Forewords

HEALTH PATHWAYS

The Mediterranean has been – and is, to date – a battlefi eld for hope and despair, solidarity and segregation, knowledge and prejudice. The diff erences in ancestry, culture and heritage brought by the stream of refugees from Africa and Middle East, far from being sources of growth, are cause of confl ict. While the principle of health right is repeatedly stated, the presence of striking inequalities in health status, healthcare and health promotion is dramatically apparent. This co-operative volume is based on a workshop which was focussed on one key question: what are the key actions to tackle health inequalities and improve health for people living on or moving across the Mediterranean?

The current situation regarding health and healthcare in the Mediterranean area was explored by applying the lenses of global health and public health. By the mean of a multidisciplinary discussion, the respective responsibilities for national and international agencies emerged, along with the role for lay organisations, decision makers and citizens.

Cover: Bruce Clarke ©

Sea Ghosts is an itinerant exhibition project paying tribute to migrants, victims of trans-Mediterranean human traffi cking.

“I don’t judge the reasons that push so many to migrate; somebody who fl ees risking so much, everything, is doing so for valid reasons. Can we not refocus the debate in terms of humanity to defend the necessity of giving succour to a person in distress? We want to place the public visiting the exhibits in the positions of witnesses. To say: «yes, now I know that ghosts exist»”.

Emilio Di Maria (MD, PhD) is a medical geneticist at the Department of Health Sciences, University of Genoa, Italy; visiting professor in Universities in North Africa and Middle East. His work in medical genetics has been regularly integrated with the implications of public health and technology transfer. Since the early 1990s he has been involved in a network of organisations committed to ensure health right and healthcare for migrant persons.

RESEARCH

Health right across the Mediterranean

tackling inequalities and building capacities

Edited by

Emilio Di Maria

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Edited by Emilio Di Maria

Health Pathways 1

Editorial Board:

Emilio Di Maria (Università di Genova)

Advisory Board:

Francesco Castelli (Università di Brescia)

Giuseppe Costa (Università di Torino)

Francisco José Raga Gimeno (Universidad Jaume I de Castellón, Spagna)

Ilario Rossi (Université de Lausanne, CH)

Health right across the Mediterranean

tackling inequalities and building capacities

Edited by

This book has been object of a double peer-review according with UPI rules.

is the bookmark of the University of Genoa

Print Centro Stampa

Università degli Studi di Genova - Via Balbi 5, 16126 Genova e-mail: [email protected]

Publisher

GENOVA UNIVERSITY PRESS

Piazza della Nunziata, 6 - 16124 Genova - Italy Tel. +39 010 20951558 Fax +39 010 20951552 e-mail: [email protected] e-mail: [email protected] http://gup.unige.it Printed in June 2019

The authors are at disposal for any eventual rights about published images. Copyrights are protected by law.

All rights reserved by copyright law © 2019 GUP

ISBN: 978-88-94943-50-4 (printed version)

ISBN: 978-88-94943-51-1 (e-Book) (e-Book)

Contents:

First section:

From global phenomena to individual health

Forewords

Marina Rui, Riccardo Spinelli

The health gap: social determinants and health equity

Michael Marmot

Migration at the core of public health

Santino Severoni

Health, environment, development and peace

Grammenos Mastrojeni 9 11 23 49 55 Second section:

Refl ections on health promotion, between global and local

Interlinguistic and intercultural mediation at a standstill: causes and eff ects

Francisco José Raga Gimeno

Healthcare mediation: a proposal of refl ection to foster understanding

Danilo De Luise and Mara Morelli

Exploring strategies for culturally competent health services in the Italian context: a qualitative study

Giuseppina Dell’Aversana and Andreina Bruno

Global threatens by antimicrobial resistance: are we losing the miracle drugs?

Daniele Roberto Giacobbe and Claudio Viscoli Third section:

From global reasoning to local actions for health promotion Cooperation, research and collective health practice

Rita Ferrelli

Health Technology Assessment (HTA) as a global tool for universal health coverage

Francesco Cardinale and Gaddo Flego

Humanitarian corridors: a road to life

Luciano Griso 143 161 197 131 Contributors 205 Acknowledgments 69 83 107 179 Introductory address:

The International Year of Global Understanding

Franco Montanari Introduction:

Health right across the Mediterranean, from evidence to equity – a challenge for public engagement

Emilio Di Maria

9

This foreword stemmed from the introductory address given at workshop Health

right across the Mediterranean: tackling inequalities and building capacities,

held at the University of Genova on April, 2017.

The event took place within the framework of the initiatives of the International Year of Global Understanding (IYGU) and represented another valuable contribution by the University of Genova to this celebration.

The IYGU Initiative focussed its activity on the co-operation of over 30 Regional Action Centers (RACs), with offi ces in fi ve continents. The University of Genova had set up a Regional Action Center for the whole of Italy with the purpose of promoting actions in the fi eld of research, education and communication, in line with the IYGU objectives.

International cooperation for development is a fairly new area of activity for Universities, but is progressively gaining importance within the framework of academic public engagement. This holds particularly true here, in Italy, where the new legal framework on international cooperation gives Universities an important role in the overall national cooperation system.

Consistently with the University’s mission, the workshop focussed on a very relevant topic, on which the scientifi c competence of academic scholars profi tably balanced the experiences of supranational institutions and other actors such as Non-Governmental Organisations.

Health issues – and in particular, health inequalities – associated with the migration phenomenon in the Mediterranean area are known to everyone. Notably, the thread that connects the structure of the workshop, which is built around the juxtaposition of the concepts of global and local and properly highlights the complexity of the issues that were subsequently addressed in this book.

On the one hand – from global to local – a high critical mass is certainly needed to face these problems on a global scale, as health issues are quite often global

Marina Rui, Riccardo Spinelli

10

Forewords

issues by their very nature. Hence, the key role of supranational institutions such as WHO, that can contribute to the worldwide diff usion of good practices and the coordination of global interventions.

On the other hand – from local to global – the importance of all the activities, projects, experiences that are implemented by local actors and researchers cannot be forgotten. They often generated good practices that are then leveraged on the largest possible scale. Hence, the importance of sharing the body of knowledge that is locally generated, to turn it into a common toolbox to apply very far away from where these ideas have born.

Consequently, effi cient and eff ective action against health inequalities cannot do without a continuous dialogue between the local and the global dimension. The workshop gave ample space to both dimensions, with a multidisciplinary perspective that further enhances the value of the contributions.

Riccardo Spinelli, PhD, Rector’s Delegate for International Cooperation for Development,

and