Raising equity in prevention policy making in Italy: Results of an assessment of the 21 regional plan

Background In the recent years, Italian health policies increase their aware on health inequalities (HI) issues. A clear political commitment aimed at reducing HI was included in the National Plan for health prevention and promotion (2014-2018) (PNP). During 2015 each Italian Regions (IR) elaborated and approved by law its prevention plan (PRP) according to the PNP. To support this process a factsheet for each IR describing educational inequalities (EI) in the exposure to risk factors (RF) was provided. To assess the level of adherence to the national direction, an evaluation of the 21 PRP was performed. Methods A checklist for the evaluation of the PRP was developed and discussed with experts. Both the systemic approach and the programs section of each PRP were independently evaluated by a reviewer. Frequency of success was calculated for each dimension investigated in the 21 PRP. An overall score assessing the regional level of adherence to the national recommendation was computed and compared to the size EI in the exposure to the RF targeted by the PRP in each IR. Results 21 PRP and 194 programs were assessed. 13 PRP considered the need to address HI and 8 declared to have used quantitative information on HI for priority setting. 8 PRP monitored the magnitude of HI, but only 6 decided to set specific actions tackling such disparities. Overall 4 IR failed to comply with the national recommendation to include equity in the PRP, while 14 faced the challenge with different level of engagement in equity. The adherence to the equity recommendation and the size of inequalities in exposure to RF were not correlated. Conclusions In a short time it has been possible to push the IR to incorporate the issue of equity in prevention in the majority of their PRP, thanks to the special effort of dissemination of evidence on HI tailored to each IR. However, evidence of high level of HI is neither sufficient nor necessary to encourage decision makers to raise equity in their agenda. Key messages: Our results showed that more than half of the Italian Regions adhere at different level to the national directions on equity issues This first evaluation provides a snapshot of the Italian commitment on HI issues in the prevention policy