An important goal in the recent history of Italian public health was achieved with the “Guadagnare salute” (“Gaining health”) action plan, approved through a decree of the Prime Minister on 4 May 2007, in agreement with the Independent Regional and Provincial Governments. “Gaining health: encouraging healthy choices” is, as the subtitle itself explains, an action plan whose main objectives are to prevent and change unhealthy conducts; these are the main risk factors for major non-communicable diseases, which have the highest epidemiological relevance and strongest impact on public health: cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory pathologies, disorders of the muscle-skeletal and gastro-intestinal system, mental health problems.
This initiative, therefore, should be assessed both as a long-term investment to reduce the incidence of chronic diseases on the national health system and on society, but also as regards its short-term advantage of attempting to improve the citizens’ lifestyle by immediately promoting healthy choices and correct lifestyles (stop smoking, follow a correct diet, limit the alcohol intake and exercise regularly). With this new culture of prevention, all individuals become protagonists and accountable for the quality of their life.
The international framework
Within the European framework, “Guadagnare salute” is an integral part of the chronic disease prevention and control strategies for the “Gaining health”, promoted by the WHO in autumn 2006. On an international level, the WHO Action Plan 2008-2013 on non-communicable diseases (pdf 58 kb) defines the objectives and actions which need to be implemented over a period of six years, from 2008 to 2013, as well as setting performance indicators as regards the work done by WHO nationally and internationally, with specific reference to low and medium-income countries.
Read the description of the WHO action plan for the prevention and control of non-communicable diseases.
The action plan areas
Chronic diseases, according to WHO, account for 86% of deaths, 77% of the healthy life years lost and 75% of health expenses in Europe and in Italy; there are two underlying risk factors: those which cannot be modified (such as age, gender and family history for a pathology) and those which can be modified by changing lifestyles or through medication (for example unhealthy diet, smoking, alcohol abuse and lack of exercise).
The strategy of “Guadagnare salute” (a transversal government programme) is based on the four changeable risk factors and major determining factors for the most frequent chronic diseases, by identifying four subject areas (or specific programmes):
- promoting healthy eating patterns (as regards the risk factor “inappropriate diet”)
- counteracting smoking (as regards the “smoking” risk factor)
- counteracting alcohol abuse (as regards the “alcohol” risk factor)
- promoting exercise (as regards the “sedentary lifestyle” risk factor).
An essential element in the Gaining health plan is communication which is a basic component of the prevention actions in the sense that it is an important knowledge and information tool for professionals and the general public.
The plan is developed across three institutional communication areas:
- specific plans for each action
- an information campaign geared towards citizens’ choices for their health and encouraging governments to make healthy choices possible
- a specific programme in collaboration with schools.
Watchword: working across the board
“Gaining health” indicates strategies across the board, based on actions which involve several social sectors and institutions, with specific actions to counteract smoking and alcohol abuse as well as to promote exercise and a healthy diet, through close cooperation among all institutions and social organisations involved. Such an approach results from the awareness that most of the effective actions to prevent risk factors and promote healthy lifestyles are implemented outside the national health system. In order to act appropriately on the environment-related elements and socio-economic causes of chronic diseases it is necessary to join forces, working together in a coordinated way.
One of the main aspects of Gaining health is indeed, collaboration among the various Ministries.
National platform on diet, exercise and smoking
With the ministerial decree of 26 April 2007 (pdf 270 kb) the former Ministry of Health established the national Platform on diet, physical activity and smoking with the task of making suggestions and implementing actions, in line with the "Gaining health" plan. The Platform is a three-year project supervised by the Ministry of Health, involving representatives of the central authorities involved, of the independent regional and provincial governments of Trento and Bolzano and of the associations which signed the protocols of agreement.
The Platform, in view of the changed political structure being reviewed, involved:
- Ministry of Health
- Department for Family Policies of the Council of Ministers’ Presidency
- Department for Rights and Equal Opportunities of the Council of Ministers’ Presidency
- Department for Youth Policies and Sports of the Council of Ministers’ Presidency
- Ministry for Agricultural, Food and Forestry Policies
- Ministry of Education
- Ministry for Economic Development
- Ministry for Economics and Finance
- Ministry of Transport
- Ministry for the Environment and Protection of Land and Sea
- Conference for Relations between State, independent Regional and Provincial Governments of Trento and Bolzano
- National Association of Italian Municipalities (Anci)
- Advanced Health Institute (Iss)
- Advanced Institute for Prevention and Safety on the Workplace (Ispesl)
- National Research Institute on Food and Nutrition (Inran)
- Independent Regional and Provincial Government of Trento and Bolzano
- Trade associations in the food sector
- Consumers’ associations
- The most representative national trade unions, which have signed specific protocols of agreement with the Ministry of Health
- Associations of independently-chosen General Practitioners and Paediatricians.
Protocols of agreement
The inter-ministerial action plan “Guadagnare Salute” was underwritten on 3 May 2007 when the protocols agreement were signed between the former Minister of Health Livia Turco and the representatives of 22 trade union, business and association entities. These agreements are signed with a view to developing concrete initiatives for the population and they are not a point of arrival but rather steps in a continuously developing process, whose goal is a radical change of approach, based on the assumption that a correct lifestyle leads to a good quality of life.
Protocols of agreement have been signed with:
- Ministry of Education (read the protocol of agreement)
- Ministry for Agricultural, Food and Forestry Policies - Inran (read the protocol of agreement, pdf 140 kb)
- Ministry for Youth Policies and Sports (read the protocol of agreement)
- Manufacturers and public service Managers (read the protocol of agreement with the Italian national railways)
- Local health units (read the protocol of agreement with the Company Villa Luisa and the Lecce local health trust)
- Local entities (read the protocol of agreement with sport promotion Organisations)
- Human resource managers in the private and public sector (read the protocols of agreement with associations, companies and trade unions)
- Bread makers’ associations. Read the protocols of agreement with Fip (pdf 966 kb), Assipan Confcommercio (pdf 1 Mb), Assopanificatori Fiesa Confesercenti (pdf 832 kb) and Aiipa (pdf 3,3 Mb).
The projects in support of "Gaining health"
Ccm promotes the plan “Guadagnare salute” through a set of projects, based on the expected action areas. Some of these projects, in line with the inter-sector approach, are “transversal” to the four subject areas concerned.
- "Pane, sale e salute", information about the agreement with bread makers’ associations for the gradual reduction of the salt content in bread
- "Gestione delle malattie non trasmissibili", regarding the guidelines of WHO Europe for policy-makers “Gaining health. Analysis of policy development in European countries for tackling non-communicable diseases”
- the pages dedicated to Gaining health on the website of the ministry for Labour, Health and social policies: apart from general information it includes interesting documents as regards regulations, protocols of agreement, projects, etc
- the Formez website – health section: it includes an actual database of local experiences as regards the prevention of the main risk factors for chronic diseases
- in the EpiCentro website: focus on Guadagnare salute and the broad chronic disease topic.