**3. The current situation and 2020 data**

The phenomenon of accidents at work in Italy is read through the data of the complaints to Inail and shows how the first months of economic recovery in 2021 led to an increase in risk situations and accidents. Among other things, it must be taken into account how reporting to Inail represents a legal and correct method of verifying the accident phenomenon, but how in Italy there is the problem of accidents not reported to the national insurance institution, especially in situations concerning the conditions of irregular work, present above all in some sectors. In any case, the latest Inail report of 2021 [2] shows an increase in the accident phenomenon of particular significance. In the period January–August of this year, compared to the same period of 2020, there was an increase in overall accident reports, a decrease in fatal ones, and a rise in occupational diseases. The reports of accidents at work submitted to Inail by last August [3] were 349,449, over 27,000 more (+ 8.5%) compared to 322,132 in the first 8 months of 2020, a summary of a decrease in complaints observed in the quarter. January–March (−11%) and an increase in the April–August period (+ 26%) in the comparison between the 2 years. The data collected on 31 August of each year show in the first 8 months of 2021 a national increase in accidents while commuting, that is, those occurring on the return journey between the home and the workplace (+ 20.6%, from 38,001 to 45,821 cases), which decreased by 32% in the first 2 months of this year and increased by 59% in the period March–August (thanks to the massive use of smart working last year, starting from March), and an increase of 6.9% (from 284,131 to 303,628) in those occurred on the occasion of work, which fell by 10% in the first quarter of this year and increased by 22% in the April–August period. The number of reported work accidents increased by 6.9% in the Industry and Services insurance management, by 3.6% in Agriculture, and by 29.2% in the state sector. The territorial analysis shows a decrease in complaints only in the North-West (−3.6%), as opposed to the Islands (+ 16.5%), the South (+ 14.9%), the Center (+14, 5%), and the North-East (+ 13.6%).

The increase that emerges from the comparison of the first 8 months of 2020 and 2021 [4] is linked only to the male component, which records a + 14.7% (from 195,612 to 224,400 complaints), while the female one is down by 1.2% (from 126,520 to 125,049). The increase affected both Italian workers (+ 7.8%) and non-EU (+ 14.5%) and EU workers (+ 2.5%). The analysis by age group shows a decline only among the 15–19 year olds (−0.7%), with increases for the 20–49 year-old group (+ 9.9%) and among the over 50s (+3, 5%).

The reports of accidents at work with a fatal outcome submitted to the Institute by August were 772, 51 less than the 823 recorded in the first 8 months of 2020 (−6.2%). The comparison between 2020 and 2021 requires caution as the data of the fatal reports of the monthly open data, more than those of the reports as a whole, are provisional and strongly influenced by the covid-19 pandemic, with the result of not counting a significant number of "late" fatal reports of contagion, in particular relating to the month of March 2020. At the national level, the data collected on 31 August of each year show an increase only in cases occurring in progress for the first 8 months of this year, went from 138 to 152 (+ 10.1%), while those at work were 65 less (from 685 to 620, −9.5%). The decrease observed in the comparison between the first 8 months of 2020 and 2021 is linked both to the female component, whose fatal cases reported went from 83 to 78 (−6.0%) and to the male component, which went from 740 to 694 cases (−6.2%). The decrease concerns the complaints of Italian workers (from 700 to 663) and EU workers (from 41 to 25), while those of non-EU workers went from 82 to 84.

As of August 31, 2021, 12 multiple accidents occurred in the first 8 months for a total of 29 deaths, 17 of which were road accidents. Last year, however, there were six multiple accidents recorded between January and August, with 12 fatal cases reported, half of which were road accidents. The complaints of occupational disease registered by Inail in the first 8 months of 2021 were 36,496, 8735 more than in the same period of 2020 (+ 31.5%), a summary of a decrease of 26% in the January–February period and of an increase of 66% in that of March–August, in the comparison between the 2 years.

The pathologies reported, therefore, start to increase again, after 2020 strongly conditioned by the pandemic with reports in a constant decrease in comparison with previous years [5–7]. In fact, last year, arrests and restarts of production activities reduced exposure to the risk of contracting occupational diseases. Pathologies of the osteo-muscular system and connective tissue, of the nervous system, and of the ear continue to represent, even in the first months of 2021, the first three occupational diseases reported, followed by tumors, which exceed those of the respiratory system in August.

