Salutogenesi versus paradigma prometeico della scienza medica

Salutogenesi versus paradigma prometeico
della scienza medica
Pier Paolo Dal Monte, MD
Bologna, Italy
Board member Associazione Italiana di Bioetica Chirurgica
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domenica 30 novembre 2014

Dipinte in queste rive
Son dell'umana gente
Le magnifiche sorti e progressive
G.Leopardi, La ginestra

Fonte: Jim Oeppen and James W. Vaupel Science 10 May 2002
Figure 5.1. World GDP and Population Since 1750
During the twentieth century both output and population growth increased. However,
as a result of accelerating technical progress, output growth increasingly exceeded
population growth.
Real GDP and Population
(1900 = 100)
1750
1800 1850 1900 1950 2000
Fonte: Angus Maddison, The World Economy: Historical Statistics (Paris:
OECD, 2003); 2002–2003 data: World Bank.
Growth in 50-Year Intervals
(period total, in percent)
Real GDP
Population
GDP Population
2000
1600
1200
800
400
0
700
600
500
400
300
Anatomia di un secolo
Speranza di vita alla nascita
(paesi OCSE)

1.1. Life expectancy at birth
1.1.1 Life expectancy at birth, 2009 (or nearest year), and years gained since 1960
Life expectancy at birth, 2009 Years gained, 1960-2009
Japan
Switzerland
83.0
82.3
81.8
Italy
81.8
Spain
81.6
Australia
81.6
Israel
81.5
Iceland
81.4
Sweden
81.0
France
81.0
Norway
80.8
New Zealand
80.7
Canada
80.7
Luxembourg
80.6
Netherlands
80.4
Austria
80.4
United Kingdom
80.3
Germany
80.3
Greece
80.3
Korea
80.0
Belgium
80.0
Finland
80.0
Ireland
79.5
Portugal
79.5
OECD
79.0
Denmark
79.0
Slovenia
78.4
Chile
78.2
United States
77.3
Czech Republic
75.8
Poland
75.3
Mexico
75.0
Estonia
75.0
Slovak Republic
74.0
Hungary
73.8
Turkey
73.3
China
72.6
Brazil
71.2
Indonesia
68.7
Russian Federation
64.1
India
51.7
South Africa
90 80 70 60 50 40 0 5 10 15 20 25 Source: OECD Health Data 2011; World Bank and national sources for non-OECD countries.
15.2
10.9
12.0
12.0
10.7
9.9
8.6
8.3
10.7
7.2
9.7
9.4
11.3
7.1
11.7
9.6
11.2
10.4
10.2
11.0
10.0
15.6
11.2
6.6
10.5
21.4
8.3
6.7
8.0
17.8
6.5
4.4
Source: 6.0
OECD Health Data 2011;
World Bank and national sources for
non-OECD countries
25.5
26.7
18.1
0.0
21.7
2.6
Years Years

20
18
16
14
12
10
8
6
4
2
0
17.4
Il costo della salute
12.0
11.8
11.6
11.5
11.4
11.4
11.0
10.9
10.3
10.1
10.0
9.8
9.7
9.6
9.6
9.6
9.5
9.5
9.5
9.3
9.2
9.1
9.0
8.7
8.5
8.5
8.4
8.2
7.9
7.8
7.4
7.4
7.0
6.9
6.4
6.1
5.4
4.6
4.2
2.4
Public Private
% of GDP
United States
France
Germany
Netherlands1
Canada
Switzerland
Denmark
Sweden
United Kingdom
Portugal
Austria
Belgium2
New Zealand
Greece
Norway
Iceland
OECD
Ireland
Finland
Slovak Republic
Italy
Spain
Slovenia
Japan
South Africa
Brazil
Australia
Chile
Czech Republic
Israel
Luxembourg3
Poland
Estonia
Hungary
Korea
Mexico
China
Turkey
Russian Federation
India
Indonesia
Total health expenditure as a share of GDP, 2009
OECD Health Data 2011; WHO Global Health Expenditure Database

