Territorial health inequalities of the elderly in Italy

Elena Pirani, University of Florence
Silvana Salvini, University of Florence

Italy displays several territorial differences: as it is well-known, the South shows less favourable conditions than the North, with respect to economic, social, and environmental aspects and also in the field of health. Our analysis intends to provide a comprehensive overview of main socio-economic factors acting on the perceived health status, using an indicator suggested by WHO. Moreover we intend to verify if there is a regional gradient in the subjective evaluation of health. Do health inequalities due to socio-economic differences operate differently depending on the area of residence? And, finally, is the regional breakdown sufficient in order to examine and explain the differences in health performances, or we need a more detailed territorial level of analysis? The study makes use of a representative cross-sectional survey Health conditions and recourse to health services carried out by the Italian National Statistical Office (ISTAT) in 2004-2005. The large sample size and the sampling design allow us to analyse health characteristics at a sub-national level. Focussing on elderly people (65 years and over), the analysis will refer both to the regional and to a sub-regional level. In order to describe the relationships among the health status of individuals, their demographic and socio-economic characteristics, and the area of residence, and to capture the role of different levels of determinants, a multilevel framework is adopted. The first result of this study is that Italy still presents health differences depending both on gender and on individual socio-economic status. A second result is that the residential context has a relevant effect on the perception of individual health status, confirming that it still persists a “regional effect” even after controlling for individual covariates. Finally, we proved that Italian regions explain territorial differences in health status, but some heterogeneity still remains within the regions.