ObjectivesPublic–private partnerships (PPPs) are considered key elements in the development of effective health promotion. However, there is little research to back the enthusiasm for these partnerships. Our objective was to describe the diversity of visions on PPPs and to assess the links between the authors and corporations engaged in such ventures.MethodsWe reviewed the scientific literature through PubMed in order to select all articles that expressed a position or recommendation on governments and industries engaging in PPPs for health promotion. We included any opinion paper that considered agreements between governments and corporations to develop health promotion. Papers that dealt with healthcare provision or clinical preventive services and those related to tobacco industries were excluded. We classified the articles according to the authors' position regarding PPPs: strongly agree, agree, neutral, disagree and strongly disagree. We related the type of recommendation to authors' features such as institution and conflicts of interest. We also recorded whether the recommendations were based on previous assessments.ResultsOf 46 papers analysed, 21 articles (45.6%) stated that PPPs are helpful in promoting health, 1 was neutral and 24 (52.1%) were against such collaborations. 26 papers (57%) set out conditions to assure positive outcomes of the partnerships. Evidence for or against PPPs was mentioned in 11 papers that were critical or neutral (44%) but not in any of those that advocated collaboration. Where conflicts were declared (26 papers), absence of conflicts was more frequent in critics than in supporters (86% vs 17%).ConclusionsAlthough there is a lack of evidence to support PPPs for health promotion, many authors endorse this approach. The prevalence of ideas encouraging PPPs can affect the intellectual environment and influence policy decisions. Public health researchers and professionals must make a contribution in properly framing the PPP issue.

Background: Although public-private partnerships have become common in the health sector, the evidence supporting their effectiveness is limited, and when the products or services provided by the private partner are harmful to health inherent conflicts of interest may be difficult to overcome. The objective of this study is to appraise the evidence describing process or effectiveness of public-private partnerships (PPPs) that aim to promote population health, and analyse how characteristics such as independence or competing interests influence the results of their evaluation. Methods: We carried out a systematic search of Medline and Web of Science to identify scientific reports evaluating the process or effectiveness of PPPs that aim to promote population health. Two reviewers applied inclusion criteria, extracted and evaluated study quality. We classified PPPs according to the health problem tackled, the independence of the evaluation, and the potential for competition between business interests of the private partner and health promotion activity undertaken. We classified the conclusions of the evaluation as positive (supportive/tentatively supportive) or negative (semi-critical/critical). Results: We identified 36 studies evaluating 25 PPPs. Evaluations that were favourable to the use of PPPs in health promotion were more frequently classed as "not independent" and of poor quality. On the other hand, negative evaluations were more common when the PPP involved a private partner with a high potential for competition between the health promotion activity undertaken and their financial interests. PPPs that sought to prevent noncommunicable diseases were more frequently negatively evaluated compared to PPPs tackling infectious disease or other types of health problem. Almost all of the evaluations evaluated process, with only 2 papers reporting quantitative health related outcomes. Conclusions: There is still a lack of sound evidence supporting the effectiveness of public-private partnerships in health promotion, and the evidence base is skewed by non-independent evaluations. Public health actors should abstain from engaging in agreements with industries whose business interests have a high potential for competition with the health promotion activity undertaken.

In most European countries, facemasks use is recommended or mandatory in enclosed spaces where physical distancing is not possible. In Spain, this measure was first extended to open public spaces and later made mandatory regardless of whether or not the interpersonal safety distance can be kept. At present, there is no evidence on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2. The mandatory use of masks poses some ethical questions. Firstly, it entails a paternalistic action. Secondly, application of the principle of precaution becomes questionable when there is no clear benefit-risk relationship. Thirdly, compulsoriness can interfere with equity of public health actions. Fourthly, it can result in social stigma and discrimination against those who do not wear one, even though they well may have good reasons for doing so. Lastly, this measure may generate confusion in the population, along with an altered perception of the risk. The World Health Organization recommends its use in public places with a high potential risk of transmission and where other prevention measures, such as physical distancing, are not possible. Mandatory use of masks in public open spaces, regardless of the risk of transmission or of whether or not the interpersonal safety distance can be kept, is an intrusive measure that restricts individual freedoms, and would not appear to be justified on the basis of available scientific evidence. What we need are recommendations explaining where, when, how and what type of mask to wear.

Resumen: La construcción de modelos de cobertura universal en España y en Europa, estableciendo los derechos sociales, ha ofrecido un periodo de prosperidad, paz y libertad en la segunda mitad del siglo XX, con la base en la justicia social. Esos valores nos han beneficiado a todos. A pesar de los importantes logros alcanzados, el momento de crisis económica ha levantado diferentes voces alertando acerca de la inviabilidad de los sistemas de protección social. Las dificultades del momento y la escasez de recursos han alentado la ofensiva ideológica, contra el Estado de Bienestar, pronosticando su final a corto plazo. Por tanto hay que considerar que el momento actual es de revisión y "deconstrucción" de todo lo anterior. Uno de los principales problemas de la protección social en España, consiste en la financiación y la insuficiencia de recursos para sufragar los gastos producidos por unos cambios sociodemográficos que han incrementado considerablemente los niveles de dispensación en materia de bienestar. El trabajo que se presenta, lleva a cabo un proceso de revisión de la sostenibilidad económica, social y política de los distintos sistemas establecidos y ofrece una serie de recomendaciones encaminadas a garantizar los avances sociales alcanzados.Palabras clave: Bienestar, Sistemas de Protección Social, Derechos Sociales, Sostenibilidad, Familia. Abstract: The construction of models of universal coverage in Spain andEurope, that established social rights, has offered a period of prosperity, peace and freedom in the second half of the twentieth century that was based on social justice. These values have benefited all of us. Despite the significant achievements that were made, the economic crisis has raised different voices warning about the impossibility of social protection systems. The difficulties of the time and the resource constraints have encouraged an ideological offensive against the welfare state, predicting its end in a short term. Therefore we have to consider that the present moment leads to the review and "deconstruction" of what existed before. One of the main problems of social protection in Spain is the financing and the insufficient resources to cover the expenses incurred by the demographic changes that have significantly increased the levels of dispensing welfare. The work that we