The figure seems small: 2.7. Placed next to a thousand live births, it tells how many children die today in Italy before turning one. It is an almost silent number, used to slipping between statistics, tables and graphs. Yet within those 2.7 deaths per thousand births there is one of the most radical changes in national history: a country that in the second half of the nineteenth century lost around 230 children out of a thousand within the first year of life, and which today ranks among the safest places in the world to be born.
In 1872 life expectancy at birth in Italy was just 29.8 years; today he reaches 83.4 years. In between there are drinking water, vaccines, antibiotics, better nutrition, hygiene, schools, medicine, public health. Very concrete things. Taps, sewers, milk, visits, needles, soap, books, hospitals.
When being born was already a test
In the second half of the nineteenth century, Italian health had little to do with the idea of well-being to which we are accustomed today. Very high infant mortality weighed on everything: on families, on countries, on life expectancies, even on the way we looked at our children. A newborn passed through the first year like a fragile threshold. The causes lay within a very harsh normality: malnutrition, poor hygienic-sanitary conditions, little availability of drinking water, widespread illiteracy. Even the most basic hygiene rules became difficult to follow when tools, knowledge and material conditions were lacking. The decline in infant mortality was almost continuous, with violent spurts during the two world wars and with the impact of the 1918-1919 influenza pandemic. In the 1990s the rate had already fallen to five deaths per thousand live births; in 2023 it reached 2.7.
The transformation of Italian health also passes through another, more crude number: until the end of the nineteenth century the general mortality rate was close to 3 thousand deaths per 100 thousand inhabitants, and over a quarter involved children in the first year of life. In the decades after the Unification, the main threats had names that today we often read as history: cholera, tuberculosis, malaria. In 1881, infectious and parasitic diseases accounted for approximately 30% of deaths, and another 30% were related to respiratory and digestive diseases. Then the country began to change its skin. Hygiene conditions have improved, medicine has made progress, vaccines have had an impact, sulphonamides since 1935 and antibiotics after the Second World War have pushed down many causes of death that for generations had seemed almost inevitable.
The twentieth century brought a less spectacular revolution than many others, but much more decisive: dying as children has become increasingly rare. Even the median age at death tells it brutally. In the second half of the nineteenth century it was between 5 and 10 years, precisely because deaths in the first years of life were enormously frequent. At the beginning of the twentieth century it rose to around 20-25 years, exceeded 65 years after the Second World War and in 2023 reached 81.6 years for men and 86.3 for women. The territorial difference remains significant: the median age at death ranges from less than 82 years in Campania to over 86 in the Marche, with a clear disadvantage for the more populous regions of the South.
The victory that changes the problems
When a country stops dying early, problems change shape. Since the 1990s, infectious diseases have represented around 1% of total mortality, with the dramatic exception of Covid-19, which in 2020 made them 12.4% of deaths, then dropped to 5.0% in 2023. Respiratory diseases went from 500-600 deaths per 100 thousand inhabitants to 60-70; those of the digestive system from around 400 to 40. Meanwhile, chronic-degenerative pathologies have grown: tumors, which at the end of the nineteenth century accounted for 2-3% of deaths, reach 26.3% in 2023; cardiovascular diseases go from 6-8% to 30%, becoming the main cause of death since the second half of the twentieth century.
This is the least comfortable part of the story. We live longer, so we encounter diseases of advanced age more often. Between 1990 and 2024, life expectancy at birth increased by approximately 8 years for men and 6.5 years for women, reaching 81.5 and 85.6 years respectively. In 2025, multimorbidity, i.e. the simultaneous presence of two or more chronic pathologies in the same person, will affect 13 million people, compared to 10.3 million in 1993. The share of over-75s in this group has risen from 21.3% to 39%. Yet, net of aging, the standardized prevalence in the overall population has reduced by three points: many frailties move later in life, as if the body gained years of resistance before presenting the bill.
Alongside longevity, lifestyles come into play. Diabetes goes from 2.9% of the population in 1980 to 6.4% in 2025. Hypertension rises from 6.4% to 18.9% in the same long period, also due to greater diagnostic capacity and earlier checks, together with worsening risk factors, such as excess weight among young people and adults. Obesity among adults grows from 5.9% in 1990 to 11.6% in 2025, with more marked disadvantages among men, less educated people and residents in the South. The photography here is very Italian: adults still among the least affected in Europe, children and young people already exposed to levels of overweight and obesity that weigh on the future.
Well-being remains unequal
Italian health is improving, but it is doing so at different speeds. Between 1990 and 2023, age-standardized mortality decreases by 43% among men and by almost 40% among women. The decline is strongest in the Centre-North, where in some regions it exceeds 50%, while in almost all of the South it stops at around 35%. In 2023, the maps of male and female mortality end up looking similar: both show higher levels in the South, with Campania and Sicily distanced from the rest of the country. Educational qualifications also have an impact: among adults aged at least thirty, those with a low level of education have a mortality rate that is approximately 40% higher than those with a high education.
Even the perceived health shows an improvement, with some cracks. Over the last thirty years, the share of people who declare themselves to be in poor health has fallen from 8% in 1995 to 5.5% in 2025; in standardized terms, correcting for the effect of aging, it goes from 9.8% to 4.5%. Among the over 85s the change is clear: in 2025 almost 28% of women declare they are ill or very ill, a share halved compared to 1995; among men of the same age the figure drops from 39.5% to 17.2%. Here too, the North improves more, the South less. The body ages, medicine holds up better, perception changes. Where you live continues to matter a lot.
Then there is smoking, an old Italian habit that has lost ground especially among men. In 1980, over half of males aged 14 and over smoked, 54.3%; in 2025 the share drops to 22.9%. Among women the decline is much smaller, from 16.7% to 15.9%. In the meantime, alternative products are advancing, especially among young people: in 2025, 16.5% of 18-34 year olds will use electronic cigarettes and heated tobacco together. Chronic bronchitis, also linked to smoking, has risen from over 4 million people in 1980, more than two thirds of whom were men, to 2 million in 2025, with no gender differences. Here too, progress has left a new queue, more technological, younger, less easy to archive.
The long history of Italian health, seen from these numbers, resembles a house being rebuilt room by room. First the massacre of newborns stopped. Then the infections, the hunger, the dirty water, the diseases that ran where hygiene and care were lacking. Then other enemies arrived, slower, quieter, more linked to age, income, territory, education, daily habits. The country that in 1872 had a life expectancy of 29.8 years today exceeds 83. An enormous, concrete achievement, built without poetry: water, vaccines, antibiotics, hospitals, prevention, access to treatment. Just look at them carefully, those 2.7 deaths per thousand. They are only small on paper.
You might also be interested in:
