Stress and mental health in the workplace

191919- founding of the ILO: Following the Treaty of Versaille, which put an "end"to the First World War, the ILO was founded - International Labor Organization,better known by its English acronym ILO- International Labor Organization.  Essa, still present and active today in as many as 181 Member States, is a specialized agency of the United Nations (UN), with which it was associated in 1946, and has as its primary objective the pursuit of social justice and the universal recognition of human rights in labor, through the promotion of decent work-the so-called "Decent Work"-under conditions of freedom, equality and security for all women and men, so much so that the ILO was also awarded the Nobel Peace Prize in 1969.

1950- Joint Commission of the ILO and WHO: indicated the essential purposes, still relevant and always true, of Medicine in the Field of Labor namely:

• promote and maintain the highest possible level of physical, mental and social well-being of workers in all occupations;
• prevent any damage to health caused by working conditions;
• protect workers in their employment against risks resulting from the presence of agents detrimental to their health;
• place and maintain the worker in employment convenient to his physiological and psychological aptitudes;

1955- Presidential Decree No. 547: regulations for the prevention of accidents at work.

1956- Presidential Decree No. 303: general regulations for occupational hygiene. Both of these Decrees still represent a very valid point of reference in the performance of occupational health activities.

1968- Law No. 132: initial, albeit unsuccessful, attempt to create a public hospital welfare network, with more than valid basic purposes, as it was geared to guarantee care for all Italian citizens through the creation of the first forms of hospital corporation to replace the health insurance funds. Its implementation created excessive inequality among citizens for two reasons: the first related to better and more careful protection of wage-earners and their family members at the expense of other citizens, due to the ceding of part of wages, in favor of a fund intended to cover medical and welfare expenses for themselves and their loved ones.

The second related to an exponential increase in both hospitalizations, particularly unnecessary ones, and in the length of stays, factors that, both caused an excessive increase in the debt owed by the mutual societies to the hospital ones.

1974- Law No. 836: reciting: "Rules for the extinction of the debts of the mutualist institutions to hospital institutions, the financing of hospital expenditures and the initiation of health care reform"with which the Government sought to remedy the damage caused by the previous Law.

1978- Law No. 833: Institution of the"National Health Service"

The model devised in this Law is definitely innovative and a source of inspiration for many other "countries," since it is based on principles of Universality, Globality and Equality. Indeed, in the first article, emphasis is placed on the protection of health as a fundamental right of the individual and in the interest of the community (principle of universality): such protection must take place through the promotion, maintenance and recovery of the physical and mental health (principle of globality) of the entire population, without distinction of individual or social conditions and in a manner that ensures equality (principle of equality) of citizens. In the second article, on the other hand, emphasis is placed on the objectives to be pursued in order to be able to ensure the principles set forth in Article 1, namely:

• Health education;
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• The prevention of disease and injury in every sphere of life and work;
• The diagnosis and treatment of morbid events;
• The rehabilitation of somatic and mental states of disability and incapacity;
• the promotion and preservation of the healthfulness and hygiene of the natural living and working environment;
• The hygiene of food, drink...
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• The regulation of experimentation, production, marketing and distribution of drugs and scientific information on them directed to ensure the therapeutic efficacy, non-harmfulness and cost-effectiveness of the product;
• The professional training;
• The safety of work, with the participation of workers in preventive activities;
• Responsible and informed procreation choices, including maternity and child protection;
• The promotion of health in developmental age;
• The health protection of sports activities;
• The health protection of the elderly
• The protection of mental health

Other elements, which affect us directly, appear in Article 6 which states:Administrative functions concerning various areas are the responsibility of the State but I will mention only two of them since they are inherent to the subject of the current discussion:

1. international relations and international, maritime, air and border prophylaxis, including veterinary matters; health care to Italian citizens abroad and assistance in Italy to foreigners and stateless persons, within the limits and under the conditions provided for by international commitments, making use of existing health garrisons;
2. the prophylaxis of infectious and diffusive diseases, for which compulsory vaccination or quarantine measures are imposed, as well as interventions against epidemics and epizootics;

Law 833/78 has, in addition, established the Local Health Units within which the responsibilities related to the protection of health in the workplace has been entrusted, specifically, to the Prevention and Safety Services in the Workplace (SPESAL) whose main activities are two:

1. Prevention Activity, the dominant one, aimed at ensuring adequate and suitable working conditions and health in all areas; based on the identification of risk agents and the dangerousness of certain situations potentially present in the work environment and subsequently on the indication of measures dedicated to the elimination or, at least, the reduction of such risks.
2. Control Activities, carried out by highly specialized personnel, such as physicians, engineers, chemists and technical experts, which is aimed at controlling the correct and careful application of regulations on hygiene and safety in the workplace. Such professional figures are given, by the Local Prefect, the Power of Access and Warning, and the interventions of this body, may be scheduled with defined periodicity, as is the case for companies with defined medium-high risk, or may be occasional as, for example, on the disposition even of the judiciary.

From the above it is therefore easy to see how, for any type of company, it is necessary to have professional figures of reference, who are highly specialized, such as the Occupational Physician, whose task is simply to be able to enforce compliance with the regulations in force, regulations that since the distant 1919 are increasingly in strong evolution.