The evolution of the Italian National Health Service.

40 years ago, Italy saw the birth of a national, universal health-care system (Servizio Sanitario Nazionale [SSN]), which provides a full range of health-care services with a free choice of providers. The SSN is consistently rated within the Organisation for Economic Co-operation and Development among the highest countries for life expectancy and among the lowest in health-care spending as a proportion of gross domestic product. Italy appears to be in an envious position. However, a rapidly ageing population, increasing prevalence of chronic diseases, rising demand, and the COVID-19 pandemic have exposed weaknesses in the system. These weaknesses are linked to the often tumultuous history of the nation and the health-care system, in which innovation and initiative often lead to spiralling costs and difficulties, followed by austere cost-containment measures. We describe how the tenuous balance of centralised versus regional control has shifted over time to create not one, but 20 different health systems, exacerbating differences in access to care across regions. We explore how Italy can rise to the challenges ahead, providing recommendations for systemic change, with emphasis on data-driven planning, prevention, and research; integrated care and technology; and investments in personnel. The evolution of the SSN is characterised by an ongoing struggle to balance centralisation and decentralisation in a health-care system, a dilemma faced by many nations. If in times of emergency, planning, coordination, and control by the central government can guarantee uniformity of provider behaviour and access to care, during non-emergency times, we believe that a balance can be found provided that autonomy is paired with accountability in achieving certain objectives, and that the central government develops the skills and, therefore, the legitimacy, to formulate health policies of a national nature. These processes would provide local governments with the strategic means to develop local plans and programmes, and the knowledge and tools to coordinate local initiatives for eventual transfer to the larger system.

A Short History of Occupational Safety and Health in the United States.

As this short history of occupational safety and health before and after establishment of the Occupational Safety and Health Administration (OSHA) clearly demonstrates, labor has always recognized perils in the workplace, and as a result, workers' safety and health have played an essential part of the battles for shorter hours, higher wages, and better working conditions. OSHA's history is an intimate part of a long struggle over the rights of working people to a safe and healthy workplace. In the early decades, strikes over working conditions multiplied. The New Deal profoundly increased the role of the federal government in the field of occupational safety and health. In the 1960s, unions helped mobilize hundreds of thousands of workers and their unions to push for federal legislation that ultimately resulted in the passage of the Mine Safety and Health Act of 1969 and the Occupational Safety and Health Act of 1970. From the 1970s onward, industry developed a variety of tactics to undercut OSHA. Industry argued over what constituted good science, shifted the debate from health to economic costs, and challenged all statements considered damaging.

Health as an independent predictor of the 2017 French presidential voting behaviour: a cross-sectional analysis.

BACKGROUND: It has been suggested that poor health has influenced vote for Brexit and the US presidential election. No such research has been published regarding the 2017 French presidential election. METHODS: We performed a cross-sectional analysis using a comprehensive set of socioeconomic and health indicators, to be compared with voting outcome at the first round of the 2017 French presidential election. The 95 French departments were selected as the unit of analysis. Data were obtained from publicly available sources. The linear model was used for both univariate and multivariate analysis to investigate the relation between voting patterns and predictors. Sensitivity analyses were done using the elastic-net regularisation. RESULTS: Emmanuel Macron and Marine Le Pen arrived ahead. When projected on the first factorial plane (~ 60% of the total inertia), Emmanuel Macron and Marine Le Pen tended to be in opposite directions regarding both socioeconomic and health factors. In the respective multivariate analyses of the two candidates, both socio-economic and health variables were significantly associated with voting patterns, with wealthier and healthier departments more likely to vote for Emmanuel Macron, and opposite departments more likely to vote for Marine Le Pen. Mortality (p = 0.03), severe chronic conditions (p = 0.014), and diabetes mellitus (p < 0.0001) were among the strongest predictors of voting pattern for Marine Le Pen. Sensitivity analyses did not substantially change those findings. CONCLUSIONS: We found that areas associated with poorer health status were significantly more likely to vote for the far-right candidate at the French presidential election, even after adjustment on socioeconomic criteria.

Unit 731 and moral repair.

Unit 731, a biological warfare research organisation that operated under the authority of the Imperial Japanese Army in the 1930s and 1940s, conducted brutal experiments on thousands of unconsenting subjects. Because of the US interest in the data from these experiments, the perpetrators were not prosecuted and the atrocities are still relatively undiscussed. What counts as meaningful moral repair in this case-what should perpetrators and collaborator communities do decades later? We argue for three non-ideal but realistic forms of moral repair: (1) a national policy in Japan against human experimentation without appropriate informed and voluntary consent; (2) the establishment of a memorial to the victims of Unit 731; and (3) US disclosure about its use of Unit 731 data and an apology for failing to hold the perpetrators accountable.

