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I determinanti sociali di malattia e di salute. Gianfranco Gori MD. … sonno della ragione …. F.Goya – Los caprichos 1799 Madrid Museo del Prado “Il sonno della ragione produce mostri ”. … sonno della ragione …. Il Messaggero 9/4/’99. … sonno della ragione ….
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I determinanti sociali di malattia e di salute Gianfranco Gori MD
… sonno della ragione … F.Goya – Los caprichos 1799 Madrid Museo del Prado “Il sonno della ragione produce mostri”
Il Messaggero 9/4/’99 … sonno della ragione … non esiste la “sindrome di Salgari”bassa prevalenza di patologie di importazione e rischi minimi di trasmissione alla popolazione ospite
… proviamo a non essere emotivi … La logica del ragionamento può essere dura … ma non scoraggiamoci !!!!
… mortalità nell’affondamento del Titanic a seconda della classe dei passeggeri per donne e bambini ... Women Children Broom L & Selznick P, 1968
… e a parlare di cose concrete … Social determinants of health are the economic and social conditions under which people live which determine their health. Virtually all major diseases are primarily determined by a network of interacting exposures that increase or decrease the risk for the disease.
… probabilità di essere vivi a 65 anni a seconda del grado di istruzione…
… e a parlare di cose concrete … While medical care can prolong survival and improve prognosis after some serious diseases, more important for the health of the population as a whole are the social and economic conditions that make people ill and in need of medical care in the first place. Nevertheless, universal access to medical care is clearly one of the social determinants of health.
… percezione del proprio stato di salute a seconda dell’appartenenza politica e del livello di ricchezza …
… i problemi … • early life • education • employment and working conditions • food security • gender • health care services • housing • income and its distribution • social safety net • social exclusion • unemployment and employment security World Health Organization. (2008). Commission on the Social Determinants of Health. http://www.who.int/social_determinants/en
… un problema … A Fence or an Ambulance Joseph Malins (1895) - a poem about prevention - 'Twas a dangerous cliff, as they freely confessed, Though to walk near its crest was so pleasant; But over its terrible edge there had slipped A duke and full many a peasant.
… come affrontare i problemi … Prevenzione primaria, la medicina preventiva in senso stretto Prevenzione secondaria, la medicina come tradizionalmente intesa
The traditional 10 Tips for Better Health 1. Don't smoke. If you can, stop. If you can't, cut down. 2. Follow a balanced diet with plenty of fruit and vegetables. 3. Keep physically active. 4. Manage stress by, for example, talking things through and making time to relax. 5. If you drink alcohol, do so in moderation. 6. Cover up in the sun, and protect children from sunburn. 7. Practice safer sex. 8. Take up cancer-screening opportunities. 9. Be safe on the roads: follow the Highway Code. 10. Learn the First Aid ABCs: airways, breathing, circulation L. Donaldson, Ten Tips for Better Health (London: Stationary Office, 1999) … i buoni consigli …
The social determinants 10 Tips for Better Health • 1. Don't be poor. If you can, stop. If you can't, try not to be poor for long. • 2. Don't have poor parents. • 3. Own a car. • 4. Don't work in a stressful, low-paid manual job. • 5. Don't live in damp, low-quality housing. • 6. Be able to afford to go on a foreign holiday and sunbathe. • 7. Practice not losing your job and don't become unemployed. • 8. Take up all benefits you are entitled to, if you are unemployed, retired or sick or disabled. • 9. Don't live next to a busy major road or near a polluting factory. • 10. Learn how to fill in the complex housing benefit/asylum application forms before you become homeless and destitute • D. Gordon, Ten Tips for Better Health, 1999. Message posted on the Spirit of 1848 Listserv. … buoni consigli “provocatori” …
… la complessità dei problemi … S. Glouberman, B. Zimmerman Complicated and Complex Systems: What Would Successful Reform of Medicare Look Like? Commission on the future of the health system in Canada DISCUSSION PAPER NO.8 2002 ( c.d. Rapporto Romanow )
… i limiti dei numeri … “Oh, where do you think you lost them?” “Down the block near my car,” he says. “So why are you looking for them here?” “Because the light is better.” “La nostra speranza per il futuro risiede nel nostro saper riconoscere e nell'apprezzare la complessità dei problemi che affrontiamo.” W. M. Enkin “mezzo secolo di assistenza alla nascita” comunicazione personale a G. Gori ( testo pubblicato sul sito SaPeRiDoc) www.saperidoc.it
… soluzioni ??? … Rethinking Poverty, the 2010 issue of the Report on the World Social Situation seeks to contribute to rethinking poverty and its eradication. It affirms the urgent need for a strategic shift away from the market fundamentalist thinking, policies and practices of recent decades towards more sustainable development- and equity-oriented policies appropriate to national conditions and circumstances. Such national development strategies, as called for by the 2005 World Summit, should seek to achieve the development goals. Responsible development and counter-cyclical macroeconomic policies to foster productive investments and generate decent employment must be at the core of this effort. The Report makes a compelling case for rethinking poverty and poverty-reduction efforts, saying that over-reliance on market forces and economic liberalization have led to neglect of nationally designed and developmentally-oriented strategies, to the detriment of the world’s poor. The most important lesson, according is that governments need to play a developmental role, integrating economic and social policies that support inclusive output and employment growth, while attacking inequality and promoting justice.
… grazie dell’attenzione !!! Ceremony for IG Nobel Prize Winners - University of Harward USA 2003
