AIES 2018 Napoli

Opening address

Vincenzo Atella

September 27th, 2018

 Due date da ricordare

 5 luglio 1948

 23 dicembre 1978

National Healthcare Systems and universal coverage:

are they still feasible?
Lessons learned and challenges ahead after 70 years of the British NHS
and 40 years of the Italian NHS
 Due date da ricordare

 5 luglio 1948

 23 dicembre 1978

National Healthcare Systems and universal coverage:

are they still feasible?
Lessons learned and challenges ahead after 70 years of the British NHS
and 40 years of the Italian NHS
 Where we do come from:
the awful initial conditions

 In 1873, Carlo Maggiorani, a Bolognese physician, reported the

health conditions of the population to the senate of the Italian
kingdom: “pale looks, morbid flesh, frail machines and weak
constitutions”, the result of the “heap of ills” that afflicted the
Kingdom’s population (Della Peruta 1980, p.200). («cere pallide,
tempre di carne morbidamente impastate, macchine gracili e frolle
costituzioni», risultato della «caterva di mali» )

 Charles Dickens came back dazed from his trip to mid- nineteenth-
century Italy, charmed by the magnificence of its artistic heritage,
but deeply disturbed and disgusted by the living conditions of the
mass of the population (Dickens 1846).

 Italy was, in short, hardly an enviable place to live in, as noted by

witnesses of the times.
 Life expectancy at birth in Italy:
a comparison with the rest of the world
Increasing LE likely due
to health improvements
in YOUNG population,
e.g. immunization

Increasing LE likely due to

health improvements in
OLD population, e.g. heart
disease treatment

Source: Atella, Francisci e Vecchi (2017) (2017), “Health”, in G. Vecchi (2017), “Measuring Wellbeing. A History of
Italian Living Standards”, ch. 2, pp. 43-87. New York: Oxford Universty Press.
 Infant mortality rate in Italy:
a comparison with the rest of the world
Increasing LE likely due
to health improvements
in YOUNG population,
e.g. immunization

Increasing LE likely due to

introduction of antibiotics and
improvements in pediatric care

Source: Atella, Francisci e Vecchi (2017) (2017), “Health”, in G. Vecchi (2017), “Measuring Wellbeing. A History of
Italian Living Standards”, ch. 2, pp. 43-87. New York: Oxford Universty Press.
 The epidemiologic transition in Italy

Source: Atella, Francisci e Vecchi (2017) (2017), “Health”, in G. Vecchi (2017), “Measuring Wellbeing. A History of
Italian Living Standards”, ch. 2, pp. 43-87. New York: Oxford Universty Press.
 Child mortality (deaths x 1000)
USA

GBR

FRA

NLD

DEU

BEL

AUS

AUT

ITA

ESP

SWE

JPN

0 2 4 6 8 10 12 14 16
1980 2015
The WHO health system ranking - 2000
Bloomberg 2017
Causes of chronic conditions
UNDERLYING FACTORS

Globalization Urbanization Pollution Ageing

MODIFIABLE RISK FACTORS – LIFE STYLES

Diet Physical Obesity Tobacco Alcohol Drugs

activity

CHRONIC DISEASES

Heart Stroke Cancer Diabetes BPCO

Disease
 The ageing process

Source: ISTAT (2017). “IL FUTURO DEMOGRAFICO DEL PAESE. Previsioni regionali della popolazione residente al
2065.” Statistiche Report. 26 Aprile 2017. https://www.istat.it/it/files/2017/04/previsioni-demografiche.pdf.
Pollution
POLLUTION CONCENTRATION LEVELS IN EUROPE

Particulate matter (PM) 2.5

concentration in Europe in
2015 (7x7km grid).
 Per capita daily calorie availability
over time

Source: Sorrentino e Vecchi (2017), “Height”, in G. Vecchi, “Measuring Wellbeing. A History of Italian Living
Standards”, ch. 2, pp. 43-87. New York: Oxford Universty Press.
 Nutrient composition over time

Source: Sorrentino e Vecchi (2017), “Height”, in G. Vecchi, “Measuring Wellbeing. A History of Italian Living
Standards”, ch. 2, pp. 43-87. New York: Oxford Universty Press.
Vegetable eating
Physical activity
 Overweight and obesity

For GIRLS: For BOYS:

Italy = 34% Italy = 36%
England = 26% England = 22%
Germany = 22% Germany = 26%
France = 15% France = 15%
 Overweight and obesity (%) in children 8-9
years by region. Italy, 2014

47,8%

Source: OKkio alla SALUTE: Risultati 2014

Smoking
Drunkenness
Cannabis and cocaine
 Percentage of patients by sex, year
and number of chronic diseases

Source: Atella et al., The burden of age-associated chronic diseases in Italy. Ageing Cell, 2018 Forthcoming
 Final remarks

 L'epidemiologia sta cambiando lungo il ciclo di vita e i giovani

adulti sembrano essere i più a rischio.

 Il permanere di questi trend pone a rischio la sostenibilità

dell’intero sistema sanitario (e potenzialmente di quello della
sicurezza sociale).

 Da un punto di vista economico è importante capire quali sono

i canali e i meccanismi coinvolti e perché ciò accade.
Statistiche su AIES 2018

 Oltre 130 paper inviati

 107 paper accettati

 99 paper presentati

 2 plenary sessions

 10 paper presentati da ricercatori di istituzioni non

italiane
Tipologia delle sessioni

 Applied health economics/econometrics

 Health economic theory

 Policy impact evaluation

 HTA

 Quality and efficiency

 Equity

 VISITINPS / Dati amministrativi

 Management dei sistemi sanitari

Assemblea soci

 Vincitori premio Fondazione Farmafactoring

 Premi best paper giovani ricercatori

 Scelta sedi per AIES 2019 e 2020

 Presentazione nuove proposte sito AIES

 Presentazione nuove attività

Ringraziamenti

 Comitato Scientifico  Comitato organizzatore

 Fabio Amatucci  Edoardo Di Porto
 Elenka Brenna  Carla Guerriero
 Edoardo Di Porto  Stefania Maddaluno
 Giacomo Pasini  Imma Marino
 Anna Prenestini  Roberto Nisticò
 Domenic Salvatore  Jonathan Pratschke

Special thanks to:

Lucia Carpaneto, Simone Chinetti, Emanuele Loffa,

Loredana Mattei, Marco Scaglione e Annalisa Tirozzi
 Buona conferenza
e
grazie per l’attenzione