As housing and employment are key determinants of health, this project entails the opening of a single offi ce to provide orientation, counselling and information to resident immigrants on housing and job opportunities in the north-west zone of Florence. It supports them in securing fi rst-house mortgages, special loans and job search services in Florence Province.
One of the greatest challenges faced by the Community Health Partnership of the north-west zone of Florence has been reorienting stakeholders and the public to see health services as not only being available in hospitals and specialized centres, but also being available through different community structures and in people’s homes. Convincing partners of the cost–
effectiveness of bringing health services into the community has been one of the most diffi cult tasks of the Partnership.
Community health partnerships have managed to achieve signifi cant outcomes in different sectors – mainly social and health services, but also other sectors that act on the broader determinants of health. For instance, efforts to provide affordable
Lessons learned
Italy (Tuscany Region)
References
INAIL (2007). Accidents in merchandise transport [web site]. Rome, Italian National Insurance Institute for Work-related Accidents (http://www.
inail.it/Portale/appmanager/portale/desktop?_nfpb=true&_pageLabel=PAGE_INAIL, accessed 3 November 2008).
Ministry of Health, Health Planning Directorate General (1992). Testo aggiornato del decreto legislativo 30 dicembre 1992, n. 502 recante:
“Riordino della disciplina in materia sanitaria, a norma dell’art.1 della legge 23 ottobre 1992, n. 421” [Updated text of the legislative decree of 30 December 1992, no. 502, embodying: “Health care reform under Article 1 of the Law of 23 October 1992, no. 421”]. Rome, Ministry of Health, Health Planning Directorate General (http://www.ministerosalute.it/imgs/C_17_normativa_157_allegato.pdf, accessed 3 September 2008; in Italian).
Parliament (1978). Legge 23 dicembre 1978, n. 833: Istituzione del servizio sanitario nazionale [Act of 23 December 1978, no. 833: Establishment of National Health System]. Gazzetta Uffi ciale della Repubblica Italiana [Offi cial Gazette of the Italian Republic], n. 360 of 28 December 1978, Ordinary Supplement (http://translate.google.co.uk/translate?hl=en&sl=it&u=http://www.handylex.org/stato/l231278.shtml&sa=X&oi=translate
&resnum=1&ct=result&prev=/search%3Fq%3DLegge%2B23%2Bdicembre%2B1978,%2Bn.%2B833%2B%2522Istituzione%2Bdel%2Bserviz io%2Bsanitario%2Bnazionale%2522(Pubblicata%2Bin%2BG.%2BU.%2B28%2Bdicembre%2B1978,%2Bn.%2B360,%2BS.O.)%26hl%3Den
%26rlz%3D1T4SUNA_en___DK210, accessed 3 September 2008).
Parliament (2001). Legge costituzionale del 18 ottobre 2001 n.3: modifi che al titolo V della parte seconda della Costituzione [Constitutional Law of 18 October 2001 n.3: amendments to Title V of the second part of the Constitution]. Gazzetta Uffi ciale della Repubblica Italiana [Offi cial Gazette of the Italian Republic], n. 248 of 24 October 2001 (http://www.parlamento.it/leggi/01003lc.htm, accessed 22 October 2008;
in Italian).
Parliament (2002). Legge 30 luglio 2002, n. 189: modifi ca alla normativa in materia di immigrazione e di asilo [Act of 30 July 2002 no. 189:
changing the rules on immigration and asylum]. Gazzetta Uffi ciale della Repubblica Italiana [Offi cial Gazette of the Italian Republic], n. 199 of 26 August 2002, Ordinary Supplement (http://www.parlamento.it/parlam/leggi/02189l.htm, accessed 21 June 2010, in Italian).
Regional Council of the Tuscany Region (2001). Piano Integrato Sociale Regionale 2001 (deliberazione 5 giugno 2001 n.118) [Regional Integrated Social Service Plan 2001 (deliberation of 5 June 2001 no. 118)]. Florence. Regional Council of the Tuscany Region (http://www.rete.
tos.it/sett/polsoc/PISR2001/PISR2001.doc, accessed 21 October 2008; in Italian).
Regional Council of the Tuscany Region (2002). Piano sanitario regionale 2002–2004 (deliberazione del 9 aprile 2002 n. 60) [Regional Health Plan 2002–2004 (deliberation of 9 April 2002 no. 60)]. Bollettino Uffi ciale della Regione Toscana [Offi cial Bulletin of the Tuscany Region], no.
