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Health in Italy in the 21St Century

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Health in Italy in the 21St Century FOREWORD Rosy Bindi Minister of Health of Italy Roma, September 1999 This report provides the international community with an overall assessment of the state of health in Italy, as well as with the main developments of the Italian public health policy expected in the near future. It is intended as an important contribution towards the activities which, beginning with the 49th WHO Regional Committee in Florence, will be carried out in Europe with a view to defining health policies and strategies for the new century. This publication, which consists of two sections, illustrates the remarkable health achievements of Italy as regards both the control of diseases and their determinants, and the health care services. Overall, a clearly positive picture emerges, which is due not only to the environmental and cultural characteristics of Italy, but also to its health protection and care system which Italy intends to keep and indeed to improve in the interest of its citizens. The recent decisions taken in the framework of the reform of the National Health System in Italy intend to improve and strengthen the model of a universal health system based on equity and solidarity, which considers health as a fundamental human right irrespective of the economic, social and cultural conditions of each citizen. The new national health service guarantees, through its public resources, equal opportunities for accessing health services as well as homogenous and essential levels of health care throughout the country. Such a reorganization of the system has become necessary in order to meet new and growing demands for health within the framework of limited resources and with the understanding that equity in health is not only an ethical requirement, but also a rational and efficient way for allocating resources. We truly believe that health consumerism- does not lead to greater and better health care, but rather exhausts resources and increases inequity. Yet, given that the real challenge over the next years will be the provision of an extended health protection, it is necessary to bring about significant changes to the health care system through strengthening of prevention, rehabilitation and integration of the social and health dimensions, as well as the role of citizens and health professionals in promoting the process of change. This means, in essence, moving the focus of the policy from treating- to taking care- of the sick in a broader perspective, which is more consistent with the World Health Organization's definition of health as physical, psychological and social well-being. This is also the direction outlined in the 1998-2000 Italian National Health Plan (which is also included in the present report) that has been conceived as a true Solidarity Agreement for Health-. Such an agreement commits institutions, professionals, citizens and their organizations, the research community and industries to taking on common responsibilities for achieving the health objectives agreed upon. We would like to share the spirit of this agreement with the other countries of Europe looking forward to the new century. file://Q:\-COMMON\TRANSPRT\From%20Nicoletta%20to%20Dany\Ehi\itahfa21\fore...w 07-Jan-02 FOREWORD J.E. Asvall WHO Regional Director for Europe As we stand on the brink of the twenty-first century, we have a strong obligation to take action to improve the health of the 870 million people of the Region. The Health21 policy approved by the WHO Regional Committee for Europe in September 1998 provides the framework for accepting that challenge by applying the best strategies that have emerged from Europe's collective experience during the past ten to fifteen years. It is not a vision beyond our grasp it can be done. Experience has shown that countries with vastly differing political, social, economic and cultural conditions can develop and implement health for all policies designed to put health high on the agenda and when they do, they stand to gain from a fundamental change for the better. The major challenge for the 51 Member States of the European Region is to use the Health21 policy as an inspirational guide to update, as necessary, their own policies and targets. The commitments taken by the European member countries at the Third Ministerial Conference on Health and Environment held in London 16-18 June 1999 are an excellent example of what can be achieved when scientific evidence, innovative thinking and political leadership are put together within a coherent health policy framework to achieve common goals. The Health in Italy in the 21st century- report, prepared by the Italian Government with the assistance of the Rome Office of the WHO European Centre for Environment and