Two more nurses enter parliament.

The nursing presence in parliament increased last month after two nurses were elected to the House of Commons.

An Asymmetrical Network: National and International Dimensions of the Development of Mexican Physiology.

This article examines the history of Mexican physiology during the period 1910-60 when two noted investigators, José J. Izquierdo, first, and Arturo Rosenblueth, second, inscribed their work into an international network of medical research. The network had at its center the laboratory of Walter B. Cannon at Harvard University. The Rockefeller Foundation was its main supporter. Rosenblueth was quite familiar with the network because he worked with Cannon at Harvard for over ten years before returning to Mexico in the early 1940s. Izquierdo and Rosenblueth developed different strategies to face adverse conditions such as insufficient laboratory equipment, inadequate library resources, a small scientific community, and ephemeral political support. Both acquired local influence and international prestige, but the sources of financial and academic power remained in the United States. This case study provides insight into the circulation of scientific ideas and practices in an important Latin American country and suggests that the world's circulation of science among industrial and developing nations during the mid-twentieth century was intrinsically asymmetric but opened temporary opportunities for talented individuals and groups of researchers.

Firm-Led Malaria Prevention in the United States, 1910-1920.

In the absence of capable government services, a railroad company in Texas and multiple cotton mills in North Carolina successfully prevented malaria in the early twentieth century. This Article looks through the lens of economics to understand how and why people had the incentive to privately coordinate malaria prevention during this time, but not after. These firms, motivated by increases in productivity and profit, implemented extensive anti-malaria programs and used their hierarchical organizational structures to monitor performance. The factors underlying the decline of private prevention include a fall in the overall rate of malaria, the increasing presence of the federal government, and technological innovations that lowered exposure to mosquitoes. Understanding how, why, and when firms can prevent diseases has important implications for current disease policy, especially where governments, international organizations, and technologies are not enough.

Woodrow Wilson's hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy.

World War I catapulted the United States from traditional isolationism to international involvement in a major European conflict. Woodrow Wilson envisaged a permanent American imprint on democracy in world affairs through participation in the League of Nations. Amid these defining events, Wilson suffered a major ischemic stroke on October 2, 1919, which left him incapacitated. What was probably his fourth and most devastating stroke was diagnosed and treated by his friend and personal physician, Admiral Cary Grayson. Grayson, who had tremendous personal and professional loyalty to Wilson, kept the severity of the stroke hidden from Congress, the American people, and even the president himself. During a cabinet briefing, Grayson formally refused to sign a document of disability and was reluctant to address the subject of presidential succession. Wilson was essentially incapacitated and hemiplegic, yet he remained an active president and all messages were relayed directly through his wife, Edith. Patient-physician confidentiality superseded national security amid the backdrop of friendship and political power on the eve of a pivotal juncture in the history of American foreign policy. It was in part because of the absence of Woodrow Wilson's vocal and unwavering support that the United States did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless without American support and was unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the United States assume its global leadership role and realize Wilson's visionary, yet contentious, groundwork for a Pax Americana. The authors describe Woodrow Wilson's stroke, the historical implications of his health decline, and its impact on United States foreign policy.

The 1965 White House Conference on Health: inspiring the physician assistant movement.

The 1965 White House Conference on Health brought together the best minds and the boldest ideas to deal with the nation's pressing health provider needs. The Community Health Clinics Act and the Duke University physician assistant (PA) program were among the many initiatives announced at this conference. The authors explore the conference proceedings, link them with other historical documents and events, and suggest that this conference was a contributing factor to the contemporary PA movement.

McGovern's Senate Select Committee on Nutrition and Human Needs versus the meat industry on the diet-heart question (1976-1977).

For decades, public health advocates have confronted industry over dietary policy, their debates focusing on how to address evidentiary uncertainty. In 1977, enough consensus existed among epidemiologists that the Senate Select Committee on Nutrition and Human Need used the diet-heart association to perform an extraordinary act: advocate dietary goals for a healthier diet. During its hearings, the meat industry tested that consensus. In one year, the committee produced two editions of its Dietary Goals for the United States, the second containing a conciliatory statement about coronary heart disease and meat consumption. Critics have characterized the revision as a surrender to special interests. But the senators faced issues for which they were professionally unprepared: conflicts within science over the interpretation of data and notions of proof. Ultimately, it was lack of scientific consensus on these factors, not simply political acquiescence, that allowed special interests to secure changes in the guidelines.

History and evolution of warning labels for automotive friction products.

