{"id":5579,"date":"2024-12-10T12:11:43","date_gmt":"2024-12-10T11:11:43","guid":{"rendered":"https:\/\/www.rivistaeco.com\/?p=5579"},"modified":"2024-12-10T12:11:43","modified_gmt":"2024-12-10T11:11:43","slug":"the-first-thousand-days","status":"publish","type":"post","link":"https:\/\/www.rivistaeco.com\/en\/2024\/12\/10\/the-first-thousand-days\/","title":{"rendered":"The First Thousand Days"},"content":{"rendered":"

Italy has a low infant mortality rate. However, more newborns die in the South than in the North. Moreover, the care provided during the first two and a half years of life significantly influences long-term health and behavior. Why, then, does the National Health Service fail to invest in foundational early childhood services and instead reduce funding for family clinics and pediatricians?<\/span><\/i><\/p>\n

Providing care and support to all children during the early stages of life and to all mothers during pregnancy has enduring positive effects for both individuals and society. In recent years, research in neuroscience, life-course health dynamics, genetics, and epigenetics (a branch of genetics studying how environmental factors like diet, physical activity, and exposure to physical and chemical agents can alter gene expression without changing the DNA sequence) has consistently shown that the conditions, environments, and experiences of the first thousand days profoundly impact cognitive development, emotional and relational skills, and overall physical and psychological well-being. Early childhood environments and care shape the foundation for mental and physical health that lasts through adolescence and adulthood.<\/span><\/p>\n

Ensuring universal and equitable access to the National Health Service and the socio-healthcare system is crucial for everyone but becomes especially critical for young children and pregnant mothers, particularly those from socioeconomically disadvantaged backgrounds.<\/span><\/p>\n

Inequalities from Birth<\/b><\/h3>\n

From birth onwards, inequalities in health outcomes are stark, despite Italy being one of the countries with the lowest infant mortality rates globally. Infant mortality refers to deaths within the first year of life. A study published in January 2024 in the <\/span>Italian Journal of Pediatrics<\/span><\/i> by Mario De Curtis, Silvia Simeoni, and Luisa Frova emphasizes that \u201cmonitoring neonatal and infant mortality rates allows us to track changes over time shaped by healthcare, social, economic, and organizational factors.\u201d<\/span><\/p>\n

Italy\u2019s infant mortality rate is very low: 2.5 deaths per 1,000 live births in 2019 and 2020, increasing slightly to 2.6 per 1,000 in 2021 before dropping to 2 per 1,000 in 2022, compared to the EU average of 3.3 per 1,000 according to the latest Eurostat update. However, these encouraging numbers mask substantial territorial disparities. In 2021, seven regions recorded infant mortality rates above the national average of 2.6 per 1,000, with peaks in Calabria and Sicily at 4.2 and 3.9, respectively. More broadly, 2.3 children per 1,000 live births in northern regions and 3.2 per 1,000 in southern regions die within their first year of life.<\/span><\/p>\n

Infant Mortality Rate by Region in 2021<\/b><\/h4>\n
\"\"
Note: The figure represents the number of children who died in their first year of life per 1,000 live births. Source: ISTAT.<\/figcaption><\/figure>\n

The differences in health outcomes are undoubtedly influenced by poverty, which disproportionately affects families in southern Italy (12.1% in absolute poverty in 2023) compared to those in the North (9%).<\/span><\/p>\n

The study, based on 2020 data, also highlights significant disparities in infant mortality rates between Italian children and those born to non-Italian parents. These differences are closely tied to socioeconomic inequalities and the material and multidimensional poverty experienced by migrant mothers. Poor living conditions make foreign women \u201cmore prone to premature births and perinatal pathologies affecting the newborn.\u201d ISTAT data confirms that absolute poverty is far more common among foreign families with minor children (about one in three) than among Italian-only families, where the rate is six times lower.<\/span><\/p>\n

The study further reveals that a newborn in southern Italy\u2014whether from a migrant or Italian background\u2014has a 70% higher chance of dying in their first year compared to a child living in northern Italy. This disparity is reflected in healthcare mobility data, as highlighted by the Gimbe Foundation in January 2024: regions with higher patient inflows are all in the North, while those with significant outflows are concentrated in the Center-South. Similar patterns were observed in a pre-pandemic study by the Italian Society of Pediatrics on pediatric healthcare migration.<\/span><\/p>\n

