Abstract
Democratic rulers have a duty to safeguard two fundamentals: public safety and health. Across Italy, misgovernance and moral and criminal corruption deeply undermine this sine qua non of associated life. I focus on the ramifications of bad legislation that has allowed a sneaky privatization of the public health service on personal and public health hazards magnified by misgovernance and discriminatory economic policies that punish the “non-guaranteed”. Naples makes a graphically exemplary case marked by the conflict between the dedication and professionalism of many health workers and the greed and corruption of some that seriously challenges key aspects—medical, moral and ethical—of the Hippocratic Oath. This combines with public health permanently jeopardized by uncollected rubbish and the lethal hazards of badly maintained public property, now including illegal immigrants’ peddling objects scavenged from dumpsters. This dangerous setup is magnified by the practice of shallow-burying poisonous waste in dumping sites. In recent years, pulmonary disease, cancer and death have multiplied exponentially. Drawing particularly on evidence from Naples, the discussion shows that when misgovernance that breaches the democratic contract with citizenship affects people where it hurts most the legitimacy of the “system” becomes questioned and the casualties are trust and, ultimately, authority.
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Notes
- 1.
We shall see that this principle, reiterated in separate legislation (law 229/1999), is betrayed by widespread exploitation of loopholes.
- 2.
- 3.
But see also law 127/15.5.1997, which shifted the emphasis from propriety to efficiency in the running of public services and law 158/2012, which was supposed to regulate more efficiently the relationship between the SSN and the private sector and engagement in the latter of publicly employed personnel. In separate works (2004, 2011, 2019), I have discussed the disruptive effects of legislation that makes legal what was illegal but continues to be regarded as illegitimate and immoral in the wider society.
- 4.
On the clumsy attempts at covering-up incompetence, inefficiency, bad decisions during the pandemic, see Giuffrida (2020b).
- 5.
As indicated by the reports cited throughout this discussion, local investigative journalism has also produced useful information.
- 6.
Campania, the Naples Region, is one of the 20 Italian Regions, each administered by a Regional Authority.
- 7.
The cases of hospitals specializing in cancer research and care and in infectious diseases are emblematic examples. These hospitals were rightly regarded as national centres of excellence until the mid-1970s. The cited new legislation brought increasingly underfunding and subsequent decline.
- 8.
Prato (2023) explains how many regulations in this field fall under the remit of regional authorities. As testified by informants’ remarks (see later), this produces confusion and inequality across the country, inducing South-to-North “health” migration, also of doctors who work in the South but choose to be treated in the North; see, for instance, SVIMEZ (2020), Banca d’Italia (2020) and the open letter by one of them reported in a local paper: http://corrieredelmezzogiorno.corriere.it/napoli/cronaca/18_marzo_14/marfella-amo-l-istituto-pascale-piu-quanto-tema-mio-cancro-6cc26df4-2758-11e8-89ed-3e6c0875554d.shtml.
- 9.
Exemplifying illegal corruption, 48 people are currently on trial in Naples (Napolitoday https://www.napolitoday.it/cronaca/camorra-ospedali-processo-richiesta-pene.html).
- 10.
- 11.
Dirty wards, insect infestation and vermin continue to be reported; see, for instance, https://www.ilmattino.it/napoli/cronaca/ospedale_san_giovanni_bosco_materazzo_pucillo_formiche_sospensione-4591618.html
- 12.
For a recent example of this kind of nationwide corruption in politics and the SSN, and the subsequent arrests, see Beneduce (2021b) and https://www.iltempo.it/attualita/2021/07/01/news/concorsi-truccati-asl-latina-2021-arrestato-claudio-moscardelli-segretario-provinciale-pd-27797006/ Judicial investigations into these wrongdoings are of course commendable, but in my experience they address the tip of this toxic iceberg.
- 13.
This behaviour is widespread across the public employment sector. In this field, it has especially disruptive ramifications.
- 14.
This links directly to the Neapolitan say, Chi pecora s’ fa ‘o lupo s’a magna (If you behave like a sheep, you’ll become a wolf’s meal), which, as I have explained elsewhere at length, belongs to a culture of sapé fa (cleverness) informed by the principles, aiutat’ ca Dio t’aiut’ (God helps those who help themselves) and Nun voglio sta’ suggett’ a nisciun’ (I don’t want to be subject to anyone).
