PUBLIC HEALTH – LECTURES

CAPITOLO 1 Human Health

Ancient societies recognized the need for sanitation, food safety, workers' health,
and medical care to protect against disease and promote well-being and civic
prosperity.

New energies and knowledge since the 18th century have produced landmark
discoveries, such as the prevention of scurvy and vaccination against smallpox.

The biological germ theory proved effective in developing modern public health
through sanitation and the control of infectious diseases.

In the latter part of the century, their incidence declined in response to innovative
preventive care of health risk factors, reductions in smoking, and increased attention
to hypertension, obesity, physical inactivity, unhealthful diets, and diabetes mellitus.

Health promotion proved effective to modern public health in tackling disease origins,
individual behavior, and hygienic, social, and economic conditions.

The global burden of disease patterns is changing with new infectious challenges
and the prominence of noncommunicable diseases, aging, rising costs, lack of
universal health coverage, inequities, inadequate prevention, and new health
technology and providers.

Human health is de ned not only by physical state of individuals rather it is a state of
complete physical, psychological, and social wellbeing (Brinkel et al., 2009). From:
Ecotoxicology and Environmental Safety, 2018

This de nition has evolved many times, often re ecting the speci c beliefs and the
levels of scienti c and medical understanding of that particular era.
Understanding these changes provides a context for the new de nition that is
needed in the present age.

The WHO de nition of health

• For nearly 70 years, many healthcare professionals have used the de nition of
health proposed by the World Health Organization in 1948. The WHO de nes health
as “a state of complete physical, mental and social well-being, not merely the
absence of in rmity or disease." This de nition was developed in the wake of
World War II, when the United Nations created the WHO to spark global health
initiatives for individuals all over the world to achieve “the highest possible level of
health

The effect:
• The de nition of health contained in the 1948 Preamble to the Constitution of
the World Health Organization (WHO) has generated controversy ever since.
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 • This article discusses the questions that continue to be raised about whether
this can function as a current operational de nition, and about how to interpret
references to terms such as ‘well-being,’ ‘health,’ and ‘happiness.’
• It argues that the WHO de nition should be seen as a historical document and
that it will be possible to learn from the debates that it has engendered and to
consider how people have struggled to formulate what they regard as the
most important aspects of health
• 1986, the WHO made further clari ca ons:
“A resource for everyday life, not the objec ve of living. Health is a posi ve concept
emphasizing social and personal resources, as well as physical capaci es.”
• It focused on the need to achieve well-being, which di ers from the simple lack of
disease by also incorpora ng psychosocial, behavioral, and environmental
considera ons.
• The WHO’s new de ni on of health had enormous social impact in the sense that it
challenged poli cal, academic, community, and professional organiza ons to allocate
resources in order to help achieve the lo y goal of universal well-being
Health
• A major problem with value-based care, however, is that these health
outcomes are subjective and determined by individual patient needs and
values.
• A new de nition of “health,” which incorporates a description of well-
being, speci c patient needs, and the organizational, value-based
system required to satisfy those needs, is now necessary
• PUBLIC HEALTH
• Founda onal principles:
• •Health and well-being of all people and communi es are essen al to a thriving,
equitable society.
• •Promo ng health and well-being and preven ng disease are linked e orts that
encompass physical, mental, and social health dimensions.
•Inves ng to achieve the full poten al for health and well-being for all provides
valuable bene ts to society.
• •Achieving health and well-being requires elimina ng health dispari es, achieving
health equity, and a aining health literacy.
•Healthy physical, social, and economic environments strengthen the poten al to
achieve health and well- being.
• •Promo ng and achieving the na on's health and well-being is a shared
responsibility that is distributed across the na onal, state, tribal, and community
levels, including the public, private, and not-for-pro t sectors.
•Working to a ain the full poten al for the health and well-being of the popula on
is a component of decision-making and policy formula on across all sectors.
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 Global Health: why global health is important ?
• • Global health is about achieving be er health outcomes for vulnerable
popula ons and communi es around the world. Those who study or prac ce global
health work to eliminate health dispari es in low-resource se ngs around the world
through research, educa on and collabora ve interven on.
• • While similar to public health, global health emphasizes a broad, mul disciplinary
approach to understanding emerging health challenges, considering social, cultural,
economic and environmental factors that underlie health inequi es.
• Global Health
• • Public goods
• Development
• Human rights
• Security and diplomacy
• globaliza on
• Self-interest
• Social Jus ce
• Altruism
GBD de ni on
• The Global Burden of Disease (GBD) study provides a comprehensive picture of
mortality and disability across countries, me, age, and sex.
• It quan es health loss from hundreds of diseases,
injuries, and risk factors, so that health systems can be improved and dispari es
eliminated

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 Life expectancy at birth is de ned as how long,
on average, a newborn can expect to live, if current death rates do not change.

Life expectancy at birth is one of the most frequently used health status indicators.

Gains in life expectancy at birth can be attributed to a number of factors, including

rising living standards, improved lifestyle and better education, as well as greater
access to quality health services.

This indicator is presented as a total and per gender and is measured in years.

Global Burden of Disease 2021(PAPER) : Findings from the GBD 2021 Study by
Institute for Health Metrics and Evaluation

What is IHME?
• The Institute for Health Metrics and Evaluation (IHME) was founded in
2007 with the goal of providing an impartial, evidence-based picture of global
health trends to inform the work of policymakers, researchers, and funders.
Through our work, we identify the world’s major health problems, how well
society is addressing these problems, and how leaders can best dedicate
resources to maximize health improvement.
• With initial funding provided by the Bill & Melinda Gates Foundation and the
state of Washington, IHME began with a core team of three members. Today,
more than 600 faculty and staff work at IHME. Our early work quickly gained
traction in international journals and media outlets, introducing novel
approaches to measuring disease burden and often prompting scientists to
rethink established methods. Ranging from tracking effectiveness of
vaccination programs to health nancing to maternal mortality, our research
tackled major topics in global health.

