The impact of the COVID-19 pandemic has been severe in Italy, particularly in the northern region of Lombardy. Spring Magazine spoke with Stefano Agnoletto, an Italian historian and economist, about how health policies in the years before the pandemic undermined emergency response, and how workers have fought back.
Canada already has overcrowded hospitals after decades of cuts, and people are very worried we will face a health crisis like in Italy. What was the state of the public health system before coronavirus, how did that contribute to the current crisis, and have there been demands to expand public healthcare?
In 1978 the National Health System (NHS) was born in Italy. A universal model of health protection for all. The NHS was the result of years of mobilizations and struggles for the right to health. In 1981, three years after the birth of the NHS, there were about 530,000 beds in Italian hospitals. In 2017 there were approximately just 215,000 beds. In addition, the burden of private health has increased significantly at the expense of public health. What has happened in Italy since the 1990s has been a process of systematic demolition of the NHS with privatizations, corporatization of public health and regionalization of the national system
An exemplary case is what happened in Lombardy, the richest region in Italy, but also the one most dramatically affected by the Coronavirus. In Lombardy, 40% of health expenditure goes to the private sector. The growth in the role of the private sector has produced the following effects on the health system of Lombardy, making it weak in the face of the Coronavirus pandemic:
- Systematic reduction of the preventive medicine network.
- Transformation of territorial public health structures into health companies managed with private logic public and private logic conflict: the private person gains if people get sick while the public makes savings if people don’t get sick. They are two alternative logics. Unfortunately, not only the private sector has increased, but the public has also moved more and more with a private logic. the private sector does not invest in first aid and on emergency and intensive care departments because they are sectors with low profit margins. This explains why in Lombardy territorial and intensive care medicine was unprepared for the arrival of the Coronavirus.
- Private health care invests in specialist surgery and chronically ill patients because they are the sectors with the greatest profit.
- Until a few years ago in Lombardy most healthcare facilities had emergency departments, while in the private sector these sectors are present in less than half of the facilities.
- In summary, in Lombardy the Coronavirus has found a favourable system due to the privatization and corporatization processes.
Media around the world called Coronavirus a “Chinese virus“, and the far right have been using the pandemic to scapegoat the Chinese community. Italy banned flights from China but now has the most cases outside of China. How did xenophobia affect the initial response to coronavirus, and what kind of anti-racist responses have there been?
I believe that in Italy two phases can be identified. Until February 22 and the first case of officially infected Italian (in Codogno in Lombardy) there were phenomena of anti-Chinese racism. After the context has changed and indeed China is often represented as a model to follow. The fact that various medical aids came from China also contributed. Clearly, some political areas try to exploit rampant racism even in this dramatic phase. For example, asking not to land immigrants arriving across the Mediterranean because “now we have to help the Italians.”
Many countries are closing schools without implementing childcare, and there have been reports that this may have contributed to infections among Italian elders. What are your thoughts?
In Italy the closure of schools, especially in Lombardy, preceded the closure of the workplace and this may have been one of the causes that favored the spread of the virus. Many children have been entrusted to grandparents resulting in the intergenerational transmission of the virus.
Quarantines and lockdowns can mean workers losing their wages or jobs, or having intense pressures at work. Workers in the US have won some access to paid sick days, and this is an ongoing demand across Canada. What was the state of workers rights in Italy prior to coronavirus, and how are workers in Italy responding to the crisis–including those prevented from working, and those under intense pressure to work like in hospitals.
The problem is that the Italian labor market had already undergone a process of mass insecurity in recent decades. In this situation, a battle is difficult to defend the rights of all. Three aspects can be identified:
- One aspect involved the battle to stop work in nonessential companies at the time of the Coronavirus crisis, in order to protect workers and avoid new infections. The associations of large entrepreneurs (Confindustria) have done everything to continue production even in situations of high risk for workers.
- A second aspect concerned the battle to ensure safety devices for workers who continued to work (for example in hospitals). Unfortunately hundreds of doctors, nurses and other health workers have died. Many of them were sent to work without protection. An exemplary case is represented by residences for the elderly where thousands of guests have died and thousands of workers have become infected.
- A third aspect concerns the battle to ensure workers’ rights, in particular the continuity of income and no layoffs. Here a problem that is being sought is the defense of hundreds of thousands of workers who do not have permanent contracts, or are self-employed. Unfortunately, the impact of neoliberalism on the Italian labor market in recent decades has made many workers weaker in times of crisis like the one we are experiencing.
Is there anything else learned from the Italian experience with coronavirus so far, both the health crisis and the response, that the left in Canada should know?
I want to highlight one aspect: Italy (and Lombardy in particular) has paid for the deconstruction of the public health system. The privatization and corporatization of the NHS meant the reduction of prevention and made the system unprepared for Coronavirus. Private health care is structurally inadequate to deal with these crises because it focuses on the treatment of a single disease, not on prevention and intensive care. Furthermore, the centrality of profit also in the NHS has disarmed us against Covid 19. This is despite the splendid work that doctors, nurses and all workers in the health system are doing every days. They are struggling for all despite a system destroyed by decades of neoliberalism.
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