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HEALTH

How bad is Italy’s north-south ‘healthcare gap’ really?

Despite recent improvements, stark regional differences in healthcare provision persist in Italy and the problem seems to be here to stay, writes Silvia Marchetti.

How bad is Italy’s north-south ‘healthcare gap’ really?
The hospital in Locri, in Italy’s southern Calabria region, which regularly sent patients elsewhere due to a lack of doctors and equipment even before the pandemic. (Photo by Gianluca Chininea / AFP)

Italians have a sad saying: ‘health is a right in the north, and a hope in the south’. 

Despite recent improvements, regional differences in healthcare standards continue to plague the country, telling a ‘tale of two Italies’ with the country divided in half, and featuring a trend of southerners travelling north for treatment.

The south-north healthcare gap of the past has of course significantly shortened. Things are very different now from the days when Turin doctor Carlo Levi wrote ‘Cristo si è fermato ad Eboli’ (Christ stopped at Eboli) in 1945, when he talked about the shock of seeing poor children in Matera, the capital of Basilicata, with flies in their eyes and infections. 

Today, Basilicata leads southern regions on healthcare performance. And there are significant differences in standards between southern regions, with Calabria and Molise lagging behind Sicily, Puglia and Campania for treatment and services.

READ ALSO: Five essential facts about Italy’s public healthcare system  

But differences remain, and the pandemic has worsened the outlook according to a recent report by the government’s CNEL agency.

Public healthcare expenditure is at a national average of 1,838 euros per person per year. But the figure is much higher in northern regions than in the south: for example, it’s 2,255 euros in Bolzano versus 1,725 euros in Calabria. 

This translates into lower investments in healthcare in the south, ranging from research in medicines and therapies to top doctors and avant-garde treatments. 

The Policlinico A. Gemelli Hospital in Rome. Italy’s capital is home to several highly-rated hospitals and clinics, but some residents still travel north in search of better or faster treatment. (Photo by Filippo MONTEFORTE / AFP)

Waiting lists in the public healthcare system for checks and surgeries are longer in the south than in the north, where all the best doctors tend to be. I’ve met many southern doctors who, after studying abroad, ditched their native regions for Rome or Milan where most of the top-rated clinics and hospitals are located.

Lombardy, Piedmont and Emilia Romagna have always shone when compared to Sicily and Calabria. And even Rome, despite being the capital, lags behind Milan.

However there have been a few improvements in southern standards lately, and the situation varies depending on the type of treatment.

According to the 2021 public hospitals performance report (PNE), even though the north is showing better results in terms of treatments for cancer and orthopaedics, the poorer southern regions are raising standards in some areas.

For instance, among the top 10 facilities with higher proportions of primary angioplasty guaranteed within 90 minutes, a good index of appropriateness and timeliness, seven are based in the south.

READ ALSO: Who can register for national healthcare in Italy?

Still, the gap has led to a type of ‘health tourism’ within Italy. There are no statistics, but I’ve met many southern people who have had to fly to the north for particular treatments, access to top doctors and cutting-edge surgeries, for example for knee and hip replacements. 

They rented apartments or stayed at hotels for weeks after their surgery to undergo rehab and physiotherapy, at considerable extra expense. 

I’ve met others who had to fly from Salerno and Puglia to Millan and Bologna for hip, shoulder and knee joint reconstruction or replacement, with all the hassle of the journey in poor health and the extra transport and accommodation costs it entails. 

It was striking to find that many Romans are among those who regularly travel to Milan for heart and orthopaedic checks and surgeries. Rome does have a few top-rated clinics, but apparently not as many as Milan.

Meanwhile many doctors from Milan, Padua and Bologna come ‘fishing’ for desperate patients in Rome and Naples who have failed to find a surgeon willing to operate on them due to their complex conditions. 

READ ALSO: The parts of Italy with the best (and worst) quality of life in 2022

This healthcare gap in my view will never completely disappear, despite the incoming European funds through the pandemic recovery plan aimed at shortening it.

