PRIN_22 (18/10/2022 to 28/02/2026)
Mortality has been declining in Italy over the past two hundred years (excluding war periods), but progress has considerably slowed down after 2008.
This deceleration has gone almost unnoticed: initially, data were not yet available, and later the outbreak of the COVID-19 pandemic catalysed attention.
Our research group will focus on the years 2008-2019 (before COVID-19) to do the following things:
1) Measure the extent of the deceleration, in general, by area (down to ASL territories), by gender, by age class and by main causes of death. We will also adopt an international perspective, comparing Italy with other developed countries.
2) Link this deceleration to four main possible, not alternative, explanations/causes:
a) Crisis and austerity. While the impact of economic crises is ambiguous, budget cuts on public health expenses tends to affect survival negatively. With the help of statistical techniques (such as difference-in-difference and counterfactuals), we will measure the mortality impact of both.
b) Causes of death. A change in the prevalence of the most important causes of death (starting with cardiovascular diseases), may well be among the reasons of the observed deceleration. We will analyse this process separately by gender.
c) Spatial issues. While the crisis has widened the traditional North-South divide in terms of wealth, health and mortality, this is not the only geographically-relevant process under way. More than half of the Italian territory is composed of municipalities far away from the centres that provide basic services such as schooling and health assistance. Following the closure of several local clinics,the number of these (so-called) “internal” areas has increased, with mortality effects that our research will bring to light.
d) Tempo effects. As life expectancy is the summary measure of a series of age-specific death risks, observing them only cross-sectionally may bias the picture and result in a misinterpretation of the underlying trends.
The policy implications of our research are potentially large. The shock due to the ongoing COVID-19 pandemic has brought with it, especially in Europe, a renewed awareness about the importance of efficient universal health care systems, after a long period of relative neglect. Also because of this shock, in Italy and in other parts of Europe, it is likely that the next few years will be devoted to an overall reorganization of health care systems with the aim of making them more responsive to future challenges. This project intends to offer a contribution to this effort by identifying the most critical aspects of our recent health policy decisions - if any can be detected.
Gustavo De Santis, Università degli Studi di Firenze
UNIFI personnel: Mauro Maltagliati
Sapienza Università di Roma
RU: Elisabetta Barbi
UNIROMA1 personnel: Miccoli Sara
Università degli Studi di Sassari
RU: Giambattista Salinari
UNISS personnel: Silvia Battino, Gianni Carboni