The global burden of diseases, injuries, and risk factors study (gbd) 2021
examines health trends worldwide. The study, which leverages 328,938 data
sources, reveals health disparities across age,sex, location, and socioeconomic
groups, emphasizing the impact of the COVID-19 pandemic alongside other
health challenges.

Despite the devastating impact of the pandemic, the long-term view shows
sustained global progress in reducing mortality worldwide, with life expectancy
increasing by 22.7 years from 1950 to 2021.

It predicts that global life expectancy will increase by 4.6 years in roughly three
decades. Forecasts up to 2050 suggest the potential for even greater health
improvements if key risk factors – notably exposure to particulate matter air
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obesity and metabolic syndrome – are addressed equitably, across all peoples
and places.

 CAPITOLO 2 AIR POLLUTION
a. STATE OF GLOBAL AIR (PAPER)

is a research and outreach initiative to provide accurate, meaningful, and the

latest information about air quality and its health impacts around the world.

8.1 Million total deaths due to air pollution in 2021

Globally, ambient PM2.5 levels are reducing or stabilizing in many

regions.31.3 µg/m3 average global exposure of ambient PM2.5

Key Findings
1. Global Impact of Air Pollution:
o In 2021, air pollution was linked to 8.1 million deaths, making it the second leading risk
factor for early deaths globally, after high blood pressure.
o Fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone were the primary pollutants
studied.
o Nearly 99% of the global population lives in areas exceeding WHO’s air quality guidelines for
PM2.5.
2. Exposure Trends:
o Ambient PM2.5: Global average exposure in 2020 was 31.3 µg/m³. The highest exposures
were seen in South Asia, Africa, and the Middle East.
o Household Air Pollution (HAP): Affects 47% of the global population, particularly in South
Asia and sub-Saharan Africa, due to reliance on solid fuels for cooking.
o Nitrogen Dioxide (NO2): Urban areas, particularly in high-income countries, experience the
highest levels. Linked with traf c-related air pollution.
o Ozone: Increasing globally due to emissions and rising temperatures; strongly associated with
respiratory diseases like COPD.

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 3. Health Impacts:
o Children Under 5: Air pollution was the second leading risk factor for death in this age
group, after malnutrition. It has been linked to low birth weight, preterm births, and childhood
asthma.
o Noncommunicable Diseases: Long-term exposure to PM2.5 contributes signi cantly to heart
disease, stroke, chronic obstructive pulmonary disease (COPD), diabetes, and cancer.
Climate change can exacerbate the health burden of NCDs . For example, the number of deaths
related to heart and lung diseases has been found to increase during heatwaves, which are
becoming more
common as the planet warms.
Although this trend is alarming, the ip side is that by reducing air pollution we can achieve
health gains, simultaneously helping to slow climate change, prevent pollution- related illnesses,
and curb the interactions that exacerbate the impacts of both .
Lifestyle factors such as diet, alcohol, smoking, and physical activity are key risk factors for many
NCD

o Ozone Pollution: Accounted for 490,000 deaths in 2021, primarily due to COPD.
4. Regional Disparities:
o South Asia and Africa bear the highest burden of air pollution-related diseases.
o High-income countries have made signi cant progress in reducing exposure to air pollutants
like NO2 through policy and technological advancements.
5. Progress:
o There has been a 36% decline in deaths from household air pollution since 2000, largely
due to reductions in exposure in China and South Asia.
o Some regions have seen stabilization or reduction in ambient PM2.5 levels, particularly in high-
income countries.

Key Focus on Children's Health

• For the rst time, the report provides a detailed analysis of the effects of air pollution on
children's health, emphasizing the impact of NO2 on the development of childhood asthma.
• Efforts to reduce exposure to household air pollution have led to a 35% decrease in child
deaths related to air pollution since 2010.

Links to Climate Change

• Many sources of air pollution, such as burning fossil fuels, also contribute to greenhouse gas
emissions, exacerbating climate change.
• The report highlights the interconnectedness of air pollution and climate-related events like
wild res and heatwaves, which worsen air quality.

Recommendations
• Expand access to clean energy solutions, particularly in low- and middle-income countries.
• Strengthen air quality monitoring, especially in regions with limited data (e.g., Africa).
• Adopt stricter air quality standards and policy interventions to reduce pollutant emissions.

Conclusion
Air pollution remains a critical public health challenge, affecting all age groups but
disproportionately impacting vulnerable populations, including children, the elderly, and those in
low-income regions. The report underscores the need for urgent, coordinated action to mitigate
air pollution and its health effects.

b. AIR POLLUTION 2

Air pollution isn’t always easy to spot. When wild re smoke or a truck’s
tailpipe
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 soot clogs the air, it seems obvious. But even air that looks and smells clean
can

still be polluted. Most people around the world are exposed to unhealthy
levels

of pollution — and it is taking a toll on our health.

When you breathe polluted air, the pollution can pass through your lungs

into your bloodstream. From there, it can reach your heart, brain, and other

organs. Pollution can even pass through the placenta to affect a developing

fetus. Pollution causes in ammation in your lungs and other body parts.

In ammation and other effects of pollution can permanently damage your

tissues and cause disease.

Sometimes pollution causes health problems that are noticeable right away,
but most problems build up gradually.

Exposure to air pollution, especially household air pollution, has also been

linked to infectious diseases including tuberculosis and pneumonia, as well as

cataracts.

Recent research shows that air pollution worsens COVID-19 outcomes,

including higher disease severity and higher risk of mortality linked to

COVID-19.

