In 1985 the Rockefeller Foundation funded a study with surprising results that few know about and that perhaps some would like to purposely keep hidden. The study is calledGood Health at Low Cost” and demonstrated how then very poor countries such as Kerala in India, Sri Lanka and Costa Rica achieved, despite the low GDP per capita, better levels of health than much richer states such as the United States for example.
For the first time, the "Good Health at Low Cost" Report has highlighted that money is not the only determining factor for our health, but that how much and how we live depends on a complex of elements such as, for example, nutrition and the number of general practitioners in proportion to the population. The most relevant evidence of the study was to demonstrate that the factor that most affects health is equity understood as equal use of health services for equal needs.
After 30 years from the Rockefeller Report one has to wonder if in Italy we have learned something from this study, or have we lost something along the way. The state of health of the Italian population has on average improved, the life expectancy for a young Italian/Italian is very high even if compared to countries that are usually set as an example for us such as England, Holland and the France.
However, many studies also show that quality of life and life expectancies vary drastically from one region to another. A girl born in the South will have a lower life expectancy and quality of life than a girl born in northern regions such as Tuscany or Emilia Romagna.
The quality of prevention, the number of beds, the number of employees in the health sector (and its turnover), the list of drugs within the regional tariff, all and many other fundamental factors, are planned in Italy at the regional level effectively creating states within the state.
The National Health Fund, distributed mainly on the basis of the old age of the regional population, benefits the wealthier regions of the North.
To this disparity of resources must be added the fact that the indiscriminate cost cutting in deficit regions it has paradoxically increased the costs borne by the regions themselves and therefore by the NHS.
One wonders whether it is fair that, due to cost cutting, the supply and quality of highly cost-effective interventions such as breast cancer screening, HPV vaccination vary according to to the "health" of the health budget of the region to which it belongs.
A prime example of how it is inefficient and unfair our healthcare system is the case of vaccinations. Vaccinations not only have a proven benefit for the health of the population by reducing the incidence of disease in the most vulnerable age groups (children and the elderly) but are also associated with significant savings in economic terms. In the USA, for example, between 1994 and 2013, 322 million cases, 21 million hospitalizations and 732 deaths were prevented. In economic terms i vaccines they saved $295 billion in direct costs and $1,38 trillion in indirect costs.
Given the benefits and savings of vaccinations, European countries such as France, Norway and Great Britain have set themselves the goal of increasing vaccination coverage (e.g. vaccinating even healthy children aged between 4 and 10 years).
In Italy however - according to what was stated by Alberto G. Ugazio, Director of the Pediatric Medicine Department of the Bambino Gesù Hospital - due to the vaccine federalism there has been a decline in vaccination coverage. For example, in vaccination against measles, rubella and mumps in all southern regions (with the exception of Basilicata and Puglia) coverage rates are below 90% while in northern regions well above. At the last Pediatrics congress held in Rome, it was also underlined that some vaccines are free in the richest regions and paid for in those subject to a procedure for reducing the health deficit.
With the exception of some pathologies for which a local/regional approach may be justified (e.g. high prevalence of patients suffering from thalassemia in Sardinia), a fair Italian healthcare system is a national healthcare system. As demonstrated by the Rockefeller Foundation report, with simple, low-cost prevention interventions accessible to all Italians, one can age well and live long.
Low-cost policies such as the recent reduction of salt in the school diet in the UK, and transversal policies such as the need to impose physical activity at school starting from the modernization (and in many cases reopening) of gyms in school buildings can be tools for a significant reduction in healthcare expenditure in all Italian regions.
In equitable healthcare there are fewer patients and more independent elderly people. Many argue that because of an aging population we can no longer afford a public health system, but perhaps one should begin to ask if what we cannot afford is an unfair health system.