France
Germany
Canada
Switzerland
Sweden
United Kingdom
Portugal
Greece
Norway
Finland
Slovak Republic
Japan
South Africa
Years
1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments.
2. Total expenditure excluding investments.
3. Health expenditure is for the insured population rather than the resident population.
Source: OECD Health Data 2011; WHO Global Health Expenditure Database.
Poland
Estonia
China
1 2 http://dx.doi.org/10.1787/888932526103
0
United States
Netherlands1
Denmark
Austria
Belgium2
New Zealand
Iceland
OECD
Ireland
Italy
Spain
Slovenia
Brazil
Australia
Chile
Czech Republic
Israel
Luxembourg3
Hungary
Korea
Mexico
Turkey
Russian Federation
India
Indonesia
Aspettativa di vita alla nascita e spese sanitarie 2009
JPN
ESP SWE CHE
NZL NOR
7.2.2 Total health expenditure as a share of GDP,
selected OECD countries, 2000-09
Canada
Switzerland
CHN
IDN
0 2 000 4 000 6 000 8 000
Source: OECD Health Data 2011.
Korea
United Kingdom
1 2 http://dx.doi.org/10.1787/888932526122
18
16
14
12
10
8
6
4
2
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
United States
OECD
% of GDP
Crescita 7.2.3 Annual annua average delle growth spese in real per sanitarie
capita
expenditure on health and GDP, 2000-09 (or nearest year)
Annual average growth rate in real health expenditure per capita (%)
OECD
-1 0 1 3 5
Source: OECD Health Data 2011.
1 2 http://dx.doi.org/10.1787/888932526141
11
9
7
5
3
1
0
-1
SVK
KOR
POL EST
GRC
IRL TUR
CZE
CHL
NZL
GBR
NLD
BEL
ESP FIN
CAN SVN
SWE
DNK
USA
MEX AUS
HUN
JPN
NOR
AUT
FRA
ITA DEU CHE ISL
PRT ISR
LUX
Annual average growth rate in real GDP per capita (%)
25
OECD countries.
1 2 http://dx.doi.org/10.1787/888932523253
1.1.3 Life expectancy at birth and health spending
per capita, 2009 (or nearest year)
Source: OECD Health Data 2011; World Bank and national sources for
non-OECD countries.
1 2 http://dx.doi.org/10.1787/888932523291
84
80
76
72
68
64
R² = 0.69
AUS
AUT
BEL
BRA
CAN
CHL
CZE
DNK
EST
FIN
FRA
GRC DEU
HUN
ISL
IND
IRL
ISR ITA
KOR
LUX
MEX
NLD
POL
PRT
RUS
SVK
SVN
TUR
GBR
USA
Health spending per capita (USD PPP)
Life expectancy in years
Il costo della salute
OECD Health Data 2011; WHO Global Health Expenditure Database
pro capite

L’identità culturale della medicina moderna
Il modello contemporaneo è basato sul progresso infinito
Illimitato progresso tecnologico
(senza riguardo per i costi a lungo termine)
L’ innovazione tecnologica definisce gli obiettivi della
sanità
(modifica continuamente i mezzi e i fini)
Il complesso medico-industriale guida il progresso e gli
obiettivi della medicina
Daniel Calllahan, Sustainable Medicine: Two Models of Health Care
! ! Giannino Bassetti Foundation - 2005

Il “cultural lock in”
L’identità culturale, che è una
specificità spazio-temporale,
diminuisce la possibilità di trovare
modelli o soluzioni alternative
Visione lineare
(Modello prometeico)

Il modello contemporaneo di medicina
“scientifica”
Progresso tecnico e creazione di un massiccio complesso medico-industriale
Caratteristiche:
•Terapia invece che cura (cure rather than care)
•Interventi tecnologici invece che promozione ! della !salute/prevenzione
•Maggiore attenzione alle patologie acute che a quelle croniche
•Paradigma quantitativo: durata piuttosto che qualità della vita
Daniel Calllahan, Sustainable Medicine: Two Models of Health Care
! ! Giannino Bassetti Foundation - 2005

