Costa Giuseppe, Marra Michele, Salmaso Stefania
Dipartimento di scienze cliniche e biologiche, Università degli studi di Torino, Roma.
Epidemiol Prev. 2012 Nov-Dec;36(6):337-66.
to estimate for the first time in Italy the consequences of the national current economic crisis on health and on social determinants of health, assessing its impact on a set of distal determinants (development and economic wellbeing, labour and environment) and of prossimal ones (material, psychosocial, professional, environmental and behavioural risk factors) on health care performance and on health outcomes normally related to economic trends, as self-perceived health, depression, number of suicides attempts, road traffic incidents and work injuries. The analysis is therefore aimed at identifying the most promising entry points in order to plan and implement either health care and other policies to tackle the negative effects of crisis on health.
using the main international and national references on the measure of wellbeing and on the role of social determinants, this paper draws a conceptual framework of all the connections between recession and health. For each mechanism identified, it examines the value of the main available indicators before and during the crisis in order to measure its impact, adjusting if possible for the trend observed in the previous years. Indicators have been selected according to their availability in the main Italian national informative sources and, when not possible, circumscribing the analysis to the regional or local level.
regarding the short term impact, results have shown an association between the recession and the raise of mental health related problems (measured in terms of number of suicides, depression and substance misuse), especially on the most disadvantaged groups because of their higher job and financial insecurity. A first ex-ante impact assessment on long term effects allows to attribute almost two hundred deaths a year due to the increase of unemployment rate. Regarding the budget cuts on public expenditure of the health care sector, significant reductions have been shown in specialist care and in drug prescriptions, associated with the increase of co-payment and with a stronger effect on the most vulnerable socioeconomic groups. Nevertheless the crisis does not seem to be associated with a reduction of indicators of quality, continuity and outcomes of the health care, at least in the considered clinical pathways (diabetes and maternal and child health). At the same time the crisis seems to be associated with the reduction in the rate of injuries in the workplace (although it has been observed an increase of the serious ones) and car crashes, probably explained by the reduction of industrial production and of household consumptions.
the conceptual framework seems to be the appropriate tool to set an Italian surveillance system for assessing the short and medium term impact of crisis on health, in particular the health of the most disadvantaged groups, mainly focusing on unemployed which are the most vulnerable target.
首次在意大利评估当前国家经济危机对健康及健康的社会决定因素的影响，评估其对一系列远端决定因素（发展与经济福祉、劳动力与环境）以及近端决定因素（物质、心理社会、职业、环境和行为风险因素）对医疗保健绩效和通常与经济趋势相关的健康结果的影响，如自我感知健康、抑郁、自杀未遂次数、道路交通事故和工伤。因此，该分析旨在确定最有前景的切入点，以便规划和实施医疗保健及其他政策，以应对危机对健康的负面影响。
利用关于福祉衡量和社会决定因素作用的主要国际和国内参考文献，本文绘制了衰退与健康之间所有联系的概念框架。对于确定的每种机制，研究危机前和危机期间主要可用指标的价值，以衡量其影响，并尽可能根据前几年观察到的趋势进行调整。指标根据其在意大利主要国家信息来源中的可得性进行选择，若无法获取，则将分析限定在区域或地方层面。
关于短期影响，结果显示衰退与心理健康相关问题的增加（以自杀、抑郁和药物滥用次数衡量）之间存在关联，尤其是对最弱势群体，因为他们的工作和经济不安全程度更高。对长期影响的首次事前影响评估显示，由于失业率上升，每年有近200人死亡。关于医疗保健部门公共支出的预算削减，专科护理和药物处方出现了大幅减少，这与自付费用的增加以及对最脆弱社会经济群体的影响更大有关。然而，至少在所考虑的临床路径（糖尿病以及母婴健康）中，危机似乎与医疗保健质量、连续性和结果的指标下降无关。同时，危机似乎与工作场所受伤率（尽管严重受伤有所增加）和车祸的减少有关，这可能是由于工业生产和家庭消费的减少所致。
该概念框架似乎是建立意大利监测系统的合适工具，用于评估危机对健康的短期和中期影响，特别是最弱势群体的健康，主要关注最易受影响的目标群体——失业者。
