Zero Disease. Angelo Barbato

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СКАЧАТЬ security. The ordinances of the nations with a greater development of the welfare state also provide greater investment and programs for the defense of the natural environment and unemployment benefits (citizen income).

       The health care models are essentially two: a mutualistic system (Bismarck) based on private appeal and a National Health Service (Beveridge) with public and universal vocation.

      In relation to the welfare state of the post-war Europe until the 80s, four main areas can be classified: Scandinavia, Anglo-Saxon, Continental Europe and Southern Europe. Although for large schematization it can be said that historically the north of Europe as a matrix refers to the universal model (Beveridge) while continental Europe and southern historically is characterized as originally mutualistic (Bismarck).

      Scientific and popular literature offer a wide variety of treaties on the History of Public Health, providing a definitely eclectic and comprehensive view on the various aspects and focus areas. In 1989, Mullan wrote about the history of public health in the US; Duffy in 1992 focused on the work of Health Care Workers; Fee in 2002 has followed a wide variety of articles on the historical aspects of public health while Warner and Tighe in 2006 have emphasized the link between Public Health and Clinical Medicine¹² .

      In ancient civilizations, public health was geared exclusively towards the protection of public hygiene. During the Roman Empire, the care of the poor sick was entrusted to archiatrists paid by the city. The creation of the first hospital-like structures dates back to the Middle Ages: they were centers who had a more charitable rather than health purpose, in fact the first institutions of its kind developed in the vicinity of bishoprics, monasteries and along pilgrimage routes¹³ .

      During the Renaissance the first attempt of a systematic classification of diseases was undertaken; while during the Enlightenment took place the first investigation of diseases and of the overall health of the population. The French Revolution and the first industrial revolution (about 1760-1870 ) with the consequent urbanization, contributed to giving a strong incentive to the concept of public health.

      The Health Movement has been a product of the second industrial revolution, a new approach to public health developed in England between 1830 and 1840. With the growing industrialization and urbanization, increasing awareness about the importance of personal hygiene and the human waste treatment has led as a strategic choice in the fight against infectious diseases to sanitation and removal of filth from the cities. However, as understood by Edwin Chadwick, urban cleaning in the literal sense, has become, over time, a deviant figurative meaning, and was seen as the removal of a potential health threat represented by "dangerous classes." Other European cities such as Paris and Naples followed suit, undertaking reconstruction projects on a large scale. However, these technological reforms marked an undeniable step forward for public health, often leading to the exclusion of economic and educational reforms¹⁴ .

       The concept of Public Health, therefore, has over time expanded its scope of application and interest, taking shape first as action towards the Community for the prevention of diseases and threats to health, for the wellbeing of individuals and the population; successively reaching to include both the promotion and the protection of health¹⁵ .

      In the eighteenth century, in Europe, the organization of Public Health was the exclusive competence of judicial and police organs with tasks limited to the management of epidemics and outbreaks.

      In England, the British factory act is approved for the regulation of the workloads in factories (1833) and in 1948 the NHS (National Health Service) is founded. Doctors of Public Health were appointed: the Medical Officer of Health.

      Surprisingly, it is up to America to lead the first attempt to establish a Health System of Universalistic nature, extended to the majority of the population. In 1910 C. Chapin wrote what later became the reference text of the 'Public Health', not only American.

      Appearing between the lines of the ideal of a Public Health, is not only 'science and art of preventing disease' but also the promotion of a quality of life, preservation and extension of the state of health and physical efficiency. In that sense, the participatory role of the entire community becomes fundamental. In this model of 'distributed' Public Health, the community becomes, albeit with still a passive role, starring in ensuring the maintenance of adequate living standards, appropriate for the extension of health conditions. Among the main action lines of the document was education of the patient on common preventive measures, the elementary rules of hygiene, and the promotion of environmental health.

      Public Health therefore becomes 'Health System', beginning to take a tangible organizational configuration and initially structured in centers of power and control and in systems of provision of health actions. Just as we will see later in the historical evolution of these public models in different countries, the inability to keep separate and distinct the commissioners’ roles (the centres of power and control) and the role of the regulator has heavily contributed to the crisis of the system.

      Currently, the concept of New Public Health ¹⁶ is emerging, according to which health is an investment in the life of the community. The New Public Health focuses on the behavior of individuals in their environment and the conditions that influence such behavior.

      The application fields of public health include not only the scientific, but also the social, cultural and political spheres.

      In addition to the classic notion of disease prevention, the work of Public Health is dedicated to promoting physical and mental health of individuals. Those objectives are reflected in trying to influence the habits and living conditions, but also in promoting self-esteem, human dignity and respect.

      Public Health is the set of actions undertaken by the company to improve the health of a population.

      A commonly accepted classification of health systems is based on the terms of financing and is distinguished between insurance-based systems (Social Health Insurance) and tax-based systems (general taxation).

      The more established Health Systems in Europe are: the Beveridge model, the Bismarck model, the Mixed model and the Semasko model.

      While the last two have hybrid features, among the first two substantial differences can be identified.

      The mixed model instead provides for the simultaneous presence of taxation mechanisms and forms of social insurance, providing coverage of the entire population.

      The Semasko model, finally, is typical of those countries which currently or in the past decade have seen a political and social environment in transition (Central Europe and the former Soviet Union). This system is similar to the Bismarck model for the connotations related to social insurance mechanisms, even though it is funded by directly withholding tax on salary.

      In the Beveridge model, health systems are primarily financed through tax revenues and should provide all of the services. The taxation may be direct or indirect, national or local.

      The British National Health Service, or NHS, was founded in 1948 in order to provide free healthcare to the entire population of Britain. It is the first National Health System of the Beveridge style: universal, free, financed by general taxation¹⁷ .

      A first attempt of de-verticalization of the healthcare system took place in Britain in 1990 with the 'NHS and Community Care Act', better known as the Thatcher Reform.

      History, ever since the first reforms and the Darwinian evolution of the healthcare system would not seem to have favored vertically integrated organizational models, centralized or monocratic in the regulation of supply and demand, but have rather veered towards more 'distributed forms' for the provision and management of health. In the specific СКАЧАТЬ