People in Italia live long lives, but how? Here’s the burden of chronic diseases
Our country, which is among those with the highest life expectancy, drops to 21st place among OECD countries when years lived free from illness and disability are also taken into account
There is one statistic that Eurostat updates every year and which Italia is particularly fond of: in 2023, an Italian citizen could expect to live 69.1 years in good health – the second-highest figure in the European Union after Malta and well above the EU average. Add to this a life expectancy of 83.5 years – around 2.4 years higher than the OECD average – and the picture is that of a country ageing well.
Then a new international report is published, and the picture becomes more nuanced. The Value of Chronic Care, recently published by Zurich Insurance, analyses the burden of chronic diseases and the response of healthcare systems across 38 OECD countries, cross-referencing a decade’s worth of data from the Global Burden of Disease, the world’s largest epidemiological database, which is independent of the insurer itself. In its composite index, the Chronic Care Index, Italia ranks 21st out of 38: not a disastrous result, but hardly flattering either for a country that prides itself on its longevity and good health.
Rather than a contradiction, the two snapshots illustrate different aspects of the same phenomenon. From the film. Eurostat and the OECD provide a snapshot of the current situation. Zurich, on the other hand, tracks the trend over the last decade, and this is where Italy shows a weakness: it is one of the few OECD countries in which both premature mortality and disability linked to chronic diseases have risen in tandem between 2014 and 2023. This is a global phenomenon: across the 38 countries on average, healthy life years lost to illness rose from 23,762 to 24,874 per 100,000 inhabitants over the decade, but it is not mortality that is rising fastest, but chronic disability. Cardiovascular diseases and cancers remain the leading causes of death, but their relative prevalence is slowly declining thanks to advances in treatment; the main increases are in mental health disorders, neurological conditions such as dementia, and musculoskeletal problems: conditions that are not immediately fatal, but which affect those who have them for the rest of their lives. In short, people are dying less prematurely, but they are living longer with a diagnosis, often for decades. More years, but not necessarily healthier ones.
A closer look at the breakdown of Italia’s score reveals a more detailed picture. The healthcare system scores well for the quality of care, striking a balance between clinical effectiveness and equity of access, but ranks among the lowest in the entire classification for efficiency. This picture is consistent with official OECD data: Italia has 3 hospital beds per thousand inhabitants, compared with an average of 4.2. And, crucially, only 44 per cent of Italians say they are satisfied with the availability of quality care, compared with an OECD average of 64 per cent. A gap of twenty percentage points – one of the widest among the 38 countries.
This is what the report refers to as the ‘access gap’: not a lack of clinical expertise, but the difficulty of accessing care, of navigating a fragmented system, and of receiving coordinated care over time. For those living with diabetes, high blood pressure or a cardiovascular condition, this is not a mere bureaucratic detail: it is the difference between a condition that is under control and one that is getting worse.