It will be further reduced in time, but not in the near future, particularly if all the good doctors continue to flee north for higher salaries, prestige and a more promising career.

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TRANSPORT

OPINION: Why are Italians so addicted to cars?

In a country as attached to the car as Italy, what would it take to get more people to use greener transport? Silvia Marchetti looks at what’s behind the country’s high levels of car ownership.

OPINION: Why are Italians so addicted to cars?

Many foreigners I speak to are shocked by the ‘car first’ mentality that rules in Italy, and by Italians’ degree of addiction to any wheeled vehicle. 

There’s practically one car around for each Italian. Between 2010-2020 the population dropped but there were three million more cars on the roads, despite soaring living costs and falling salaries. 

Italy’s rate of car ownership is the second-highest in Europe after tiny Luxembourg. All Italian regions have a lot of cars running but surprisingly, the number of passenger cars which is the highest at EU level can be found in the Alpine regions of Valle D’Aosta and the northern autonomous province of Trento, where particular regional statutes envisage special tax incentives helping locals to buy new cars.

Most Italians just don’t like walking. They aren’t active travelers who’d opt for a bike, and can’t go even 500 meters without a wheeled vehicle, be it a Jeep, motorbike, Vespa or motorino. 

But it’s not really their fault. People in Italy haven’t been educated on eco-friendly modes of transport, simply because infrastructure like bike lanes, pedestrian paths, high-speed trains, efficient trams, subways and buses are rather lacking. And there aren’t many walkable pavements in cities, let alone in old villages. So the car is Italians’ second home. 

READ ALSO: These are the most (and least) eco-friendly towns in Italy

There’s an historical reason for this, too. After the second world war, during the economic boom when Italy finally rose from the ashes of the defeat, owning a cinquecento or maggiolino was a status symbol. In the 1960s my father would squeeze eight friends into his cinquino and drive around all night, sharing the fuel cost. Then the car fad turned into a frenzy, and now it’s an obsession.

Iconic Italian car and motorbike models fuelled a post-war fad – which has become an obsession. (Photo by Vincenzo PINTO / AFP)

Whenever I need to go somewhere far from my house I wish I could do the entire trip by public transport and ditch my car, so as to avoid having parking problems too. I remember once when I was at university there was this huge party near the Colosseum, I drove around for an hour looking for a parking spot and eventually I gave up, went back home really frustrated. 

Car sharing also is something totally foreign to Italians. You just need to look around in the morning at rush hour to see that there’s just one person per car, which is totally unsustainable climate-wise.

READ ALSO: Rome ‘among worst cities in Europe’ for road safety, traffic and pollution

Even in areas like Milan, where public transport is more efficient than in the southern regions, people still stick to their car or motorino which just proves how it’s a matter of mentality rather than of transport provision. 

On the other hand, if I want to visit Tuscany or Umbria from my house in Rome’s northern countryside, there aren’t even any direct connections.

My Italian millennial friends refuse to take a bus or tram to the gelateria a few blocks away from their home – the car is the rule, and they don’t care if they risk a fine for double parking, or parking in front of a building entrance. Forget walking, it just isn’t ‘done’.

Italy will soon invest some €600 million in projects aimed at improving bike and pedestrian lanes under initiatives funded by the PNRR, but the mindset of drivers must also modernize for all this money to be really effective. 

OPINION: Why cycling in Rome isn’t as crazy as it sounds

Italy needs an information campaign to raise awareness of environmental and health issues, and this must start inside schools and continue in college. Families also should educate kids to healthier transport modes, and stop buying those ‘micro cars’ when they’re 13 which don’t require a driver’s license. 

I often ask myself what it would take to get Italians – but also other nationalities – out of their cars, or off their noisy motorino with illegal upgrades that make a hell of a noise. Rising oil prices haven’t done the miracle in making car ownership unaffordable. 

Hiking car prices would kill the industry, so the only way is to give tax breaks or incentives to families who keep just one car and manage to share it, or raise taxes if each family member has one. 

Perhaps in a very remote future, interconnected green transport from the doorstep to the destination might be the solution, but at the moment that’s science fiction.

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