The Key Role of Social Movements in Protecting the Health of People and the Planet Comment on "Ensuring Global Health Equity in a Post-pandemic Economy".

In his recent article, titled "Ensuring Global Health Equity in a Post-pandemic Economy," Ronald Labonté addresses a key challenge the world is facing, trying to 'build back' after the global crisis related to the COVID-19 pandemic. He explores and critically examines different policy options, from a more inclusive 'stakeholder model' of capitalism, to a greater role of states in shaping markets and investing in the protection of health and the environment, to more radical options that propose to reframe the capitalist mantra of growth and look at different ways to value and center our societies around what really matters most to protect life. Social movements are key players in such transformation, however the political space they move in is progressively shrinking.

Health equity during COVID-19: A qualitative study on the consequences of the syndemic on refugees' and asylum seekers' health in reception centres in Bologna (Italy).

BACKGROUND: As coronavirus infection spread across the world, the dramatic consequences of Sars-CoV-2 and confinement measures highlighted the disparities within our society, impacting more severely on the wellbeing of the most disadvantaged groups of people, such as migrants. The structural characteristics of reception centres create many challenges in the implementation of measures to contrast the diffusion of the virus, putting refugees and asylum seekers (RAS) even more at risk. For these reasons, we carried out a qualitative study to analyze the impact of the syndemic on the health of RAS who reside in reception facilities in Bologna (one of the cities with the highest number of migrants in Italy) and the measures that were introduced to contrast the diffusion of Sars-CoV-2. METHODS: Between April and September 2020, we interviewed 25 professionals and volunteers who were critical in the management of the COVID-19 epidemic in reception centres. Key-informants were selected through a snowball sampling process and covered various professions (i.e. doctors, nurses, social workers, psychologists, cultural mediators, anthropologists, lawyers). The semi-structured interviews explored the consequences of COVID-19 on the health of RAS living in reception centres, the measures implemented to contrast the diffusion of the epidemic and the challenges that interviewees had in handling the emergency. After transcription, the interviews were analyzed using deductive and inductive approaches. RESULTS: All key-informants agreed to participate in the study. Even though various measures were implemented in reception centres (i.e. mass quarantine, supply of personal protective equipment, risk communication campaigns and specific governance tools) they often had a discriminatory approach towards migrants and only considered the biomedical aspects of COVID-19, excluding its social roots and repercussions. This factor, together with the lack of an effective governance system at both the local and the national level, was the most relevant issue associated with the management of the syndemic in reception facilities and affected all the social determinants that shape the health profile of RAS. CONCLUSIONS: The study revealed the importance of social factors in the management of the syndemic in reception centres. It also highlighted how the underlying causes of the impact of COVID-19 are tightly correlated to the political and social approaches of local and national institutions to migration. In order to guarantee the well-being of society as a whole and successfully control the epidemic, it is necessary to consider migration as a human reality rather than an emergency, and demolish all the policies and bureaucratic systems that act as structural violence on RAS. This process brings into play different levels of responsibility and many action plans. We need to develop intersectoral collaborations for more holistic and interconnected practices, while investing the resources to build a worthy reception system and effective social protection programs. This way it will be possible to develop more inclusive approaches to public health and guarantee the conditions for RAS' empowerment.

O potencial transformador do comum em saúde / The transformative potential of health as a Commons / El potencial transformador de lo común en salud

RESUMO A Itália foi um dos países participantes do projeto de pesquisa-ação multicêntrica do Movimento pela Saúde dos Povos (Peoples's Health Movement), chamado 'Engajamento da Sociedade Civil para a Saúde para Todos' (Civil Society Engagement for Health for All). A equipe italiana, um coletivo chamado Grup-pa, realizou várias atividades participativas de pesquisa-ação, incluindo, em uma primeira fase, um mapeamento de grupos ativos em áreas ligadas à determinação social da saúde e à promoção da saúde, através de entrevistas individuais e coletivas. Em uma segunda fase, três oficinas públicas, estruturadas em torno do intercâmbio de práticas, focalizaram-se em temas-chave surgidos durante a primeira fase. Um importante construto originado deste trabalho, centrado em torno da co-construção do conhecimento experiencial do comum em saúde, foi denominado 'práticas do comum em saúde'. O foco nas práticas não é meramente estratégico (produzir sinergias e alianças), mas inerentemente político (conceber a participação como um valor) e ligado à saúde e à manutenção da saúde (dos indivíduos; da comunidade). O conceito de 'práticas do comum em saúde' pretende tornar visível uma área de transformações contínuas em novos espaços criados pelos movimentos sociais e em ações mais tradicionais em defesa dos serviços públicos existentes, abordando a saúde como uma questão sociopolítica. Neste ensaio, esboça-se uma reflexão em torno de seis palavras-chave que lhe são centrais: comum, cuidado, tecnologia, eficácia, sustentabilidade, instituição.

