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The new public health imposed and its missing links - people, cultures, anthropology, health for all

Abstract Critical medical anthropology has been active throughout the decades (Baer, Susser, Singer 1986; Lock, Nichter, 2002; Lupton, 1995. 2000, 2015) in proving that public health is not only an addition to equations of equity in health care but rooted in cultures of people globally (Špoljar Vržina 2003, 2007, 2008; 2011, 2013, 2021; Špoljar Vržina, Rudan, 2009). Italian anthropologist codified the postmodern 'doing good only in states of emergencies' (Pandolfi, 2010). In times of Corona Covid 19 -2020 epidemiological freights we are urged to take this further into account, especially since witnessing racial stigmatizing on the basis of ethnicity and nationality. Paradoxically, Italy as one of the cradles of quarantines is facing the potential permanent closure of neighbouring borders rather than experiencing a historically practiced cooperation, as in the case with Croatia, over centuries (Blažina, Blažina 2015). If there should be a New Public Health (Baum 2016, 2019; Lupton 1997, 2000) it should be recalibrated by anthropological findings that re- focus towards the good of people, cultures and their cooperation. The work of this paper presents this urgent challenge. This anthropological research is a long-term follow up of Croatian medicine system dismantling (Špoljar Vržina, 2008 onwards) through a continuous analyses of micro (people), intermediary (governmental) and macro (international) changes (Bear et al. 1986), departures from functioning for the benefit of people and finding entry points for ethical corrective interventions. The analysis proved an existing switch of the public health paradigm from global health into states of neoliberal sickness, with clear possibilities of returning to 'health for all' if disengaging from the politics of culture/public health. Public health enhancements need to be based on the recalibration towards knowledges of populational and cultural realities. Key messages Reintroducing the ‘innovative’ wisdom of doing good for all regardless of emergencies is the core of a new public health agenda. The new public health agenda is based on recognizing cultures as pillars of communities and global societies that matter.


Background:
Home care and hospices are gaining higher importance in providing end-of-life care. The main aim of this study is to investigate clinical decisions of healthcare professionals in north-eastern home-care services and hospices caring for patients in their end-of-life. Moreover, the study aims to study nurses' and physicians' opinions on palliative care.

Methods:
A questionnaire was administered to healthcare personnel in 5 homecare services and 2 hospices in a regional health service trust in north-eastern Italy. The questionnaire is made of three parts: the first deals with clinical decisions for the last patient who died, the second investigates opinions on terminal care, while the last collect data on participants. Results: 42 subjects have been enrolled, most of them are nurses, 64,1% without bioethics training and 53,8% without palliative care training. All the End-of-Life Decisions (DEL) were ''nontreatment'' decisions. None of the participants discussed the potential life-shortening effect with the patient. The involvement of patients' relatives in terminal care was meaningful for 86% of the professionals. The participants reported they usually discuss terminal issues only when patients or relatives ask for them, but palliative care seems to be the most discussed care-related topic.

Conclusions:
Comparison with previous studies can't be performed because of the small number of participants. DEL were exclusively ''non-treatment''. We found relevant data about options of shortening life, which was not discussed at all. Mainly only the professionals who give great importance to patient's religious beliefs discussed spiritual themes with them. Finally, the professionals trained in palliative care were more comfortable starting to talk to patients about the possibility of receiving palliative care.

Key messages:
This study investigates clinical decisions taken by professionals in home-care and hospices in terminal ill patients care and professionals 'opinions on palliative care. Communication on palliative care (PC) has been widely investigated: professionals trained in PC were more comfortable starting to talk to patients about the possibility of receiving PC.
The virus and its images -Metaphorical genealogy of the risk society The research has the challenge of building a genealogy of the images produced within the risk society and establishing a relationship between the concept of risk and the imaginary. As a theoretical framework, we will have Gilbert Durand's theory unrolled in the Anthropological Structures of the Imaginary. As a corpus of analysis, we will make a case study regarding visual representations of the risks, specifically, of diseases caused by viruses such as HIV, SARS, H1N1, Ebola and Coronavirus. In the study the concept of risk will be analyzed in a broad way, from a philosophical, communicational and anthropological reasoning of the term, to an instrumental conceptualization for the field of Risk Communication. For that, we will analyze constellations of images that metaphorically represent the risks and their effects. One of these effects are narratives and practices produced by the risk society that least caution about hazards, and that, however, act in the production of chronic, stigmatized and punitive subjectivities, as Vaz (2019) predicts. One of the strategies is to consider the metaphor not only as an ornament or as something that moves the sense from one place to another. The metaphor will be observed as a producer of truths. The concept of risk is thus perceived by theorists such as Beck, Giddens and Douglas as a form of normalization that became a kind of microphysics that acts in all areas of everyday life. This contemporary form of normalization is significant in the process of oppression and identification where the relationship and life management change significantly.

