**3. Reasons for the high mortality rate among Italians and the implications of post Covid 19 trauma**

In the long months drawn out by the Covid pandemic, Italy's found itself in a situation characterised by some basic contradictions. On one hand, being the first Western country hit in February 2020, the delays in the initial closures significantly worsened the impact of the first wave. Generally speaking, the Italian health system ranked second in the wold by the WHO for efficiency, according to the 2019 index, held up, though this is arguably due to the impact of the pandemic being somewhat concentrated from the outset in regions with the most solid health structures. In spite of this, Italy remains among the countries in the world with the highest mortality rate and a high rate of contagion, this is a likely result of the country having a high percentage of the elderly population matched with a decrease in the number

of intensive care units in health centres, especially when compared to countries like Germany. In any case, even in the Italian situation, the risk factors have been increased by the lower investment across health systems in recent years, in particular, the lowered investments in emergency therapy departments.

If we consider the comparison with the indicators of the state of concern among European citizens, we can evaluate how Italians today have a far greater concern for work and the fate of the economy than for their own or family's health conditions and the possibility of getting sick. The second wave of the virus has, in fact, increased the fears of Italians for the economy, while decreasing those for the disease. The emotional dimension remains in this decisive situation, having said this, there are also reports which indicate the inherent stress enforced upon Italian families as a result of the health crisis. This leads to an assessment of the fragility in families, which in turn highlights the importance and need to strengths social networks and communities as a means of alleviating burdens or stressing in isolation, such a notion is generally supported in the results of surveys carried out in countries such as Spain and Poland. In Italy, as in other countries, the family has represented a decisive factor of resilience, as is typical with countries with a prevailing Catholic culture.

Another form of discomfort during the months of the pandemic concerns itself with the younger side of the spectrum, poor socialisation, deprivation of play and sharing with peers. Social isolation has resulted in widespread forms of unease and fragility among the younger generation, to the point of real 'broken sociality' crises. Professor Massimo Ammaniti, developmental psychoanalyst and honorary professor of Developmental Psychopathology at the Faculty of Medicine and Psychology of the University of Rome, and member of the international Psychoanalytical Association, has published an important research on this very aspect. Professor Ammaniti argues that: "The identity of children is closely linked to the rhythms, habits, rituals of daily life and its environments, so, in the absence of these elements, the risks are disorientation and insecurity. In fact, everyday life reassures children and confirms them in their identity and in the fact that they live in a predictable environment on average. These shortcomings, together with the absence of other important stimuli (confrontation with other children, group games, school activities), have created a real syndrome of social deprivation" [14].

Research has highlighted the difficulties faced by the younger generation during the period of the pandemic, with around 30% of Italian children having faced difficulties and disturbances of emotional regulation, i.e. sleep disturbances, irritation, mood swings, and increased tendency to favour the opposition and increased anger.

All these phenomena lead to a situation that requires the adoption of tools and behaviours capable of dealing with the evident increase in situational discomfort. The turning point is the investment in human development and the ability to intervene on the pre-existing development models, increasing social ties and promoting the resulting economic activities. Through analysing the ongoing phenomena and evaluating its data, we can observe how socioeconomic and health resilience capacities find common ground in the relationship with the human development index: this is an interesting albeit diminutive studied convergence, measurable not only in European counties but also among Italian regions and the various factors of human development, the ability to react to the social and economic crises of the territory and the response to the health crisis in terms of care and assistance systems.

#### **4. Welfare systems and work-related stress in the context of Covid 19**

If we consider the evolutionary indicators of economic frameworks, such as the Excelsior forecast reports by UnionCamere as well as the various company

#### *Inclusion Policies and Territorial Welfare Networks between Society, Work and the Economy… DOI: http://dx.doi.org/10.5772/intechopen.96035*

