The photograph seems almost counterintuitive: an older country, with more chronic diseases, more diagnoses, more people living with two or more pathologies, yet with fewer citizens who declare they are ill. Within the new data collected by Istat on health in Italy there is precisely this gap, small only in appearance: in 1995 8% of the population declared themselves to be in poor health, while in 2025 the estimated share drops to 5.5%. If the data is then corrected for the effect of aging, the improvement becomes even clearer: from 9.8% to 4.5%.
Put like this, it seems like one of those pieces of news to read with a raised eyebrow, because all you have to do is enter a pharmacy, wait for a specialist visit or listen to a conversation between relatives to get the opposite impression. Yet the data tells something precise: living longer does not automatically mean feeling worse. In many cases it means reaching old age with more tools, more diagnoses, more drugs, more prevention, more the habit of controlling oneself. With all the inequalities that remain, and weigh.
The elderly improve most of all
The most interesting passage concerns the older age groups. Perceived poor health naturally increases over the years, especially among women, but the strongest improvements are seen among the elderly. In 2025, almost 28% of women aged at least 85 say they feel bad or very bad, a share halved compared to 1995. Among men of the same age the decline is even more dramatic: from 39.5% to 17.2%.
This doesn’t erase fragility, it moves it into a different framework. Today we live longer and often live with pathologies that once would have weighed much more on daily survival. Life expectancy at birth, between 1990 and 2024, increased by approximately 8 years for men and 6.5 years for women, reaching 81.5 and 85.6 years respectively.
Then there is the question of multimorbidity, an inelegant word to say a very concrete thing: having two or more chronic diseases together. In 2025 it will concern around 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%. As the country ages, certain conditions become more visible. However, net of age, the standardized prevalence of multimorbidity is reduced by 3 points and tends to become increasingly concentrated after the age of 75.
More diagnoses, less smoking, new risks
Some numbers explain why the general feeling can be improved even within a complex health situation. Infant mortality, which was very high in post-unification Italy, fell to 2.7 deaths per thousand live births in 2023, one of the lowest values in the world. Mortality from infectious diseases, which weighed enormously at the end of the 19th century, has represented around 1% of total deaths since the 1990s, with the exception of the rise during Covid-19: 12.4% in 2020, then 5% in 2023.
Meanwhile, the diseases that accompany long life are changing. Diabetes goes from 2.9% of the population in 1980 to 6.4% in 2025. Hypertension rises from 6.4% to 18.9%. Here both aging and greater diagnostic capacity come into play, with earlier checks and thresholds updated over time. But lifestyles also come into play, especially excess weight and a sedentary lifestyle.
On smoking, however, the improvement is clear 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, new habits are appearing: between 18 and 34 years old, in 2025, 16.5% use electronic cigarettes and heated tobacco together.
The North runs faster, the South lags behind
Perceived health improves, but improvement occurs at different speeds. In 1995, territorial differences in self-reported poor health were less marked; by 2025, progress is strongest in the North and weakest in the South. The same pattern appears in mortality: between 1990 and 2023 the standardized rates decrease by 43% among men and by almost 40% among women, with more robust reductions in the Centre-North and slower in many southern areas.
The territory, therefore, continues to decide a lot. Access to care, quality of services, prevention, education, income, daily habits: everything enters the body long before becoming statistics. Educational qualifications also have an impact, although the differences in perceived health have been reduced thanks to the strong improvement among people with low education, who were initially more disadvantaged.
It remains a less dark read than one would expect. Italy is older, more medicalized, more chronic, but a significant part of the population feels better than thirty years ago. Thanks to medicine, prevention, vaccines, hygiene, nutrition, the National Health Service created in 1978 and a broader familiarity with controlling one’s health.
Then there are the cracks: adult obesity rose from 5.9% in 1990 to 11.6% in 2025, children with levels of overweight and obesity still too high compared to other European countries, new tobacco products among young people, territorial differences that die hard.
Perceived health improves, and that’s good news. Now it remains to be seen whether we will be able to protect it, before old inequalities and new habits slowly consume it.
