Across Europe, life expectancy has been rising since the 1960s. However, the rate of increase varies between countries.
No matter where a person is born, everyone deserves the right to a longer and healthier life. It is unacceptable to treat these disparities as a lottery, where the winning ticket is determined by one’s birthplace and upbringing. Discussing these disparities is especially timely in certain countries: for instance, the Italian parliament has just approved a law that paves the way for devolving fiscal powers to regional governments. Opposition parties criticized this reform, arguing that the policy shift would widen the gap between Italy’s wealthiest and poorest regions. So, the critical question is: has the health of Italians improved over time, and if so, are there marked differences across territory? To address this question, we will use life expectancy—the average lifespan at birth based on current mortality rates. Life expectancy is a crucial factor in understanding a country’s health status, especially when evaluated alongside other socio-economic indicators, such as citizens’ satisfaction with living conditions, quality of life, and per capita income.
The good news is that Italy ranks third in Europe in life expectancy at birth, closely following Sweden and Ireland. From 1960 to 2022, Italy has seen an average increase of over fourteen years in life expectancy, largely due to advancements in medical technology and preventive care. However, the picture is not entirely rosy. The increase in life expectancy has not been uniformly distributed across Italy, exacerbating regional inequalities, particularly between the North and the South. While Northern Italy has experienced substantial improvements, the Central and Southern regions, including the islands, have lagged. This disparity has led to a closer alignment between Northern and Central Italy, but it has left the South behind. For example, a resident of Trento can expect to live over 84.5 years, whereas a resident of Naples has a life expectancy of around 81.2 years.
Taking a wider perspective on life expectancy in the Western world, have countries been experiencing longer lifespans compared to four decades ago, and does nationality influence our longevity? In the aftermath of the European elections, it becomes crucial to consider whether Brussels should grant more economic autonomy to member countries or centralize control to enhance public health outcomes. In recent history with Covid-19, we have learned that public health interventions were fragmented and ineffective at different points in time. On the other hand, the multi-million recovery fund given to some countries (largely in debt) has not sufficiently bolstered resilience or resolved issues such as waiting times, emergencies, and shortages of nurses and specialists.
Figure 1 illustrates the life expectancy across European countries in 1960 and 2022. Over this period, there has been a significant increase in life expectancy, climbing from an average of 66.4 years in 1960 to 77.2 years in 2022.
This well-documented rise in health outcomes among developed nations indicates that not only are more individuals reaching old age, but elderly people are also living longer lives. However, it’s crucial to note that populations are not aging uniformly across all nations. Cyprus and Portugal have seen particularly significant gains in life expectancy over time, positioning them at the top of the rankings in recent years. In contrast, Eastern European countries like Bulgaria and the Latvia have consistently shown the lowest life expectancy values.
Figure 2 illustrates the time series patterns of life expectancy across European countries. Towards the end of the study period, life expectancy trends in many countries have tended to converge. However, 10 countries stand out for consistently lower life expectancy throughout the period: Latvia, Estonia, Lithuania, Hungary, Czecho, Croatia, Poland, Bulgaria, Slovakia, Romania.
What are the possible causes of geographical differences in population health? If we follow the literature in health economics, the differences in life expectancy across countries can be attributed to several key factors. One significant factor is the level of healthcare expenditure, which, driven by technological progress, varies considerably between nations. There is little association between changes in life expectancy and changes in health expenditure as a share of GDP, but a substantial portion of the increase in health spending over time is driven by medical advances.
Technological innovation plays a crucial role in these differences. In countries with higher healthcare expenditure, medical technologies that treat previously untreatable illnesses are more readily adopted, leading to better health outcomes. For instance, less invasive technologies for treating acute myocardial infarction, such as percutaneous coronary interventions and drug-eluting stents, have reduced hospital stays, rehabilitation times, and healthcare costs. These advancements improve health productivity, especially when they replace more invasive and expensive procedures like coronary artery bypass graft surgery.
Furthermore, economic factors influence health outcomes. In wealthier countries, as people become more affluent and their consumption of non-health goods becomes saturated, they allocate more resources to healthcare, extending their lifespans. This shift results in rising health expenditure relative to income.
Healthcare productivity also varies significantly across countries due to differences in the adoption of medical innovations. Some healthcare systems are more efficient and incorporate new technologies faster, resulting in better survival rates and health outcomes. In contrast, systems that are slow to adopt new technologies, often due to inefficiencies or corruption, lag behind.
Additionally, cost-effective medical innovations account for much of the variability in hospital productivity. Countries with healthcare systems that efficiently integrate these innovations see better health outcomes and reduced costs. For example, the use of statins for preventing atherosclerosis has proven effective in reducing the need for more expensive treatments like angioplasty.
Geographical disparities are also influenced by the varying lifestyles adopted by communities, which can differ significantly from one country to another, including habits such as excessive alcohol consumption or smoking. As discussed at the recent Annual Health Economics and Policy Forum organized jointly by Brunel University London, Ca’ Foscari University of Venice, and the University of Oxford, shifting from high-risk behaviours to more prudent lifestyles (such as using e-cigarettes and heated tobacco instead of traditional cigarettes, moderate alcohol intake, regular physical activity) can greatly enhance life expectancy and overall quality of life. From an economic standpoint, this transition can help reduce avoidable healthcare expenditures or at least mitigate their impact by promoting healthier habits.
While life expectancy serves as an approximate indicator of a country’s health status, it is crucial, when using it to inform the public and policymakers, not to overlook genuine geographical disparities. It is essential to explore ways to narrow these gaps. Regardless of nationality, whether Spanish or Hungarian, everyone deserves the opportunity to pursue a longer and healthier life. However, in examining the Italian case, it is crucial to also understand the differences within countries. Policymakers must be guided by evidence to ensure they do not exacerbate existing geographical disparities a central and local level.
Francesco Moscone, with a bachelor’s and master’s degree in economics from the University of Essex and a PhD in health economics from King’s College London, is a Full Professor of Business Economics at Brunel University London and an Associate Professor of Public Economics at Ca’ Foscari University of Venice. He has taught at the University of Cambridge and the University of Leicester and has been a researcher at the London School of Economics and a visiting scholar at the University of Berkeley. He has published in numerous international scientific journals in economics and medicine and has won several European, Italian, and British research grants.