Increasing evidence is also linking air pollution to brain disorders, including

impact on neurodevelopment in children and neurodegenerative diseases

such as Parkinson’s disease and Alzheimer’s disease in older adults.
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 When people get sick or die early from air pollution exposure, it is devastating
for

individuals and families. At the population level, the disease burdens of air
pollution strain health care systems and have rippling effects on

communities and economies.



 Different places have different combinations of sources
and types of pollution. The type of pollution

in uences the health impacts seen in different groups of people. Major sources of
PM2.5 vary substantially by country, but key contributors include energy generation,
industry, transportation, residential fuel use, windblown dust, and agriculture.

c. Air Pollution and Health: The Global Impacts of Fossil

Fuels

Exposure to ambient, or outdoor, air pollution has been linked to a variety of poor
health effects. Breathing polluted air for a long period of time (months or years) can
make a person more likely to develop or die early from heart disease, chronic lung
diseases, lung cancer, respiratory infections, diabetes, and other health problems. It
can also make a baby more likely to be born too early or too small, which raises
their risk of other health problems. Recent studies have reported that breathing
even low levels of air pollution can result in negative health effects, and the health
risks can increase signi cantly with exposure levels.

Key air pollutants include ne particulate matter (PM 2.5 , or particles smaller than 2.5
micrometers in aerodynamic diameter, and less than a 30 th of the diameter of a
human hair), coarse particulate matter (PM 10 ), nitrogen oxides (NO x ), and ozone
(O 3 ). Among the pollutants, long-term exposure to PM 2.5 has been found to be the
most consistent and accurate predictor of poor health outcomes across populations.
In 2019, exposure to ambient PM 2.5 was linked to 4 million deaths worldwide and
reduced global life expectancy by 1 year and 8 months . In addition to the impacts
on mortality, exposure to air pollution can contribute to chronic diseases, which can
result in high healthcare costs, loss of productivity, and deterioration in quality of life.

Although 99% of the world is exposed to PM 2.5 levels above the World Health
Organization Air Quality Guidelines , the health impacts of air pollution are not
distributed evenly around the world. Explore the map below to see how levels of
PM 2.5 and associated health impacts vary around the world.

Major Sources of PM 2.5

Sources of air pollution vary across the globe; signi cant contributors include
residential fuel use, energy generation, industries, transportation, agriculture,
windblown dust, and waste combustion.

Primary sources of PM 2.5 include anthropogenic, or human-made sources such as

fossil fuel (coal, oil, and gas) combustion for energy generation and for the
transportation, industry and residential sectors; combustion of solid fuels for cooking
and heating; agriculture; waste combustion; and natural sources such as dust.
PM 2.5 can also form because of chemical reactions in the atmosphere between
emissions from sources such as agriculture, vehicles, and solvent use; this is known
as secondary PM 2.5 .
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 Some of the sources of air pollution, including combustion of fossil fuels and biofuels,
are also relevant from the climate perspective; fossil fuels are an important
contributor of greenhouse gases, and combustion of both fossil and biofuels is linked
to emission of short-lived climate pollutants (SLCPs) including black carbon.

Relative contributions of different sources to ambient PM 2.5 vary across the

globe. For example, fossil fuel combustion is a large contributor to PM 2.5 levels in
countries such as Singapore and South Africa, windblown dust is a major source in
many countries of Africa and the Middle East, and across South Asian countries,
residential fuel combustion is the largest contributor to PM 2.5

In 2019, fossil fuel combustion (including coal, oil and gas) contributed to 1.05 million
deaths (95% Con dence Interval [CI]: 0.74-1.36 million), 27% of all deaths from
outdoor PM 2.5 . The combustion of solid biofuels, such as wood or charcoal for
heating and cooking, is another major source of PM 2.5 , and resulted in an additional
740,000 deaths (20%; 95% CI: 0.54-0.99), especially across South Asia and Sub-
Saharan Africa.

Windblown dust is another major source, contributing to 620,000 deaths (95% CI:
0.44–0.80) in 2019. In some regions, especially those in proximity to deserts (e.g.,
Middle East, Sahel in Africa), experience high levels of air pollution due to sources
like desert dust or windblown dust. A review of available evidence indicates higher
risk of in ammation, and allergic lung diseases like asthma in adults and children as
a result of exposure to dust. Evidence on other health effects, including
cardiovascular mortality is growing. More .

Across the world, fossil fuels are used for energy production, residential heating and
cooking, transportation, and industrial activities. Thus, if we consider contributions to
ambient PM 2.5 and associated health impacts, we nd that anthropogenic
combustion activities, including use of fossil fuels across sectors and the use of
biofuels in the residential sector contribute to nearly 40% of the total global ambient
PM 2.5 .

Given this large contribution of fossil fuel combustion on air quality and associated
health impacts and the links to climate change, this story map focuses on data on
the impacts of fossil fuel combustion on air quality and human health. Furthermore,
combustion-related emissions can be managed through targeted interventions and
are important components of air quality management strategies.

Note that the data here are for 2019, and are taken from a global analysis. As the
energy transition gets underway in countries, and access to clean energy improves,
periodic updates will be necessary. For similar data on household air pollution
primarily linked to use of biofuels, explore Hearths and Health , a story map from
Clean Cooking Alliance.
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 The story map discusses the impact of fossil fuel combustion on air pollution and the
associated health impacts; the impacts on greenhouse gases or short-lived climate
pollutants are discussed elsewhere.

Contribution of Fossil Fuels

Combustion of fossil fuels, including coal, oil, and natural gas, contributed to more
than a quarter of all PM 2.5 -related deaths globally in 2019.

