Mapping the Roots of Healthcare Inequalities in Post-Unification Italy. Geographical Accessibility and Territorial Disparities

The distribution of healthcare infrastructure has historically influenced health inequalities. Consequently, geographic accessibility — the alignment between facility locations and population distribution — is crucial to mitigating these disparities. In Italy, territorial inequalities have persisted since unification (1861), and have been exacerbated by delayed public health investments. While regional disparities in healthcare infrastructure have often been linked to mortality differences, accessibility remains a neglected issue of study due to data limitations. This study aims to address this gap by using data from the Inchiesta delle Condizioni Igienico Sanitarie del Regno d'Italia (1884–1885) to study healthcare access. The study uses a two-dimensional framework, encompassing availability, defined as the number of facilities, and spatial accessibility, which is measured by travel distance and geographic barriers. Adopting an ego-network approach incorporating altitude and distance provides an updated and more sophisticated study of inequalities in access to primary and institutionalized healthcare services, identifying potential origins of persistent inequalities.