Gianfranco Gori MD
I determinanti sociali di malattia e di salute
… sonno della ragione …
F.Goya – Los caprichos 1799
Madrid Museo del Prado “Il sonno della
ragione produce mostri”
… sonno della ragione …
… 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
!!!!
… e a parlare di cose concrete …
… mortalità nell’affondamento del Titanic a seconda della classe dei
passeggeri per donne e bambini ...
Women
Children
80
Mortality (%)
70
60
50
40
30
20
10
0
1st
2nd
3rd
.
1st/2nd
3rd
Passenger class
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 …
… una terza via …
… i buoni consigli …
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)
… buoni consigli “provocatori” …
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
.
… 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
… la complessità del problema …
… la complessità del problema …
… la complessità del problema …
… 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 developmentallyoriented 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.
… soluzioni ??? …
… soluzioni ??? …
… soluzioni ??? …
… grazie dell’attenzione !!!
Ceremony for IG Nobel Prize Winners - University of Harward USA 2003