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SHARING THE HEALTH FOR SHARING THE FUTURE

Regarding the exam of the fourth periodic report on the implementation of the International Covenant submitted by Italy under art. 16 and 17 of the Covenant

ORAL STATEMENT presented to the 33° session of the United Nations Committee for economic, social and cultural rights, Geneva 8 November 2004

 

Regarding the exam of the fourth periodic report on the implementation of the International Covenant submitted by Italy  under art. 16 and 17 of the Covenant

 

Health taken in its widest context, is now universally recognised as one of the most fundamental and important of human rights and as such it needs to be addressed.

In Italy the health conditions of immigrants and poor people appear to be worse, not only in subjective terms but also because of the social disadvantages caused by their heavier workload and by the lack of economic, social and cultural resources.

Some individuals develop social needs which, if not satisfied, create situations of social exclusion. These include particularly disadvantaged categories who suffer the greatest discrimination, such as immigrants, prisoners, non-self-sufficient elderly, disabled and mentally ill and other groups of poor people.

 

I would like to mention briefly some of the main health markers of inequality in Italy:

 

-   HEALTH Of THE PEOPLE UNDER EIGHTEEN: in the group of 25,000 children who were born in Italy in 2001, with at least one foreign parent, the prematurity, the low birth weight and the neonatal mortality are more frequent. Moreover, the programmes of vaccinations are carried out in delay or incompletely, in particular in the nomadic populations. A child born in a poor family has a probability to die while he/she is still an infant, 2,5 times higher than a child of the same age who is born in a wealthy family.

-   POVERTY: health is an important determinant of socio-economic development. But socio-economic status is also an important determinant of health. Rates of mortality, morbidity and disablement are highest among the lowest socio-economic groups. The same pattern applies to socio-economic differences in risk factors for morbidity and mortality. Socio-economic status refers to the position of each person in society. This is stratified according to many criteria. The criteria frequently utilised in the medical literature are macroeconomic determinants, level of education, family patterns, other social networks, income and employment. As to homelessness, in Italy the most reliable statistics come from the NGO service providers. This source will, however, clearly underestimate the extent of the problem since it will exclude homeless people who do not avail themselves of the services provided (e.g. young people staying with friends), people who are excluded from services (e.g. people who are using drugs, illegal immigrants) or for whom services do not exist (e.g. ethnic minority groups, women in some countries).

-   AGEING: people today live longer and remain active further into old age than ever before. The number of citizens over age 60 could rise from 24.2% in 2000 to 46.2% in 2050, which would have an enormous impact on health care resources, as well as on the entire health system. An increased number of elderly would dramatically raise the prevalence of chronic diseases and subsequently the need for appropriate health services. Considering that the national public health system is financed by general taxation, a reduction of the active labour force could have a major effect on the availability of funds and resources. Elderly persons living alone are poorer than the rest of the population, although their condition seems to be improving according to recent data. On the other hand, contrasting data are obtained concerning the poverty rate for couples where at least one person is an old-age pensioner, depending on whether an income-based or consumption-based survey is used. The Italians in need of care are today 2,7 million, 5% of the population, of which 73.2% are elderly people. The OCSE states that in Italy 2.8% of over-65 year old non- self-sufficient persons are assisted at home, compared to 5.5% in UK, to 6.1% in France and to 9.6% in Germany.

-   UNEMPLOYMENT: Eurispes, in its 2004 Report, regarding Italy, estimated that over 5.5 million persons (equivalent to just less than a fifth of present active population) have no  regular job, but some are jobless, others do several types of permanent illegal job, or still, illegal and occasional jobs. These workers, so-called "ghosts", have no provision for health assistance.

-   IMMIGRATES: Available data show that, generally speaking, immigrants are in good health at the time they leave their own countries but their health deteriorates during both the journey and their stay in Italy. In fact, the diseases most frequently suffered by immigrants in our country are the non-infectious ones developed in the host country, typical of the hardship in which most immigrants are forced to live. The immigrant workers, particularly if irregular, face "serious risks for their human rights and the fundamental freedoms when they are illegally recruited or employed.

