A public health infrastructure that should have been in place two years ago
In the Basque Country, institutions sometimes arrive late but carry the accumulated weight of the years they missed. After nearly three years of parliamentary criticism and consulting fees spent without visible result, the regional government has finally set in motion the creation of Osasungintza, a public health institute mandated by law in 2023. The agency will inherit not only a broad mandate — from pandemic coordination to food safety and disease registries — but also the backlog of data left ungathered, including cancer records dormant since 2019 and congenital anomaly data stalled since 2015. It is a reminder that the architecture of public health is built slowly, and that its absence is never truly invisible.
- A law passed in 2023 promised a new public health institute within eighteen months — by 2025, opposition lawmakers were demanding answers in parliament while two consulting firms had been paid and the agency still did not exist.
- The cancer registry serving the Basque Country has gone unupdated since 2019, and the congenital anomalies registry has been dormant since 2015 — years of missing data that the new institute will now be expected to confront.
- Health Minister Alberto Martínez signed the preliminary decree on Tuesday, formally launching the process to transfer operations from the existing Public Health directorate to the new agency, though no start date or headquarters location has yet been confirmed.
- Osasungintza's governance spans seven government departments — from Education to Environmental Affairs to Security — reflecting an ambition to treat public health not as a single ministry's concern but as a cross-cutting responsibility.
- The institute formally adopts a 'one health' philosophy, integrating surveillance of human disease with animal health and ecosystem monitoring, signaling a structural shift in how the Basque Government conceptualizes the boundaries of public health.
After nearly three years of delays and mounting parliamentary pressure, the Basque Government has finally moved to create Osasungintza, a public health institute that was mandated by law in 2023 but whose implementation repeatedly stalled. Health Minister Alberto Martínez signed the preliminary order on Tuesday, setting a decree in motion that will establish the agency and transfer functions from the current Public Health directorate. Opposition lawmakers, particularly EH Bildu's Rebeka Ubera, had grown openly critical, noting that the government had spent over 66,000 euros on consulting firms — including PwC and LKS — to draft bylaws and action plans, yet still produced no functioning institution.
The mandate Osasungintza will inherit is sweeping: coordinating epidemic and pandemic response, monitoring food and environmental safety, running laboratory analyses, preventing addiction, and maintaining statistical registries covering cancer, congenital anomalies, sexually transmitted infections, rare diseases, and more. The agency will operate across all three Basque provinces and will absorb existing Public Health directorate staff without altering their employment conditions.
Perhaps the most consequential detail is what the new institute will inherit by way of neglect. The Basque cancer registry has not been updated since 2019. The congenital anomalies registry has been dormant since 2015. When pressed in parliament, the health minister suggested the latter would not be resumed as it was not legally required — yet the agency's own bylaws explicitly include management of both registries. Osasungintza will arrive not to a clean slate but to years of deferred data.
The governance structure is deliberately broad, with a board chaired by the health minister and drawing representatives from Education, Security, Environmental Affairs, Agriculture, and Heritage. Underpinning the entire project is the 'one health' philosophy — the conviction that human health is inseparable from animal and ecosystem health — which the bylaws formally embed into the agency's mission. The decree is now in motion, though when Osasungintza will actually open its doors, and from where, remains unannounced.
After nearly three years of delays and parliamentary pressure, the Basque Government has finally moved to establish Osasungintza, a new public health institute that will coordinate everything from pandemic response to food safety monitoring across the autonomous community. Health Minister Alberto Martínez signed the preliminary order on Tuesday morning, setting in motion a decree that will create the agency and transfer its operations from the current Public Health directorate.
The institute was mandated by law in 2023, with officials initially projecting it would be operational within eighteen months. That timeline slipped badly. By 2025, opposition lawmakers were openly criticizing the government in parliament for the stalled implementation. EH Bildu's parliamentary spokesperson Rebeka Ubera pointed out that the Pradales administration had spent 66,308 euros hiring the consulting firm PwC to draft the agency's bylaws, and contracted another firm, LKS, to develop an action plan—yet still the work dragged on.
