By Francesco Carelli
Professor Family Medicine, Milan and Rome
EURACT Council, Executive

The crisis we are experiencing not only implies a severe impact on the socio-economic conditions of the people , but also has serious consequences on the determinants of population health.

Not to say about the dramatic increase in suicides that is occurring in Italy or in other southern Europe, we would like to focus attention on the consequences of indiscriminate cuts put in place by the last governments on the health system and on those, announced, but still to come, and the new poverty determined the impact of living conditions on the health of populations.

The costs of the health system
During the last century modern medicine has enjoyed resounding success : it has eradicated many diseases that were among the major causes of death in the past, has been responsible for the dramatic increase in life expectancy and declining infant mortality that have occurred in industrialized nations ( and , to a lesser extent , in the rest of the world) . However, the modern health systems are facing increasing difficulties, not only in improving their effectiveness in health care , but also simply in keeping the levels of the recent past.
The discussion on sustainability of care is not new , and covers all the so-called ” advanced countries ” . However, for what concerns the countries of the South ‘ ” Eurozone ” and , in this case in Italy, the reference to cost containment is due to some alleged ” external constraints ” (” Europe asks us “), which refer only to a determinism of accounting , a sign by the abdication of the political sphere in favor of the economic. Or rather, in favor of very specific interests that , in the last thirty years have influenced in his favor , the narrative economy (which, as is well known following the “golden rule” , or “who owns the gold , sets the rule”)
A clear example of this determinism were announcements in the recent past , the president of the so-called ” technical government ” (which showed , on the contrary , an attitude very political in favor of certain socio-economic entities , rather than the others ), questioned the sustainability of the NHS in the long term , according to this orientation with instrumental motivations that wants to give the country ( the mantra of ” less state, more market” )
These ads were in the perfect style of the shock doctrine , so well described by Naomi Klein , in which they proclaim ads for effect, designed to scare the public about the risk of collapse of an essential service , so when this has become a matter a fact , it is easier to accept downsizing or liquidation of the service in question.
This approach was endorsed by the government inevitably next , because also to it it Europe demanded that Italian citizens must ” die to Maastricht “
.It is time that we can observe a gradual ” hollowing out” of health services : Many services have become onerous , and the operators are made increasingly difficult by indiscriminate cuts , which do not enter at all into the merits of the interventions really useful to rationalize a complex system such as that of health care.
But , surely , this rationalization , that if such could be agreed, is not the real target of this operation. In fact, the Italian Health System is one of the least expensive among the Western countries., We should remember that as regards the United States, the percentage of health expenditure to GDP , and the per capita are much higher than those observed in our country.
There are , however, those who continue to advocate the privatization of the system , citing the efficiency and effectiveness of the private sector than in the public .If we look at In life expectancy at birth. not only Italy is at the top of the list, well ahead of the United States , but these are also passed from Cuba ( see United Nations Department of Economic and Social Affairs , Population Division, / unpd/wpp/JS-Charts/mor-life-exp-female_0.htm ) , which has a per capita health expenditure amounted to about one-tenth that of the U.S. and where privatization do not enjoy huge popularity
Moreover, in the decade 2000-2009 Italy is the only country among the OECD , in which health care costs have been reduced.
Socio-economic determinants of health
It can be said that most of the successes of modern medicine has been obtained with relatively simple and inexpensive methods , such as improved nutrition , hygiene and living conditions , then, but to a lesser extent , with the introduction of antibiotics and vaccines, with aseptic surgery and the advent of modern resuscitation techniques
However, a serious crisis that affects a socio-economic system seriously affects not only on health systems, but has some very important right on the other conditions ( feeding, hygiene, lifestyle ) that are crucial to the health of the population.
Referring to an example from the recent past , and we look at trend in life expectancy in Russia in the years immediately before and after the collapse of communism , from 1988 to 1993 , life expectancy has declined for men , no less than eight years old, and about four for women ( with a peak decline between 1990 and 1992).
In recent times we are seeing in many countries of the European Monetary Union the same phenomenon (although less severe in terms of quantity ) that occurred in Russia.
From this point of view is very clear that shortsightedness of austerity policies deployed in recent years in the countries of southern Europe, with the declared intention to reduce the deficit in public budgets. These policies (especially those characterized by indiscriminate cuts in public spending and tax increases as indiscriminate ) depress the economy and have a very negative influence on the socio-economic determinants of health.
Effect of job insecurity on health
An example of the impact point of the socio-economic conditions on the health of the population is one of Glasgow , Scotland, called by epidemiologists ” Glasgow effect ” . In the Scottish town the inequalities in health are such that the life expectancy of the suburb of Calton (54 years) is 28 years less than that of the residential area of Lenzie, located only 7.5 miles away :

Not only the area of Calton has a life expectancy much lower than that of the OECD countries , but appears to be back even than that of many African countries.
Inequalities in health between the two areas are attributable , on the one hand , to social and economic deprivation , and to a combination of factors such the “psycho- social ” problems they entail (depression , anxiety, drug addiction ), rooted not only in poverty , but also in the loss of social ties and community.
The most effective way to increase life expectancy and improve health, would be to analyze the impact of government policies and programs on health and equity of social and health conditions, and make this a criterion for evaluating the goodness of a government.
We see something similar in policies to achieve the ‘ ” European nightmare ” . Or maybe this will be the true meaning of the phrase “To die for Maastricht ” ?