analyses carried out by the Foundation of Labour Consultants, we can see how the Italian economy might emerge in the coming months, generating or at the very least accentuating a tendency towards specialisation, which runs the risk of creating higher levels unemployment, or people who cannot easily be re-employed in the labour market. It would seem that the crisis has had a greater effect on sectors with low added value, for example catering or tourism, which during recent years have provided opportunities of employment even for people with low professionalism and/or low incomes. Considering this, the effect of the pandemic, in Italy just as in other counties, will weigh more on families with low-professionalism and income workers, contributing to both social and economic unease. This unease is only magnified in counties with less investment in social promotion and active policies. The criticalities linked to the exceptional nature of the economic and health phase, deriving from a client of uncertainty, include difficulty of planning, management of remote work, stress of workers, organisational problems and naturally, a worsened climate and quality of work. The long months of the pandemic as well as those following have imposed greater levels of work-related stress, which seem to be only partially mitigated by the presence of remote work, even more so given that such work is not always turned into effective 'smart-working'. The phenomenon of work-related stress undoubtably impacts a given company's productivity and is a route cause faced by many Italian companied today. Company priorities in the pursuit of resilience and recovery are therefore closely linked to the recovering and raising of productivity levels as well as the reconstruction of a peaceful working climate within the structures. The internal reorganisation of work processes, prompted by the many innovations introduced over the course of the pandemic, are instrumental in the growth of productivity and play an important role in helping to orientate corporate strategies on human resources, together with the acquisition of new skills and the introduction and strengthening of a work logic geared towards objectives and results. In Italy, Covid 19 has emphasised the differences between territories and social classes, as well as the differences between various economic sectors, penalising, as mentioned previously, economies with less added value or a weakened capacity for innovation. According to the analyses on the Italian employment situation, the majority of losses are recorded within the fields of accommodation and catering, suffering from a 20% reduction in staff, followed by trade, recreational, cultural and sports services. The expectations for manufacturing activities are generally less critical, especially for companies with a greater capability for innovation and sustainability as well as the production of Made in Italy excellence, and show signs of growth, albeit moderate. Fortunately, there are industry sectors that are significantly less affected by the crisis, and are in fact showing signs of improvement, such as credit and insurance, information and communication and social services and assistance. Generally speaking, the social and economic data reporting on the effects of the Covid 19 pandemic show how the crisis has weakened industries that were already considered as weak, emphasises fragility leads to further disintegration, inequality and social unrest which has been coming to light in the recent decades, the consequences weigh not just on the health system but also on the economic one.

#### **5. Elements of resilience and control, and overcoming the Covid 19 crisis**

To understand what the elements of resilience are with respect to health risk factors, it's useful to first verify how the Covid 19 pandemic affected Italian regions in different ways throughout 2020, and how the level of lethality does not strictly depend on the level of the elderly population within a given region. Covid 19 does

not result in the same mortality rate across the board but instead manifests itself with extreme variability, with positivity levels ranging from a maximum of 5.4% in Lombardy to a minimum of 1.3% in Campania, averaging out at 3.5% nationwide. The morality rates for Covid 19 vary significantly across the different regions, with the same prevalence of new infections irrespective of the age range in a given territory. This is what we are led to believe from the emerging analysis of data collected by the national health observatory in Italian Regions of the Catholic University (Rome campus). The recent analyses further confirmed the data which emerged in the outset of the pandemic, namely that Covid 19 had a different intensity and lethality both in Italy and in Europe. The evidence ought to be analyses and fully understood by medical science and experts within the field of organisational health systems, especially since the differences found do not solely concern the fragility of the elderly population, those whom seem to be most affected by the virus. The researchers underline that the reasons for the regional and European differences must be sought among a very wide range of factors; organisational deficiencies, initial delays in understanding the severity of the emergency, deficits in the infection tracing systems, variant levels of virus aggression or aggressiveness, individual behaviour and the choices of central and local governments.

Another possible interpretative path suggested by the study is that among the most affected territories, with many having high levels of anthropisation, urbanisation and mobility, where most of their social and economic relationships take place. These areas, in all probability, have been subjected to a greater risk of contagion. Take Lombardy for example, the Italian region has both the highest intensity of movements and also, the greatest number of recorded infections. Paying attention to the relationship between deaths and infected people (the lethality), European analyses even depicts a high level or variability in this case, even the comparison amidst the elderly population (over 65) shows a correlation that is not always significant. In other words, the rate of mortality does not depend on the elderly structure of the population (**Figure 1**). Across Europe, the analysis of lethality recorded in its individual counties in relation to the percentage of elderly people has brought to light significant differences. For example, in groups with the highest

**Figure 1.** *A graph to represent the lethality of Covid 19 per country in relation to the proportion of elderly people.*

percentage of an elderly citizens, lethality varies from 1.3 in Latvia to 3.1 per 100 inhabitants in Bulgaria; comparatively, in countries with the lowest percentage of elderly people, lethality varies from 0.5 recorded in Cyprus to 3.5 per 100 inhabitants in Great Britain.

