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Work is essential to people's lives and society. And, therefore, everyone's health and, in general, public health is intimately and biunivocally related to work.
In the National Health Service (SNS), it is public, there are serious problems of lack of health professionals. health, with consequences for the working conditions of employed persons and, consequently, risks for the sufficiency, safety, quality and availability of health care provided to users.
In these two perspectives, the implications for working conditions workers and, at the same time, for users, already in this journal was written how much, also for his (about) intensification, "the work has a long arm " i . to this metaphor, but in another sense, which, even with regard to the debate on the SNS, is even more interesting, even because it is less noticeable compared to the SNS.
From the point of view of the SNS's internal analysis about people and means exist the government, while admitting that there are still "many problems to be solved", says that since 2015 not only has there been a lot of investment (around 700 million euros) but there are also more hospitals, more health care, more hospital beds. And more health professionals, requiring (data from the Ministry of Health), more than 8,000: more than 3,626 doctors, 3,072 nurses, 291 senior diagnostic and therapeutic technicians and 912 professionals of the remaining professions.
(19659003) Yet from the point of view of the internal explanation, we have heard that in the years when the work of health professionals has been intensified, and the inherent consequences for users, (and, in particular, in the previous government's mandate) many professionals have left (by emigration or private sector health), as well as disinvestment in the NHS as the most recent increase in investment and of the installed capacity will not be yet
We have also heard the internal analysis of the complaint (that the government itself, in the voice of the Minister of Health, is the (19659003) But this is not the case. is especially on the external level, on the side of increasing demand, not so much on the side of the inadequacy (and / or inefficiency and ineffectiveness) of the Offer, which is meant to be here to make more visible just how " long arm of work "must (also) be (more) considered in the reflection (and action) on the SNS.
So – it will still be asked – not too much explanation "Over there", on the increased demand side for the SNS?
We have heard and read many explanations in this regard. Among others, the aging of the population, social isolation, lack of information, eating and other behaviors, lifestyles and so on.
Also, we have seen, heard and read as an explanation "a model of health policy oriented exclusively for the treatment of disease and centered on the traditional institutions of health …" ii and not oriented towards prevention.
It is precisely on this latter aspect that, from "the outside", something very "stirs" in the SNS but that of the analysis of this much has been (and continues to be) a "blind spot" iii
"What do you feel?" which, probably centuries ago, we are used to hearing all the doctors when we are sitting in front of him in the office.
Of all doctors, no. At least one was an exception. In the 17th century, in Italy, a doctor who, instead, asked the first question that usually differentiated a patient: "What does he do?" And, probably, he asked, " How do you do that? What are you doing? Where are you? When does he do it? How many? "
After more than three centuries, because of the repercussions that work has on the health of people, good and bad, this question is perhaps even more relevant than Dr. Bernardino Ramazzini, (Italy, 1633-1714) , the forerunner of occupational medicine (by studying the diseases of cloacaeiros, the workers who cleaned the street sewers, through which the garbage and the excrement flowed) 19659003] In fact, the health does not occur. is not a private affair, which depends only on genetics and individual behavior, and it also depends, and many, on the economic and social (and other) conditions in which people are born and live.
Work is essential to people's lives and to society, and therefore the health of everyone and, in general, public health is intimately and biunivocally related to work.
Yes, work may be, in principle, a condition of sustenance, d & # 39; physical and mental balance, professional and personal development, social integration. Therefore, health. Physical and mental. So it's a basic assumption that work is supporting the health of the population. But, in fact, it can also be a factor of illness and even of death.
Cancer, the second leading cause of death in Portugal after cardiovascular disease, is the one that mobilizes the NHS in people and resources
Directly or indirectly, sooner or later, many of the cancerous situations will not be born or will not be aggravated at the workplace, where, as is well known, those who closely and continuously monitor the workplaces, are daily exposed unprotected to cocktails substances, or potentially carcinogenic processes?
