Zero Disease

to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else (concept of caste);

I will apply the diet regime for the advantage of the ill, according to my ability and judgement, I will spread them against anything harmful and unjust;

I will not administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion;

I will keep pure and holy both my life and my profession. I will not operate on who sufferers from stone, and will leave such practice to professionals;

“Into whatever house I enter, it will be to help the sick, and I will abstain from all intentional corruption, especially from seducing women, men, free and slaves. And whatsoever I shall see or hear in the exercise of my profession as well as outside my profession that I can hear or see regarding the life of others that should not be divulged, I shall tacite, holding such things as secrets (concept of professional secret);

I carry out this oath all the way and honour it, may I be able to enjoy the fruits of my life and of this art, forever honoured by all men; but if I transgress it and forswear myself, may the opposite befall me”.

Hygiene, from greek "salutare", is the branch of medicine that deals with health in a holistic way from its earliest conception that studies the wholesomeness of air, soil and water to its most modern conception that studies how to organize in public and private health care the health services as efficiently and effectively as possible. Hygiene has always dealt with how to prevent disease.

Democritus (460 B.C. - 370 B.C.) developed the theory of pores that came to condition the scarcity of hygiene that was found in the Middle Ages. For the school of Democritus, depending on whether the pores were open or closed, there would have been a condition respectively of relaxation or tension. According to this theory, it was necessary to try to maintain the pores naturally open with resulting attention on how to wash and on the water temperature. This concept was misinterpreted in the Middle Ages condemning water as a cause for the closure of the pores.

Fortunately, the erroneous theories of Democritus were uptaken only many centuries later (Middle Ages) while during the Greek and Roman era there was a remarkable development of hygiene. The water was the key element of Roman society that allowed the realization of impressive aqueducts passing through the streets of the empire and considerable construction of spas and saunas with an advanced water and sewage system.

The contrast to infectious diseases was conducted over the centuries especially thanks to the different hygiene techniques that, as we will see, will lead to the development of preventive medicine to the very recent predictive medicine and personalized medicine.

To fight diseases, medical facilities with a high concentration doctors and technology called hospitals, have developed over the past centuries. The modern hospital's origins can be traced back to the early twentieth century and initially it was the wealthy landowners who left a will in favor of places that dealt with poor and dying patients. These were charitable structures, almost always managed and organized by religious people.

Despite the catastrophic plague pandemics and raged leprosy and tuberculosis of the fourteenth and seventeenth centuries there was no awareness that the disease could be contagious to another living organism. The modes of transmission of infectious diseases were unknown and the most accepted theory was that odors carried the contagion, but no one knew how. In the Middle Ages there was no concept of hygiene and the sick were put on the beds with dirty sheets that was recycled without washing.

The hospital of the first industrial revolution can be traced back to the eighteenth century, a large and promiscuous operation between social and health care, where febrile patients were hospitalized with women in childbirth, psychiatric cases, surgical patients at risk of nosocomial gangrene but also the poor in need of shelter and food.

With the rise of environmental health knowledge to counter infectious diseases the pavilion hospital model began its development, built with low buildings separated from each other to avoid to a maximum contagion from one patient to another. Around 1850 began the construction of the first hospitals in pavilions that can still be seen today in the center of ancient metropolitan cities such as the Umberto I General Hospital and the San Camillo Hospital in Rome.

Gerolamo Fracastoro (1478 - 1553)

doctor, mathematician and poet, taught logic in the University of Padua. He wrote the latin poem Syphilis sive de morbo gallico (1530), which tells of a young and handsome shepherd who, having offended Apollo, is punished with a terrible ulcerative colitis. Syphilis, a venereal disease at the time newly spreading, took its name from this poem. Fracastoro was among the first to believe that epidemic diseases were transmitted by a sort of seminal entity that carries the contagion (De contagione et contagiosis morbis, 1546).

Carlo Francesco Cogrossi (1682-1769) was the first who noticed that bovine plague had living organisms that transmitted the plague, but his argument fell on deaf ears.

Edward Jenner (1749-1823) was a british naturalist and doctor, know for introducing the vaccine against smallpox and considered the father of immunization.

The use of certain molds and plants for the cure of infections was already recognized in ancient cultures- greek, egyptian, chinese - their effectiveness was due to antibiotic substances produced by the vegetale species or by the mold. However, there was no possibility to distinguish the effectively active component nor isolate it. Vincenzo Tiberio, Molisane doctor in the University of Naples, already in 1895 described the antibacterial power of some molds

.

Modern research began with Alexander Flemming’s casual on penicillin in 1928. More than ten years later, Ernst Chain and Howard Walter Florey managed to obtain antibiotics in pure form. The three obtained for their merits the Nobel Prize for medicine in 1945.

2.2. The healthcare systems: public (welfare state and Beveridge) and private (Bismark)

Bruno Corda, Angelo Barbato, Angela Meggiolaro

The welfare state is based on the principle of equality and characterizes the modern states of law. The rights and the welfare state guaranteed services are basically health care, public education and social security. The ordinances of the nations with a greater development of the welfare state also provide greater investment and programs for the defense of the natural environment and unemployment benefits (citizen income).