L’aporia del modello contemporaneo
Attualmente non esiste, in nessun paese, un Sistema Sanitario
sostenibile
Aumento dellʼetà media e dei bisogni di cura
Aumento continuo del costo della tecnologia (con benefici marginali)
Se le cure non sono sostenibili non possono essere equamente
distribuite
Discriminazione di censo
Risultato
Rischio del crollo dellʼidea di Sistemi Sanitari “universali”

Tutto questo è fantastico, ma che cosa
succederà se non potremo più permettercelo?

USA, Ottobre 2013

Sostenibilità:
Legge dei ritorni marginali decrescenti
In economia, I ritorni marginali di un fattore di produzione
in genere diminuiscono con l’aumento di input del fattore
medesimo
!
David Ricardo. On the Principles of Political Economy and Taxation (1817)
Col 20% degli investimenti può essere
ottenuto l’80% di successo;
ma è necessario l’80% degli
investimenti per arrivare al 100%
Decrescita del ritorno per aumento della complessità
!! J. Tainter, The collapse of complex society 1988

Sostenibilità:
Legge dei ritorni marginali decrescenti
Produttività del sistema sanitario U.S.A. 1930-1982.
Indice di Produttività = Aspettativa di vita/ spese per la sanità
Tainter, The collapse of complex society ,1988

Il nostro modello è sostenibile?
Crisi economica
Scarsità materie prime
Sovrappopolazione
Cambiamento climatico
Disoccupazione
Guerre per le risorse
Migrazioni
Distruzione Picco del petrolio della biosfera
+$9(:(³3($.('´
Le esigenze dell’economia e quelle ecologiche sono radicalmente irreconciliabili
Probabilmente sarebbe necessaria una depressione economica mondiale di entità
catastrofica per salvare la specie umana dal rischio di estinzione
OTC 2009 Topical Luncheon
Houston, Texas
Philip Goodchild, Capitalism and religion, 2002

Il caso della Russia dopo il crollo
dell’Unione sovietica
Vladimir M. Shkolnikov, France Mesle:
The Russian Epidemiological Crisis as Mirrored by Mortality Trends
In: DaVanzo, Julie and Gwen Farnsworth. Russia's Demographic ''Crisis''.
Santa Monica, CA: RAND Corporation, 1996.

Aumento dell’aspettativa di vita
Condizioni di vita
Igiene
Alimentazione
XX secolo
Tecnologia Medica
Antibiotici
Chirurgia asettica
Tecniche anestesiologiche

Salutogenesi
this is a www.salutogenesis.net initiative
post your message at
netmembers@salutogenesis.net
Poichè la malattia è universale, ogni società umana ha
sviluppato un paradigma, una filosofia, SALUTOGENESIS
una serie di
categorie per cercare di comprenderla.
STUDYING HEALTH VS. STUDYING DISEASE
Aaron Antonovsky
Lecture at the Congress for Clinical Psychology and Psychotherapy,
Nelle moderne società industrializzate, esso si può
Berlin, 19 February 1990
definire cosiddetto “paradigma patogenetico”
Esso è alla base del complesso delle istituzioni sanitarie
The paper's point of departure is the proposal that the pathogenic paradigm which at present
dominates disease research and clinical practice in the industrialized world is of decreasing
power as we try to understand and deal with the health and illness of human beings. limitations of the paradigm are not resolved by preventive medicine or the biopsychosocial
model. Five important contrasts are presented to show that the difference between pathogenic and the salutogenic model, which posits that the great mystery is the origin health, are fundamental.
che abbiamo creato
Abstract
Aaron Antonovsky, SALUTOGENESIS: STUDYING
HEALTH VS. STUDYING DISEASE, 1990
The search for the answer to the question What explains movement toward the health end the health/ illness continuum? led to formulation of the sense of coherence concept and three components, comprehensibility, manageability and meaningfulness. The overarching

