Analyzing health inequalities in Italian metropolitan cities: a multidimensional approach

This study aims to verify whether, as with other previously investigated demographic and socio-economic phenomena (Cangialosi et al., 2023; Istat, 2023), in Italian metropolitan cities, the relationships between the capital city and other surrounding territorial aggregates, divided based on geographical proximity, can explain health inequalities among the population. Health, defined as a state of complete physical, mental, and social well-being (WHO, 1948), is influenced by various determinants, including individual, social, economic, and environmental factors. It is plausible to hypothesize the existence of a territorial health gradient among municipalities with high availability of health infrastructures, low out-of-region hospital mobility, and favorable socio-economic conditions, compared to those with less accessibility to such services and less advantageous socio-economic conditions. Capitals (and sometimes municipalities in the first urban belt) often exhibit these advantageous conditions and play a central role in the organization of the territory (Logan et al., 2002). Furthermore, the geographical positioning of territories is a significant factor in the proposed analysis, traditionally highlighting an increasing North-South discrepancy (Istat, 2024). A cluster analysis carried out on representative indicators of health conditions, health supply and economic situation facilitated the identification of homogeneous territorial groups and the description of their characteristics.