ABSTRACT Italy was a participating country in the People's Health Movement multi-centred action-research project (Civil Society Engagement for Health for All). The Italian team, a collective named Grup-pa, undertook several participatory action-research activities including, in a first phase, a mapping of groups active in fields linked to the social determination of health and health promotion, through individual and collective interviews. In a second phase, three public workshops, structured around the exchange of practices, focused on key themes emerged from phase one. A major construct originated from this work, centred around the co-construction of experiential knowledge on health as a commons, has been named 'health commons practices'. The focus on practices is not merely strategic (producing synergies and alliances), but inherently political (conceiving participation as a value) and connected to health and staying healthy (as individuals; as a community). The construct of 'health commons practices' is meant to make visible an area of ongoing transformations in new spaces created by movements and in more traditional actions in defence of existing public services, addressing health as a socio-political issue. In this essay, we sketch the reflection around six keywords that are central to it: commons, care, technology, efficacy, sustainability, institution.

RESUMEN Italia fue uno de lo países que participó en el proyecto de investigación-acción multicentrico (Compromiso de la Sociedad Civil para la Salud para Todos) del People's Health Movement (Movimiento para la Salud de los Pueblos). El grupo italiano, un colectivo llamado Grup-pa, llevó a cabo varias actividades de investigación-acción participativas incluyendo, en una primera fase, un mapeo de los grupos activos en ámbitos vinculados a la determinación social de la salud y la promoción de la salud, mediante entrevistas individuales y colectivas. En una segunda fase, se organizaron tres talleres públicos, estructurados alrededor del intercambio de prácticas, se centraron en temas clave surgidos en la primera fase. Un constructo importante originado en este trabajo, centrado en la co-construcción de los conocimientos experienciales sobre salud en común, ha sido denominado 'prácticas de lo común en salud'. El enfoque en las prácticas no es meramente estratégico (para la producción de sinergias y alianzas), sino intrínsecamente político (concibiendo la participación como un valor) y conectado con la salud y el mantenerse saludable (sea individualmente que como comunidad). La construcción de 'prácticas de lo común en salud' pretende hacer visible un área de transformaciones que se están gestando en nuevos espacios creados por los movimientos y en acciones más tradicionales en defensa de los servicios públicos existentes, abordando la salud como una cuestión sociopolítica. En este ensayo, esbozamos la reflexión en torno a seis palabras clave que son centrales para ella: común, cuidado, tecnología, eficacia, sostenibilidad, institución.

O potencial transformador do comum em saúde / The transformative potential of health as a Commons / El potencial transformador de lo común en salud

RESUMO A Itália foi um dos países participantes do projeto de pesquisa-ação multicêntrica do Movimento pela Saúde dos Povos (Peoples's Health Movement), chamado 'Engajamento da Sociedade Civil para a Saúde para Todos' (Civil Society Engagement for Health for All). A equipe italiana, um coletivo chamado Grup-pa, realizou várias atividades participativas de pesquisa-ação, incluindo, em uma primeira fase, um mapeamento de grupos ativos em áreas ligadas à determinação social da saúde e à promoção da saúde, através de entrevistas individuais e coletivas. Em uma segunda fase, três oficinas públicas, estruturadas em torno do intercâmbio de práticas, focalizaram-se em temas-chave surgidos durante a primeira fase. Um importante construto originado deste trabalho, centrado em torno da co-construção do conhecimento experiencial do comum em saúde, foi denominado 'práticas do comum em saúde'. O foco nas práticas não é meramente estratégico (produzir sinergias e alianças), mas inerentemente político (conceber a participação como um valor) e ligado à saúde e à manutenção da saúde (dos indivíduos; da comunidade). O conceito de 'práticas do comum em saúde' pretende tornar visível uma área de transformações contínuas em novos espaços criados pelos movimentos sociais e em ações mais tradicionais em defesa dos serviços públicos existentes, abordando a saúde como uma questão sociopolítica. Neste ensaio, esboça-se uma reflexão em torno de seis palavras-chave que lhe são centrais: comum, cuidado, tecnologia, eficácia, sustentabilidade, instituição.

ABSTRACT Italy was a participating country in the People's Health Movement multi-centred action-research project (Civil Society Engagement for Health for All). The Italian team, a collective named Grup-pa, undertook several participatory action-research activities including, in a first phase, a mapping of groups active in fields linked to the social determination of health and health promotion, through individual and collective interviews. In a second phase, three public workshops, structured around the exchange of practices, focused on key themes emerged from phase one. A major construct originated from this work, centred around the co-construction of experiential knowledge on health as a commons, has been named 'health commons practices'. The focus on practices is not merely strategic (producing synergies and alliances), but inherently political (conceiving participation as a value) and connected to health and staying healthy (as individuals; as a community). The construct of 'health commons practices' is meant to make visible an area of ongoing transformations in new spaces created by movements and in more traditional actions in defence of existing public services, addressing health as a socio-political issue. In this essay, we sketch the reflection around six keywords that are central to it: commons, care, technology, efficacy, sustainability, institution.

