Hasan Sajid, group 20E
In Italy the healthcare system is organised through the government, and available to all citizens as well as foreign citizens. Additionally the WHO report on Italian healthcare did identify that amenable mortality remains on of the lowest in the EU which suggests the healthcare system is ef fective in treating life treating conditions such as cerebrovascular diseases. In terms of spending Italy spends 9.1% of the GDP on healthcare which does sit just below the EU average of 9.9%. Es sential healthcare services are free such as access to GP’s etc however dental and pharmaceuticals are paid for out of pocket by patients.
Key Health Indicators
There are a few key health indicators that are important to analyse when looking at the cerebrovas cular health of Italy in comparison to the rest of Europe to evaluate the level of the problem. One such indicator is the occurrence of strokes in Italy which has a value ranging from from 175 to 360 individuals per 100,000 individuals in the population. Additionally the rate of lethal cases of stroke is 41 individuals per 100,000 members of the population. The western European average was 49 cases per 100,000 people which shows that Italy’s value is slightly lower than the rest of western Europe suggesting that people live healthier lifestyles or there are fewer hereditary factors in Italy compared to other western european countries. When looking at the values from central Europe such as the Czech Republic there are higher volume of stroke cases at a value of 110 per 100,000 values. However countries such as Bulgaria had values of 391 per 100,000 individuals which is sig nificantly higher than Italy suggesting there are big differences in lifestyle.
When looking at cerebrovascular diseases there is one factor which increases the risk of stroke and other diseases massively and it is smoking. Italy in particular has a large population of smokers, with 23.3% of the population being smokers which equates to 12.2 million Italians and this is an increase of 0.4% on the previous year in 2018 . Now in comparison to Bulgaria where 36% of the population smoke and that working out to 920,000 people in 2017, this begins to explain the differ ence in the prevalence of strokes between the two nations. For reference smoking doubles the risk of stroke and smoking 20 cigarettes a day will increase your risk of having a stroke by 6 times, due to the effect of cigarette smoke which thicken the blood, increase clot formation as well as narrow ing arteries.
New stroke cases per year = 180,000 with 48,000 lethal
1972 stroke rate = 673 per 100.000 woman
596 per 100,000 men
175-360 per 100,000
stroke rate current – 4
41 deaths per 100,000
Specific indicators
When looking at cerebrovascular diseases in Italy there are a few statistics to look at to attain whether these specific diseases are linked by other diseases or genetic / environmental factors. There are a small list of factors which increase the risk of developing cerebrovascular disease such as hypertension. The increased blood pressure damages the blood vessels which in turn increases the risk of blood clot formation or the splitting of an artery. In Italy around 55 – 59% of the adult population as well as 11% of population between 18 – 35 have hypertension. Additionally there was a blood pressure screening in May 2017 of 10, 076 people and 3099 were diagnosed with hyperten sion. This works out to a hypertension rate of 308 per 1000 people when using the sample size. This specific test for hypertension also found out that individuals were aware of the ways to reduce blood pressure but there wasn’t enough education on the risks that are associated with hypertension, therefore a method of reducing the amount of people developing hypertension would be to increase the amount of education on the effects of having high blood pressure as well as an increase in en couraging people to visit their doctor and ask for a blood pressure check.
Another factor which can affect the development of cerebrovascular disease is obesity. Usually obese individuals are more likely to have a poor diet , reduced exercise levels as well as higher cho lesterol levels. Having high cholesterol levels increases the risk of developing a blood clot which can cause blockage of an artery. Obese individuals also are more likely to have a higher blood pres sure. Italy specifically in terms of obesity has one of the lowest rates of adult obesity in Europe with only 10 % of adults obese. However unusually Italy also has one of the highest childhood obesity obesity rates with 36% of boys obese and 34% of girls. The key factor to explain the high childhood obesity is difficult to explain, especially as it seems to affect the south of the country more. The Ital ian government spends 9 billion euros a year on obesity, and there is a recent health expenditure restriction making it difficult to improve education and treatments. The best way to reduce obesity would be to improve education on eating healthier amongst new parents and younger children as the issue for Italy seems to be the obesity during childhood.
Diabetes is another factor which can increase the risk of cerebrovascular diseases is the presence of diabetes in either type one or type two form. This is due to the high glucose levels that can be present which result in damage to the blood vessel wall, and increasing the risk of a blood clot forming. Diabetes in Italy is a disease affecting 3,402,300 individuals which is 7.6% of the adult population in 2017. In Italy the prevalence of diabetes in adults between 18-99 is 8.5 per 100 indi viduals which is higher when compared to the UK at 5.9 per 100 individuals. The prevalence of type 1 diabetes is recognised as an autoimmune disease where the beta islet cells of the pancreas are destroyed and this unfortunately is a genetic disease so the prevalence cannot really be limited. However in terms of limiting the prevalence of type two diabetes there are multiple factors such as increasing the amount of exercise, stopping smoking, limiting alcohol and eating a healthy and bal-
anced diet. To reduce the prevalence of diabetes type two in Italy the best methods would be to in crease education for living a healthier lifestyle through the use of highlighting risks of smoking, ex cessive alcohol consumption as well as promoting eating a balanced diet and staying active.
Health determinants
There are many determinants for health such as the large range of social, personal, economic and environmental factors which make up the health of both individuals as well as the population. There are lifestyle factors such as the diet we eat which can effect our health in both a positive or negative way.In the case of cerebrovascular diseases a diet which is rich in fat does increase the risk of the formation of plaque on the walls of arteries leading to ischemic strokes. Another determinant for health also is the genetic factor, which is passed through from parents and in the case of cerebrovas cular diseases it does have an effect. There has been animal and clinical studies which do show a link between a genetic predisposition towards atherosclerosis and cerebrovascular diseases, in par ticular ischemic stroke. It is suggested that variants in protein convertase PCSK9 gene can affect stroke and familial hypercholesterolemia.
There are also a large range of other determinants such as the income and social status of the indi vidual. In reference to Italy these factors do not affect individuals massively due to the presence of the governmental run Servicio Sanitario Nazionale which does provide free healthcare to individu als. As with most nations there is private healthcare available if patients would like also.
Another determinant of healthcare would be the environment around the individual, and there are some studies looking into the effect that cerebrovascular diseases interact with external environ mental conditions. Both the heart and vascular system are both sensitive to ambient air pollution, as well heavy metals such as metal arsenic, cadmium, and lead. These factors can increase the dis ease’s impact as well as cause the initiation of the disease through affecting blood – pressure con trol, carbohydrate and lipid metabolism, vascular function, and atherogenesis. There is evidence based clinical and public health strategies that are being used to attempt to reduce the environmental exposures from current levels which could have a knock on effect and reduce the number of cases of cardiovascular and cerebrovascular cases worldwide.
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