Salutogenesi
1. Come è classificato lo stato di salute delle persone?
Classificazione dicotomica (salute/malattia) piuttosto che secondo un
continuum
2. Che cosa bisogna comprendere e trattare?
Diagnosi specifica vs. valutazione dello stato di salute globale
3. Quali sono i fattori eziologici importanti?
Fattori di rischio particolari vs. “storia” globale del paziente
4. Come sono concettualizzati i fattori di stress?
Fattori inusuali e patogenetici vs fattori di ubiquitari e non direttamente
causali
5. Come trattare la sofferenza?
Guerra coi “proiettili magici” contro la malattia vs rafforzamento delle
risorse personali

Salute
Promotori di Malattia
(esogeni e endogeni)
Inibitori di malattia
(esogeni e endogeni
L’organismo umano è un sistema adattativo complesso
(Prigogine: struttura dissipativa) ed è, quindi, soggetto all’entropia
Il vero mistero non è comprendere perchè le persone si ammalano e muoiono. Il vero
mistero è capire perchè alcune persone hanno una salute migliore di altre

Salute
Uno stato di completo benessere fisico, mentale e sociale e non la
semplice assenza dello stato di malattia o di infermità. (WHO, 1948)
Carta di Ottawa (1986): requisiti fondamentali per la salute
Pace
Adeguate risorse economiche
Alimentazione
Abitazione
Ambiente di lavoro
Sviluppo personale
Comunità
Ecosistema stabile
Uso sostenibile delle risorse.
Inestricabili legami esistenti tra le condizioni socioeconomiche, l'ambiente
fisico, lo stile di vita delle persone e la salute

society, so that even among middle-class office
workers, lower ranking staff suffer much more
disease and earlier death than higher ranking staff
(Fig. 1).
Occupational class differences in life
the same people, and their effects on health
accumulate during life. The longer people live in
stressful economic and social circumstances, the
greater the physiological wear and tear they suffer,
and the less likely they are to enjoy a healthy old
age.
Policy implications
If policy fails to address these facts, it not only
ignores the most powerful determinants of health
standards in modern societies, it also ignores one
of the most important social justice issues facing
modern societies.
• Life contains a series of critical transitions:
emotional and material changes in early
childhood, the move from primary to secondary
education, starting work, leaving home and
starting a family, changing jobs and facing
possible redundancy, and eventually retirement.
Each of these changes can affect health by
pushing people onto a more or less advantaged
path. Because people who have been
disadvantaged in the past are at the greatest risk
in each subsequent transition, welfare policies
need to provide not only safety nets but also
springboards to offset earlier disadvantage.
Fig. 1. Occupational class differences in life
expectancy, England and Wales, 1997–1999
expectancy, England and Wales, 1997–1999
10
Professional
Managerial
and technical
Skilled non-manual
64
LIFE EXPECTANCY (YEARS)
Skilled
manual
Partly skilled
manual
Unskilled
manual
Men Women
66 68 70 72 74 76 78 80 82 84
OCCUPATIONAL CLASS
Donkin A, Goldblatt P, Lynch K. Inequalities in life
expectancy by social class 1972–1999. Health
Statistics Quarterly, 2002
5 . W O R K
Stress in the workplace increases the risk of
disease. People who have more control over their
work have better health.
What is known
In general, having a job is better for health than
having no job. But the social organization of work,
management styles and social relationships in the
workplace all matter for health. Evidence shows
that stress at work plays an important role in
contributing to the large social status differences
in health, sickness absence and premature death.
Several European workplace studies show that
health suffers when people have little opportunity
to use their skills and low decision-making
authority.
Having little control strongly related back pain, sickness disease (Fig. 4). independent of of the people studied. related to the work Studies have also demands. Some demands and control. and low control indicates that social be protective.
Further, receiving effort put into associated with Rewards can take self-esteem. Current may change the harder for people These results show environment at of health and contributor ill health.
Policy implications
• There is no trade-productivity established: lead to a healthier to improved opportunity productive workplace.
• Appropriate is likely to benefit organization. be developed the design and Fig. Salute
Self-reported level of job control and incidence of coronary
( opportunity to use skills and decision-making authority)
18
heart disease
4. Self-reported level of job control and
incidence of coronary heart disease in men and
women
Adjusted for
age, sex, length
of follow-up,
effort/reward
imbalance,
employment
grade, coronary
risk factors
and negative
psychological
disposition
RISK OF CORONARY HEART DISEASE (WITH HIGH JOB CONTROL SET AT 1.0)
2.5
2.0
1.5
1.0
High Intermediate Low
JOB CONTROL
Bosma H et al. Two alternative job stress models and risk of coronary heart
disease. American Journal of Public Health, 1998