RESUMEN Italia fue uno de lo países que participó en el proyecto de investigación-acción multicentrico (Compromiso de la Sociedad Civil para la Salud para Todos) del People's Health Movement (Movimiento para la Salud de los Pueblos). El grupo italiano, un colectivo llamado Grup-pa, llevó a cabo varias actividades de investigación-acción participativas incluyendo, en una primera fase, un mapeo de los grupos activos en ámbitos vinculados a la determinación social de la salud y la promoción de la salud, mediante entrevistas individuales y colectivas. En una segunda fase, se organizaron tres talleres públicos, estructurados alrededor del intercambio de prácticas, se centraron en temas clave surgidos en la primera fase. Un constructo importante originado en este trabajo, centrado en la co-construcción de los conocimientos experienciales sobre salud en común, ha sido denominado 'prácticas de lo común en salud'. El enfoque en las prácticas no es meramente estratégico (para la producción de sinergias y alianzas), sino intrínsecamente político (concibiendo la participación como un valor) y conectado con la salud y el mantenerse saludable (sea individualmente que como comunidad). La construcción de 'prácticas de lo común en salud' pretende hacer visible un área de transformaciones que se están gestando en nuevos espacios creados por los movimientos y en acciones más tradicionales en defensa de los servicios públicos existentes, abordando la salud como una cuestión sociopolítica. En este ensayo, esbozamos la reflexión en torno a seis palabras clave que son centrales para ella: común, cuidado, tecnología, eficacia, sostenibilidad, institución.

Global health activists' lessons on building social movements for Health for All.

BACKGROUND: The People's Health Movement (PHM) was formed in 2000 and drew inspiration from the Alma Ata Declaration on Primary Health Care's 'Health for All' (1978). Since then PHM has been an active part of a global counter-hegemonic social movement. This study aimed to gain insights on social movement building, drawing on the successes and failures reported by activists over their experiences of working in the Health for All social movement to improve health, justice and equity. METHODS: Qualitative research methods were employed in this study to capture complex and historical narratives of individual activists, through semi-structured interviews and subsequent thematic analysis of transcripts. The research design and analysis were informed by social movement theory and literature on health activism as a pathway for social change. In this study we examine the semi-structured interviews of 15 health activists who are part of the PHM, with the aim of deriving lessons for strengthening movements for Health for All. RESULTS: This study locates the activists' narratives within a socio-political analysis of the global trends of late modern individualism and capitalist neoliberalism. This highlights the challenges faced by civil society groups mobilising collective action and building social movements for Health for All. The study found that within the constraints of the neoliberal socio-political and economic conditions which have caused the rise in social and health inequities, this group of long-term health activists have been nurturing alternative approaches to structuring society and building collective agency to improve health. CONCLUSION: The practical long-term experiences of the PHM activists examined in this study contribute to a better understanding of the processes and motivations that lead to and sustain health activism, and the dilemmas, strategies, impacts and achievements of such activism.

Usuários frequentes dos serviços de emergência: um estudo observacional de métodos mistos na Emilia-Romanha (Itália) / Frequent users of the emergency department: a mixed-methods observational and retrospective study in Emilia-Romagna (Italy) / Usuarios frecuentes de los servicios de emergencia: un estudio de observación retrospectivo y de métodos mixtos en la región de Emilia-Romagna (Italia)

HISTÓRICO. A superlotação dos serviços de emergência (SE) representa uma grande preocupação na Itália. Os usuários frequentes (UF) contribuem para a superlotação, desperdiçando recursos de saúde. OBJETIVO. Descrever as características dos UF e avaliar a confiabilidade dos sistemas de informação do SE. Desenho. Estudo retrospectivo observacional unicêntrico. MÉTODOS. Análise quali-quantitativa de prontuários médicos de admissões de UF para SE em um período de 15 meses em um hospital de ensino na Itália. RESULTADOS. 1.766 UF acessaram o SE, realizando 11.842 admissões. Os códigos verde e branco foram mais frequentes (n = 9,065; 76,5%). As condições agudas prevaleceram entre os motivos da admissão. A análise qualitativa mostrou que os UF estiveram sobrecarregados principalmente com condições crônicas e destacou o papel do SE na sua administração. DISCUSSÃO. Os UF sofrem de condições múltiplas e crônicas, que não são capturadas pelo sistema de informação do SE. CONCLUSÕES. A adoção de uma abordagem centrada no paciente, orientada para condições crônicas, pode resultar em informações mais ricas e melhor gerenciamento dos UF.

