Rapporto 2018 "I cambiamenti nella salute in Italia: la salute nell'età adulta" - Fondazione
Round Tables. A discussion with NHS stakeholders.
The main objective of the welfare system created in the United Kingdom after the Second World War was the basic social protection of citizens throughout their life cycle (from "the cradle to the grave") (Beveridge Report, 1942). In today’s rapidly changing world, an individual no longer conforms to a linear sequence of life stages that relate only to age (birth, education, marriage, work, ageing). On the contrary, individuals are increasingly following cycles that are often influenced by economic, social and spatial changes, which in turn lead to career and responsibility changes, thus requiring a total reprogramming of life and expectations. The management of these phenomena is certainly one of the most important challenges that Italy must face, given the political, social and healthcare implications it imposes.
In the three-year study launched by the Foundation, after analysing these phenomena in the elderly and in the young, the last year will now focus on adulthood, i.e. that extended period of time from 18 (coming-of-age) up to 65 years (which often coincides with retirement). This long period is characterised by several events which are responsible for many of the changes mentioned above. The research aims to analyse the polarization and challenges between "expectations and fears", between "conflicts and controls" or between "desires and sacrifices". In a nutshell, modern expectations, conflicts and desires are much more pressing than in the past and generate fears, anxiety over control, pressures to sacrifice, bringing out a whole series of needs with important health implications for which the NHS is not always equipped to respond. Consider for example cosmetic surgery, problems related to impotence, the boom in nutraceuticals, the spread of intolerances and allergies, compulsive gambling, the use of addictive substances. Expectations, conflicts and desires often alter the lifestyles of individuals, generating negative effects on the state of health of the adult population and contributing to an increase in healthcare spending and, therefore, in undermining the system's sustainability. More than in other age groups, an important role in adulthood is that of gender; also due to the significant changes in family structures and in the labour market, women have significantly modified how they relate to their body and health, adopting radically different behaviours and lifestyles compared to only a few decades ago.
On this front, recent national and international epidemiological research has shown that despite a generalised increase in life expectancy, the issue of anticipating the onset of certain chronic diseases such as diabetes, cardiovascular diseases, respiratory problems and mental health problems is increasingly evident, with consequent repercussions on both the healthcare system (assumption of responsibility) and on the economic system (reduction of productivity). The recent economic crisis that began in 2007 has greatly influenced and contributed to this state of affairs, adding a further factor of complexity in the context of all these polarities.
This information is of fundamental importance for policy makers, since the adult generation of the future could have a worse health condition than the one experienced by the "silver generation" today. Many regions and healthcare authorities have noticed these dynamics and have put in place, unfortunately in an all too random fashion, interventions to take charge of this chronicity in light of the new evidence.
The Report focuses on the evolution of the state of health of this segment of the Italian population and on the actual capacity of the healthcare system to take care of the needs that will be expressed, trying to draw a series of possible future scenarios that can be used to evaluate healthcare and social policies.
The meeting closed with a Round Table attended by experts of the sector and operators with the aim of taking stock of the situation and discussing the possible solutions to be applied in Italy.