Beale N, Nethercott S. Job-loss and family morbidity: a study
of a factory closure. Journal of the Royal College of General
Practitioners, 1985, 35:510–514.
Bethune A. Unemployment and mortality. In: Drever F,
Whitehead M, eds. Health inequalities. London, H.M.
Stationery Office, 1997.
Burchell, B. The effects of labour market position, job
insecurity, and unemployment on psychological health.
In: Gallie D, Marsh C, Vogler C, eds. Social change and the
experience of unemployment. Oxford, Oxford University Press,
1994:188–212.
Ferrie J et al., eds. Labour market changes and job insecurity:
a challenge for social welfare and health promotion.
Copenhagen, WHO Regional Office for Europe, 1999 (WHO
Regional Publications, European Series, No. 81) (http:
//www.euro.who.int/document/e66205.pdf, accessed 15
August 2003).
Iversen L et al. Unemployment and mortality in Denmark.
British Medical Journal, 1987, 295:879–884.
Source of Fig. 5: Ferrie JE et al. Employment status and health
after privatisation in white collar civil servants: prospective
cohort study. British Medical Journal, 2001, 322:647–651.
Socioeconomic deprivation and risk of dependence on
alcohol, nicotine and drugs, Great Britain, 1993
KEY SOURCES
can make an important contribution to job
security and the reduction of unemployment.
• Limitations on working hours may also be
beneficial when pursued alongside job security
and satisfaction.
Fig. 8. Mortality from coronary heart disease in
relation to fruit and vegetable supply in selected
European countries
KEY SOURCES
Fig. 7. Socioeconomic deprivation and risk of
dependence on alcohol, nicotine and drugs, Great
Britain, 1993
Diet, nutrition and the prevention of chronic diseases. Report
of a Joint WHO/FAO Expert Consultation. Geneva, World
Health Organization, 2003 (WHO Technical Report Series, No.
916) (http://www.who.int/hpr/NPH/docs/who_fao_expert_
report.pdf, accessed 14 August 2003)
First Action Plan for Food and Nutrition Policy [web pages].
Copenhagen, WHO Regional Office for Europe, 2000 (http:
//www.euro.who.int/nutrition/ActionPlan/20020729_1,
accessed 14 August 2003).
Roos G et al. Disparities in vegetable and fruit consumption:
European cases from the north to the south. Public Health
Nutrition, 2001, 4:35–43
Systematic reviews in nutrition. Transforming the evidence on
nutrition and health into knowledge [web site]. London,
University College London, 2003 (http://
www.nutritionreviews.org/, accessed 14 August 2003).
World Cancer Research Fund. Food, nutrition and the
prevention of cancer: a global perspective. Washington,
DC, American Institute for Cancer Research, 1997 (http:
//www.aicr.org/exreport.html, accessed 14 August 2003).
Source of Fig. 8: FAOSTAT (Food balance sheets) [database
online]. Rome, Food and Agriculture Organization of the United
Nations, 25 September 2003.
WHO mortality database [database online]. Geneva, World
Health Organization, 25 September 2003.
Health for all database [database online]. Copenhagen, WHO
Regional Office for Europe, 25 September 2003.
Policy implications
Local, national and international government
agencies, nongovernmental organizations and the
food industry should ensure:
• the integration of public health perspectives
into the food system to provide affordable and
nutritious fresh food for all, especially the most
vulnerable;
• democratic, transparent decision-making and
accountability in all food regulation matters,
