Stefania Ostahie, LLB International and European Law (Technology Law track) (University of Groningen), s.ostahie student.rug.nl

What provoked Italy, which 9.6 million tourists visit for its famous gastronomy, to adopt a National Prevention Plan for its citizen’s dietary insufficiencies?[1]

An introduction to Non-Communicable Diseases (NCDs)

Non-communicable diseases (NCDs) are chronic and stem from a combination of “genetic, physiological, environmental and behavioral factors”.[2] As several categories of NCDs exist, the United Nations (UN) and World Health Organization (WHO) identified five major NCDs in combination with the five most relevant risk factors. The five major NCDs are cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, and mental disorders, and the five key risk factors are tobacco usage, alcohol usage, unhealthy diets, insufficient physical activity, and air pollution.[3] As the nature of NCDs shows, the risk of developing such diseases depends not only on individual choices, but also on communal and societal elements such as the commercial promotion of tobacco products and unregulated carbon emissions. These elements highlight the significant impact that legislative measures can have on regulating such risk factors: if their community and living environment can severely influence an individual’s health, then legislative action taken against such factors can, in turn, influence an individual’s exposure to them. [4] Nevertheless, [5] [6] [7] implementing such legislative measures can prove to be of more importance to citizen’s well-being than their mere adoption. Therefore, the effectiveness of Italy’s National Prevention Plan at regulating risk factors must be assessed against the right to health, to ensure that an efficient system which guarantees healthier behavior is established. This analysis will consider both the theoretical and the concrete implications of dietary measures imposed through the National Prevention Plan.

The Impact of Poor Diets and NCDs on Italy’s Population

As surprising as it may sound to any Italian citizen or avid visitor, the leading risk factor for mortality is linked to unhealthy or poor diets.[4] Correspondingly, NCDs rank as the top diseases for years of life lost in Italy from 1990 to 2010.[5] Although the past 15 years[8] [SO9]  have shown much global change in health risk factors, notably due to the COVID-19 pandemic, dietary risks are still one of the most significant contributors to Italy’s mortality rate. As the Italian Health Profile by the European Commission from 2021 shows, “low fruit and vegetable intake, and high sugar and salt consumption” currently account for 14% of Italy’s mortality rate.[6] As a result, overweight and obesity rates have increased across all age groups due to poor nutrition and low physical activity, particularly in the south of Italy where poorer socio-economic conditions are prevalent.[7] This may seem surprising for many who love Italy, where one’s passion for rich Italian cuisine and long walks along beautiful breezy coasts define everyday life, blurring the line between happy and healthy. 

Italy’s National Prevention Plan 2020 – 2025 (NPP)

Italian authorities have stressed the importance of adopting a multidisciplinary approach to preventing NCDs based on a thorough understanding of the different behavioral and socio-economical complex factors contributing to an individual’s exposure to risk factors. This is shown through the Italian Ministry of Health’s National Plan for Prevention (NPP) 2020 – 2025, which is a comprehensive action plan involving several policies intended for various national sectors.[8] The NPP aims to promote better health in response to the specific needs of individuals from different backgrounds and reduce the progression of diseases through the adoption of specific planning and monitoring systems and intersectoral cooperation.[9] Italian authorities have recognized NCDs as a major objective, and have identified “incorrect nutrition”, allergens and low physical activity as major risk factors for chronic NCDs.[10]

Accordingly, the NPP provides specific strategies directed at the community, that is for cross-sectors, schools, cities, workplaces, and the individual.[11] In order to best combat the major nutritional risk factor, a section regarding the “surveillance and prevention of chronic diseases, including the promotion of healthy lifestyles and organized screening programs; nutritional surveillance and prevention” has been added to all programs defined in the plan.[12] For the promotion of healthy lifestyles, the joined “School” and “Health” path was adopted based on the “Global Approach to Health”, an integrated policy guideline recommended by the WHO which delineates improvement plans that are, inter alia, aimed at collaborating with local communities and improving individual life skills.[13]

The Right to Health: An Overview

The right to health is protected under Article 12 of the International Covenant on Economic, Social and Cultural Rights, which recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.[14] Additionally, the Committee on Economic, Social and Cultural Rights (CESCR) adopted its General Comment No. 14, titled “The Right to the Highest Attainable Standard of Health (Art. 12)”.[15] This comment provides several means through which the ‘highest attainable standard of health’ may be achieved, such as “health policies, the implementation of health programs by the WHO, or the adoption of specific legal instruments”.[16] This document also includes the positive obligations of States to enable and assist individuals and communities in their enjoyment of the right to health, which includes “the dissemination of appropriate information relating to healthy lifestyles and nutrition” and the provision of “access to the minimum essential food which is nutritionally adequate and safe”.[17] Ultimately, the right to health entails the obligation for States to go beyond informing their citizens about healthy lifestyles and ensure that they belong to a system that allows and ensures healthier behaviors.

Does Italy’s NPP meet the standard for the Right to Health?