Fossil fuel combustion accounts for most of the global energy demand . Emissions
from combustion of coal and liquid fuels (i.e., diesel, gasoline, fuel oil) include
particulate matter including black carbon and polycyclic aromatic hydrocarbons,
nitrogen oxides (NO x ), sulfur dioxide (SO 2 ) and mercury. Gases such as NO x and
SO 2 can undergo chemical reactions in the atmosphere to form secondary particles
as well.

Air Pollution and Coal

Coal combustion for energy generation and industrial processes was linked to more
than 500,000 deaths, more than half of the total deaths linked to fossil fuel
combustion in 2019.

Of the fossil fuels, coal combustion has the largest contribution to global
PM 2.5 pollution and associated health impacts. This is not surprising since coal is the
most common fuel used for energy generation globally and is used in many
industries including steel, iron and cement. More than 500,000 deaths worldwide
were attributed to PM 2.5 linked to coal combustion in 2019. This large disease
burden was regionally strati ed with the largest impacts in Southern Africa, Central
Europe, and East Asia. Countries with the largest contributions to the disease burden
from coal include Eswatini (Swaziland, 43.7% of all PM 2.5 -related deaths) South
Africa (36.5%), Botswana (31.2%), Serbia (25.8%), and Bosnia and Herzegovina
(23.8%), each with nearly a quarter or more of PM 2.5 deaths linked to coal
combustion.

Indoor emissions from the combustion of coal in households was designated as a

Group I carcinogen (i.e., carcinogenic to humans) by the International Agency for
Research on Cancer. Use of coal for energy generation has also been linked
to increased risk of lung cancer. Exposure to PM 2.5 related to coal burning, and
fossil fuel combustion in general, is linked to cardiovascular diseases. Furthermore,
exposure to air pollution has been linked with respiratory infections and poor lung
function in children.

Combustion of coal contributes to both poor air quality and greenhouse gas as well
as short-lived climate pollutants’ emissions. Technologies such as scrubbers and
ue-gas desulfurization can provide some reductions for air pollutants, while carbon
capture, utilization, and storage has some potential to reduce greenhouse gas
emissions.
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Case Study- South Africa

Africa experiences some of the worst air pollution and severe health consequences.
In 2019, air pollution was the second leading risk factor for deaths across Africa,
resulting in more than one million deaths. Across Southern Africa, in countries
including South Africa, Botswana, and Zimbabwe, energy production accounted for
23% of ambient PM 2.5 exposure, resulting in almost 10,000 deaths across southern
Africa in 2019 alone.

Air Pollution from Liquid Fuels and Gas

Combustion of liquid fuels and gas was linked to more than 13% of air pollution
attributed deaths, nearly 50% of the total deaths linked to fossil fuel combustion in
2019.

Globally, liquid fuel and natural gas combustion was linked to 13.2% of PM 2.5
deaths (540,000 deaths) in 2019. In this context, liquid fuels include light, heavy, and
diesel oil used in transportation, energy generation, and other commercial and
industrial purposes. Of note, natural gas combustion is relatively less polluting
compared to coal or oil; particulate matter emissions from natural gas are also lower
compared to coal or oil . For this reason, many countries are switching from coal to
natural gas with the goal of improving air quality and reducing carbon dioxide (CO 2 )
emissions. However, while natural gas combustion does release less CO 2 , it
releases larger quantities of methane (CH 4 ), a powerful but short-lived climate
pollutant, compared to other fuels.

Similar to coal, we see signi cant regional variability in the impacts of oil and gas
combustion on air quality and health. The health impacts are largest in regions
including North America, Western Europe, and the Caribbean. For example, in 2019,
almost 25% of deaths from PM 2.5 in North America and Western Europe were due
to the combustion of liquid fuels and gas.

Case Study

Bangladesh

Historically, South Asia is among the most polluted regions in the world. In 2019, air
pollution was linked to over two million deaths across the region and accounted for
an average reduction in life expectancy by 2.6 years.

Data is crucial to informing action at a global level.

Air pollution and climate change pose a signi cant challenge to national and local
governments and public health of cials, with far-reaching implications for economies
and human well-being. The data presented here illustrate the complex interplay
between air quality, energy, and climate policies and opportunities for reducing
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 population exposures, providing public health bene ts, and mitigating climate
change.

d. How air pollution impacts our brains

there is more and more emerging evidence that especiall long-term exposure to air
pollution increase incidence and progression of Alzheimer's diseases and
Parkinson's, and other neurocognitive disease.

what we are nding from this study with enormous statistical power

is that long-term exposure to ne particulate matter increases the incidence and

hospitalization of Alzheimer's disease. It also increases the progress session

in terms of rehospitalization of Alzheimer's disease. And also we are seeing

that among people that are diagnosed with Alzheimer's, exposure to ne particulate

matter tends to increase the rate of hospitalization for all causes and also increase

risk of mortality. And the brain is, frankly, hugely dependent on the cardiovascular
system.

So if the cardiovascular system is affected, we think there could be

impacts on the brain. And I think that started--that sort of was at the origins of the
interest that maybe something's going on there.

And we do know that can absolutely happen.

But there's-- particles can generate sort of in ammatory immune effects in the
systemic

circulation that can get to the brain.

There's some ideas that the particles can get to the brain directly, actually, not just
through these secondary effects.

And more recently, there's been a lot of interest on the idea that actually when you
breathe in through your nose, you're smelling things because you've got neurons
that are sticking out in the world,exploring it that way.

And we now understand that some particles, or aspects of particles can actually

get transported directly back into the brain, so skipping the lungs and the
cardiovascular system.

So that's an almost more immediate route.I understand there's also a link to anxiety
and depression from poor air quality.

And that that's shown up in school performance too.

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 And we had about 450 of ce workers, and the same thing, we looked at indoor air
quality and these cognitive outcomes.

And this will tie into the work here.

