Italy is one of the countries in the world most affected by the covid-19 pandemic. [1] However, hopefully soon, Italy shall overcome covid-19 and the time will come to assess how our value chains have been rethought and reshaped. We are two young Italian physicians, and there is one thing that the pandemic has made us realise that we should not take for granted anymore: none of the affected individuals will be presented with an invoice at the end of their sickness, except for their contribution to the system as taxpayers.

Even though we have not seen the end of the pandemic, we should already start planning how to preserve the public nature of our health system. What is currently happening to the Italian health system and what will come after? [2] The National Healthcare Service (Servizio Sanitario Nazionale, SSN) established in 1978 has its roots in the principle of universality of access, equity, and solidarity which are praised by the World Health Organization in its run towards Universal Health Coverage for all. Italy health expenditures account for around 8.8% of its GDP, in line with the average of OECD countries, yet behind all other Western European countries. [3] The same applies if we consider that the Italian share of public spending for health considerably decreased compared to Western European countries, with a study estimating a cut of 37 billion in the last ten years. [3,4]

We should appropriately fund and reorganize the structure of our system to be prepared for the new global health challenges that will strike in the upcoming years. [5] Not forgetting the potential for new a new covid-19 pandemic, we should keep in mind that climate change is the most serious health threat in the longer term. The consequences of the climate emergency are already hitting Italy. Serious heat related effects on daily mortality are affecting the population, as well as the impact of air pollution exposure. [6] Extreme events might take a similar wave-shape that overwhelmed our hospitals in a short lapse of time as covid-19 did, threatening the resilience of the healthcare system to promptly respond to the health needs of the population. 

The preparation process towards COP-26 is an extremely important time to gather momentum and to gain reflections on these issues, even though the conference has been postponed to 2021 due to the pandemic. Italy is a hosting partner with the United Kingdom in the next climate negotiations, a country whose National Healthcare Service was inspirational for structuring the Italian one. Health authorities now have the chance and opportunity to address both the sustainability of the National Health Service while taking into account the environmental and climate challenges that are already posing an incredible toll on people’s health and will increasingly continue to do so in the upcoming years. 

The Italian National Healthcare Service and health workers must start working as soon as possible as our generation will have to carry on the political struggle to ensure a public, universal, and equal access to health for all in the years to come.

Samantha Pegoraro, Climate and Health coordinator, Italian Climate Network, Pisa, Italy.

Stefano Guicciardi, Health Directorate, Local Health Authority Unit of Bologna, Bologna, Italy.

Competing interests: None declared

References:

(1) Task force COVID-19 del Dipartimento Malattie Infettive e Servizio di Informatica, Istituto Superiore di Sanità. Epidemia COVID-19, Aggiornamento nazionale: 23 aprile 2020 https://www.epicentro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_23-aprile-2020.pdf 

(2) Remuzzi A, Remuzzi G. COVID-19 and Italy: what next?. Lancet. 2020; (published online March 12.) https://doi.org/10.1016/S0140-6736(20)30627-9 

(3) OECD Health Statistics 2019. Last update 15 November 2019. Available at: www.oecd.org/els/healthsystems/health-data.htm. Last access: 7 April 2020.

(4) Report Osservatorio GIMBE n. 7/2019. Il definanziamento 2010-2019 del Servizio Sanitario Nazionale. Fondazione GIMBE: Bologna, settembre 2019. Accessible at: www.gimbe.org/definanziamento-SSN. Ultimo accesso: 24 Aprile 2020.

(5) World Health Organization. Ten threats to global health in 2019 [Available from: https://www.who.int/emergencies/ten-threats-to-global-health-in-2019.]

(6) World Health Organization & United Nations. (2018). Climate change and health country profile: Italy. World Health Organization. https://apps.who.int/iris/handle/10665/260380. License: CC BY-NCSA 3.0 IGO