Public health reforms and the mortality decline in nineteenth-century Italy

This study examines the impact of Italy’s 1887–8 health reforms on mortality, contributing to the historical debate on the state’s role in Europe’s health transition. Leveraging event-study-style difference-in-differences approach, we assess the effectiveness of the Crispi–Pagliani reforms, which strengthened public health governance and introduced targeted non-pharmaceutical interventions to mitigate deaths from infectious diseases. Mortality from targeted diseases decreased by 8.5 per cent relative to non-targeted diseases within 5 years of the reforms. The results highlight the role of sanitary surveillance and coordinated governance, particularly effective in less-educated regions, where public authorities compensated for limited health knowledge and prompted information flow in a broader process of top-down modernization.