We actually saw a link between PM 2.5,so a main component of

outdoor air pollution,and acute performance on these cognitive function tests.

So air pollution measured at your desk, most of which is coming from outside,

and these acute tests.So across all these dimensions, we have of ce workers,

university workers,kids in elementary school, high school students,

we see over and over the impacts of air pollution on the whole range of
mentalhealth, anxiety, all the way through higher order cognitive function.

the Clean Air Act 1963 (is the US’s primary federal air quality
law) intended to reduce and control air pollution nationwide. It is one of the Us’
most in uential modern environmental laws.
U.S. environmental protection agency (EPA) establish national ambient air
quality standards, to protect public health and environment.

EPA recently approved stronger standards for pollution,strengthening the annual

health-based national ambient air quality standard for ne particulate matter.

The current safety standard for long-term exposure to ne particulate matter is

an annual average of 12 micrograms per cubic meter.And the Biden
administration has recently announced that it will be lowered to 9, so three
units, which is a substantial act in terms of making it more stringent.

But why 9?

Studies have provided evidence

that there is a threshold,or what it means
is a lower level of ne particulate
matter below which there is no adverse health effect.
But there is noT data to point out that 9 is the magic number,and below 9, there
are no adverse health effects.(So it's a compromise between
the science and, I would say, the political landscape.)
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 The new pollution standards will improve air quality and begin to address the
injustices and inequities that have existed historically.
N.B (STA TUTTO NELLA QUALITY DEL BUILDING- expensive lter.)
“we can design places that actually reduce that 12 to virtually nothing if you
have good levels of ltration,good building design.= MONEY”
And we can now have the tools to clean the air indoor. But we need to make
accessible ($$$) to everybody not only to the people that can.
But they sort of targeted-- they said that the wild re signal and agricultural PM was
particularly related to the dementia, subsequent dementia.

CAPITOLO 3 ANTIMICROBIAL RESISTANCE

• Antimicrobials – including antibiotics, antivirals, antifungals, and
antiparasitics – are medicines used to prevent and treat infectious diseases in
humans, animals and plants.
• Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and
parasites no longer respond to antimicrobial medicines. As a result of drug
resistance, antibiotics and other antimicrobial medicines become ineffective
and infections become dif cult or impossible to treat, increasing the risk of
disease spread, severe illness, disability and death.
• AMR is a natural process that happens over time through genetic changes in
pathogens. Its emergence and spread is accelerated by human activity,
mainly the misuse and overuse of antimicrobials to treat, prevent or control
infections in humans, animals and plants.

ANTIMICROBIAL RESISTANCE: a global concern

• Antimicrobial medicines are the corner stone of modern medicine.The

emergence and spread of drug-resistant pathogens threatens our ability to

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 treat common infections and to perform life- saving procedures including
cancer chemotherapy and caesarean section, hip replacements, organ
transplantation and other surgeries.
• Inaddition,drug resistant infections impact the health of animals and
plants,reduce productivity in farms, and threaten food security.
• AMR has signi cant costs for both healthsystems and national economies
overall.For example,it creates need for more expensive and intensive care,
affects productivity of patients or their caregivers through prolonged hospital
stays, and harms agricultural productivity.
• AMR is a problem for all countries at all income levels.Its spread does not
recognize country borders. Contributing factors include lack of access to clean
water, sanitation and hygiene (WASH) for both humans and animals; poor
infection and disease prevention and control in homes, healthcare facilities
and farms; poor access to quality and affordable vaccines, diagnostics and
medicines; lack of awareness and knowledge; and lack of enforcement of
relevant legislation. People living in low-resource settings and vulnerable
populations are especially impacted by both the drivers and consequences of
AMR.

ANTIMICROBIAL RESISTANCE: drug resistance in bacteria

• The global rise in antibiotic resistance poses a signi cant threat, diminishing
the ef cacy of common antibiotics against widespread bacterial infections.
The 2022 Global Antimicrobial Resistance and Use Surveillance System
(GLASS) report highlights alarming resistance rates among prevalent
bacterial pathogens. Median reported rates in 76 countries of 42% for third-
generation cephalosporin-resistant E. coli and 35% for methicillin-resistant
Staphylococcus aureus are a major concern. For urinary tract infections
caused by E. coli, 1 in 5 cases exhibited reduced susceptibility to standard
antibiotics like ampicillin, co-trimoxazole, and uoroquinolones in 2020. This is
making it harder to effectively treat common infections.
• Klebsiella pneumoniae, a common intestinal bacterium, also showed elevated
resistance levels against critical antibiotics. Increased levels of resistance
potentially lead to heightened utilization of last-resort drugs like carbapenems,
for which resistance is in turn being observed across multiple regions.

