I determinanti sociali di malattia e di salute

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I determinanti sociali di malattia e di salute
Gianfranco Gori MD
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sonno della ragione
F.Goya Los caprichos 1799 Madrid Museo del
Prado Il sonno della ragione produce mostri
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sonno della ragione
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sonno della ragione
non esiste la sindrome di Salgaribassa
prevalenza di patologie di importazione e rischi
minimi di trasmissione alla popolazione ospite
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proviamo a non essere emotivi
La logica del ragionamento può essere dura ma
non scoraggiamoci !!!!
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e a parlare di cose concrete
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mortalità nellaffondamento del Titanic a
seconda della classe dei passeggeri per donne e
bambini ...
Women
Children
Broom L Selznick P, 1968
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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.
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probabilità di essere vivi a 65 anni a seconda
del grado di istruzione
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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.
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percezione del proprio stato di salute a
seconda dellappartenenza politica e del livello
di ricchezza
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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
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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.
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come affrontare i problemi
Prevenzione primaria, la medicina preventiva in
senso stretto
Prevenzione secondaria, la medicina come
tradizionalmente intesa
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una terza via
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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)
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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 .

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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 )
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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
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la complessità del problema
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la complessità del problema
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la complessità del problema
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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 worlds 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.
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soluzioni ???
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soluzioni ???
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soluzioni ???
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grazie dellattenzione !!!
Ceremony for IG Nobel Prize Winners - University
of Harward USA 2003