HEALTH CARE COVERAGE
In this instance, the term ‘coverage’ means the proportion of a population receiving a needed health intervention. Examples of necessary interventions are the determination of blood acetylcholinesterase levels in organophosphorous pesticide exposed workers, the conduction of an obstetric ultrasonography in pregnant women, or the periodical monitoring of growth in children. It is obvious that the coverage depends mainly on the availability of health services and the possibility of their utilization by the potential users, which in its turn, depends on distance, costs, and users’ behaviours. Realistic estimates suggest that in typical developing regions occupational health coverage ranges from 5% to 10% at best, and that self-employed, small-scale enterprises and informal sector are usually not covered at all, whilst in the European region a wide variation among countries is reported, ranging from 5% to 90% coverage. In the agricultural sector, the high prevalence, even in developed countries, of daily paid, seasonal, or expatriate workers dramatically reduces the coverage rate. Furthermore, large sectors of the general population, in particular in developing countries and rural areas, suffer a limited access to the health care system, or even do not have any access at all.
ESSENTIAL HEALTH PACKAGES
There is therefore a growing need of interventions addressed at improving access to the health care system of the disadvantaged populations. This can be reached, having in mind the shortage of providers and services, through the optimization and a better exploitation of the existing resources and capacities. A second option is the creation of new structures in the territory, adequate to deliver the essential interventions needed. The term ‘essential interventions’ means a limited and well defined list of public health and clinical services (Essential Health Packages), necessary to fulfil local health care needs. In this light, the contents of an Essential Health Package can vary on a case by case basis, because they should be established based on local priorities, and should be delivered by adequately trained personnel at the primary and in some cases secondary care level. In this frame, it is evident the role of primary health care providers, those who represent the first contact between a citizen and the health care system, that is GPs and OH physicians. In fact, for some populations, the occupational health physician may be the only available provider of health care: this is often the case for plantation workers in tropical regions, who may have access to occupational health service at their workplace, but not to GPs. The occupational health physician may be the only available health care provider also for their families; alternatively, rural dwellers may have access to a primary care provider, but no access to occupational health at all.
OCCUPATIONAL HEALTH AND PRIMARY CARE
In this scenario, essential interventions towards increasing health care coverage can be soundly developed only by linking occupational health and primary care.
This should be done bearing in mind that since 1978 the Declaration of Alma-Ata (now Almaty) recommends bringing health care as close as possible to the places where people live and work.
The creation of a network of structures able to deliver essential interventions and improving the access to the health care system requires also a continuous collaboration between international networks on occupational health, rural health and general practice. The development of training activities for rural physicians and primary care providers to create the background knowledge needed to deal with workers’ health is urgently required—from both a preventive and diagnostic and curative point of view. The International Centre for Rural Health in Milan, Italy is developing these working lines in the frame of the WHO collaborating centres for occupational health network and is actively involved in collaboration with EURIPA and Wonca Rural Health Party.
IMPORTANT EVENTS IN RIGA (2014) AND BRESCIA (2015)
An example of this kind of collaboration is the EURIPA meeting of September 2014 in Riga, where rural GPs and Occupational Health Physicians will discuss reciprocal collaboration in improving the access of disadvantaged population subgroups in the health care system. A further chance of debate on these topics will be the International Congress on Rural Health organized by ICRH and planned in Brescia (Italy) on 8–11 September 2015.