In comparison with the Italian population, there is a greater frequency of admissions to hospital due to traumatisms: 5,7% in the foreigners against 4.8% in the Italians.

- Accidents rate among immigrant workers is considerably higher than among Italian workers: 55,6% against 43,2% in 1,000 workers.

- The percentage of the cases of tuberculosis in foreign persons is in constant increase: from 8.1% in 1992 to 16.6% in 1998.

- As regards the infection from HIV/AIDS, the data of the National Institute of Health (Istituto Superiore di Sanità-ISS) have highlighted a constant and rapid increase in the time of the proportion of notified AIDS cases in foreign persons: from 3.0% in the 1982-‘93 to 16.1% in 2003.

- The phenomenon of prostitution is important, with an esteem of immigrant prostitutes in Italy in the year 2000 of approximately between  35.000 and 50.000.

- As far as the health of the immigrant woman is concerned, it is worthwhile remembering that physiological conditions like pregnancy can constitute a problem. There are high rates of abortion, for insufficient information about methods of contraception. Another problem is the presence of female genital mutilations.

-   PRISONERS: the overcrowding (at 31 December 2003 the jail population was 54,237 while   the places available are only 41.943) and precarious hygienic-sanitary conditions are the consequence. Since 1995 until now a constant increase of deaths in prisons, particularly among young prisoners, has been recorded: approximately half of the 500 dead persons were under 40 years. Only in 2003 the number of suicides in prison was 67, of which two were minors.

 

In order that the National Health System (NHS) can find effective solutions for the improvement of the public health and sharing it with the all people it is necessary to realize a new perspective that is characterized by "multi-causality" and "multi-sectoriality" of the health care interventions, that will have to consider disease, disability and quality of life as the result of the interaction between human biology, life-style and environmental factors. This innovative approach will be able to come true only through common actions and single planning coordinated and carried out by structures of the NHS. These include the human resources for health (HRH), that can be defined as the complex of all individuals engaged in promoting, protecting or improving the health of populations. HRH issues are strongly linked to non-health policies and should be dealt with in the context of development and macroeconomic policies. But actions and plans must be financed by public agencies (Ministry of Health, and different domains of health systems such as Administrations of Regions, Provinces and Municipalities, Ministry of Justice, of the Interior, of Labour and Social Security and Ministry of Education) and by private institutions (Foundations, NGO, ONLUS, private for-profit and not-for-profit systems and other private social institutions). It is also acknowledged that health workforce development should be considered in a broad perspective, taking into account the influences of globalisation, national and sub-national political, socio-demographic, economic, geographical and cultural factors. A systematic development of such interdisciplinary activities, with the supervision of international organs of surveillance could supply, within the next 5-7 years, useful indications on the effectiveness of interdisciplinary methods of prevention, diagnoses and treatment, and obtain immediately enjoyable, extensible and reproducible results on all the national territory.

It  is well know that poverty in Italy as in Europe and in the world, is multidimensional and is linked not only to material deprivation but also to low educational achievement, poor health, vulnerability and exposure to environmental and occupational risks, as o voicelessness and powerlessness. “Disease weighs heavily on economic development. … But economic development requires more than just healthy individuals. […] Economic development is a multisectoral process, and the strategy for economic development must build on a broad range of social investments as well as strategies to encourage private-sector business investments.”

Therefore, it can be firmly stated that:

the Health Care Services can widely contribute to economic development. The scientific confirmation of such important conclusion comes to us proposed also by the WHO that, in a document published in 2004 (“Health Systems Confront Poverty”) introduces some examples on how the Health Systems of the European Region, that comprises 52 States and a total of over 900 million inhabitants, can contribute to reduce the poverty and to improve the public health. Although the same document acknowledges that it is difficult to recommend similar policies and methods for the whole European Region, I believe that some of the examples described in this study can be repeated easily in other situations in the same Country. In fact, the reproducibility of innovative models of social-health care inside the same Country is based necessarily on the common legislation and in the totality of practices, social values and expectations substantially shared by the national community.


CWM