19 of 8 May 2002:2–262 (http://www.epicentro.iss.it/focus/piano-sani/piani-tosca/paragrafo1.pdf, accessed 21 June 2010, in Italian).
Regional Council of the Tuscany Region (2003). Atto di indirizzo regionale per l’avvio della sperimentazione delle Società della Salute (deliberazione del 24 settembre 2003 n. 155) [Regional law to start the experimentation of the Community Health Partnership (deliberation of 23 September 2003 no. 155]. Bollettino Uffi ciale della Regione Toscana [Offi cial Bulletin of the Tuscany Region], no. 42 of 15 October 2003:15–29 (http://www.sds.zonapisana.it/sdspisa/apri?legislazione, accessed 21 June 2010, in Italian).
Regional Council of the Tuscany Region (2005a). Legge Regionale 24 febbraio 2005 n. 40: disciplina del sistema sanitario regionale. [Regional Law of 24 February 2005, no. 40: regional health system regulation]. Bollettino Uffi ciale della Regione Toscana [Offi cial Bulletin of the Tuscany Region], no. 19 of 7 March 2005 (Supplement):2–58 (http://www.sds-nordovest.fi .it/nw/docdoc/lr40-2005.pdf, accessed 4 September 2008; in Italian).
Regional Council of the Tuscany Region (2005b). Legge Regionale 24 febbraio 2005, n. 41: sistema integrato di interventi e servizi per la tutela della cittadinanza sociale [Regional Law of 24 February 2005, no. 41: integrated interventions and services for the protection of social rights of citizenship]. Bollettino Uffi ciale della Regione Toscana [Offi cial Bulletin of the Tuscany Region], no. 19 of 7 March 2005: 22–42 (http://www.
sds-nordovest.fi .it/nw/docdoc/lr41-2005.pdf, accessed 4 September 2008; in Italian).
housing and adequate transportation have been implemented in a way that does not separate the community into advantaged and disadvantaged areas.
Also, the partnerships have served as mechanisms for the participation of local communities in decision-making processes. In the past two years, the involvement of labour unions, civil society and the voluntary sector in community health partnerships has been essential to the effective implementation of initiatives.
Local ownership of priorities is at the core of the community health partnerships. Because the partnerships’ activities are based on an assessment of community needs, the services provided are not a pre-assembled set imposed by a higher level of government. Rather, they are delineated, monitored and regularly adjusted to meet the specifi c health and social needs of a particular population. The membership of the Committee and the convening of the round-table consultations also further strengthen local ownership.
The Tuscany Region is currently evaluating the best legislative instruments and modalities with which to continue the experience of the community health partnerships. More specifi cally, work is being done towards a law that will effectively extend the community health partnerships to the entire Tuscany Region, where municipalities have an important role in the programmes for health and the best ways to govern them.
Valdré A, Zecchi L, Galli S (2005). Il profi lo di salute della zona fi orentina nord ovest [The health profi le of the north-west zone of Florence].
Florence, Società della Salute Nord Ovest (http://www.sds-nordovest.fi .it/nw/docdoc/Profi lo%20Salute.pdf, accessed 8 September 2008; in Italian).
WHO (2005). Constitution of the World Health Organization. Geneva, World Health Organization (http://www.who.int/governance/eb/who_
constitution_en.pdf, accessed 22 October 2008).
10. Italy (Veneto Region): integration of social and health services for immigrants – the case of Padua
Giovanna Barzon 1, Luigi Bertinato 2, Giorgio De Gobbi 3, Fiorita Luciano 1, Eleonora Martinello 3, Lorenzo Panizzolo 1 and Laura Thorogood 4
1 Social Service Department, Municipality of Padua
2 International Health and Social Affairs Offi ce, Veneto Region
3 Regional Union of the Chambers of Commerce of Veneto (Unioncamere)
4 Regional Observatory on the elderly and disabled people, Local Health Unit AUSL 12
The aim of this case study is to describe Padua’s experience in the fi eld of social and health services for immigrants. A unique aspect of this experience is the high level of integration of these services. This is based on the commitment of all the social actors (public and private) to provide services for everyone – including foreign-born people – for their health and well-being, thus safeguarding their right to health.
Padua is a city in the Veneto Region, whose capital is Venice. The Veneto Region is located in north-eastern Italy and has 4.7 million inhabitants. The economic model for the Region is characterized by: a prevalence of small and medium-sized companies; production based on traditional manufacturing sectors (such as food, textiles, shoes and wood); and decentralization of the companies within the territory. Padua, the home of one of Europe’s oldest universities, has 210 000 inhabitants and a thriving economy. Due to its economic success, Veneto is among the regions in Italy that attract the most immigrants.
