Salute globale e Medicina di Comunità in Italia

Global Health and Community Medicine in Italy

Bruno Paccagnella

A new concept of health has been introduced in 1946 by the Statute of the World Health Organisation when the human health has been defined as a physical, mental and social state of wellbeing, not as merely absence of disease or infirmity. In the middle of the twentieth century also a rapid aging process of the population started as well as an epidemiological transition trend from the acute to the chronic degenerative diseases.

Furthermore the evolution of the concepts concerning the relation between men and total environment (i.e. biophysical, social and economic environment) according to the principles of human ecology had a strong impact on the approach of the public health services for the protection and promotion of the health of the population.

In Italy, the right for health has been declared by the new Republican Constitution in 1946, after World War II, and, in 1978, the Public Health Service (NHS) has been reoriented and nationalised putting the accent on the development of Primary Health Care in the District Areas of the Local Health Units of the NHS, in line with WHO and UNICEF 1978 Declaration of Alma Ata on the Primary Care.

The global evolution had a serious and large impact on the medical education and the Association of the traditional General Practitioners (GP) carried on researches on the new job profiles of the professionals engaged in the Health Districts of the NHS.

In 1982, a new Family and Community Physician has been proposed by the Association of the traditional GPs. Educational and professional oppositions have been raised by some medical unions as well as resistances inside some University Medical Faculties. Nevertheless, in 1996, the post-graduate Medical Specialisation in Community Medicine has been approved by the government and was introduced in the University of Padua and in several other universities with the objective to educate medical specialists in Community Medicine for the management of Primary Heath Care.