Abstract

Universalism in welfare state, especially in the health sector, is threatened by various reasons, above all the supposed economic unsustainability and the challenges posed by the attempts of guaranteeing people’s free choice and satisfying intentions of autonomy of regions. Should we be concerned that these threats will lead to a widening of population health inequalities? The article traces an identikit of health inequalities for the readers who are not familiar with their nature and extent; then examines the state of health inequalities in Europe and Italy illustrating how much and where they were modified by the Covid-19 pandemic and what are the inequalities in the Essential Levels of Health Care and in the Non-Health Essential Levels of Performance; it follows arguing whether we know enough about the causal nature of the effect of social determinants on health; finally describes what Italy has done for health equity so far and what still remains to be done. The analysis suggests that Italy seems to show a particular resilience to health inequalities, a resilience that is partially linked to the preventive and protective capacity of the National Health Service, the main bulwark of universalism along with the school system. We must defend and broaden these bulwarks, because the avoidable health inequalities that are still there suggest that further mitigating social inequalities would allow us to improve people’s health