The new report from the Italian Health Equity Status Report Initiative (IHESRi), “Healthy, prosperous lives for all in Italy”, explores what is holding people back from being healthy and provides key recommendations for reducing health inequity. IHESRi reaffirms the commitment of WHO/Europe and the Italian Ministry of Health to improving health and health equity in the country, leaving no one behind.
The report recommends ensuring the sustainability and resilience of the health-care system, reducing poverty, and building more robust and stable economies, in the regions and nationally. Additionally, the Italian Health Equity Dataset platform, launched by WHO/Europe, allows users to explore the data underlying the report and analyze who is falling behind with poor health, as well as assess which policy and service gaps are key to health equity from the early years to later in life.
“By implementing the recommendations from this report, Italy could increase its national gross domestic product by 4.2%. With these recommendations, we could improve, within 4 years, the lives of 150 000 Italians,” underlined Chris Brown, Head of the WHO European Office for Investment for Health and Development, located in Venice.
The Italian government has taken a number of steps to enhance health equity, including embedding an equity approach in the current National Prevention Plan 2020–2025. Investing in health and reforms to reduce disparities among regions, generations and genders are also the main priorities of the National Recovery and Resilience Plan. In addition, in 2019, the Italian National Institute of Health (ISS), established a unit on health inequities, which promotes practical actions to reduce health inequalities.
“Investing in the new generations, to guarantee access to childcare, improve the school system, ensure women and men have equal social opportunities and strengthen the home care [and telemedicine] system is essential for the Ministry of Health,” underlined Dr. Angela Meggiolaro, from the Directorate General for Health Prevention at the Italian Ministry of Health.
From analysis to action
The analyzes in the report show the differences in the last 10 years between the most and least disadvantaged adults. For example, the gap in self-reported health and well-being has decreased, but for other key indicators, such as non-communicable diseases, the morbidity gap has not followed the same trend, especially for women. In addition, it shows that women with lower education levels suffer more symptoms of depression.
Italy’s key drivers of health inequity include lack of income security and social protection, and poverty. The report’s analysis shows that 43% of the population in Italy struggles with income security and social protection and 22% of people live in poor housing conditions. In addition, the cost-of-living crisis is a new challenge which could further expand health gaps. Unless mitigating measures are adopted, poorer households will be disproportionately affected.
“If we want to shift from the problem to the solution, we need to understand the drivers and underlying conditions to prioritize actions to reduce inequity gaps. We need policies with strong data for their impact on health equity and which are relevant to Italy,” highlighted Dr Sara Darias-Curvo, Professor of Public Health at the University of La Laguna and Consultant at the WHO European Office for Investment for Health and Development .
IHESRi brought together key stakeholders from different Italian institutions, including the ISS, the Directorate General for Health Prevention, and the National Institute for Health, Migration and Poverty, a juridical body under the Ministry of Health, with representatives from the Italian regions of Emilia- Romagna, Lombardy and Veneto, who particularly appreciated this multisectoral collaboration.
“Our main achievement is fostering local processes for health equity: rethinking priorities together with local health units, defining feasible interventions, and redesigning equity boards and integrating them into organizational processes,” said Luigi Palestini, Coordinator for Health Equity Governance from the Regional Agency for Health and Social Services of Emilia-Romagna.
The Lombardy Region has piloted IHESRi, highlighting the importance of integration between schools and the health service in reducing inequalities among students and mitigating the impact of COVID-19 on the student population and their families.
“Lombardy has adopted and disseminated the model of health-promoting schools in a widespread manner and implements evidence-based programs in the school context to help develop life skills and competencies for reducing the health inequalities gap,” said Corrado Gelata, Manager of the Healthy Lifestyle, Prevention, Health Promotion and Screening Unit, General Directorate of Welfare of the Lombardy Region.
Improving people’s lives
During the COVID-19 pandemic, about 1 million people in Italy lost their jobs. According to the latest data from the Italian National Institute of Statistics (ISTAT), 7.7% of families and 9.4% of individuals were living in poverty in 2020, compared to 6.4% and 7.7% respectively in 2019. The Veneto Region was also affected and has adopted measures to improve people’s lives and health, including through a communications campaign called “Vivo Bene”.
“Vivo Bene is a part of the Veneto Regional Prevention Plan, which reinforces the creation and strengthening of environments in favor of people’s health through investing in health-promoting schools and workplaces, active municipalities and child-friendly communities. The plan tackles inequalities in health, supporting a gender approach and protecting vulnerable people,” explained Federica Michieletto, from the Directorate for Prevention, Food Safety and Veterinary Public Health, Veneto Region.