[Work as a basic human need and health promoting factor].

The Italian Constitution (1948) defines 'work' as the founding value of the Italian Republic. This choice was not motivated by mere economic reasons, but rather stemmed from the recognition that work is the most appropriate tool for the expression of the human personality in society, that it is an asset and a right that will increase the dignity of every person, and which corresponds to a fundamental human desire to fulfil oneself in relationship with other persons and the entire world This view of work, including its technical and manual aspects, was unknown to the ancient mentality and became familiar to us through the monastic orders of the early middle ages, which began to conceive and practise human work as a means of participating in the work of creation and transmitted this value over the centuries. As we experience today, if occupation is lacking, a basic condition for the development of the person and for his/her contribution to the growth of society is lost. Given the meaning of work in human experience, it is not surprising that unemployment represents not only a worrisome economic indicator, but also the cause of ill health. At the end of 2009 unemployment in the European Union reached 10%, similar to the rate in the US; in Italy it was estimated at 8.5% in December 2009 and is expected to reach 10% in 2010. In Lombardy, although employment had been constantly increasing between 1995 and 2008, and the current unemployment rate is as low as 4.9%, 100,000 jobs were lost in 2009. Several scientific papers have demonstrated the association between lack of occupation and lack of physical and mental health. In the present period of crisis, increases of 30% in cases of anxiety syndrome and of 15% in cases of depression have been reported. An increase in suicides among unemployed persons has been documented in several countries even if there are still problems of interpretation of the causal chain of events. Mortality among the unemployed increased, not only that due to violent causes, but also mortality for all causes, cardiovascular diseases and cancer. A survey in the Turin area, Northern Italy, showed a twofold increase in mortality among unemployed men. Women were affected both by husbands' unemployment and by their own unemployment because of the previous increasing rate of female occupation. The worse the occupational condition (from "seeking work" to "temporary employment" down to "unemployed and no longer seeking work") the higher the mortality: in the latter category, where the most evident problem is marginalization and social exclusion, the increase in mortality was fourfold. The role of occupational health physicians is to recognize the possible negative effects of working conditions and at the same time promote a positive approach to work, even in difficult conditions. This makes prevention more effective and promotes health. To be aware of the meaning of work makes work itself more liveable and more productive. This is how health promotion contributes to the wellbeing of the individual and, at the same time, to the development of the economy and society at large.