with participation by all stakeholders, including
consumers;
• support for sustainable agriculture and food
production methods that conserve natural
resources and the environment;
• a stronger food culture for health, especially
through school education, to foster people’s
Mortality from coronary heart disease in relation to fruit
and vegetable supply in selected European countries
900
800
700
600
500
400
300
200
100
0
Greece
Ukraine
Belarus
Russian Federation
Lithuania
Poland
Germany
France
Spain
100 150 200 250 300 350 400 450
AGE-STANDARDIZED DEATH RATES PER 100 000 MEN AGED 35–74
SUPPLY OF FRUIT AND VEGETABLES (KG/PERSON/YEAR)
knowledge of food and nutrition, cooking skills,
growing food and the social value of preparing
food and eating together;
• the availability of useful information about food,
diet and health, especially aimed at children;
• the use of scientifically based nutrient reference
values and food-based dietary guidelines to
facilitate the development and implementation
of policies on food and nutrition.
United Kingdom
Italy
21
Alcohol
Nicotine
Drugs
FAOSTAT (Food balance sheets) [database online]. Rome, Food and
Agriculture Organization of the United Nations, 25 September 2003.
Fig. 5. Effect of job insecurity and unemployment
on health
Unemployed
RISK OF ILL HEALTH (WITH SECURELY EMPLOYED SET AT 100)
Long-standing illness
Poor mental health
EMPLOYMENT STATUS
Securely
employed
Insecurely
employed
300
250
200
150
100
50
0
debts and increasing social networks.
Effect of job insecurity and unemployment on health
Ferrie JE et al. Employment status and health after
privatisation in white collar civil servants: prospective cohort
study. British Medical Journal, 2001
KEY SOURCES
Bobak M et al. Poverty and smoking. In: Jha P, Chaloupka F, eds.
Tobacco control in developing countries. Oxford, Oxford University
Press, 2000:41–61.
Makela P, Valkonen T, Martelin T. Contribution of deaths related to
alcohol use of socioeconomic variation in mortality: register based
follow-up study. British Medical Journal 1997, 315:211–216
Marsh A, McKay S. Poor smokers. London, Policy Studies Institute,
1994.
especially in the case of tobacco, efforts by governments to use limit consumption.
Policy implications
• Work to deal with problems illicit drug use needs not only treat people who have developed patterns of use, but also to of social deprivation in which rooted.
• Policies need to regulate pricing and licensing, and about less harmful forms education to reduce recruitment people and to provide effective services for addicts.
• None of these will succeed that breed drug use are left to shift the whole responsibility clearly an inadequate response. victim, rather than addressing of the social circumstances use. Effective drug policy supported by the broad framework economic policy.
Meltzer H. Economic activity and social psychiatric disorders. London, H.M. Stationery Surveys of Psychiatric Morbidity in Great Ryan, M. Alcoholism and rising mortality British Medical Journal, 1995, 310:646–Source of Fig. 7: Wardle J et al., eds. Smoking, activity and screening uptake and health et al, eds. Inequalities in health. Bristol, 213–239.
DEPRIVATION SCORE
RISK OF DEPENDENCE (WITH MOST AFFLUENT SET AT 1)
Most
affluent
Most
deprived
10
9
8
7
6
5
4
3
2
1
0
0 1 2 3 4
Wardle J et al., eds. Smoking, drinking, physical activity and
screening uptake and health inequalities. In: Gordon D et al,
eds. Inequalities in health. Bristol, 1999
Salute

