The Italian National Health Service in a Time of Crisis. What Were the Responses for the Most Vulnerable People?

An effective healthcare system is crucial for promoting societal well-being. Italy’s healthcare system, established with the National Health Service in 1978 and reformed in the 1990s into twenty Regional Health Systems (RHSs), faces significant challenges. The 2008 economic crisis and subsequent austerity measures strained the system, reducing resources for providing high-quality care. The COVID-19 pandemic further exposed vulnerabilities, particularly among marginalized groups such as those in crowded settings (nursing homes, prisons), irregular migrants and sex workers. These populations, often overlooked by public health systems, face heightened health risks due to poor living conditions and limited healthcare access. This chapter explores the complex factors - both structural and contingent, as well as the institutional and organizational characteristics - that have impeded RHSs from effectively serving vulnerable populations. Marginalized groups, facing socioeconomic hardships including low education and unemployment, are particularly at risk. The discussion highlights the need for a shift toward a social and community-based perspective in public health. By acknowledging these challenges and proposing reforms focused on inclusivity and community engagement, Italy’s healthcare system can better address the needs of its most vulnerable members, promoting health equity and societal well-being.