A/HRC/44/40/Add.2 European Commission found that as of 2017, 25.7 per cent of households with children at risk of poverty had great difficulty in paying education costs. 39 29. Spain led the European Union in school dropouts in 2018, with a 17.9 per cent rate of early leavers.40 That comes at an estimated cost of between 5.9 and 10.7 per cent of total GDP.41 It also has the second highest grade repetition rate in the European Union, 42 with the most economically disadvantaged students six times more likely to repeat the year.43 These troubling figures are an indictment of the overall education system and a major drain on the economy. 30. An alarming 44 per cent of students and 72 per cent of children in vulnerable situations study in de facto segregated schools that have a large concentration of children from poor socioeconomic backgrounds, Roma and migrant children, and those with higher support needs. 44 School segregation increases grade repetition, failure and dropouts, decreases assessment scores and adversely affects students’ expectations of pursuing university studies.45 The Special Rapporteur visited one school in Andalusia with a 100 per cent Roma student body, where 75 per cent of students dropped out before completing secondary school and families received remarkably little support, despite living in one of the poorest areas in the country. Concentrating children from the poorest backgrounds in the same schools is no recipe for educational success or overcoming poverty. 46 Health care 31. Spain is justifiably proud of its excellent health-care system, with near universal health coverage, but important gaps remain for those who may need coverage the most. 32. According to a 2019 study, around 5 per cent of people in poor households who needed medical assistance, 25.5 per cent of those who needed dental care and 3 per cent of those who needed mental health services were unable to receive care for economic reasons. Almost 7 per cent were unable to access prescription drugs. The National Health Survey indicates that almost 10 per cent of people at risk of poverty are not involved in preventative health practices47 and rising precarious employment means that taking a sick day is just not possible. 33. In 2018, Spain largely repealed Royal Decree-Law No. 16/2012, which had limited universal health coverage, including for migrants. However, the current system leaves out some migrants in their first 90 days in Spain 48 and one network (Red de Denuncia y Resistencia al RDL 16/2012) has documented 4,755 cases of exclusion from the national health system since 2014.49 The Ministry of Health acknowledged this gap and politicians have promised to address it, but they have presented no plan for doing so. 34. The increasing privatization of elements within the health-care system is troubling, and risks prioritizing profits over service provision. Representatives of the Ministry of Health maintained that this was done only in exceptional circumstances, for reasons of efficiency and necessity, and that the quality of care was unaffected. However, they could 39 40 41 42 43 44 45 46 47 48 49 8 European Commission, Country Report Spain 2019, p. 55. Eurostat, “Early leavers from education and training”. European Anti-Poverty Network, “Poverty watch Spain 2019”, p. 38. OECD, Economic Surveys: Spain (November 2018), p. 53. Save the Children “The future we want to grow up in” (February 2019), p. 5. European Anti-Poverty Network, “Poverty watch Spain 2019”, p. 34; Save the Children, “All join in: from socioeconomic segregation to inclusive education”, p. 3. European Anti-Poverty Network, “Poverty watch Spain 2019”, p. 34. Save the Children, “Mézclate conmigo” (April 2018). European Anti-Poverty Network, “Poverty watch Spain 2019”, p. 27. Submission from the Spanish Ombudsman, available from www.ohchr.org/Documents/Issues/Poverty/VisitSpainSubmissions/11_Defensor_del_Pueblo.pdf, p. 6 (in Spanish). Red de Denuncia y Resistencia al RDL 16/2012, “Leave no one out: the urgency of ensuring universal health care” (October 2018), pp. 4, 6, 7 and 12.