(Note 1) That it is important to create and work in a healthcare network has been an established concept for a number of years, even though it is not an objective or a process that can be taken for granted or achieved with ease.
Building a network is actually at times difficult; it also comes up against a wide range of obstacles that make it impossible to achieve in its entirety.
The network needs therefore to enable requirements to emerge, to promote work where it has been carried out successfully, but especially to retain flexible strategies that different local actors can redefine in accordance with their territory and their organisation so as to avoid pointless Procrustean measures that leave everyone involved dissatisfied.
Resistance to working in a network can be overcome to the extent that the advantages are made clear, e.g. acquisition of new competences, promotion of good practices and rationalisation and distribution of resources, and to the extent that objectives are shared between all of the partners, be they individuals or institutions.
Anyone who deals with improving social, physical and mental wellbeing, i.e. a person's overall health, has the shared objective of meeting the needs of citizens and offering health services to individuals and to the community. Citizens are increasingly considered to be active protagonists, people who are responsible for their health choices and who must be placed in a situation where they can choose a healthy lifestyle. Although individual behaviour plays a major role, these conditions also depend heavily on living and social conditions. This is the concept of promoting health as a process that enables people to exercise greater control over their health and to improve it.

Within this framework is the Guadagnare Salute, programme, which is promoted by the Ministry of Health (DPCM del 4 maggio 2007); it was launched in order to spread and facilitate a change in behaviour that would benefit the population's health by acting on four main health risk factors at the root of chronic and degenerative illnesses: smoking, alcohol, poor diet and physical inactivity.
The Guadagnare Salute programme marks a major change in health prevention and health strategy: as a consequence, the Italian government adopted a wider approach and a new method that aims to promote health as a collective asset by means of optimum integration of measures that are the responsibility of the community and those that are the responsibility of individuals. Guadagnare Salute is a major public health measure that is to be integrated with measures regarding the other main risk factors, paying attention not only to strictly health-related features but also to environmental, social and economic factors which influence health, in particular those factors which influence individual choices and behaviour.
A key concept of this programme is its cross-sector nature (Note 2): it needs to be based on integrating the roles played by all the subjects that can contribute to achieving health by introducing measures that are shared by the institutions, civil society and business. In order to improve the population's health, it is vital that sectors outside healthcare are involved, i.e. education, culture, transport, agriculture, tourism etc. The healthcare establishment, however, plays a leading and promoting role for the other protagonists, one that goes beyond its traditional role of providing healthcare services.
This cross-sector programme fosters the active participation of individuals by providing greater access to information and introducing competences, creates living and social conditions that promote health and eliminates disparities in health conditions.
The Guadagnare Salute programme aims to achieve its objective of "making the right health choices easier" with a National Platform on nutrition, physical activity and smoking, which is run in association with a range of institutions: ministries, regions, municipalities, the National Institute for Occupational Safety and Prevention, the Higher Institute of Health, and the National Institute of Research on Food and Nutrition; other instruments include conventions between institutions and civil society (food supply-chain businesses, trade unions, Slow Food, producers organisations (UNAPROA and UNIPRO), sports associations (CSI, UISP and US ACLI), consumer associations (Altroconsumo), State railway Ferrovie dello Stato, work groups and monitoring systems.
Regione Veneto participates in the work of Italy's National Platform along with the rest of the country's regional governments. The regions cooperate to produce strategies, priorities and ensuing annual plans, as they are the institutions responsible for the planning of the health promotion activities of Italy's National Health Service. At a local level, Veneto's regional government is spearheading a "health promotion system" by working towards inter-institutional cooperation and by taking a cross-sector approach.
A number of years ago, Veneto launched health prevention and promotion projects that turn commitments taken at national level into an effective reality.
Another node is collaboration with schools. With an agreement signed on 5 January 2007, the Ministry of Public Education and the Ministry of Health pledged to establish joint strategies between health and schools and to set up programmes that commit both schools and healthcare to the prevention of chronic illnesses and to fighting typical phenomena that affect young people. In light of this, one of Veneto's many projects has included participation since 2007 in a pilot project "Inter-institutional planning of paths towards the promotion of health", which aims to define shared policies for the promotion of health in schools by introducing measures underpinned by a range of disciplines, continuity, transferability, cost-effectiveness and consistency; the aim is also to develop a model of inter-institutional cooperation and a network of actors with different competences and responsibilities and to test a cross-sector approach to styles of life.
Knowing how to operate in a network is thus a key challenge for the social healthcare system of the Veneto region. This challenge will only be won when everyone is thoroughly convinced that health can only be protected effectively and cost-effectively in human and financial terms with a cross-sector approach, synergy and tangible integration.
This chapter includes examples of measures within the health prevention network.