Reviewer: Alain Touwaide, PhD (Ronin Institute)
Description: As per the author's own statement "the book provides a historical account of health and health care in Italy since 1861, the year of its unification, to the present COVID-19 pandemic." Though divided into 12 chapters, it proceeds in three major phases: the first post-unification period of the country; the Mussolinian period; and the post-WWII period, that is, the Republic. It is a multi-spectral and comparative analysis of the development of a health system in its diverse forms over time.
Purpose: The objective is clearly stated by the author: "to fill a void in the English language literature about health, medicine, and healthcare organization in Italy for students, teachers, and scholars of Italian politics, history, and culture." This void is all the more critical "since health and healthcare policy and politics are among the most distinctive characteristics of a country." And, indeed, Italy has been a laboratory for the construction of a modern health system, the history of which has not been carefully scrutinized until recently.
Audience: Although the author defines the audience as "the scholars of Italian politics, history, and culture," the potential readership of this book is much broader. Italy as it is today has had a significant history, which started recently (end of the 19th century) and is characterized by experiments to create a health system. From this viewpoint, it is a real laboratory with three very different systems. Thanks to this, this inquiry will be of interest to a great range of audiences, including policymakers worldwide.
Features: The key message of this book is the history of Italy. Until the late 19th century, Italy was a mosaic of polities inherited from history. The unification of the country in 1861 was a unique opportunity to design a country and its organization from scratch. In these circumstances, organizing a health system was a priority. Because of Italy's specific history, its health system went through three phases: liberalism of the early years, a piloted authoritarian system in the Mussolinian era, and a post-WWII system, universal in nature and taken in charge by the state. Three major health crises made it possible to check the systems: the Spanish flu, malaria, and, more recently, COVID-19, each corresponding to one of the three periods of Italy's health system. The book's analysis is multi-spectral, proceeding in brief, thematically unitary chapters, structuring the whole analysis in a very clear way.
Assessment: This book is a small masterpiece with a clear vision, a well-articulated analysis, and efficient writing. The text runs fluidly, with intra-textual references and a specific bibliography at the end of each chapter. The volume closes with a short but efficient index. The most important point is the clear analysis of the three strategic options behind the health systems adopted by Italy: individualism, radical communitarism, or statalism. Approached in this view, this will be a very useful work as a "manual" for the making of health systems (or their revision). It is a very timely contribution.
