Portugal is part of the Iberian Peninsula which lies in the south-west of Europe. The archipelagos of  (nine islands) and Madeira (two main islands and a natural reserve of uninhabited islands Desertas and Selvagens) in the Atlantic Ocean are also part of Portugal. The mainland is 91.9 thousand km² (960 km north to south and 220 km east to west), with 832 km of Atlantic coastline and an inland border with Spain that stretches for 1215 km.

Fig 1. Map of Portugal

The River Tejo, which rises in Central Iberic Peninsula, divides the country into two distinct geographical areas. The northern and central regions are characterized by rivers, valleys, forests and mountains – the highest range in the Continent is the Serra da Estrela, peaking at Torre (1993 m). The Pico, in the Açores Island is the highest mountain 2100 m. The south is less populated and, apart from the rocky backdrop of the Algarve, much flatter and drier. 

Portugal has a temperate climate influenced by the Atlantic Ocean. However, it experiences considerable variations in climate; the southern region of the Algarve can experience extremely high temperatures in midsummer whilst, during winter, the north receives plenty of rain and temperatures can be chilly, with snowfall common in the mountains, particularly in the Serra da Estrela range. As a result, the natural flora is very varied. It is possible to find not only species from western Europe, but also those characteristic of Mediterranean countries.

According to the 2001 census the total resident population of Portugal was 10 355 824 (8 611125 in 1970, 7 755 423 in 1940 and 5 960 056 in 1911), which represents a 4,9% increase over the last decade (National Institute for Statistics, Demographic statistics, 2001). Population density is 109,09 persons per square kilometre, similar to Slovakia, Hungary and France (WHO, Health For All Database, 2003).

One factor which contributed to this increase in population, together with the increase in life expectancy at birth, was the return of more than half a million Portuguese from the Portuguese administered overseas territories of Angola, Moçambique, Guiné-Bissau, Cabo-Verde, São-Tomé e Príncipe and Timor, which became independent following the 1974 revolution (Mattoso, J. História de Portugal. Vol 8. Lisboa, Circulo de Leitores, 1994).

Another important demographic feature of the Portuguese population is migration out of Portugal. It is estimated that between 1960 and 1970 approximately 1200000 Portuguese migrated to almost every continent but mainly to European countries. In recent years some of the older migrants have started to return to their birth places in Portugal (Nazareth, JM. Introdução à demografia. Lisboa, Presença, 1996).

Recent legal and illegal immigration movements from Brasil ant Central and Eastern Countries, together with the more tradional immigration from Africa (Cape Vert, Guinea-Bissau, S. Tomé e Principe, Angola, Moçambique) are raising new problems and challenges to the Portuguese health care system.

According to the 2001 census the immigrant population represents 2,2% of the resident population (Instituto Nacional de Estatística, Censo 2001). The majority (81,2%) are in the active age groups (15 to 64 years old) confirming the strong economic reasons for migrating to Portugal. Only 5% of the immigrants are above 64 years of age and 14%  below 15 years of age. Immigrants from east European countries have become more frequent during the last decade. A distinctive feature is the higher literacy of this group of the population (Instituto Nacional de Estatística, Censo 2001).

Research shows less use of curative and preventive health services by African immigrant communities living in Portugal (Espinosa 1989), including use of services of reproductive health  (Calado 1997). African migrants also have higher rates of tuberculosis (Gardete 1997). Utilization of hospital and health centers by African immigrants is different and dependens on the duration of residence in Portugal and on holding a legal residence permit (Gonçalves 2003).

While in 1970 only 26% of the population lived in urban settings this percentage has risen to 65.6% in 2000. Today the majority of the population lives in urban coastal areas. Large suburban areas were build to accommodate the influx of internal and external migrants. The rapid growth of these suburban neigbourhoods without an accompanying expansion of the public transportat network is posing great traffic pressure to city centers due to the daily influx of workers.

The two main metropolitan areas are greater Lisboa (resident population 1 897 033 in 2001), including the capital city, Lisboa, and greater Porto (population 1 252 842 in 2001) which includes the city of Porto. The migration of the population from the interior to the litoral cities has always been a constant feature of Portugal mainland but increased after the 1974 revolution. In 2001, 65,6% of the population lived in urban settings, compared to 34,0% in 1990, 29,0% in 1980 and 26,0% in 1970 (WHO, Health For All Database, 2003).

The demographic profile follows that of other west European countries with an increase in life expectancy at birth from 71.15 years in 1980 to 76.9 in 2001(51). However, Portuguese men still have the lowest life expectancy at age 65 among EU countries (14.3 years) whereas women's life expectancy at birth is the second lowest (17.8 years) (Eurostat, Key figures on health, 2000).

The number of births has been declining steadily since 1960 (24,10 live births per 1000 population) and in 1990 the crude birth rate for Portugal was 11,76 live births per 1000 population, below the European average of 12,02 live births per 1000 population, for the first time since 1970 (WHO, Health For All Database, 2003).

In 2000, the crude birth rate was 11.75 live births per 1000 population ranking again above the European Union average of 10,69 live births per 1000 population (WHO, Health For All Database, 2000).

The median age of the population has risen from 31 years old to 36 years old over a ten-year period 1986–1996, whilst the dependency ratio has fallen from 79.7 in 1984 to 48.1 in 2001 (based on the relation of the population under 15 and over 65 years of age to the 15–64 year olds) (National Institute for Statistics, Demographic statistics, 2002). Demographic changes seem to have followed a global improvement in the socio-economic conditions of the population similar to changes seen in other countries in the past.

Due to the aforementioned indicators of the population dynamics it is expected that in 2015 the total population will be bellow 10 million (World Bank, 2002).

Recent Economic growth began in early 1994, has gathered pace and real GDP growth increased to an estimated 3.2% in 2000 (OECD in figures 2000, OECD 2001). In 2000, GDP per capita was 11288 Euros (5135 in 1990), or 9546 Euros at 1995 GDP price level (7506 in 1990), or 17638 US$ PPP (9875 in 1990) (OECD Health data 2002). The inflation rate increased 3.8% from December 1999 to December 2000, and was just above 2% in 2001, (OECD in figures 2000, OECD 2001).

Unemployment has fallen from 7,2% of the total population in 1996 to 4,0% in 2000 (WHO, Health For All Database, 2000). In 1999, long term unemployment was 41.2% of the total unemployment (oecd in figures 2000, oecd 2001). Unemployment among the young (under 25 years old) was 11.1% among women and 7.5% among men (OECD in figures 2000, OECD 2001). Developments in the national and international economic situation during 2002 have resulted, according to official reports, in increasing signs of recession with moderate unemployment growth.

Despite global economic growth Portugal has one of the highest levels of income inequality in Europe together with the United Kingdom according to the 2002 European Health Report (WHO, The European Health Report 2002). The influence of this on the health of the population and its subgroups is not well studied.