Italy has a high level of lethality, with a contagion rate that places it within the central range of European rankings. Data has helped to verify that many of these deaths occurred within the elderly Italian population, Italy, in comparison to other European countries, ranks first for its share of elderly people, however this is only one factor that contributes towards mortality. In fact, the more worrying situation can be found in Great Britain, the cost with the highest level of lethality, despite having a relatively young population compared to many other European states. Similarly, Ireland also shows a high level of lethality in relation to the share of elders in the population. In general, there are very different situations with respect to lethality which do not necessarily rely solely on the share of the elderly population.

The analysis helps to clarify a plausible connection between the health crisis and the characteristic of the development model, and the connection between the lethality rate and the level of economic growth between Italian regions appears to be somewhat verifiable in this sense. The first phase of the epidemic was principally consolidated in northern Italy, while the second affected the whole national territory, albeit with varying intensity. What's interesting to note is that northern cities continued to record the highest mortality rate even in the second phase of the infection: in November 2020, for example, the mortality rate was 73 percent in north cities compared to 46 percent in the south. Despite the spread of the epidemic throughout the country in the second phase, the lethality rate remained higher within the urban context and in areas with a higher presence of productive settlements and mobility. Building on this, the highest mortality rate was found amidst Italian regions with a presence of territorial industrial systems, including Lombardy, Veneto, Friuli and Piedmont.

There is also a connection between the environmental risk factors and those relating to the health risk, which can also be found with regards to the spread of Covid 19. In particular, Italian provinces which, over past decade prior to the start of the pandemic, had the highest levels of atmospheric pollution (as reported in January 2020 by the Air Quality Index) appear to align themselves to the greater levels of spread-ability in the first phase of the pandemic, such was the case for Bergamo, Brescia, Lodi, Piacenza, Milan, Monza, Turin. Pavia, Parma and Modena. Unsurprisingly, the effect was greatest in northern Italy, one of the places in Western Europe with the highest levels of atmospheric pollution, and at the same time, home to the greatest presence of production sites. Over the course of the second wave, we can see a greater challenge in containing the rate of contagion especially in areas with a higher presence of pollutants. If the environmental element is an important factor in preventing health risk, arguably, the ability of social and welfare systems to contain and manage risk factors can be found in the greater capacity to contain and manage the consequences of said contagion that appear to be present in regions such as Emilia Romagna, Lazio and Tuscany. All of whom happen to have a better human development index compared to other regions that have been proportionally more affected by the health risk, namely, Lombardy, Umbria and Piedmont. The human development index is an official indicator that measures, among other things, the quality of social ties, the health and the welfare systems present in a given territory. In comparing Italian regions, which appear similar from a socio-economic point of view and neighbouring from a territorial perspective (which ultimately allows for a comparable level of exposure to the health risk), we can see how territories with a better human development index have been able to develop a greater resilience capacity and health risk

containment; i.e. Emilia Romagna reacts better than Lombardy, Trentino better than South Tyrol, and Lazio is considerably more resilient compared to Abruzzo or Umbria. This correspondence is further supported by pre-covid data, under the comparison between the management and containment of the health risk and the levels of social and health services measured through the official LEA indicator. If we combine this data with research indicators that attempt to measure 'social capital' (the presence of social participation, civic sense, non-profit enterprises and associative and voluntary networks within a territory) we can see a significant correspondence with the human development index and a partial alignment with measurements in health care quality levels. In fact, the relations they maintain with other subjects of the social protection system, both public and private, within a territory contribute to the value generated by non-profit institutions. The network of social and economic relationships that non-profits build ought to also be considered as an important indicator of social capital. Territories ranking top in this regard, i.e. Emilia Romagna, Trentino, Tuscany and Friuli, show a greater capacity for socio-economic resilience and at the same time a greater ability for containment with regards to the effects of the health crisis.

Such data can certainly stand to be depended and strengthened by further comparisons and feedback, but nonetheless seem to indicate that the various risk and crisis factors of this economic phase (from the productive crisis to a social one and from an environmental crisis one of health) have a common denominator that requires a reflection on the development model and shift in direction towards environmental and social sustainability. This empirical evidence establishes the needs for further fields of research and studies to highlight and support the following considerations;


The comparative analysis of the connected phenomena and the effects produced by the coronavirus pandemic from a social, health and economic perspective highlight the need to intervene and amend the current development model, promoting ecological reconversion of the economy that goes hand in hand with the promotion

*Inclusion Policies and Territorial Welfare Networks between Society, Work and the Economy… DOI: http://dx.doi.org/10.5772/intechopen.96035*

of central social ties. Questioning the current neoliberal and global economic model, which can in part find references and tools in the innovation model of the Fourth Capitalism, providing interesting examples and good practises in Italy's own social and economic system.