Key messages:
To make a scientific conceptualization for an ethic of the Communication of Risk in the contemporaneity having as a foundation the imaginary produced by the visual metaphors that describe the viruses. This study has as a challenge to know the relationships between the concept of risk and imaginary that can collaborate in the development of prevention practices in the field of Communication. Critical medical anthropology has been active throughout the decades (Baer, Susser, Singer 1986;Lock, Nichter, 2002;Lupton, 1995Lupton, . 2000Lupton, , 2015 in proving that public health is not only an addition to equations of equity in health care but rooted in cultures of people globally (Špoljar Vržina 2003(Špoljar Vržina , 2007(Špoljar Vržina , 20082011, 2013, 2021Špoljar Vržina, Rudan, 2009

Background:
Chile has a high prevalence of obesity (PO), and this has increased even more in recent years. Public health interventions have not impacted, probably because a geographic distribution of the cases at a lower level is unknown. We described the geographic distribution and change of obesity at a sub-regional level in Chile, and to identify targets areas/ groups for interventions.

Methods:
We did a secondary analysis of the latest two National Health Surveys (2009,2016), using Regions and Health Service (HS) levels, which are the second and third administrative division of Chile, respectively. HSs were the smallest geographical unit possible to analyze with this data. Logistic regression models were fit to test differences between sex, age, number of children, family income, educational level, regions, and HS, using the lowest value of each variable as the reference group, adjusting by sex and age.

Results:
At the national level, PO increased from 25% to 34% from 2009 to 2016. The southern regions have the highest PO in 2016 (Los Rios: 45%, Aysen:44%, Araucania:42%), and the lowest PO is even more than 30%. Although, the highest relative increase was in the north and central regions (Tarapacá:94%, Valparaíso:89%, Coquimbo:62%), as well as their HS. At HS level, in the Metropolitan Region, the PO varies from 21% to 46% in 2016 (OR = 3.3 IC95%1.4-7.9). Likewise, in the Valparaiso Region, it goes from 24% to 44% (OR = 2.9 IC95% 1.2-7). These differences in PO among HS levels in those regions were lower in 2009. Lower family income, educational level, and females with two or more children were associated with obesity in both surveys.

Conclusions:
There is a high prevalence and increases in obesity in Chile at national and sub-national levels. The large variability in obesity observed among regions and Health Services suggests that lower geographical areas would be a potential target for effective interventions, complementarity to those at national levels.

Key messages:
Analysis and intervention at a subnational level are required for preventing obesity in Chile.
The high prevalence of obesity in Chile has a large variability among the subnational levels.

Background:
Each year, 23 million people get ill from unsafe food in Europe. Food safety refers to the absence or safe acceptable levels of hazards in food that may harm the health of consumers. The Public Health Unit of Baixo Vouga Primary Healthcare Cluster (Aveiro region) developed a programme to identify hazards and promote implementation of corrective measures in community canteens that serve children and elderly. It has three fields of action: qualitative evaluation of the installation and operating conditions, based on the legislation; microbiological surveillance of food and utensils; training of food handlers and managers. This study aims to describe the results of such programme in 2018 and 2019.

Methods:
This cross-sectional study used data from qualitative evaluation and microbiological results for a descriptive analysis. Additionally, an assess of the compliance of the critical points was performed to identify the main barriers in achieving the proposed targets.

Results:
From a total of 420 registered canteens, 211 and 294 were evaluated in 2018 and 2019, respectively. For these years, only 87 (41.2%) and 124 (33.3%) fully complied with all critical points. The main problems were the lack of non-manual activation system in wash basins and faucets and inadequately instructed food handlers about required hygiene measures. Microbiological surveillance results of 371 and 393 samples had a proportion of satisfactory or acceptable results of: 93.5% and 91.3% for the main dish; 56.1% and 46.6% for the salads and 82.4% and 79.8% for the utensils. Coliform bacteria were the most common agent.