ANTIMICROBIAL RESISTANCE:Drug resistance in fungi

• •As drug-resistant fungal infec ons increase, WHO is monitoring their magnitude and
public health impact. Fungal infec ons can be di cult to treat, including due to drug-
drug interac ons for pa ents with other infec ons (e.g. HIV). The emergence and
spread of mul -drug resistant Candida auris, an invasive fungal infec on, is of
par cular concern.
DRUG RESITANCE in tubercolosis
• Tuberculosis (TB) is a major contributor to an microbial resistance. Mul drug-
resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not
respond to isoniazid and rifampicin, the two most e ec ve rst-line TB drugs. MDR-
TB is treatable and curable by using second-line drugs, but these medicines are
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 expensive and toxic, and in some cases more extensive drug resistance can develop.
TB caused by bacteria that do not respond to the most e ec ve second- line TB
drugs can leave pa ents with very limited treatment op ons. MDR-TB is therefore a
public health crisis and threat to health security. Only about 2 in 5 people with drug
resistant TB accessed treatment in 2022.
• Children and the elderly are most acutely a ected.
• Young children are at signi cant risk: In 2019, 1 in 5 deaths caused by AMR occurred
in children under the age of 5 – o en from previously treatable infec ons.
• An microbial Resistance Collaborators. Global burden of bacterial an microbial
resistance in 2019
WHAT to DO?
• One Health approach
• • AMR is a complex problem that requires both sector-speci c ac ons in the human
health, food produc on, animal and environmental sectors, and a coordinated
approach across these sectors. One Health refers to an integrated, unifying approach
that aims to achieve op mal and sustainable health outcomes for people, animals
and ecosystems. It recognizes that the health of humans, domes c and wild animals,
plants and the wider environment are closely linked and inter-dependent. The One
Health approach to preven ng and controlling AMR brings together stakeholders
from relevant sectors to communicate and work together in the design,
implementa on and monitoring of programmes, policies, legisla on and research to
mi gate AMR and a ain be er health and economic outcomes.
• Measuring Infec ous Causes and Resistance Outcomes for Burden Es ma on
• • h ps://vizhub.healthdata.org/microbe/
• Discussion of quan ta ve data on septsis, bacteria and resistance in
• the world
by Ins tute for Health Metrics and Evalua on (IHME),
• University of Oxford.

CAPITOLO 4 - FOOD INSICURITY

FAO DEFINITION : A person is food insecure when they lack regular access to
enough safe and nutritious food for normal growth and development and an active
and healthy life. This may be due to unavailability of food and/or lack of resources to
obtain food. Food insecurity can be experienced at different levels of severity.
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 MALNUTRITION WHO
• Malnutrition refers to de ciencies, excesses or imbalances in a person’s
intake of energy and/or nutrients. The term malnutrition covers 2 broad groups
of conditions.
• One is ‘undernutrition’—which includes stunting (low height for age), wasting
(low weight for height), underweight (low weight for age) and micronutrient
de ciencies or insuf ciencies (a lack of important vitamins and minerals).
• The other is overweight, obesity and diet- related noncommunicable diseases
(such as heart disease, stroke, diabetes, and cancer).

State of Food Security and Nutrition in the World 2023 - Interview with FAO
Chief Economist (VIDEO)

122 million more people face hunger in 2022 than in 2019 before the pandemic
it is projected that almost 600 million people will be chronically undernourished in
2030.
The war in Ukraine sent another choke through the global economy
exacerbating the prices of food as a result the recovery observed in 2021 a
slow farther in 2022

1.INFLATION DUE TO UKRAINE AND COVID

The Global Trends in the Hunger re ected the combination of two factors
(Guerra in Ucraina e COVID) plane in opposite directions at the household level :
Prices have been affected and it had affected hunger numbers.
The resulting rise in food in poor cost, because of the increasing prices,
countries that are highly dependent on food imports (price of food ^^^^).
General in ation has also affected the poorest segments of the population who have
spent a larger share of their income on food.

2.URBANIZATION
The trend of increasing urbanization is a key factor to take into account if we want to
improve food security and nutrition.
This fenomena will change the agri-food system, rapresenting for this system :
Challenges:

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like provinding affordable healthy diets,
diffusion oF convinience pre-pared fast food which are high in fats and sugars,
malnutrition inef cience,
exclusion of small farmers from former value chains and lots of lands and natural
Capital.
Opportunities: longer more formal and complex food value chains that expand
income ($$),
generating activities in no Farm employment especially for women and youth,
increase the variety of nutritious,
possibility for Farmers to gain better access to agricultural inputs andservices as
urban areas grow closer to rural areas.

WHAT TO DO:
1. we need to integrate humanitarian development and peace building
policies where there is con ict ( building efforts must be linked to
livelihood ,social protection nutrition),
2. we need to cope with the risk of climate change. we need to scale up
climate resilience across agri-food systems by reducing climate related
risk and adapting to climate change relying on climate risk
monitoring and early warning systems and improving
3. we need to strengthen the resilience of the most vulnerable to
economic adversities which requires strengthening the agri-food
system productivity and Market linkages along the food supply chain
curving crises in food prices and excessive, price volatility , boosting
job creation and expanding social protection schemes

ALL OF THESE MEASUREMENTS REQUIRE MINIMIZAZION OF POVERTY AND

INEQUALITIES:

which require empowering vulnerable and marginalized populations reducing

General inequalities by supporting women's economic activities and ensuring a more
equitable distribution of resources.

HOW THIS INDIGENOUS FARMER IS SOLVING FOOD INSECURITY (video)

We are experiencing food insecurity globally, nationally, locally right now.
And when we encounter a new climate – especially during climate chaos,
we should reach back to our indigenous, traditional, ecological knowledge, and
approach our farming practices from that lens.
This is an example of the GOOD RAIN FARM which is located in Portland.
It is a direct-to-consumer Community Supported Agriculture (CSA) vegetable farm
with organic practices (biologico).
They share this property with 11 other operating farms. Their aim is to produce,
celebrates all forms of foods emphasizing traditional native foods and create a
connection with native communities (in order to avoid exctintion and share
tradictions).
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 PANEL DISCUSSION 'SUSTAINABLE FOOD CREATING A FOOD SYSTEM FOR
HEALTHY PEOPLE AND PLANET'. (VIDEO)

- The achievement of Global food system to meet the 1,5C° target

depends on:

a. Consumers orientd habits and diets (the people in which the food
system acts)

b. production systems changing : yields increasing ef ciency through

fertilizer implementation or reducing food loss

c. POLICY - Identi cation and use of labels, certi cations and policies,
banks insurers and investors. Institutions have an in uence in making
decisions and in uencing our food systems. So the mission and the
goals that includes pro t for businesses and at the same time
sustainable nances. Lots of institutions really care a lot about their
brand and their reputation.

