Primary care Italian style

Abstract

During the period 6-12 December 1981 I visited the Centre for Social Medicine, Giugliano, Italy, to study the health and welfare activities carried on there. The centre was established in 1974, in the local authority area of Giugliano (population 180,000), a suburb of Naples. The province of Naples is located in the Campania Region, and it is this regional level which was given respotasibility in I978 for reorganization of the Italian national health service. Each local authority is now assisted by the region in establishing a basic health and welfare unit, with a unified approach to public health and prevention. The .principal arm of the new service is the ' mother and child centre, one of which is intended to be established for each 10,000/persons or less. This may seem a straightforward and familiar exercise, but the way in which the service is being developed is extraordinary, at least by European standards. Since the Giugliano Centre for Social Medicine was established prior to the 1978 changes, it has had its own approach from the beginning. The Centre now constitutes the basic health and welfare unit for the locality. It is situated in a deprived sector of southern Italy, which is itself one of Europe's least-developed regions. There are therefore problems of grossly unequal distribution of wealth, mass immigration from the countryside, and unemployme.nt, together with the violence and social marginalization which result f rom these forces. The severe earthquake of last winter has added to the difficulties. All these problems have combined to produce social, medical and psychological damage to the population. The services at the centre are designed to recognize these effects.