Poverty, migration and health in the age of fiscal federalism

Cittadella della Cultura
Bari, 29 April 2009

On 29 April 2009 NIHMP and the Apulia Region Health Agency organized the seminar “Povertà, immigrazione e salute…ai tempi del federalismo fiscale” (Poverty, migration and health in the age of fiscal federalism). The meeting took place in the Cittadella della Cultura in Bari, via Pietro Oreste 45. It was the first event organized by the Regional Referral Centre for Apulia of NIHMP.
Migration and poverty are not diseases, but it was demonstrated that they can worsen the health conditions of a person and make the access to health care difficult. In many developed countries, and particularly in Italy, the gap between wealthy people having access to advanced treatments and those who are excluded is increasing. The current economical crisis is making the existing inequalities more marked and the announced fiscal federalism is likely to lower the quality of regional welfare services.
In the last few years marginalized groups have been growing, also as a consequence of the presence of migrants from developing countries a situation which increases both health inequalities and social exclusion.
Migrants are the first, clear, objective of NIHMP’s mission but they are not the only people needing appropriate actions. A large part of the Italian population is confronted with serious social and economical difficulties. Interventions aimed at facilitating the access to the health services have to be carried out for those who are not able to refer to the National Health System, unaware of their rights and exposed to prejudices and difficulties.
In this context Apulia Region asks for an official and systematic action from the Institutions to support the national and international initiatives with suitable financial and human resources, according to the level of the Italian public health assistance, and in cooperation with the voluntary and non-governmental organizations.
The Apulia regional centre of NIHMP will be involved in: a. facilitating the access to health services; b. coordinating welfare activities; c. providing specialist and high-level health care; d. developing and carrying out expertise, scientific research and training.
This regional centre, whose seat is in Tatarella Hospital in Cerignola, is part of a national and international project but it has some peculiar features, i.e. migrants and other people in precarious and disadvantaged conditions do not live in peripheral metropolitan areas but are scattered in a large territory, partly rural, and characterized by different situations. NIHMP’s health policy in favour of weak and disadvantaged people can be an example for managing immigration, inclusion, protection of the migrants’ rights and dignity.
In the age of fiscal federalism the inequality conditions of marginalized and disadvantaged people risk to get worse in the different regional welfare systems. The principle of equity in health policy might be no longer respected and this might entail a revision of the distribution criteria of government’s financing, taking into account the regional deprivation indexes.