According to the latest Italian National Institute of Statistics report on the foreign population living in Italy, 350 215 foreigners reside in the Veneto Region, accounting for 7.3% of its population. Padua has 58 498 resident immigrants, showing a 10.9%
increase for 2006. To respond to the social and health needs of an increasing number of immigrants, Padua has created an integrated system of services.
The main organization that provides social and health care services for legal and illegal immigrants in Padua is the High Professional Immigration Body, a part of Local Health and Social Authority No. 16. It is the result of a collaboration of institutional bodies that – with different contributions – have implemented a coordinated system of plans and activities.
Services created specifi cally for foreigners are: the Listening Centre, which provides information and health and social orientation services; a multi-ethnic unit for obstetrics and gynaecology; a unit for dermatology; and units for community paediatrics. The Municipality of Padua and Local Health and Social Authority No. 16 signed a memorandum of understanding about the management of health services for unaccompanied foreign minors. The voluntary sector in Padua also responds to the health needs of immigrants through a network of outpatient services. The implementation of such services is possible precisely because of the integration of related health and social services.
Padua’s experience with immigrants shows how the implementation of effi cient interventions for the target group comes from the creation of a system that coordinates the roles of the local actors involved. In Padua, these actors include Local Health and Social Authority No. 16, the municipality, the Veneto Regional government, the provincial government, the hospital,
Summary
Socioeconomic and policy context
The Veneto Region of Italy is situated in the north-east of the country and is divided into seven provinces. It covers 18 380 km2 and has a population of 4 773 554 people (Veneto Statistics Offi ce, 2008a). Over the last 35 years, the population has increased by more than 600 000 residents. In the Veneto Region, 350 215 foreigners are listed as legal residents, which represents a twofold increase since 2001. The Region’s resident legal immigrant population is about 12% of Italy’s total legal immigrant population, which is 2 938 922 immigrants in a total population of 59 131 287 people. Today, legally resident foreigners comprise 7.3% of the Region’s population, a percentage that is higher than the national average (4.9%) and is one of the highest in Italy, after the Lombardy and Emilia Romagna regions (ISTAT, 2008).
According to the last Italian National Institute of Statistics (ISTAT) report, Padua Municipality has 19 661 immigrants, which represent 9.35%f the overall population (ISTAT, 2008). In 2006, the foreign population increased 10.9% (ISTAT, 2008); it is the second highest increase recorded in the Veneto Region (only Venice had a larger increase: 13.8% (ISTAT, 2008)).
The Veneto Region statistical report for 2008 notes that the Region has developed economically over recent years (Veneto Statistics Offi ce, 2008b:9). According to the report, in 2005 the Veneto Region economy produced a consistent 9.3% share of the national GDP and was third in regional rankings for production of national wealth, after the Lombardy Region (20.9%) and the Lazio Region (10.9%). Between 1997 and 2007 employment in the Veneto Region increased 16%. Once again, a relevant contribution came from the foreign population.
In the past few years, the predominant countries of origin of immigrants have changed and, consequently, this has altered the composition of the foreign population in the Region. In the period 2004–2006, the number of immigrants from eastern Europe doubled, with a signifi cant rise in regularization: 48 000 new residence permits a year (including immigrants from the newer EU countries). In 2005, the largest number of immigrants obtaining their residence permits originated from the countries of central and eastern Europe (CCEE) (133 000 people, 45% of the total for the year), thus Europeanizing the process of immigration (Veneto Region Immigration Observatory, 2006).
The infl ux of immigrants is unevenly distributed over time, as characterized by duration of stay. A signifi cant proportion of immigrants, estimated at about 55 000 people, has resided in the Veneto Region for more than 10 years, whereas between 130 000 to 135 000 foreign-born people have been in Veneto for over 5 years. Also, between 20 000 and 25 000 foreigners have been in the Region for less than two years. These infl uxes involve a considerable proportion of citizens from eastern Europe (Moldovans, Romanians and Ukrainians), a proportion from Africa (especially Ghana and Morocco) and a proportion from the Balkan states (especially Albania, Montenegro and Serbia).
With the increase in the overall foreign population, the number of new foreign minors and women in the Veneto Region is worth noting. Since the early 1990s, this subpopulation has grown, which can be interpreted as a consequence of the increase in permits granted for family reasons. The overall increase in minors and women in the immigrant population demonstrates the tendency of family heads to settle and seek stabilization in Italy; at the same time, it points to an increasingly consistent establishment of a greater number of foreigners as a structural component of the population.