Re-starting from a social-ecological approach to health
The Covid-19 pandemic, being an “extraordinary” event, has led to a serious crisis of the “ordinary”: of medicine (and its established certainties) and of the healthcare system (and especially its sclerotic practices).
The emergency has hit our lives like an unexpected storm. Not because a pandemic was not expected – pandemics are cyclical – but because the power of science and technology had given us an illusion of invincibility. The very idea of death seemed to have been dismissed, banished, to some extent defeated. As Gordon pointed out, medicine had offered us the illusion that «humans can overcome nature, no longer a victim, but in the omnipotent driver’s seat» (1).
Death and illness, however, have returned with force to mark our days through the bulletins that arrive from the territories and inform us of new cases, admissions to hospital and intensive care, and deaths. The Covid-19 pandemic reminded us that «the radical autonomy projected in western society is a social construct, aided greatly by naturalism and biomedicine» (1).
As to healthcare organisation in Italy, the pandemic has highlighted the limits of a structure of services focussed on highly technological hospital care, rather than on primary care, and in general too much oriented towards therapy and very little towards prevention activities. The pandemic has brought to the forefront the central role of communities – meant as groups of people who live or work together, or who share relationships, interests, and habits – and of community institutions (families, associations, informal networks, etc.), in taking care of patients. On the whole, we can say that Covid-19 has highlighted the limits of an approach to care and health that may go unnoticed by those who are generally in good health and come into contact with the service system in a sporadic and occasional manner, but that has already negatively affected those categories of people who were in a particularly fragile condition: the chronically ill, the elderly, immigrants and ethnic minorities, the homeless. And it pointed the way to reorient the health system from “cure” to “care”.
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