BACKGROUND. The overcrowding of Emergency Departments (EDs) represents a major concern in Italy. Frequent users (FUs) contribute to overcrowding, wasting health care resources. OBJECTIVE. To describe the characteristics of FUs and to evaluate the reliability of the ED information systems. DESIGN. An observational single-centre retrospective study.METHODS. A quali-quantitative analysis of medical records from FU admissions to the ED in a 15-month period at a Teaching Hospital in Italy. RESULTS. 1,766 FUs accessed the ED, totalizing 11,842 admissions. The green and white codes were the most frequent ones (n=9,065; 76.5%). Acute conditions prevailed among the reasons for admission. The qualitative analysis showed that FUs were mainly burdened with chronic conditions and highlighted the role of the ED in managing them. DISCUSSION. FUs suffer from mltiple and chronic conditions, which are not captured by the ED's information system. CONCLUSIONS. The adoption of a patient-centred approach oriented towards chronic conditions could result in richer information and better management of FUs.

ANTECEDENTES. La saturación de los Servicios de Emergencia (SE) representa una gran preocupación en Italia. Los usuarios frecuentes (UF) contribuyen a dicha saturación, desperdiciando recursos sanitarios. OBJETIVO. Describir las características de los UF y evaluar la confiabilidad de los sistemas de información de los SE. DISEÑO. Estudio retrospectivo unicéntrico observacional. MÉTODOS. Análisis cuali-cuantitativo de las historias clínicas de los ingresos de los UF a los SE en un período de 15 meses en un Hospital Universitario de Italia. RESULTADOS. Un total de 1.766 UF accedieron a los SE, notificándose una cantidad de 11.842 ingresos. Los códigos verde y blanco fueron los más frecuentes (n=9.065, 76,5%). Entre los motivos de ingreso predominaron las afecciones agudas. El análisis cualitativo demostró que los UF padecían principalmente enfermedades crónicas y destacó el rol de los SE en el manejo de las mismas. DISCUSIÓN. Los UF padecen enfermedades múltiples y crónicas, que no son diagnosticadas por el sistema de información de los SE. CONCLUSIONES. Adoptar un enfoque centrado en el paciente y orientado a las condiciones crónicas podría dar lugar a información más detallada y a una mejor gestión de los UF.

We Need Strong Public Health Care to Contain the Global Corona Pandemic.

The corona virus (COVID-19) outbreak has spread from China to over a hundred countries in less than 2 months. Now is the time to take stock and to assess the responses of different countries to the outbreak so far. What we can learn from the global Corona pandemic so far is that strong public health systems have the resilience to address massive health threats with the collective responses they require. Privatization of health services and individualization of risks might further undermine our ability to address this and future global pandemics.

An ecological study on health inequalities in the city of Bologna (Emilia-Romagna Region, Northern Italy): bridging knowledge and action.

BACKGROUND: since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consisting of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services. OBJECTIVES: to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them. DESIGN: the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. SETTING AND PARTICIPANTS: residents in the city of Bologna aged >=18 years in the period 2011-2015, grouped into 90 statistical areas. RESULTS: a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence. CONCLUSIONS: an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

[Healthcare models and challenges for refugees and asylum seekers: the response of Emilia-Romagna (Northern Italy) to the recent migration trends]. / Modelli organizzativi e criticità dei percorsi assistenziali per richiedenti e titolari di protezione internazionale: la risposta dell'Emilia-Romagna ai recenti fenomeni migratori.

OBJECTIVES: to characterize healthcare for refugees and asylum seekers. DESIGN: a quali-quantitative study with semi-structured interviews was carried out with key informants of the regional clinics which provide health assistance to refugees and asylum seekers during the first phases of arrival. SETTING AND PARTICIPANTS: key informants of 14 health centres were interviewed across the 9 provinces of the region. MAIN OUTCOME MEASURES: the study investigated the different healthcare interventions and the quality of the relationships among the main actors involved in providing healthcare to refugees and asylum seekers. RESULTS: three healthcare models were identified: one involved Local Health Units (LHUs), one based on the recruitment of NGOs, and the last one formed by the combination of LHAs and General Practitioners. Challenges in guaranteeing a good level of health assistance were reported at all levels, such as specific barriers in accessing health and social services, fragmentation and lack of coordination amongst services and the poor quality of care for vulnerable groups. CONCLUSIONS: the healthcare for asylum seekers is characterized by various critical issues, mainly related to accessibility and coordination of health and social services. In order to guarantee health equity, it is necessary to strengthen the primary health care system and improve local governance.