This pandemic has certified the need to rethink the way in which the State, Regions and Municipalities must take care of the well-being of their citizens. In fact, it is necessary to review how local medicine manages to reach private homes and how it interacts with the territory; and how the latter should be rethought to better respond to the health needs of the citizens who live there. On the other hand, if the response to the pandemic were a play, it could only be Pirandello’s, characterized by existential paradoxes that slowly sink into the tragic. After all, one year later, everyone agrees on one element: the Covid emergency in Italy has certified the absence of that network of prevention and health care widespread and rooted in the territory that could have saved many lives.
To confirm this, we are offered the testimony of the many doctors, nurses and hospital staff who have tried, and still try, to contain the umpteenth wave. They are the ones who tell us how the heroic hospitals are working tirelessly, while the structures for prevention, the notorious territorial and preventive medicine, are still struggling to get into gear, or, worse still, respond to logics with evident organizational and planning limits.
And to say that among all the potential pandemics that have threatened humans in recent years, Covid is perhaps the least serious, at least from a clinical point of view. Mers, Sars and Ebola, in fact, have much higher mortality rates, but a lower contagiousness, which in fact made them more manageable. And it is therefore precisely by virtue of the lower lethality of SarsCov2, but its greater speed of propagation, that it is necessary to retrace the stages of the year that has just greeted us to understand what went wrong.
In fact, SarsCov2 was able to benefit from at least three accelerators. The first was the change in lifestyles made possible by globalization, which has favored a greater flow of people from one continent to another and has allowed the virus to spread faster. The second, on the other hand, is to be found in the ineffectiveness of the containment plans established at central and local level. And finally, the last accelerator, as well as probable zero point of transmission, was the environment in which the virus has spread the most, namely those cities rich in relationships, exchanges, meetings, which are a favorite place of contagion. Those same cities in which, to be honest, there were already other health problems, which reappear, for example, cyclically whenever the European Union fines us for exceeding fine particles.
And this is why we must ask ourselves: what can we do to stem future pandemics, emergencies and the growing expectations of the population on health issues?
A first response could be to make the immune system of our cities and municipalities stronger in the area. It is therefore necessary to integrate the hospital system with one of local health and social assistance, which must therefore be built and enhanced through a presence on the territory, which does not correspond exclusively to new physical and building institutions but which must really provide for innovative and home intervention systems . We need to design a system that has the tools, resources and professional figures capable of reaching all those homes and people who need assistance. In fact, overcoming the concept that it is the patient who goes to the place of treatment and not vice versa.
It is therefore necessary to design an agile healthcare, not only telematic, but made up of people prepared and equipped to reach where there is need, even house by house, a bit like Amazon does. In the Recovery Plan, telematic medicine is mentioned, which certainly is needed, but it is also necessary to understand how to really strengthen the network of operators in the area, otherwise the workload will always weigh on the current poorly designed structures.
It is then necessary to carry out a real professional training of the health personnel employed in the territory and with it a total revision of the role and figure of the general practitioner. In this way, the filter between the request for assistance of citizens and the functions of hospital emergency rooms, which has disappeared during the current pandemic, could be made more effective. On the other hand, it is only by reinforcing, but above all by rethinking the role of local health units as a whole, that we could have those “antibodies” of the first line necessary to prevent new problems for the overall health system.
But in addition to rethinking how local health should be understood and organized, it is also necessary to rethink the urban space and therefore the structure of our cities, to make them more congenial to the health and well-being criteria of their citizens, as suggested by Stefano Capolongo in the Sole 24. Hours. It is in fact necessary to place the concept of urban health at the center of the organization criteria of urban planning, thus placing concrete attention on the expansion of green areas in cities, together with a rethinking of city spaces, which introduces and facilitates new ways of move and that incentives and promotes lifestyles more oriented towards physical and psychological well-being. It is also on this, that is, on the ability of the city to offer a model “in health”, that the competition between metropolises will be played out.
It is very true, economic well-being is central to the functioning of any contemporary society, but it is still subordinate to the physical and psychological one, and the current pandemic has demonstrated this. For this reason Italy, thanks to the Recovery Fund, finally has the possibility to invest its money (on loan) to make concrete all those projects that put the well-being of its citizens at the center, in all its forms. Without a spending plan that knows how to look to the future, capable of rethinking entire sectors of society, setting itself the ambitious and necessary goal of uniting areas hitherto understood as distant as that of health care and urban planning, there is a risk of throw to the wind an unrepeatable and perhaps the last opportunity, at least for the present generation and the one to come. Awareness of new problems should lead to the search for truly innovative solutions. Did we get it or not?
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