Excellence in Public Health Depends on Teaching Children to Eat Right
The latest Bloomberg report ranks the Italian health service as the world's first in terms of the ratio between resources invested and health performance. Indeed, Italians spend less for health than most other Europeans but have very high levels of life expectancy (80 years for men and 85 for women). It is hard to find other contexts where Italy performs so well in international comparisons. All is going well, then? Not exactly.
It is complex work to evaluate how various factors contribute to longevity. And it is essential to keep in mind that the health of a population is only partially determined by health services, because it is influenced by behavioral factors (lifestyle), social factors (e.g. pollution and workplace safety), and climate factors. Therefore, caution is needed in giving the national health service all the merit for the good health of the Italian population.
But it's not just a question of socio-economic factors. The relationship between health spending on the one hand and performance indicators on the other is not simultaneous. There is growing agreement around the idea that it is the whole "lifecycle" that determines one's healthiness and susceptibility to disease. In other words, today's excellent indicators could be the result of favorable interventions in the past, including the good functioning of the health system, while the future could be different (and less positive) because of determinants whose effects will emerge in the longer term.
Therefore, if there is a lag between the functioning of the health system and its effects on people's health, it is essential to read any signs that might anticipate a looming crisis. It is precisely for this reason that it is important not to overlook the data on childhood obesity reported by the Italian Ministry of Health: they show a worrisome situation. In the last survey conducted on about 50,000 children, 9.3% were obese and 22.5% were overweight. These are very high percentages, which place Italy at the bottom of EU rankings, just ahead of Greece. The same survey also portrays a strong heterogeneity between areas of the country. In the South, the prevalence of obesity among children is 15-18%, more than double the percentage of Northern regions. At the regional level, the correlation between low-income households and childhood obesity is very strong. Paradoxical as it may seem, childhood obesity is a condition that disproportionately affects the poorest sections of the population.
More detailed analyses also show that children affected by obesity tend to have similar parents, and that educational and cultural levels are determining factors. For example, children from a mother with college education have a 5% likelihood to turn out obese, while children from mothers with only junior high school have a 17% propensity to become obese.
The high prevalence of child obesity, which is a risk factor for future health conditions, and the strong correlation with socio-economic well-being are a clear signal that Italy will find hard to maintain past levels of health excellence. And it is perhaps no coincidence that such alarm signals concern the health of our children, considered the generational imbalance of our welfare system, skewed in favor of the elderly.
If the Italian health system wants to maintain levels of excellence in the coming decades, it must invest more in prevention and on younger generations. The data available on child obesity should make us ponder the vulnerability of youngest generations, the need for stronger prevention strategies, and the importance of recognizing socio-economic inequalities as fundamental in determining the state of health of the entire population.