- 15.
As judicial inquiries have proved, when false illnesses are certified for invalidity claims (giving access to benefits, pensions or priority in job applications), this scam involves the complicity of corrupt doctors, bureaucrats and lab technicians.
- 16.
Among the many cases of such behaviour that make the headlines, see Vesuviolive.it 25 May 2022 at Medico del Pascale sospeso: “Ti opero in clinica, in ospedale non c’è posto” (vesuviolive.it).
- 17.
Media reports abound. See, for instance, https://corrieredelmezzogiorno.corriere.it/napoli/cronaca/19_giugno_07/noi-ammalati-tumore-dobbiamo-pagarci-cure-esami-9a8c3e30-8946-11e9-b250-10fe1a53aac1.shtml
- 18.
Doctor may get “informal fees” for the patients sent there.
- 19.
This dominant style of governance has marred central government, too (Pardo, 2021).
- 20.
The city is dotted with large pot-holes, overflowing sewage, falling trees and light poles, broken or uneven walkways and pieces of masonry that fall from public buildings (Il Mattino, 2019, Repubblica Napoli 2019).
- 21.
By Council regulations, rubbish is to be placed in the dumpsters between 8 p.m. and 8 a.m.
- 22.
A graphic testimony to this is offered by several documentaries, like those listed at the end of this chapter.
- 23.
Even considering that in this field official data only offer a partial picture, it is still interesting that, according to the Italian Office of Statistics, unemployment in Naples has reached 21.5%, of the active population, raising to over 40% among the young (http://dati.istat.it/Index.aspx?QueryId=20745).
- 24.
A quantitative assessment of informal activities is, of course, extremely difficult. Some estimates (Istat, 2020) value the shadow economy in Italy at about 211 billion Euros—this is 11.9% of GDP, which rises to 19.4% of GDP in the South.
- 25.
See, for instance, https://www.liberoquotidiano.it/news/spettacoli/televisione/26193861/striscia-la-notizia-scandalo-ambulanze-come-guadagnano-pelle-malati-covid.html and the results of police investigation (Dardari, 2021).
- 26.
This is a recurring inefficiency, in many cases, leading people to hijack ambulances.
- 27.
Some say negligence and express no surprise that Conte and 6 Cabinet Ministers are under criminal investigation for mishandling the crisis (il Sole 24Ore, 2020).
- 28.
- 29.
This brings to mind a World Health Organization’s clumsy attempt at political correctness: the reader may recall that, having earned discredit for the politicized way it handled the pandemic, it has recently engaged in verbal casuistry, assigning to COVID-19 variants Greek letters, as opposed to the names of the countries where they were first detected.
- 30.
This man was elected mayor in 2021 with a clear majority. He was supported by the PD and the M5S.
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Video Evidence — Examples
On the Waste Crisis in Naples: http://www.tgcom24.mediaset.it/2018/video/a-napoli-torna-l-emergenza-rifiuti_3066739.shtml; also https://www.youtube.com/watch?v=Vnt57DLjpx4
On the Waste Crisis in Rome: https://www.youtube.com/watch?v=IcF364epHIE
On the Waste Crisis in Milan: https://video.corriere.it/emergenza-rifiuti-cassonetti-pieni-rifiuti-strada/197fd3b2-155b-11e7-9957-bbceb60275cc
On Rubbish Peddlers in Naples: https://www.blitzquotidiano.it/video/napoli-rissa-residenti-e-immigrati-che-vendono-oggetti-recuperati-da-spazzatura-video-2030986/
On Poisonous Waste-dumping: Sick Children Die https://www.youtube.com/watch?v=Aqf-UFZYsgk; Some action is Belatedly Taken: https://www.youtube.com/watch?v=MY6261aid0A
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Pardo, I. (2023). Misgovernance Kills: Italian Evidence. In: Pardo, I., Prato, G. (eds) The Legitimacy of Healthcare and Public Health. Palgrave Studies in Urban Anthropology. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-25592-2_3
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