The First Thousand Days<\/b><\/h3>\n

Extensive research demonstrates that the first thousand days of life represent a unique and critical developmental window that cannot be replicated later. For example, improper nutrition during pregnancy or exposure to toxic substances and environmental pollutants can result in metabolic defects and adult obesity. Early interventions, however, have been shown to improve cardiovascular health in adulthood. Moreover, interpersonal skills like empathy and self-control, which are nurtured through secure and loving relationships between children and their caregivers, play a crucial role in preventing antisocial behavior and violence.<\/span><\/p>\n

In 2018, the World Health Organization published the <\/span>Nurturing Care<\/span><\/i> framework, which advocates for equipping parents and caregivers with the knowledge and skills to provide \u201cnurturing care.\u201d According to the Center for Child Health, parents must understand the behaviors that can harm fetal and child health and learn how to promote their child\u2019s well-being and development from birth. The <\/span>Nurturing Care<\/span><\/i> framework is based on five key components, each supported by specific recommendations and best practices: good health, adequate nutrition, responsive caregiving, opportunities for early learning, and protection and safety.<\/span><\/p>\n

Italy\u2019s National Institute of Health has identified several protective and risk factors through the Ministry of Health’s 0\u20132 Years Surveillance System, which surveyed a large number of new parents visiting vaccination centers. The survey investigated topics such as folic acid use during pregnancy planning, tobacco and alcohol consumption during pregnancy and breastfeeding, breastfeeding practices, early family reading habits, screen time exposure, safe sleep practices, home and car safety, and vaccination coverage. The goal of this project is to guide health promotion interventions aimed at enhancing psychophysical well-being in the first thousand days by continuously training socio-health workers, empowering families and communities, and improving maternal-child healthcare programming.<\/span><\/p>\n

The Role of Family Clinics<\/b><\/h3>\n

Family clinics, established by Law No. 405 in 1975, are multidisciplinary services designed to support women, children, couples, and families. Ideally, these clinics should include teams of pediatricians, midwives, psychologists, lawyers, social workers, and cultural mediators.<\/span><\/p>\n

Public and Private Accredited Health Facilities for Family Clinic Activities per 100,000 Inhabitants<\/b><\/h4>\n
\"\"
Source: Ministry of Health (2022).<\/figcaption><\/figure>\n

However, the number of family clinics has been steadily declining: from 2,398 in 2014 to 2,161 in 2022\u2014a reduction of 237 clinics in just eight years. Regional disparities are also significant. According to Law No. 34 of 1996, each clinic should serve approximately 20,000 people, but only four regions and one autonomous province meet this standard.<\/span><\/p>\n

Not only have family clinics decreased in number, but they have also been weakened by staffing shortages. Key professionals such as gynecologists, midwives, psychologists, and social workers work fewer hours per week than the legal minimum established by the 1996 legislation: gynecologists (-7 hours), midwives (-14 hours), psychologists (-3 hours), and social workers (-26 hours). The National Institute of Health\u2019s survey highlights that only one region meets the standards for both gynecologists and midwives.<\/span><\/p>\n

The Shortage of Pediatricians<\/b><\/h3>\n

Pediatricians, who are critical for monitoring child development, are also in short supply. The National Health Service reported 7,022 active pediatricians in 2021, down from 7,285 in 2020 and 7,408 in 2019. By 2022, this number had dropped further to 6,962, with 5,505 of these specialists having over 23 years of experience.<\/span><\/p>\n

Pediatricians per Region<\/b><\/h4>\n
\"\"
Source: Gimbe Foundation analysis of Ministry of Health data.<\/figcaption><\/figure>\n

Regional data also shows a decline in pediatricians across most areas. Tuscany is the only region that increased its pediatric workforce, from 430 in 2020 to 448 in 2021. Two other regions and one autonomous province (Aosta Valley, Molise, and Bolzano) maintained the same numbers, while all others reported decreases. Despite a decline in births, each pediatrician now manages almost 100 more children than the legal maximum of 800. With many pediatricians nearing retirement, this issue is expected to worsen. It is hoped that community health centers, funded through the National Recovery and Resilience Plan\u2019s Mission 6 and Decree No. 77\/2022, will bolster primary care, including services for early childhood.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

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