On a number of indicators of health care, Spain ranked fairly high among the advanced industrial countries. In both 1965 and 1981, the country had a better population-to-physician ratio than the average of the industrial democracies (800 to 1 versus 860 to 1, respectively, in 1965 and 360 to 1 versus 530 to 1, respectively, in 1981). In 1983, with more than 115,000 physicians, Spain ranked sixth in the world in its ratio of inhabitants to physicians. Despite dramatic strides in adding nursing personnel (causing a decline in the population-to-nurse ratio of from 1,220 to 1 to 280 to 1 in less than 20 years), the country remained near the bottom of the list of advanced industrial countries on this scale. Spain also ranked below most other West European countries in per capita public expenditures on health care--only US$220 per person in 1983. In 1981 there were in Spain slightly more than 1,000 hospitals and about 194,000 beds, or about 5.4 beds per 1,000 population.

As these figures suggest, the provision of health care in Spain was highly uneven. Even with a high ratio of doctors to inhabitants, the country had still not managed to eradicate such diseases as tuberculosis (more than 9,000 cases in 1983) and typhoid (5,500 cases) and there are still even a few new cases of leprosy reported each year. The root of this problem seems to be the maldistribution of the health care resources of the state's welfare system. Hospitals in one area of the country might be seriously understaffed, while those in other regions lay virtually empty. By and large, the worst-served areas were the workers' suburbs near large cities. One press report cited the neighborhood of Vallecas, near Madrid, where a population of 700,000 had no hospital at all and had only 3 doctors in residence, who were reduced to seeing patients at the rate of 1 per minute. A principal reason for understaffing was the system of multiple hospital assignments arranged by physicians to augment their salaries. Although regulations prohibited this practice, many doctors arranged to be on duty at more than one hospital at a time, thereby reducing their effectiveness in meeting patient needs.

In terms of the causes of death, Spain fairly closely resembled other advanced industrial societies, although cancer and heart disease appeared less frequently in Spain than in more industrialized countries. Of the nearly 290,000 deaths registered in 1980, almost half (45.8 percent) were due to a variety of circulatory system problems, principally heart attacks and strokes. The single most prevalent cause of death was malignant neoplasms about one-fifth (20.2 percent) of all deaths were caused by cancer of one sort or another. About one-tenth (9.2 percent) of all deaths were occasioned by respiratory ailments. (Spaniards were the second heaviest smokers in the European Community--EC, after Greeks. About 40 percent of adults smoked, as did 50 percent of teenagers the average 14-year-old reportedly smoked 2,700 cigarettes a year.) About 2 percent of deaths were caused by automobile accidents, and about 0.5 percent, by suicides.

99c p>In the third quarter of 1987, there were 112 cases of acquired immune deficiency syndrome (AIDS) reported in Spain, bringing to 620 the total number of Spaniards afflicted by this disease. Although high, the Spanish figure was still less than half of that France, and it was far behind the more than 40,000 cases in the United States. Slightly more than half the AIDS victims contracted the disease through narcotics-related practices about one-fifth, from homosexual contact and about one-tenth were hemophiliacs.

During the 1960s and the 1970s, Spain achieved dramatic gains in reducing infant mortality. Between 1965 and 1985, the infant mortality rate dropped from being the highest among the industrial market economies, 38 per 1,000, to only 10 per 1,000 in 1985, which placed it ninth lowest in the world, on a par with other advanced industrial societies. The death rate for children less than one year old declined from slightly fewer than 13 per 1,000 in 1975 to fewer than 9 per 1,000 in 1979, and for children less than 5 years of age, it declined from 15 per 1,000 to fewer than 10 per 1,000 in the same period.

Spain also registered some improvement in food consumption during the 1960s and the 1970s, with per capita caloric supply growing by about 1 percent per year (from 2,844 in 1965 to 3,358 in 1985). In 1983 Spain ranked twenty-ninth in the world in calorie supply per capita. Spaniards daily consumed more calories than, or about the same number of calories as, the residents of Britain, France, Finland, Japan, Sweden, or Norway.

Data as of December 1988