The majority of the Italian population has a high standard of living and quality of life resulting, in part, from well established health policies and welfare measures. Prior to the outbreak of the COVID-19 pandemic, well-being and sustainability indicators showed a generally positive performance, although geographical inequalities and a gender gap in life expectancy continue to be significant. Average life expectancy at birth in Italy had been growing steadily over the last two and a half decades, reaching 83.6 years in 2019, then the second highest in Europe. It decreased temporarily back to 82.4 years in 2020 due to the impact of the high numbers of COVID-19-related deaths (Table1.3). Even so, in 2020 Italy had the third-highest total life expectancy at birth among EU countries.
Table1.3
Cardiovascular diseases (CVDs) are the main cause of death in Italy, along with cancer and, since 2020, infectious respiratory diseases, moving neurological diseases down to fourth place (The European House – Ambrosetti, 2021). In 2020, the year of the COVID-19 pandemic outbreak, total deaths from all causes were the highest recorded since the Second World War: 746 146 deaths, which is more than 100 000 extra deaths compared with the 2015–2019 average (equal to an excess mortality rate of 15.6%) (ISTAT – ISS, 2021). Multimorbidity and chronic diseases in the older population are major challenges for the health care system.
The most common diseases in the elderly, for both genders, are osteoarthritis (47.6%), hypertension (47%), lumbar disease (31.5%), cervical diseases (28.7%), hyperlipidaemia (24.7%), heart disease (19.3%) and diabetes (16.8%) (ISTAT, 2021c).
Italy has among the lowest infant and neonatal mortality rates in the EU (2.5 deaths per 1000 live births, compared with the EU average of 3.2 in 2020), explained by effective preventive measures and skilled assistance during pregnancy and at delivery.
Population risk factors such as tobacco consumption, unhealthy diets and alcohol can be attributed to around one third of all deaths in Italy in 2019. In particular, tobacco and dietary risks are major contributors to mortality (Fig1.2). In 2020, 46.1% of the adult population was overweight, while 10.8% was obese (IBDO Foundation, 2020), with a higher prevalence registered in the southern regions. Moreover, the proportion of overweight or obese people increases proportionally with age, reaching a peak in the 65–74 age group before declining slightly among the very elderly (IBDO Foundation, 2020). Childhood overweight and obesity rates in Italy are also comparatively high: the European HBSC survey records that almost 19% of 15-year-olds were overweight or obese in 2018 while a national survey of primary school children highlights that 30% of 8- and 9-year-olds were either overweight or obese in 2019 (OECD/European Observatory on Health Systems and Policies, 2021).
Fig1.2
According to national data, the proportion of smokers among the adult population in April 2020 was 21.9% down from 23.8% in 2003, when Law 3/2003 banned smoking in public spaces. But this rate grew throughout the pandemic to 24% in November 2020 and again to 26.2% in May 2021 (ISS, 2022). Smoking cigarettes is more common in young adults and more prevalent among men than women. In 2020, 66.4% of the population consumed alcohol during the year, with 20.6% drinking alcohol every day (Ministero della Salute, 2021a).
Notwithstanding the important results gained in health status, geographical differences remain in terms of health conditions and lifestyles, as well as in the supply and quality of health services. Southern regions score lower in life expectancy, lifestyles, access to care and quality of services. These data underscore how the tenuous balance between centralized and regional and local control is shifting over time, impacting population health outcomes, and resulting in, arguably, as many as 20 different health care systems within Italy (Ricciardi & Tarricone, 2021).