Considering the assessment made above, the human right to health is also meant to include underlying determinants of health, namely food and nutrition, which States must account for in their effective implementation of measures regarding this right. For Italy, this would take the form of specific legislative action and programs focusing on food on nutrition, underlying the dietary risks faced by the population. For example, the longstanding “Fruit and Vegetables in Schools” programme aims to increase the consumption of fruits and vegetables of children between 6 and 11 years old, while raising awareness of the benefits of eating a healthier diet.[18] This programme is promoted by the European Union and is carried out by the Ministry of Agriculture, Food Sovereignty and Forests, which creates visits to educational farms, tastings and sensory laboratories to engage children with foods and vegetable products, ultimately enforcing healthier diets.[19] Such examples highlight Italy’s efforts not only to inform, but also to bring noticeable change that can be seamlessly incorporated into its citizens’ lives alongside better information about nutrition and diet.

However, while Italy’s adoption of the NPP seems promising, its implementation seems to fall short when faced with the prevalence of NCDs due to unhealthy nutrition. In order to enforce the right to health to its fullest, close cooperation among the government, the private sector, and civil society is needed to ensure healthier diets and prevent NCDs.[20] The previous example regarding the “Fruit and Vegetables in Schools” programme represents such longstanding close collaboration between institutions that are responsible for implementing the right to health. Regardless, an EPaS-ISS study showed that there was actually an 8% decrease in fruit and vegetable consumption by children, especially those from more disadvantaged families, in Italy pre-COVID-19 and during the COVID-19 period.[21] Such contradictions prove that improvement is still needed to bring about a working national system in which people of all backgrounds and ages can live healthier lifestyles and significantly lower their risk of developing an NCD.    

Concluding Remarks

Given the standard established by General Comment No. 14 for the positive obligation of States regarding nutrition and the right to health, the Italian Ministry of Health has developed all the necessary tools to succeed in the creation of a healthier system for its citizens. However, Italy manages to fall short in terms of implementing noticeable changes for those who struggle with unhealthy dietary and nutritional habits. Although Italy’s NPP contains detailed instructions regarding informative and reformative programs focusing on, inter alia, nutritional health, studies have highlighted a lack of noticeable impact on affected citizens, such as children from more disadvantaged backgrounds. With such contradictory realities, it must be concluded that, although its detailed NPP accounts for the complex relationship between both individual and societal risk factors for NCDs, Italy fails to entirely meet the standard imposed by the Committee on Economic, Social and Cultural Rights through its General Comment No.14. This is because, despite Italy’s theoretical measures within its NPP providing detailed attempts at regulating risk factors, their concrete implementation falls short of creating a system that fully ensures healthier behavior. Consequently, it can also be argued that Italy fails to fulfill its broader obligation to the right to health protected under Art. 12 ICESCR.

[1] Pamela McCourt Francescone, '2023: food and wine experiences bring more tourists in Italy' (Italiabsolutely, 10 November 2023) <https://italiabsolutely.com/inspirations/food-wine/2023-food-and-wine-experiences-bring-more-tourists-in-italy> accessed 24 November 2024

[2] World Health Organization, 'Noncommunicable diseases' (WHO, 16 September 2023) <https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases> accessed 24 November 2024

[3] United Nations General Assembly, ‘Political declaration of the 3rd High Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases’ (17 October 2018) UN Doc A/RES/73/2

[4] Institute for Health Metrics and Evaluation, 'GBD Profile: Italy' (Epicentro ISS, 2010) <https://www.epicentro.iss.it/globale/pdf/GBD%20Country%20Report%20-%20Italy.pdf> accessed 24 November 2024

[5] Ibid

[6] Organization for Economic Cooperation and Development / European Observatory on Health Systems and Policies, 'State of Health in the EU: Italy Country Health Profile 2021' (European Commission, 2021) <https://health.ec.europa.eu/system/files/2021-12/2021_chp_it_english.pdf> accessed 24 November 2024

[7] Ibid

[8] Ministero della Salute, 'Piano Nazionale della Prevenzione 2020-2025' (Epicentro ISS, 6 August 2020) <https://www.salute.gov.it/imgs/C_17_notizie_5029_0_file.pdf> accessed 24 November 2024

[9] Ibid

[10] Ibid

[11] Ibid

[12] Ibid

[13] Ibid

[14] International Covenant on Economic, Social and Cultural Rights (adopted 16 December 1966, entered into force 3 January 1976) 993 UNTS 3 (ICESCR), art. 12

[15] Committee on Economic, Social and Cultural Rights, ‘General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12)’ (2000) E/C.12/2000/4

[16] Ibid

[17] Ibid

[18] Ministero Dell’Agricoltura, Della Sovranità Alimentare e Delle Foreste, ‘ Il Programma’ (Frutta Nelle Scuole) <https://www.fruttanellescuole.gov.it/il-programma> accessed 2 May 2025

[19] Ibid

[20] Alonzo, E., and Others, ‘The «Nutritional Prevention” within Italy’s National Prevention Plan 2020-25’ (2023) 35(5) Annali di Igiene, Medicina Preventiva e di Comunità 611

[21] Paola Nardone, and Others on behalf of the EPaS-ISS Group, ‘Changes in Food Consumption and Eating Behaviours of Children and Their Families in Italy during the COVID-19 Pandemic: The EPaS-ISS Study’ (2023) 15(15) Nutrients 3494