Osasungintza will assume responsibility for a sprawling mandate. It will track disease outbreaks and coordinate responses to epidemics or pandemias. It will monitor food and environmental safety—water quality, bathing areas, air pollution. It will maintain statistical registries on cancer, congenital anomalies, sexually transmitted infections, abortions, rare diseases, and mandatory-reporting illnesses. It will run laboratory analyses. It will work to prevent addiction and promote public health education. The new agency will operate in Euskera and Spanish, and in other languages when needed to serve residents effectively.
The governance structure reflects the breadth of the mission. A board of administration will be chaired by the health minister himself, with a vice chair (the vice minister) and seven voting members drawn from across government: representatives from the Basque Health Service, the occupational safety institute, and the departments of Education, Security, Environmental Affairs, Agriculture, and Heritage. A director—someone with recognized expertise in public health, equivalent in rank to the current Public Health director Guillermo Herrero—will run day-to-day operations. The agency will be organized into five subdirectorates covering disease surveillance, health protection, health promotion and addiction prevention, laboratory services, and administration.
One detail carries particular weight: Osasungintza will inherit management of critical health data registries that have fallen into disrepair. The cancer registry, tracking the most prevalent disease in the Basque Country, has not been updated since 2019. The congenital anomalies registry has been dormant since 2015. When EH Bildu pressed the health minister on whether those registries would be revived, he said the congenital anomalies data would not be resumed because it was not legally mandatory. Yet the bylaws for Osasungintza explicitly include management of both registries, along with records on mortality, hospital discharges, and other epidemiological data. The new institute will inherit not just the responsibility but the backlog.
The decree also embeds a concept the health minister has been advocating for some time: "one health," the idea that human health cannot be separated from animal health and ecosystem integrity. The bylaws emphasize this integrated approach, suggesting that Osasungintza will monitor not just human disease but the environmental and biological conditions that shape it. The agency will have territorial delegations in each of the three provinces—Álava, Bizkaia, and Gipuzkoa—and will absorb all current Public Health directorate staff, maintaining their existing employment status and conditions.
The decree is now in motion, though no specific start date has been announced and the location of Osasungintza's headquarters remains unspecified. What is clear is that a public health infrastructure that should have been in place two years ago is finally being assembled, carrying with it the weight of years of deferred data collection and the expectation that it will restore rigor to disease surveillance across the region.
Citas Notables
The government will not resume the congenital anomalies registry because it is not legally mandatory— Health Minister Alberto Martínez, in parliamentary debate
La Conversación del Hearth Otra perspectiva de la historia
Why did this take so long? Three years is a long time to set up an agency.
The government contracted consultants to draft the bylaws and develop an action plan, which added cost and time. But there's also the complexity—this isn't just a health office. It touches food safety, environmental monitoring, disease tracking, even animal health. Coordinating across that many departments takes negotiation.
The cancer registry hasn't been updated since 2019. That's five years of missing data. How does that happen?
The old Public Health directorate was understaffed or deprioritized. When you don't have a dedicated agency with clear responsibility, things slip. The hope is that Osasungintza, with its own budget and leadership, will restore that work.
The health minister said the congenital anomalies registry wouldn't be restarted because it wasn't mandatory. But now the bylaws say it will be managed by Osasungintza.
That's the tension. Legally, the government wasn't obligated to maintain it. But once you create a new agency with explicit responsibility for health registries, you inherit the obligation to do the work properly. The bylaws close a door the minister had left open.
What's this "one health" concept about?
It's the idea that you can't understand human disease in isolation. Animal diseases, water quality, air pollution—they all feed into human health. So Osasungintza will monitor those things too, not just track illness in people.
Who actually runs this thing?
A director hired by the health minister, someone with public health expertise. But the board is chaired by the minister himself, with representatives from seven other government departments. It's designed to be cross-departmental, which is good for coordination but can also slow decisions.
What happens next?
The decree has been signed. Now it goes through formal approval processes. At some point—the government hasn't said when—Osasungintza becomes operational and the old directorate dissolves into it. All the staff transfer over. The real test is whether the agency actually restores those dormant registries and maintains them going forward.