over the period of 45 years of observation (1970-2014). Despite the gains regarding this indicator seen in Portugal, the difference in life expectancy in comparison with the EU is still in evidence due to the increase in mortality associated with certain diseases (trachea, bronchus, lung cancer and diabetes).

Top of page

Bibliography

BARROS P., MACHADO S., SIMÕES A., (2011), Portugal: Health system review, Health systems in transition, vol. 13, no. 4, p.1-156.

CAMPOS C., (1983), Saúde- O custo de um valor sem preço, Livros técnicos, Lisboa.

DOS SANTOS J., TAVARES M., BARROS P., (2016), More than just numbers: Suicide rates and the economic cycle in Portugal (1910-2013), SSM - Population Health, no. 2, p. 14‑23.

FERREIRA G., (1990), História da saúde e dos serviços de saúde em Portugal, Fundação Calouste Gulbenkian, Lisboa.

KOIVUSALO M., WYSS K. and SANTANA P., (2007), Effects of decentralization and recentralization on equity dimensions of health systems, in SALTAMN R., BANKAUSKAITE V. and VARNGBAEK K., Decentralization in Health Care Strategies and outcomes, European Observatory on Health Care Systems (WHO), Berkshire, p. 189‑205.

OLIVEIRA M. and PINTO C., (2005), Health care reform in Portugal: An evaluation of the NHS experience, Health Econ, no. 14, S203-S22.

SANTANA P., (2005), Geografias da saúde e do desenvolvimento. Evolução e tendências em Portugal, Almedina, Coimbra.

SANTANA P., (2014), A. saúde dos portugueses, in Simões J., 40 Anos Abril na Saúde, Almedina, Coimbra, p. 69‑92.

Santana P., (2014), Introdução à geografia da saúde: território, saúde e bem-estar, Imprensa da Universidade de Coimbra, Coimbra.

Santana P., Ferreira P., (2017), Equidade em saúde. O papel das condições socioeconómicas e dos cuidados de saúde primários, in Cravidão F., Cunha L., Santana P., Santos N., Espaços e tempos da geografia. Homenagem a António Gama, Imprensa da Universidade de Coimbra, Coimbra, 812 p.

Simões J., (2004), Retrato político da saúde. Dependência do percurso e inovação em saúde: da ideologia ao desempenho, Almedina, Coimbra.

SIMÕES J., AUGUSTO G., FRONTEIRA I. and HERNANDEZ-QUEVEDO C., (2017), Portugal: Health system review, Health Systems in Transition, vol. 19, no. 2, p. 1-184.

Top of page

Annex

EUROSTAT, (2016), European Commission. [online].

European health for all database, (2016), World Health Organization Europe. [online].

STATISTICS PORTUGAL - INE (2016). [online].

OECD Stat, (2016), Organisation for Economic Co-operation and Development. [online].

Top of page

List of illustrations

Title Table 4 – Potential years of life lost due to selected causes of death by sex and 100,000 inhabitants
Credits Source: Adapted from OECD Health data, 2016.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-1.jpg
File image/jpeg, 108k
Title Fig. 1 - Municipalities with Family Health Units and other Personalized Health Care Units
Credits Source: SANTANA and FERREIRA, 2016, p. 407.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-2.jpg
File image/jpeg, 1.6M
Title Fig. 2 - Age pyramid of the resident population
Credits Source: Adapted from INE, 2016.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-3.png
File image/png, 16k
Title Fig. 3 - Proportion of the resident population with 65 years old or more in 1991 and 2015
Credits Source: Adapted from INE, 2017.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-4.jpg
File image/jpeg, 836k
Title Fig. 4 - Crude birth rate (number of live births by 1000 inhabitants) in 1992 and 2015
Credits Source: Adapted from INE, 2017.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-5.jpg
File image/jpeg, 800k
Title Table 2 – Evolution of Life Expectancy (in years) at Birth, at 40, 65 and 80 years of age.
Credits Source: Adapted from OECD Health data, 2016.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-6.jpg
File image/jpeg, 40k
Title Fig5 – Evolution of the infant mortality rate, neonatal, and perinatal
Caption Infant deaths by 1,000 live births, neonatal deaths by 1,000 live births, perinatal deaths by 1,000 births
Credits Source: Adapted from Eurostat, 2016; INE, 2016.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-7.png
File image/png, 21k
Title Fig. 6 - Standardized death rates due to some selected causes of death by 100,000 inhabitants
Credits Source: Adapted from Health for All database, 2016; INE, 2016.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-8.png
File image/png, 15k
Title Table 3 – Comparison of the principal causes of mortality between 1974 and 2014
Credits Source: Adapted from Eurostat, 2016; INE, 1975.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-9.jpg
File image/jpeg, 40k
Title Fig. 7 - Infant mortality (‰) in the European Union (EU-15) in 1974 and 2014
Credits Source: Adapted from the Health for All database, 2016, Eurostat, 2016.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-10.jpg
File image/jpeg, 564k
Title Fig. 8 - Life Expectancy in European Countries (EU-15) in 1974 and 2010
Credits Source: Adapted from Health for All database, 2014; Eurostat, 2016.
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-11.png
File image/png, 32k
Title Table 5 – Evolution (1974-2015) of some indicators and gains in health (EU-15 and Portugal)
Caption 1 Values of 1980; 2 Values of 2013; 3 Values of 2014; EU-15 Countries: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom
URL http://journals.openedition.org/mediterranee/docannexe/image/10348/img-12.jpg
File image/jpeg, 95k
Top of page

References

Electronic reference

Paula Santana and Ricardo Almendra, « The health of the Portuguese over the last four decades », Méditerranée [Online], 130 | 2018, Online since 28 November 2018, connection on 11 December 2018. URL : http://journals.openedition.org/mediterranee/10348 ; DOI : 10.4000/mediterranee.10348

Top of page

About the authors

Paula Santana

Center of Studies on Geography and Spatial Planning (CEGOT), Department of Geography, University of Coimbra, Coimbra, Portugal, paulasantana.coimbra@gmail.com

Ricardo Almendra

Center of Studies on Geography and Spatial Planning (CEGOT), Department of Geography, University of Coimbra, Coimbra, Portugal, ricardoalmendra85@gmail.com

Top of page

Copyright

Tous droits réservés

Top of page
  • Logo Presses Universitaires de Provence
  • OpenEdition Journals