Health in Portugal is the best example to understand the importance of spatial planning, stressed a public policy expert, advocating strategies targeted at living conditions in the places where people reside.
In a conversation with the Lusa agency, Gonçalo Santinha, a professor at the University of Aveiro (UA) who has been working on the relationships between territory and health at the level of public policies, also challenged the underlying idea of implementing municipal health strategies, “a somewhat unhappy name,” as they would overlap with the already existing local plans, the responsibility of the authorities.
“Suddenly, a new instrument appears, the municipal health strategies, which is almost an overlap and which becomes the responsibility of the municipalities when they, often, do not have enough ‘know-how’ to develop this type of strategy or even talk to the Local Health Units (ULS) [Unidades Locais de Saúde],” he argued.
In his experience working on the elaboration of the so‑called municipal plans, the UA lecturer said that in the initial interactions with municipalities, the reaction is automatic: “they want more primary health care providers and more doctors.”
“But when we talk about health, we know that it does not depend only on hospitals, on doctors, on health centers. It depends essentially on the place where people live, and that is a pedagogical job I have been doing when I speak with them initially,” emphasized Gonçalo Santinha.
Issues such as distance to services, the existence or not of public transport, the quality of housing, incomes, proximity to green spaces or social support networks, among others, are, in his view, crucial, namely in the so-called low-density territories.
“We have to observe concrete living conditions when we talk about health issues. Two citizens who have the same clinical condition can have very different health trajectories when they live in a well-served urban area, or in an aged territory, or in an isolated territory, or with poor accessibility,” noted Gonçalo Santinha.
“I often say, in a caricatured tone, but it is true, that our postal code still often weighs more than our genetic code in terms of health opportunities,” he added.
Still on the municipal health strategies, the specialist noted that the 2019 decree-law that underpins them “is very vague” in its definition, claiming that “it must respond to the challenges outlined by the National Health Plan.”
“This can lead, in a territory that is already heterogeneous, to each municipality, if it acts in the way it wants, with the methodology it wants, with the conceptual reference frames it wants, potentially increasing the disparities that already exist,” he warned.
A concrete case of the fragility of interior populations in accessing specific health care, namely psychological support in the face of disasters, concerns the impact on those who live through forest fires, especially when these take away the little livelihood, almost survival, they possess.
Adélia Nunes, a researcher at the Center for Studies of Geography and Territorial Planning (CEGOT) of the University of Coimbra (UC), has several works published on fire risk and lamented the alleged absence of a strategy for emotional balance care for a population that is already fragile and aging in the aftermath of fires.
Relying on an example of a relative – in the large fire that devastated a forested and rural area in the municipality of Sabugal, in the Guarda district, in 2025 – the UC professor explained that he ended up having to seek help on his own, because that network of care does not exist on the ground, in addition to community support from friends and neighbors.
Adélia Nunes highlighted the psychological impact, in the face of the proximity of the flames, on these populations who, despite surviving the fire or keeping their homes, “see their cultivated lands disappear or the food they stored for the animals.”
Although arguing that firefighting interventions have been done “and well, in defense of people and property,” the CEGOT researcher defended that fires “are fought in the landscape, not at the doorstep of houses in villages.”
“Since 2017 [after the Pedrógão Grande fires] this is the practice that prevails; at the moment fires are only fought surgically, when they approach people or their property, and we are not talking about agricultural areas. Last year, in the Sabugal fire, this is precisely what happened: firefighters did not have authorization to intervene in the landscape, they had authorization to intervene, sporadically, when the fire approached settlements,” she stressed.
Now, if the farmers – whom Adélia Nunes named as “our gardeners” – have their assets in the middle of the landscape, such as the hay stored for the animals that ensure their subsistence in winter, in the face of flames they cannot quell, “they are left even more abandoned.”
“Heat waves and extreme weather conditions will always occur and become ever more intense. If we want to prevent the occurrence of fires, we have to do the work during the winter, when the conditions permit. If we do not act on the landscape and reduce the material available to burn, we will always have the same problem,” argued Adélia Nunes.
