Long-living Italians, but the people of Campania live four years less than those of Marche. Here is the ranking

In 1872, life expectancy in Italia was only 29.8 years, among the lowest in Europe, while in countries such as France, the United Kingdom, Denmark, the Netherlands, Sweden and Norway it was already between 40 and 50 years. It was mainly infant mortality that had a decisive impact. Since then, the decline in infant mortality has been continuous, interrupted only by the two world wars and the influenza pandemic of 1918-1919. And so today, thanks to a long process, sustained by improvements in diet and hygiene, advances in medicine, the spread of vaccines and, after 1978, the establishment of a universalist health system for access to care, Italia can be considered one of the longest-living countries in the world. But with a big mole: in the South, on average, people live less, with differences that are also very large, given that Marche people live four years longer than Campania people. All the figures on the health of Italians are contained in the ISTAT report 'Health: an achievement to defend'.

With a life expectancy at birth of 83.4 years, Italia is one of the longest-living countries today. Between 1990 and 2024 life expectancy at birth increased by about 8 years for men and 6.5 for women, to 81.5 and 85.6 years respectively. The median age at death in 2023 - the parameter that indicates that 50% of people died before reaching that age, while the other 50% died later - was instead 81.6 years for males and 86.3 years for females, with an important territorial variability: from less than 82 years in Campania to over 86 in Marche, with all the more populous regions of southern Italy at a disadvantage. In particular, below the Italian median age at death (84.4 years) are Valle d'Aosta (84.3 years), Augustia (84.1), Lazio (83.9), Calabria (83.8), Sicilia (83.3) and, at the bottom, Campania (81.9). Among the regions above the Italian median at death after Marches (86.1), which leads this special ranking, are Umbria (85.9), Molise (85.7), Tuscany (85.7), Emilia (85,5), Abruzzo (85.4), Liguria (85.4), Basilicata (85.3), Trento (85), Piemonte (84,4), Veneto (84.8), Friuli (84.7), Lombardy (84.6) and Bolzano (84.5). But this difference between North and South has not always been as evident as it is today.

 In 1990, the geography of mortality in Italia - ISTAT explains in its report - showed marked differences both between regions and between men and women. For males the territorial distribution was heterogeneous, with higher mortality mainly in the northern areas of the country, while for women - with lower levels overall - mortality was higher mainly in the southern regions. This differentiation reflected the different risk profiles, linked to men's greater exposure to behavioural factors (smoking, alcohol, road accidents, occupational risks) and to the different relationship with health services, an effect of both individual behaviour and territorial differences in the supply and accessibility of care. But then things changed: between 1990 and 2023, age-standardised mortality declined by 43% among men and almost 40% among women. However, the reduction is more pronounced in the Centre-North, where in some regions it exceeds 50%, while in almost all of the South it is around 35%. As a result, in 2023 the male and female geographies are now superimposable: both show higher levels in the Mezzogiorno, with Campania and Sicily far behind the rest of the country, indicating how survival in Italia is now strongly conditioned by the territory of residence

But if it is true that we are living longer in Italia, the ageing of the population poses new health and social challenges, linked to the increase in pathologies typical of old age (cancers and cardiovascular diseases) and to multimorbidity (the simultaneous presence of 2 or more pathologies in the same person), which in Italy already affects 13 million individuals. Among the main factors that have historically contributed to the increase in average longevity is the drastic drop in mortality within the first year of life, which in 2023 stood at 2.7 per thousand live births, one of the lowest values in the world, while in the 19th century it was 230 per thousand. But along with longevity gains, the prevalence of chronic degenerative diseases, typical of old age, has increased in Italia. Cancers have risen from 2-3% of deaths at the end of the 19th century to 26.3% in 2023, and cardiovascular diseases from 6-8% to 30%, becoming the main cause of death since the second half of the 20th century. Diabetics and hypertensives are also on the rise, not only because of the ageing population but also because of new diagnostic capabilities, earlier check-ups and the spread of unhealthy lifestyles.

At the same time, over the past 30 years, the proportion of people declined from 8 per cent in 1995 to 5.5 per cent in 2025 who declare themselves to be in poor health. The prevalence of people in poor health increases with age, particularly among women, but it is precisely the older age groups that have seen the most significant improvements: in 2025, almost 28% of women aged 85 and over declared being ill or very ill, among whom the share has halved since 1995; among male peers, the share has fallen from 39.5% to 17.2%, approaching that of the 75-84 cohort. "Excluding the Covid parenthesis, thanks to vaccines and antibiotics we die much less from infectious diseases and this has led to an increase in longevity,' explains Giovanni Rezza, epidemiologist and former head of the Health Ministry's Prevention Department. After that, ageing in itself leads to an increase in chronic degenerative diseases, such as cancer and cardiovascular diseases'. Rezza emphasises the central role of public health in tackling demographic change. 'We have a national healthcare system that has certainly been a great achievement and we hope, even in times of crisis, to keep it alive and efficient,' explains the expert, who points out, however, that 'the fact that the quality of care may differ from region to region plays a role in the territorial differences in life expectancy'.