Processo economico (nel mondo reale)
Processo termodinamico
Flusso di materia ed
energia a bassa entropia
Metabolismo sociale
Flusso di materia ed energia ad alta
entropia (inquinamento, rifiuti)

Che cos’è la ricchezza?
La ricchezza (wealth) non è altro che
materia ed energia in forme utilizzabili
dagli uomini e dal metabolismo sociale

Economia astratta e “mondo fisico”
Conflitto inevitabile tra concezione economica
che richiede crescita esponenziale e mondo fisico
La crescita del consumo di materia/energia ha limiti finiti
mentre la crescita monetaria (che è un’astrazione )
non ne ha alcuno

Ricchezza reale e virtuale
La ricchezza reale (i beni) obbedisce alle leggi della
termodinamica
Il denaro è un’unita di misura simbolica che può essere
creata dal nulla e distrutta a piacimento
Non si può contrapporre un’assurda convenzione come
l’incremento spontaneo del debito (interesse composto) alla
legge naturale dello spontaneo decremento della ricchezza
(entropia)
Frederick Soddy

Alimentazione
Valore d’uso
Proprietà nutrizionali
Proprietà organolettiche
Impatto ambientale

Suggerimenti per la sostenibilità
• Privilegiare il Trasporto di persone e merci per nave e ferrovia
(in ordine decrescente: acqua, ferro, asfalto)
• Modificare la catena distributiva alimentare e prediligere il
cibo prodotto nelle vicinanze (filiera corta)
• Favorire l’agricoltura biologica poichè necessita di minori
apporti di combustibili fossili
• Limitare la produzione globalizzata che richiede il trasporto
delle merci per migliaia di chilometri
Matthew P. Simmons, Banchiere e consigliere strategico per l’energia di G.W.Bush

Dieta vegetariana e dieta mista
L’energia fossile necessaria per una dieta mista è
circa il doppio di quella necessaria per una dieta
vegetariana

!
!
…..E così anche il tempo

L’impatto delle proteine animali
Più della metà dei cereali prodotti negli USA (40% nel
mondo) usata per alimentazione animale (323 MT)
Pimentel and Pimentel,Food, Energy, and Society, CRC Press 2008)
Consumo cereali pro capite USA (1997): 1015 Kg
116 consumo diretto, 615 alimentazione animale, 100
produzone birra, più altri usi (dolcificanti, melasse, ecc)
Consumo cereali pro capite nel mondo (1997): 345 kg
160 consumo diretto, 185 altri usi
M. Giampietro,Multi-scale integrated analysis of agro-ecosystems, CRC Press
2004

!
Il “costo” delle proteine animali

Consumo idrico nella produzione di alimenti
!
(traspirazione)

Un concetto più ampio di “prevenzione”
Globalization, Climate Change, and Human Health
Anthony J. McMichael, M.B., B.S., Ph.D. N Engl J Med 2013
Undertaking primary prevention at the source to reduce health risks
resulting from these global influences is a formidable challenge.
It requires conceptual insights beyond the conventional understanding
of causation and prevention, as well as political will, trust, and
resources.
For populations to live sustainably and with good long-term health,
the health sector must work with other sectors in reshaping how
human societies plan, build, move, produce, consume, share, and
generate energy.

Il paradigma patogenetico è sempre meno efficace nel
cercare di comprendere e trattare la malattia cronica.
Le limitazioni di questo paradigma non sono risolte
neppure dalla medicina preventiva o dal modello
psicosociale
Aaron Antonovsky, SALUTOGENESIS STUDYING

Antonovsky “Sense of coherence”
Sense of coherence: Percezione di pienezza di significato
della propria vita
Maggiore è il “sense of coherence” di una persona, più essa
sarà in grado di far fronte agli invitabili fattori patogenetii
dellaesistenza
Il SOC è possibile soltanto in una società che favorisca
l’autonomia, la creatività, l’equanimità, il calore nelle relazioni
umane, la dignità e il rispetto delle persone
Aaron Antonovsky, SALUTOGENESIS STUDYING

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