Health Problems in Italy
Italy boasts one of the finest national healthcare systems worldwide, boasting an expansive, high-quality universal healthcare system at affordable costs.
Italy currently ranks eighth among EU-15 countries when it comes to GBD estimates of prevalence, death, disability-adjusted life years (DALYs), and life expectancy; however, several health problems exist within its borders.
Cardiovascular Disease
Multiple epidemiological studies have shown that cardiovascular disease (CVD) risk factors, notably systolic blood pressure and total cholesterol level, are strongly correlated with an increased risk of coronary heart disease and cerebrovascular events. Yet their causes remain complex. Italy’s National Prevention Plan intends to decrease morbidity and mortality associated with noncommunicable diseases – in particular CVD – through early identification, systematic assessment, and preventive treatments.
MONICA, launched in Friuli-Venezia Giulia at the end of the 1990s, is an innovative system for tracking nonfatal and fatal cardiovascular events using data from death certificates and hospital discharge diagnosis records. Furthermore, this register tracks both frequency and case fatality of stroke cases.
Lifestyle and socioeconomic context can also play a significant role in predicting cardiovascular risk, with rural areas often seeing lower attack rates and case fatality from cardiovascular diseases than their urbanized counterparts.
Studies have demonstrated the correlation between social status – as defined by education, occupation, income and other variables – and CVD risk factors and event occurrence, particularly in Northern Europe compared with Central and Southern Italy. Men from Northern Italy who attend higher educational levels appear to have lower cardiovascular risk scores and case fatality scores due to family presence which may have significant positive and dramatic negative ramifications on cardiovascular disease mortality respectively.
MONICA Register saw an overall decrease in coronary heart disease and cerebrovascular events over its first few years of operation. Latina, located in Italy’s South Center region, experienced both men and women experiencing decreased attack rates as well as reduced stroke case fatality rates. However, regional variations exist in stroke attack rates which could be explained by socioeconomic and health service organizational considerations. According to this research, incidence and case fatality rates of CVDs could be reduced through improved management of modifiable risk factors including adopting healthy eating practices such as adhering to a balanced diet plan and quitting smoking while engaging in regular physical exercise sessions.
Cancer
Cancer is one of the primary causes of death in Italy and affects people from early childhood to old age. Although new cases continue to rise each year, survival rates have improved over the years likely due to improvements in secondary prevention programs and controls of modifiable risk factors; and advances in treatment.
Accurate and comprehensive epidemiological information about cancer is crucial to measuring healthcare systems accurately; unfortunately, its availability remains limited. While several indicators and reports are created annually, longer-term data up to municipal scale is often unavailable to citizens, researchers, scientists or associations.
At this juncture, we present a 10-year database on cancer mortality rates (in the form of Standardized Mortality Ratios; SMRs) at the Italian municipal level for purposes of tracking trends over time and assessing impactful policies, interventions and strategies on morbidity and survival rates in Italy.
This SMR database was produced using data derived from Italy’s national cancer registries and vital records as well as International Classification of Diseases version 10 (ICD-10). It allows for calculation of cancer mortality rates for all major macrotypes of neoplasms in Italy – such as breast, prostate, colorectal and lung cancers as well as their influencers such as age, gender, environmental or genetic characteristics.
Regional differences are apparent, particularly for certain tumor sites. Liver tumors, for instance, are more prevalent among women living in Southern and Islands regions of Italy compared with Central Italy or Northern Italy due to higher rates of Hepatitis B or C infection in these regions.
In 2020, lung cancer remains the leading neoplasm among men while breast cancer leads among women. Other major forms of cancers include pancreatic, testicular, thyroid and colon. Smoking tobacco is considered one of the primary contributors to their development while diet and alcohol intake can also play an integral part in its spread. Furthermore, HPV infection increases chances of cervical cancer.
Chronic Diseases
Italy boasts a tax-based universal healthcare system covering its citizens and legal foreign residents alike. Funded primarily by corporate and value-added taxes and distributed among the regions for care delivery, residents must make copayments for certain hospital services and pharmaceuticals while screenings, primary care services, maternity care are free for everyone.
Italy has an extremely low fertility rate and long life expectancy, yet still experiences an increasing burden of chronic diseases. On average, every Italian has at least one chronic condition and over half have two or more. This burden compares strongly with other European nations.
This section utilizes data from ISTAT’s Multiscopo survey system to investigate the incidence and prevalence of chronic conditions across Italy by age, sex, geographical location and disease category. Descriptive statistics are employed to examine trends in prevalence while socioeconomic status differences are also assessed.
The analysis includes a review of literature and comparison with other OECD countries, as well as an estimate of chronic diseases’ economic costs in Italy based on Global Burden of Disease 2017 data and methodologies, which provide country-level estimates for causes of death and disability-adjusted life years (DALYs) from health-related quality of life measures and behavioral risk factors that relate to socioeconomic determinants.
The national health system is composed of three layers: central, regional and local (on average 10 local health units per region). Administrative data related to healthcare reimbursed by the system are collected at local levels by these local units before being sent onward to regional levels for analysis. Transmission models at the national level are standardized; however, individuals’ personal identifiers are stripped prior to transmission so record-linkage between regional systems cannot take place. However, monitoring disparities lies within the responsibility of regions and various reports are produced on an ad hoc basis by public institutions and private companies. Furthermore, the central government imposes recovery plans on regions experiencing deficits in healthcare spending, with these plans designed to tackle root causes of costs overruns such as revising hospital fees or decreasing medical/pharmacological spending on chronic conditions.
Health Equity
Like in many other countries, Italy experiences significant health inequalities. Life expectancies among those from lower socioeconomic status tend to be five years shorter than their managers (Ardito et al. 2022). A variety of studies using various methodologies have confirmed this trend and demonstrated how differences in income drive health inequality.
Italy operates a comprehensive public healthcare system known as Servizio Sanitario Nazionale (SSN) established through legislation in 1978. This universal public healthcare system covers both citizens and legal residents regardless of nationality or social status; funding comes from both national and regional taxes as well as copayments for pharmaceuticals and outpatient care services.
Recent decades in the SSN have been marked by decentralization and economic pressure to contain health expenditures, leading to greater regionalization of services such as redefinition of pharmaceutical coverage/copayments as well as other measures – leading to significant variation between regions regarding services provided.
One key goal is the creation of regions capable of meeting health-related objectives in cost-effective manner while providing high quality healthcare provision at reasonable costs.
Even with all its efforts, the SSN remains one of the most costly healthcare systems in Europe. Development has been slow and regional disparities persist. Furthermore, an aging population and difficult economic situation will likely exert further strain on public healthcare spending in future.
Concerns arise because the SSN relies on contributions and support from its citizens and local communities in order to maintain its sustainability and resilience. Furthermore, accessing health services should be made readily available – essential if better healthcare outcomes and reduced inequalities in health are to be realized.
SSN has recently renewed its efforts on improving accessibility and equity within healthcare system. A new online platform was recently unveiled to allow users to explore health inequity trends as well as to identify key policies and services necessary for increasing accessibility of quality healthcare and equitable access to it. Users can also see how different regions and sectors perform with respect to the LEA (Levy Equity Algorithm), which measures gaps between actual performance levels vs minimum acceptable levels for health equity.