Certi cations and labeling schemes create business (agribusiness)

**IMPORTANT ASPECTS: There’s a gap in the the literature data and the
biodiversity question.

- There are so many different ways of measuring that there are also many, different
ways of valuing what exactly there is.

-INFORMATION ALSO MUST BE EASY TO UNDERSTAND (EG IF I SAY CHAIR

PRODUCE 4000 eq co2 , PEOPLE NON IN THE FILED WON’T UNDERSTAND)

-A model cannot capture all the aspects, so there are some aspects that are
missing and we don’t know the conseguences

Eg. if you choose the wrong metrics

CAPITOLO 5 - Sustainability and sustainable diet

Sustainability is a mul faceted issue, in which the food produc on system and our diets play
a crucial role.
Sustainability encompasses the environment, economics, health, nutri on, and other
related dimensions. This interconnectedness can be observed in the FAO’s de ni on of
sustainable diets:
Sustainable Diets are those diets with low environmental impacts that contribute to food and
nutri on security and to healthy life for present and future genera ons.
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 Sustainable diets are protec ve and respec ul of biodiversity and ecosystems, culturally
acceptable, accessible, economically fair and a ordable; nutri onally adequate, safe and
healthy; while op mizing natural and human resources.
More than three billion people are malnourished and many of our planet’s 7 billion
inhabitants eat diets low in quality.
The world’s popula on is rapidly expanding, and it is es mated there will be close to 10
billion people on our planet by 2050
Anthropocene” is a term used to describe the current geological epoch, a me period
de ned by humanity being the domina ng driver of change in atmospheric, geologic,
hydrologic, biospheric and other earth systems.
In terms of anthropogenic ac vi es, agriculture is the largest cause of global environmental
change.
Food produc on:
1. Contributes approximately 30% of global greenhouse gas emissions, and the livestock
sector alone represents almost half (14.5%) of these emissions
2. Occupies about 40% of global land
3. Uses 70% of freshwater
4. Is the largest factor threatening species with ex nc on
5. Causes eutrophica on (nutrient overload) and dead zones in lakes and coastal areas
6. Has led to a majority (about 60%) of the world sh stocks to be fully shed or over shed
(33%) – only 7% are under shed
Global food systems are not sustainable.
We need to rethink how we eat and rethink the way we produce food in the process.
Healthy diets from sustainable food systems
In 2019, the EAT-Lancet Commission (a group of 37 scien sts from 16 countries leading
researches in human health, nutri on, economics, agriculture, poli cal sciences, and
environmental sustainability) assessed exis ng evidence and developed global scien c
targets that de ne a “safe opera ng space” for food systems.
EAT Lancet commission Target 1: Healthy Diets
Based on extensive research on foods, dietary pa erns, and health outcomes, the
Commission de nes a “planetary health diet” with consump on ranges for each food group.
Despite its name, this is not a speci c diet but rather a exible dietary pa ern that largely
consists of vegetables, fruits, whole grains, legumes, nuts, and unsaturated oils; includes a
low to moderate amount of seafood and poultry; and includes no or a low quan ty of red
meat, processed meat, added sugar, re ned grains, and starchy vegetables. According to the
Commission, global adop on of this pa ern of ea ng would provide major health bene ts,
including a large reduc on in total mortality.
EAT Lancet commission Target 2: Sustainable Food Produc on
With current food produc on driving climate change, biodiversity loss, pollu on, and
unsustainable changes in water and land use, the Commission also iden es a set of
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 boundaries that global food produc on should stay within to “decrease the risk of
irreversible and poten ally catastrophic shi s in the Earth system.” These boundaries relate
to six key earth system processes: climate change (based on greenhouse gas emissions), land
system change (based on cropland use), use of freshwater, biodiversity loss (based on
ex nc on rate), and nitrogen and phosphorus cycling (based on the applica on of these
fer lizers).
EAT Lancet commission-Ac on
Great Food Transforma on” will not happen without widespread, mul -sector, mul -level
ac on guided by scien c targets.
To begin this process, the Commission proposes ve strategies as general star ng points for
na onal, regional, city, and local change
EAT Lancet commission-Ac on
1.Seek interna onal and na onal commitment to shi toward healthy diets. Transi oning
to a planetary health diet will require global consump on of foods such as red meat and
sugar to decrease by 50%, while consump on of fruits, nuts, vegetables, and legumes must
double.
Policies are needed to improve the availability, access, and a ordability of healthy foods
while disincen vizing the consump on of unhealthy and unsustainable foods.
EAT Lancet commission-Ac on
2. Reorient agricultural priori es from producing high quan es of food to producing
healthy food.
Shi the emphasis in food and agricultural policy from high volumes of a few crops to
greater diversity of nutrient-rich crops.
EAT Lancet commission-Ac on
3. Sustainably intensify food produc on to increase high-quality output.
Use technology and system innova on to farm exis ng land with fewer inputs in order to
experience be er yields, sequester carbon, and conserve exis ng biodiversity and
ecosystem services.
EAT Lancet commission-Ac on
4. Strong and coordinated governance of land and oceans.
Protect natural ecosystems and biodiversity by collec vely ac ng, at local and global levels,
to halt the expansion of agricultural land and harvested marine areas.
EAT Lancet commission-Ac on
5. At least halve food losses and waste, in line with UN Sustainable Development Goals.
Reduce food loss and waste in food produc on and consump on phases by 50% using a mix
of technological solu ons, consumer campaigns, and public policies.
Feeding 10 Billion By 2050 Creating a Sustainable and Healthy Food Future (video
inutile)
We should focus on how we produce our food.It's not just about what kinds of food, but how
we produce it.
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Only recently we started to look at food quality and how we get people to demand food that
can be both healthy for them, and meets their cultural and religious needs.
And we should look at how you produce that food.
We should also focus on how we manage the food. (Waste management) cause we waste 40%
of the food between the farm and the table.