There have been claims over the years that asbestos-containing product manufacturers did not sufficiently warn end users early enough regarding the potential health hazards associated with their products (1930s-1990s). To address this issue, we compared the content of the warnings associated with asbestos-containing friction products (brakes, clutches, and gaskets) manufactured by the US automotive industries to what was expected by regulatory agencies during the time period in which an understanding of asbestos health hazards was being developed. We ended our evaluation around 1990, since asbestos-containing manufacturer supplied automotive products were functionally removed from commerce by 1985 in the United States. We assessed the warnings issued in users' manuals, technical service bulletins, product packaging materials, and labels placed on products themselves. Based on our evaluation, regulatory agencies had no guidelines regarding specific warning language for finished friction products, particularly when a product contained encapsulated asbestos fibers (i.e., modified by a bonding agent). Even today, federal regulations do not require labeling on encapsulated products when, based on professional judgment or sampling, user exposure is not expected to exceed the OSHA PEL. We concluded that, despite limited regulatory guidance, the US automotive industry provided adequate warnings with regards to its friction products.

Did Hurricane Sandy influence the 2012 US presidential election?

Despite drawing on a common pool of data, observers of the 2012 presidential campaign came to different conclusions about whether, how, and to what extent "October surprise" Hurricane Sandy influenced the election. The present study used a mixed correlational and experimental design to assess the relation between, and effect of, the salience of Hurricane Sandy on attitudes and voting intentions regarding President Barack Obama and Mitt Romney in a large sample of voting-aged adults. Results suggest that immediately following positive news coverage of Obama's handling of the storm's aftermath, Sandy's salience positively influenced attitudes toward Obama, but that by election day, reminders of the hurricane became a drag instead of a boon for the President. In addition to theoretical implications, this study provides an example of how to combine methodological approaches to help answer questions about the impact of unpredictable, large-scale events as they unfold.

Governing multicultural populations and family life.

Shortly after coming to power in Britain, the Conservative-Liberal Democratic alliance placed family life at the heart of their political agenda, and set out their plans to reform adoption. The paper draws upon debates about the reforms and considers them in articulation with concerns about health of the nation expressed in political pronouncements on 'broken Britain' and the failures of 'state multiculturalism'. The paper considers the debates about domestic (transracial) and intercountry adoption, and uses feminist postcolonial perspectives to argue that we can only understand what are expressed as national issues within a transnational and postcolonial framework which illuminate the processes of state and institutional race-making. The paper analyses three key instances of biopower and governmentality in the adoption debates: the population, the normalizing family and the individual. The paper argues that we need to understand the reforms as part of a wider concern with the 'problem' of multicultural belonging, and that the interlocking discourses of nation, family and identities are crucial to the constitution and regulation of gendered, racialized subjects.

The Medicines Center and pharmaceutical care during the civil-military dictatorship (1970-1974). / A Central de Medicamentos e a assistência farmacêutica na ditadura civil-militar (1970-1974).

The present article analyzes the formation of the first pharmaceutical care policies implemented by the Brazilian Federal Government between 1968 and 1974, during the civil-military dictatorship. It examines a set of measures adopted by the Costa e Silva and Médici governments to contain a continuous rise in the prices of raw materials and pharmaceutical specialties, with this context being essential to the creation of the Medicines Center (CEME) in 1971. The core argument of the article is that CEME represented, at the federal level, the consolidation of a policy carried out at the National Institute of Social Security (Instituto Nacional da Previdência Social - INPS) between 1968 and 1970, based on the production of inputs and medicines in public laboratories. Ended in 1970, this policy was resumed the following year with broad participation of military personnel and laboratories of the Armed Forces. The originality of this article lies in its explanation of how such support influenced the establishment of CEME in its early years. Until 1974, military members were the majority in the Board of Directors of CEME, with some of the agency's early missions being the supplier for Civil-Social Actions of the Armed Forces.

O artigo analisa a formação das primeiras políticas de assistência farmacêutica executadas pelo Governo Federal brasileiro entre 1968 e 1974, durante a ditadura civil-militar. Examina um conjunto de medidas adotadas pelos governos Costa e Silva e Médici para conter uma contínua elevação nos preços de matérias-primas e especialidades farmacêuticas, sendo este contexto fundamental para a criação da Central de Medicamentos (CEME), em 1971. O argumento central do artigo é o de que a CEME representou a consolidação, em âmbito federal, de uma política realizada no Instituto Nacional da Previdência Social (INPS) entre 1968 e 1970, baseada na produção de insumos e medicamentos em laboratórios públicos. Encerrada em 1970, esta política foi retomada no ano seguinte com ampla participação de militares e laboratórios das Forças Armadas, sendo a originalidade deste artigo explicar como tal apoio influiu na montagem da CEME em seus primeiros anos. Até 1974, os membros militares eram majoritários na Comissão Diretora da CEME, sendo algumas das primeiras missões da autarquia o abastecimento de Ações Cívico-Sociais das Forças Armadas.