By Laboss (1)
As we mark the 45th birthday of our National Health Service, let us stand up for it. To counteract its progressive, but increasingly rapid, dismantling, huge public funding is needed, together with adequate health policies. The Stability Pact recently negotiated with Europe provides for the exclusion of military spending from the debt calculation. Our proposal is to reverse the priorities: exclude health expenses from the Pact, instead of military ones.
Forty-five years ago, on 23 December 1978, Tina Anselmi, the first Italian woman at the Ministry of Health, signed law no. 833, establishing the long-awaited National Health Service (SSN). The birth of the NHS marked a great leap in quality for the country, starting from its main objective: the transition from the treatment of illness, conceived mostly as individual suffering, to the universal protection and promotion of health, physical and mental, individual and collective. The new service was characterized by an integrated approach to health and social interventions, by the priority of prevention activities, by a decentralized and territorial organisation, by an approach capable of addressing issues linked to working conditions, environmental protection and overall human well-being.
The principles with which he was born were radical. Universality of coveragenot only to Italian citizens but to everyonewithout any discrimination, the right to treatment was guaranteed. Equity access e equality of treatment; globality and territorial uniformity of the services provided; coordinated use of modern prevention, treatment and recovery techniques.
And again, the centrality of preventive action; territorial decentralization; uniqueness of management of services by the Local Health Units (USL), conceived as tools of an integrated intervention to protect health which included multiple aspects. Democratic participation and controllability; planning of the offer of services and spending; financing through general progressive taxation. In its architecture, it overturned the previous healthcare structure, moving power and resources from the inefficient building of the Mutual Funds and the bodies inherited from fascism, to institutions closer to the citizens, with financing that moved from the old insurance mechanism to progressive taxation. In this way the principle of equity was achieved with financing that was part of the redistributive and solidarity mechanisms of welfare and with the provision of services based on health needs regardless of contributions paid and income.
The establishment of the NHS was the result of the social, political and cultural ferment of the 1960s and 1970s, of the mobilizations of the workers’ and feminist movements, of pressure from trade unions and left-wing parties. Experimentation with innovative, collective, decentralized, universal, public social-health services, full awareness of the links that linked environmental health and the capitalist organization of work, rethinking of the aims and devices of science, implementation of the Constitution were also central in the construction of the health service. The commitment to health that characterized many initiatives and experiences of the Seventies was decisive, as a concrete dimension of the affirmation of social rights and freedom, of participation practices, of the development of new shared knowledge.
The 1978 health reform must be remembered today because it constituted the most important universalist achievement of Italian welfare, still marked by employment logic, patriarchal strategies, strong fragmentation and categorical approach. Years of discussions, conflicts and experiments were necessary, an intense season of collective action under the banner of demands for freedom and equality which in that decade profoundly transformed the structure of the country.
Returning to the political origins of this “invented” institution is not a simple act of memory, but rather a concrete necessity, which arises from the desire and urgency to resume that path, to be conscious heirs of it. We are faced with a long, but increasingly rapid, process of privatization and dequalification of public health, with policies and narratives that day by day aim to put an end to a universalistic and democratic model of health, with the strong intrusiveness of market logics and profit, with the effect of witnessing a serious increase in social inequalities and territorial disparities in health. Countering these dynamics can be one of the key areas of today’s political and social conflict, to realize everyone’s right to health and to reaffirm one of the country’s most important achievements, obtained with great ideas and great struggles.
To start again from an initial fixed point, adequate health policies are needed in the field of personnel, as well as intervention strategies in the field of primary care and mental health. To make this possible it is more essential than ever to obtain greater funding, hypothesized in the increase in the percentage of public health spending per 7.5% of GDP. This would bring Italy into line, albeit downwards, with the main European countries, with an additional point of GDP in public health spending, equivalent to approximately 21 billion euros.
The Stability Pact recently negotiated with Europe provides for the exclusion of military spending from the debt calculation. Our proposal is to reverse the priorities: exclude health expenses from the Pact, instead of military ones.
International health systems 45th birthday, Primary care, Equity, Financing of the NHS, Law 833/78, feminist movement, workers’ movement, Stability Pact, Healthcare personnel, healthcare reform, Mental health, public health, National Health Service (NHS), Health expenditure as % of GDP, Public health expenditure, NHS, Universalism, Universalistic welfare