Differential mortality and inequalities in health services access in mainland Portugal

The guarantee of the right to health protection, with the priority of overcoming health inequalities, is a main goal of the Portuguese National Health Service. In this context, health care access equity in mainland Portugal continues to be a challenge for public health policies, with a littoral territory where health services are concentrated and interior depopulated zones, stripped of health services and isolated in physical and social terms. Based on 2001 and 2011 data from PORDATA, the present article studies how mortality is related to the distribution of health services - namely hospital infrastructures, health centres and health professionals - and with population characteristics related to illiteracy and ageing. The results show a strong association between mortality and the distribution of health services, highlighting increasing mortality in the context of decreasing health services, worsening when related to population illiteracy and ageing. Results reveal the importance of designing public policies at the local level, focused on territorial socio-cultural specificities, which are mainly materialized in a distribution of health services closer to isolated populations according to their needs.