Health, is an important step towards the implementation of the Health21 policy and principles. It underlines the achievements of the past years, relates them with the Health21 goals, and sets the direction for future health policy developments as outlined in the 1998-2000 Italian National Health Plan. The document provides scientifically sound data against which future assessments can be measured. I would like to use this opportunity to commend the Italian government for undertaking this work which transforms the vision of Health21 into a practical and sustainable reality. This, I am sure, will encourage other Member States to do the same. ACKNOWLEDGEMENTS The Report Health in Italy in the 21st Century has been produced jointly by the Ministry of Health of Italy and the WHO European Centre for Environment and Health (WHO/ECEH) thanks to the work of two teams (Ministry of Health and WHO/ECEH) and to the additional support and valuable contributions of a large number of other organizations and experts. Teams for the preparation of the Report Health in Italy in the 21st Century Overall coordination and supervision: Roberto Bertollini (WHO/ECEH) and Vittorio Silano (Ministry of Health, Repubblica Italiana) Scientific/technical/editorial work: WHO/ECEH Team Nicoletta Di Tanno, Michele Faberi, Manuela Gallitto, Daniela Giannuzzo, Philip Gorman, Lucilla Magherini, Maria Teresa Marchetti, Francesco Mitis, Candida Sansone, Manuela Zingales. Ministry of Health of Italy Team Francesco Cicogna, Gianfranco Costanzo, Gaetano Della Gatta, Katia Demofonti, Angelo De Siena, Luisa Gabrielli, Stefano Moriconi, Fabiana Leoni, Alessandra Pappagallo. Several Department and Service Directors of the Ministry of Health of Italy (Claudio Calvaruso - Director General, Studies and Documentation; Nerina Dirindin - Director General, Health Planning; Fabrizio Oleari - Director General, Prevention, and Giovanni Zotta - Director General, Institutions Control) have kindly provided highly appreciated advice, data and information, when reviewing the Report. Similary, enlightening contributions have been received by Antonio Moccaldi, Director General, National Institute for Prevention and Safety at the Workplace, and Francesco Taroni, Director General, National Agency for Regional Health Services as well as by members of their staff. Information, advice, data and support was provided throughout the preparation of this report by the National Institute of Health (ISS). Particular thanks go to Giuseppe Benagiano, Director, National Institute of Health, and to many of his staff: Riccardo Capocaccia, Marco De Sanctis, Massimo Giuliani, Donato Greco, Alfonso Mele, Giovanni Rezza, Stefania Salmaso and Barbara Suligoi. The Italian National Statistics Institute generously shared information and data. Thanks to Viviana Egidi, Director for Population and Territory, and her co-workers Giovanna Boccuzzo and Vittoria Buratta, for the collaboration. Claudia Galassi, CDS Bologna, gave a significant input and scientific contribution to the report, and Giuseppe Costa, Director of the Public Health Laboratory, ASL 5 Piemonte Region, has made available his pioneering experience and work on inequalities and health. Riccardo Poli, member of the Higher Health Council of Italy, has contributed the Chapter on "Bioethics in human health"; Edoardo Missoni, Ministry of Foreign Affairs, the Section on Italian Development Co-operation and Raffaele Tamiozzo, Head of the Legal Office, Ministry of Health, the Chapter on "Italian Health Service Reform". Eva Buiatti, CSPO, Florence; Francesco Forastiere, Lazio Region Epidemiology Unit; Colin Soskolne, University of Alberta (Canada) and Benedetto Terracini, University of Turin, have reviewed the first draft of the text and provided very useful comments and suggestions. A number of other experts, including Piero Borgia and Marina Davoli, Lazio Region Epidemiology Unit; Ernesto Caffo, Telefono Azzurro; Bruno Dalla Piccola, Second University of Rome (Tor Vergata); Anna Ferro- Luzzi and Luisa Pizzoferrato, National Institute of Nutrition; Luigi Greco, University of Naples; Paola Pula Leggio, Ministry of Health; Pierpaolo Mastroiacovo, Catholic University of Rome and Giorgio Tamburlini, Istituto per l'Infanzia Burlo Garofalo, Trieste, have provided valuable data, information and advice in their areas of expertise. TABLE OF CONTENTS FOREWORD by Rosy Bindi (Minister of Health of Italy) FOREWORD by J. E. Asvall (WHO Regional Director for Europe) ACKNOWLEDGEMENTS PART I Achievements and challenges in the European context I - International solidarity for health and development II - Italy as an ageing society III - A healthy start in life IV - Non-communicable diseases V - Communicable diseases VI - External causes of mortality and disability VII - Health determinants: nutrition, lifestyle, physical environment
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