Equity in Health

Europe has asked its member states to use the lens of fairness to investigate the state of health. And Italy responded with an innovative document promoted by the Ministry of Health, entitled “Italy for Equity in Health”. The paper was drawn up by INMP, AGENAS, AIFA and ISS with the aim of providing a picture of socio-economic inequalities in Italy and their effects on the health of the population.

In Italy, the life expectancy of a college graduate is three years more than a peer with only compulsory education. These inequalities are greater between the north and south of the country, and – even more striking – increase even if one proceeds from the center to the outskirts of a city. If, in fact, from the rich city of Turin, you climb on a hypothetical tram that measures the life expectancy of the citizens crossing the city to the poorer working area, at each kilometer of route you would lose half a year of life expectancy.

These are numbers that dramatically show how inequalities are present in Italy, even at the city level, regardless of whether they are north or south.

The Italian panorama


Therefore, even in a country like Italy, where there is a universal health care system, these inequalities persist and are often represented by disparities in health or access to health care.
Research data for Italy unfortunately shows a picture of continued inequality in life expectancy, the distribution of chronic fatal diseases, the level of perceived health and schooling, employment and quality of work, income, housing conditions, behavior at risk for health, prevention and access to care. All these factors are closely related to a person’s health.

The basic question is: what influences these inequalities in health levels? Are these phenomena avoidable?
The common factor apparently at the base of these health inequalities is social conditions, in other words, the set of resources and abilities with which a person lives. Socio-economic conditions comprise several factors, which contribute to determining the level of health of an individual (such as the home, work, education, lifestyle, etc.).

Towards a shared strategy for equity in health

For the most part, health inequality is determined by structural factors, which are therefore often avoidable.
It is interesting to dwell on what was proposed in the aforementioned document about the possible national investment strategy to work towards increased equity. In fact, the book highlights the priority objectives that can affect health determinants, mitigating inequalities:

  • investing in parenting skills and in the preschool years’ life conditions in order to increase the possibilities of learning skills and competences useful for health;
  • orientate employment policies towards fairness in terms of health care;
  • consider fundamental policies to support income and fight poverty;
  • investing in housing and urban regeneration policies as significant potential for moderating inequalities;
  • rebalance prevention policies and direct them towards the groups at greatest risk, therefore the most vulnerable;
  • counteracting all barriers to care and assistance by enhancing neighborhood social relations (social networks).

Interventions on vulnerable groups


In this scenario, immigrants certainly represent a doubly vulnerable population. These are groups that are often in extreme poverty and marginal conditions and, therefore, more exposed to health risk factors.
For this segment of the population, selective, but also holistic, interventions are needed, as are those aimed at the health of those belonging to the host communities.

According to IDOS data on immigration, in Italy the resident foreign population in 2016 amounted to 5,047,028, the requests for asylum in 2016 were 122,960 and the forced migrants received in our reception system in the first three months of 2017 were 137,218.
Specifically, Rome has a foreign population of 377,000 people, 44% of whom come from Europe. Of the remaining 56%, 33% are from Asia, 12% from Africa, and 11% from Central and South America. Part of this variegated population, about 2,500 people, has been established in informal settlements—that is, in precarious housing situations, characterized by more or less marked forms of self-management. For the most part, foreigners residing in such contexts are not included in the institutional reception system because they are waiting for access to asylum procedures, or more often because they never applied, or left the reception paths provided for by the law without completing an effective process of recognition and insertion.
It is evident that, among all the vulnerable groups, this segment of the population is particularly in need of targeted intervention that can contribute to improving their health conditions.
Although there are social numerous actions and good practices in this sense, both public and private, research shows that we are still going uphill in removing obstacles for the most vulnerable groups, and especially migrants, (due to the presence of regulatory, cultural, bureaucratic and linguistic barriers, and the high risk of giving up care and the poor coverage of health needs in the most deprived geographical areas).

The intervention of OIS and of the “Frontier Mobile Health Care Unit” Project


The intervention of OIS and of the “Frontier Mobile Health Care Unit” Project
The Association OIS-International Observatory for Health Onlus, therefore, concentrates its resources and its actions towards this challenge of civilization, contributing—as far as possible—to remove obstacles and visible and invisible barriers that deprive the most vulnerable of access to care. Treatments that fall under the right to health care enshrined in the constitution and recognized to all persons present in the territory, regardless of their legal status.
In this sense, the “Frontier Mobile Health Care Unit Project” was born, and will start operating in 2018.
The aim of the project is to improve the level of health and well-being of disadvantaged people, especially migrants living in informal settlements in Rome, through the activation of a mobile clinic, the “Frontier Mobile Health Unit”, which provides medical-health care services—such as medical visits and specific screening campaigns—as well as a permanent activity of information and guidance on the health system and access to services in the area, also in order to strengthen the interaction between these services and their beneficiaries.
The project idea stems from an in-depth analysis of the context, which highlights how the population of foreigners residing in informal settlements present characteristics of extreme vulnerability, due to conditions of social hardship, as well as cultural and psychological barriers.
Hence the need for medical-health assistance sensitive to cultural differences and an attentive and dedicated psychological approach. In this context, the project will also favor the creation of a lasting bridge between the expressed need and the existing public offer in the territory, making the beneficiaries aware of their health rights and directing them towards the competent health services.