The health care models are essentially two: a mutualistic system (Bismarck) based on private appeal and a National Health Service (Beveridge) with public and universal vocation.

In relation to the welfare state of the post-war Europe until the 80s, four main areas can be classified: Scandinavia, Anglo-Saxon, Continental Europe and Southern Europe. Although for large schematization it can be said that historically the north of Europe as a matrix refers to the universal model (Beveridge) while continental Europe and southern historically is characterized as originally mutualistic (Bismarck).

Scientific and popular literature offer a wide variety of treaties on the History of Public Health, providing a definitely eclectic and comprehensive view on the various aspects and focus areas. In 1989, Mullan wrote about the history of public health in the US; Duffy in 1992 focused on the work of Health Care Workers; Fee in 2002 has followed a wide variety of articles on the historical aspects of public health while Warner and Tighe in 2006 have emphasized the link between Public Health and Clinical Medicine

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In ancient civilizations, public health was geared exclusively towards the protection of public hygiene. During the Roman Empire, the care of the poor sick was entrusted to archiatrists paid by the city. The creation of the first hospital-like structures dates back to the Middle Ages: they were centers who had a more charitable rather than health purpose, in fact the first institutions of its kind developed in the vicinity of bishoprics, monasteries and along pilgrimage routes

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During the Renaissance the first attempt of a systematic classification of diseases was undertaken; while during the Enlightenment took place the first investigation of diseases and of the overall health of the population. The French Revolution and the first industrial revolution (about 1760-1870 ) with the consequent urbanization, contributed to giving a strong incentive to the concept of public health.

The Health Movement has been a product of the second industrial revolution, a new approach to public health developed in England between 1830 and 1840. With the growing industrialization and urbanization, increasing awareness about the importance of personal hygiene and the human waste treatment has led as a strategic choice in the fight against infectious diseases to sanitation and removal of filth from the cities. However, as understood by Edwin Chadwick, urban cleaning in the literal sense, has become, over time, a deviant figurative meaning, and was seen as the removal of a potential health threat represented by "dangerous classes." Other European cities such as Paris and Naples followed suit, undertaking reconstruction projects on a large scale. However, these technological reforms marked an undeniable step forward for public health, often leading to the exclusion of economic and educational reforms

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The concept of Public Health, therefore, has over time expanded its scope of application and interest, taking shape first as action towards the Community for the prevention of diseases and threats to health, for the wellbeing of individuals and the population; successively reaching to include both the promotion and the protection of health

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In the eighteenth century, in Europe, the organization of Public Health was the exclusive competence of judicial and police organs with tasks limited to the management of epidemics and outbreaks.

In England, the British factory act is approved for the regulation of the workloads in factories (1833) and in 1948 the NHS (National Health Service) is founded. Doctors of Public Health were appointed: the Medical Officer of Health.

Surprisingly, it is up to America to lead the first attempt to establish a Health System of Universalistic nature, extended to the majority of the population. In 1910 C. Chapin wrote what later became the reference text of the 'Public Health', not only American.

Appearing between the lines of the ideal of a Public Health, is not only 'science and art of preventing disease' but also the promotion of a quality of life, preservation and extension of the state of health and physical efficiency. In that sense, the participatory role of the entire community becomes fundamental. In this model of 'distributed' Public Health, the community becomes, albeit with still a passive role, starring in ensuring the maintenance of adequate living standards, appropriate for the extension of health conditions. Among the main action lines of the document was education of the patient on common preventive measures, the elementary rules of hygiene, and the promotion of environmental health.

Public Health therefore becomes 'Health System', beginning to take a tangible organizational configuration and initially structured in centers of power and control and in systems of provision of health actions. Just as we will see later in the historical evolution of these public models in different countries, the inability to keep separate and distinct the commissioners’ roles (the centres of power and control) and the role of the regulator has heavily contributed to the crisis of the system.

Currently, the concept of New Public Health

is emerging, according to which health is an investment in the life of the community. The New Public Health focuses on the behavior of individuals in their environment and the conditions that influence such behavior.

The application fields of public health include not only the scientific, but also the social, cultural and political spheres.

In addition to the classic notion of disease prevention, the work of Public Health is dedicated to promoting physical and mental health of individuals. Those objectives are reflected in trying to influence the habits and living conditions, but also in promoting self-esteem, human dignity and respect.

Public Health is the set of actions undertaken by the company to improve the health of a population.

A commonly accepted classification of health systems is based on the terms of financing and is distinguished between insurance-based systems (Social Health Insurance) and tax-based systems (general taxation).

The more established Health Systems in Europe are: the Beveridge model, the Bismarck model, the Mixed model and the Semasko model.

While the last two have hybrid features, among the first two substantial differences can be identified.

The mixed model instead provides for the simultaneous presence of taxation mechanisms and forms of social insurance, providing coverage of the entire population.

The Semasko model, finally, is typical of those countries which currently or in the past decade have seen a political and social environment in transition (Central Europe and the former Soviet Union). This system is similar to the Bismarck model for the connotations related to social insurance mechanisms, even though it is funded by directly withholding tax on salary.