CAPITOLO 6
Health and income inequality: a comparative analysis of
USA and Italy (LA PORTA)
It shows that the income class determines the incidence of chronic pathologies,
associated risk-factors and psychiatric conditions, but ind striking differences in health
inequality between the two countries. We then focus our attention on a fraction of very
disadvantaged households in the USA whose income in persistently at the bottom of the
distribution over a span of 20 years and which is shown to display particularly dire
health conditions. Low income people in the USA also display comorbidity patterns that
are not found in higher income people, while in Italy income appears to be less relevant
for comorbidity. Taken together our indings illustrate how differences in lifestyle and
the healthcare systems affect health inequality.
IMPORTANT ASPECTS:
2. The life expectancy at birth of the Italian and US populations were similar in 1960
but started to diverge around 1980. Today, people in Italy have a life expectancy at
birth which is around 5 years longer than the one measured in the US population ,
even if the USA is one of the richest countries in the world,
3. We then analyzed food insecurity in the USA and observed that it is largest among
persisters (Figure 6D). Food insecurity was also correlated with obesity, since
households experiencing food insecurity had also a larger incidence of obesity
(Figure 6E). The differences in obesity could be associated to the dietary patterns in
USA and Italy (Figure 6F). By analyzing the composition of food products available in
Italy and USA, we noticed marked differences in the amount of sugar and meat which
is larger in the USA, while the fraction of cereal and grains is larger in Italy.
Furthermore, the caloric intake per capita is generally larger in the USA than in Italy.
4. The incidence of this pathology is not equally distributed throughout the population:
the persisters are signi icantly more affected than the rest of the population.
Similarly, our analysis also shows that hypertension, diabetes and cancer are
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 unequally distributed across the population. These diseases are not equally
distributed not only in USA where there is a great inequality in wealth but also in in
low- and middle-income countries (LMICs) both in adults and adolescents (27–29).
ONE IMPORTANT RISK FACTOR FOR THESE DESEASES IS RELEATED TO A
NUTRITIONALLY POOR DIET.
5. FOOD INSECURITY is not only a problem in developing countries but also in
developed countries. As our results show, levels of food insecurity in the USA are
much higher than in Italy, and are particularly prevalent in extremely poor people.
The connection with ultra-processed food is therefore related to their precarious
economic conditions

CAPITOLO 7 – MENTAL HEALTH

Where are mental disorders most common? (2021)
• The countries with the highest age-standardized prevalence rates of mental
disorders in the world are Portugal, Iran, and Lebanon. We also see high
prevalence and disability in Australia, Western Europe, and parts of the
Americas, including the US and Brazil.
• Some of the lowest age-standardized prevalence rates in the world are in
parts of Asia, like VietNam, Taiwan, and Brunei.

Alain Ehrenberg La societ della salute mentale festivalfilosofia

2024
Nel 1908 Freud discute i rapporti tra la civiltà e la malattia nervosa e attribuisce alla morale
sessuale Borghese la responsabilità delle malattie nervose che oggi vanno rapidamente
diffondendosi nella nostra società.
Osserva che i pazienti che ne soffrono appartengono spesso a famiglie di origini modeste che
hanno fatto una rapida scesa nella scala sociale e Freud rimane perplesso quando nel suo
studio pazienti affermare frasi come “ devo diventare qualcosa di meglio rispetto alla mia
orgine di provenienza.
Freud mette Dunque in luce un disagio individuale legato agli ideali sociali collettivi e
comuni di mobilità e di autorealizzazione che non erano ancora molto diffusi nella società
dell'epoca.
Psichiatri e psicologi sottolineano la presenza di nuove patologie derivanti dalle
trasformazioni che interessano l'organizzazione del lavoro, la famiglia e la scuola.

Nelle nostre società individualiste si è sviluppato un individualismo di disimpegno e

questo individualismo si manesta proprio in queste patologie narcisistiche.

Le personalità sono oggi più disorganizzate di ieri a causa di un'accelerazione della

dinamica di individualizzazione che non è più temperata né dalla coercizione sociale,
à
 che vincolava gli individui , né dal con itto psichico che li struttura (comportando la
rottura delle catene dell'obbligo sociale)

Per quanto riguarda l’indebolimento dei legami sociali e della perdita di forza della
vita :

per prima cosa bisogna smettere di confondere l'individualismo con l'egoismo o

l'utilitarismo  l'individualismo è la glori cazione non dell'io ma dell'individuo in
generale, la sua molla non è l'egoismo ma la simpatia.

Nella società moderna individualista invece la regola sociale è quella di farsi da soli,
di autorealizzarsi, nel corso della storia abbiamo assistito ad un passaggio
dall'individuo disciplinato e colpevole (quella che era nota come la nevrosi freudiana)
all'individuo autonomo che soffre meno di senso di colpa piuttosto che di incapacità
di agire .

Questa è la depressione ,questo è ciò che gli psicoanalisti hanno rilevato con le
patologie narcisistiche e i sintomi di insicurezza interiore che ruotano attorno
all'angoscia di non essere all'altezza.

La salute mentale positiva invece appare non come un ne ma come una risorsa
per affrontare i rischi dell'esistenza in una società che richiede invece un forte
autocontrollo emotivo e pulsionale per potersi realizzare nella vita.

Queste esigenze di autocontrollo danno più spazio ai disturbi della personalità vale
a dire alle dif coltà di socializzazione poiché la salute mentale riguarda la socialità
dell'individuo moderno e il suo possibile destino nella vita, ed essa chiama in causa
elementi essenziali delle società individualiste come il valore che ci diamo.
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