Respiratory diseases are the third leading cause of death in Portugal (kill more than 22,000 people a year) and are the most important
To what extent, directly or indirectly, immediately or differently, it has not occurred much to do with work, especially with the illumination of certain materials, products and processes and in environments without aerobic and thermal conditions?
They spread disabling lesions or musculoskeletal diseases that also "push" people to health facilities.
The consumption of antidepressants, sedatives and anxiolytics, indicator of a lot of psychic suffering and their effects, increases. (19659003) There is not much that will also be caused by, or will be aggravated by, the conditions of psychological pressure, (on) intensification of the work of (19459007) burnout ) , the only existing indicator of physical and / or mental hypersolicitation of people?
All the more so that such a hypersolitation of people is often silent and retracted. If it's not because of the fear of unemployment (who, from the "outside", scared and cala who works "inside"), how much is "wrapped" in sub (sub, sub, sub …) contractor, (work, organization and duration of working time and place of work), difficulty of reconciliation with family life, unbridled professional competition, individualization
It is then It is illusory to assume that projections of workers' health are "imprisoned" by law in (legal) labor relations, and do not exceed, in the sense (19659003). Of course, it surpasses, projects itself in the NHS by the express manifestation of the disease, if not in the active life of people, at least because of its delayed effect (even if hidden in the latency period of certain diseases or even in their intentional expulsion of workers so as not to suffer harm in their condition when they are still at work), lunch in (19659003) It is also illusory to assume that in Portugal, today (and almost always), companies and public administrations react to the response to policies, organization, processes, (And it's a subject for a lot more space than this modest text.)
As it's still to be, it's an illusion to assume that In fact (organically and functionally), as the law prescribes, there is a consequent (sufficient, effective and ready) articulation between health at work and health Thus, on the one hand, it is disturbing that the repercussions that work has, as it has done, on the health of people are not evident in the notification of occupational diseases.
But, on the one hand, on the other hand, it is perhaps even more disturbing that the instruments of analysis and monitoring (direct and indirect) of the NHS lack sensitivity for identify this source (occupational risks to the health and life of people)
For example, in the successive reports of the Portuguese Observatory of Health Systems (OPSS), and in particular in the last (Report of spring 2018 iv ), (19659004) v )
Poor health and safety conditions in the health system. (For example, employers and other organizations where work is done, including public administration) are, in fact, a hidden form of employers transferring to the NHS, and then to the state (c & o). Ie, to citizens as individuals and taxpayers), the human, social and economic costs of the suffering and illness of workers in some way associated with the conditions in which they work.
In fact, the conventions of the International Labor Organization and the directives of the European Union transposed into Portuguese law (through the Labor Code vi ] and other regulations ) stipulate that employers "must ensure the safety and health of workers in all aspects of work …"
It is necessary to consider how, in addition to administrative and regulatory has not been effective and consequent the taking into account of the Work in the policies, strategies, organization and means of public health, in particular in the National Service of Health
That it is at the professional level (formation, conditions and the sensitivity of health professionals, either in the context of the NHS or in the context of employers' organizations in occupational health services), q (strategies, structures, organization, theologies, means and management also oriented towards the professional valence of public health, by the respective organizational units of the NHS) or at the administrative level (skills and action of the health authorities).
Health conditions at work can not be a "dead letter" of the law or employment contract or a simple abstract and purely formal concept of administrative or judicial bureaucracy. Nor can they remain hidden in the "black box" of companies, public administrations and other organizations where the work is done.
It is in this sense and under this concern that, given the current NHS conditionality, it is relevant to consider whether the Minister of Labor is not particularly interested by what is intrinsically (non) SNS and if the Minister of Health is not particularly interested in what is (not)
Finally, it is in this sense and under this concern that we we ask if we do not feel in hospitals, health centers and other public health units how much and how "stirs" and "stirs" (and most importantly, what is it, what does it mean? is, what is it, where is it, when is it, how much it is, that is …) achieved in the In 19659055, the "Manifesto for our health, by the NHS ", July 2017
vi which is a programmatic reference, with a more substantial development in other regulations, Article 281 [function(dsid){19659056]
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