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150 CHAPTER 7 ■ Choose Health in Food Vending Machines

Major Public Health Issues
The life expectancy at birth in Italy is one of the longest in the world: it reaches 78
years for males and 84 for females, while the healthy life expectancy (HALE) at
1
birth is, respectively, 71 years and 75 years. Furthermore, the infant mortality
rate—data traditionally linked to socioeconomic and environmental conditions,
and to performance of health services—suggests that the health of the Italian pop-
ulation has reached a good level. In fact, this rate in Italy is low (4 per 1,000 live
births), as compared to that of other countries (WHO, 2007).
Italian Health Service is founded on the principles of equity and of universal
healthcare coverage: it guarantees everyone access to appropriate services. The
right to safeguarding health is defended by the constitution. Total expenditure on
health is 8.7% of the gross domestic product; 75.1% is covered by the general gov-
ernment and 24.9% is private. In 2004, the per capita total expenditure on health at
the international dollar rate was US$2,414. In comparison, the average value of the
entire European region was US$1,564 (WHO, 2007).
As in other European countries, chronic diseases are one of the main public
health issues. According to recent WHO statistics (2007), noncommunicable dis-
eases cause 86% of years of life lost in Italy. It is also estimated that in 2004, tumors
and cardiovascular illnesses caused almost 390,000 deaths, a total of 72% of overall
deaths (ISTAT, 2007). It is widely recognized that unhealthy lifestyles are the major
cause of chronic diseases. To reduce their spread, the WHO Regional Office for
Europe (2006) launched Gaining Health: The European Strategy for the Prevention
and Control of Non-Communicable Diseases. In coherence with European strategy,
the Italian government (Decreto del Presidente del Consiglio dei Ministri 4 maggio
2007 [Decree of the President of the Council of Ministries, May 4, 2007]) has ap-
proved the national Gaining Health: Making Healthy Choices Easier program
(Guadagnare salute: Rendere facili le scelte salutari, in Italian), whose focus is on
diet, physical activity, smoke, and alcohol. Through communication and environ-
mental interventions, this national program aims to create favorable conditions in
adopting healthy habits. Its strength is the promotion of activities that involve dif-
ferent subjects of the society, such as public institutions, private business (produc-
tion, distribution, management, etc.), and scientific associations, with the purpose
of health promotion.

1 The World Health Organization (WHO) defines healthy life expectancy at birth as the “average num-
ber of years that a person can expect to live in ‘full health’ by taking into account years lived in less
than full health due to disease and/or injury.” This definition was retrieved February 10, 2009, from
the WHO Web site at: www.who.int/whosis/indicators/compendium/2008/1hat/en/index.html.