This situation, which exposes the data of the national information system of Inail, provides for interventions on the system of rules, which the Italian government has announced and which also concern the strengthening of inspection and control activities. However, it seems important to point out the impact that the accident phenomenon continues to have on the social and health system and how the evolution of the economic system has introduced some risk factors that can be addressed not only through increased controls but also through different ways of carrying out the work performance, greater attention to organizational well-being and a widespread introduction of corporate welfare tools. The accident data does not derive only from the introduction of dangerous work tools and the lack of controls in some sectors, but is often a consequence of excessive workloads, the acceleration of work times, and a "culture of performance" and productivity which increases risk margins and which, when it does not cause an injury, in any case, causes an increase in the condition of "work-related stress" [8–10].

### **4. The phenomenon of accidents for working women**

In this context, it becomes useful to analyze the impact of the phenomenon of accidents on the female component of Italian work. Also in this case it becomes useful to analyze the trends shown by the Inail database on the evolution of accident reports reported is more present. This makes this assessment partly underestimated. However, the data show us that in some situations it is women who appear to be more exposed to greater conditions of risk. If we analyze the most consolidated annual Inail data in the period between 2015 and 2019, accident reports [11–13] presented to Inail increased overall by 1.3% (from 636,674 in 2015 to 644,970 in 2019).

Faced with an increase in female employment equal to +1.1% 1, the complaints and accidents of female workers went from 227,068 in 2015 to 231,128 in 2019, equal to a percentage increase of 1.8%, higher than that recorded among male workers (+ 1.0%), for which Istat recorded an increase in employment equal to +0.3%. In the same 5 year period, the incidence of women in total accidents was almost constant and on average equal to 35.8%. On the other hand, reports of accidents with fatal outcomes among female workers decreased, from 117 cases in 2015 to 97 in 2019, equal to −17.1%, more markedly than the 8.9% reduction recorded over the same period of time among workers. It is important to point out that the incidence of accidents for female workers is particularly high in the domestic and family services sector (domestic workers and carers), with 89.9%

*The Social and Health Impact of Accidents at Work: The Analysis of the Italian Case DOI: http://dx.doi.org/10.5772/intechopen.101501*

of the total complaints in the sector, followed by health and social assistance (74, 2%) and from the packaging of clothing items (70.9%), while in the riskiest sectors of the industry it drops to 2.8% recorded in construction. The complaints related to the insurance policy against domestic accidents (mandatory for all people aged between 18 and 67 who take care of the home in a habitual, exclusive, and freeway), in 2019 were a total of 760 and registered an exceptional increase of 58.3% compared to 2018, when 480 were registered. Almost all (742) concerned women and no cases with a fatal outcome were recorded in 2019, compared to 20 cases in 2015–2018. A truly significant figure is that which concerns the overall complaints of accidents at work "in progress", that is, occurring on the return journey between home and work, which continue to be for female workers, even in 2019, more than men: 54,299 cases against 51,524. In relative terms, ongoing cases represent 23.5% (practically one in four) of female complaints (231.128) and 12.5% (just over one in ten) of male ones (413.779). For complaints with a fatal outcome, the incidence of this type of accident among female workers is even higher: in 2019, almost one in two female deaths (44 out of 97, 45.4%) occurred in progress, a ratio that for men dropped to about one in four (281 out of 1087, 25.9%). A gender difference that is confirmed by looking at the broader category of accidents "outside the company" (sum of all accidents while traveling and those during work occurring with the means of transport involved) generally attributable to the risk of road traffic: 25.3% (58,396) of female complaints against 16.1% (66,485) of male ones.

### **5. Data analysis**

For a correct analysis of the phenomenon of accidents, it is necessary to consider how, in addition to issues of a cultural nature, one of the major problems concerning the scourge of deaths and accidents at work—in Italy and beyond—is that relating to the measurement of the phenomenon as when comparing the data between countries, the incidence rates are difficult to interpret. In fact, the probability of going into an injury is, among other factors, related to the work activity that the worker carries out and the weight of the different economic activities varies from one country to another depending on the structure of each economy. Furthermore, a higher number of accidents ascertained at work does not necessarily indicate worse safety conditions; on the contrary, it may indicate a greater propensity to report and therefore paradoxically better protection of the worker. It should also be considered that among the various injured, sick, and dead at work, there is a part of workers in irregular conditions that are difficult to estimate. It should also be considered how in Europe those accidents on the way from home to work or vice versa are not considered in the data, i.e., accidents "in itinere", which the Italian system instead evaluates and considers from an insurance point of view. In any case, if we consider the pre-Covid data, Italy ranks above the EU28 average (1.8) for the number of deaths at work out of the total number of employees, with 2.3 deaths per 100,000 employed. Among the states most similar to Italy, France recorded a higher figure (2.7); the United Kingdom (0.8), Germany (0.8), and Spain (2) a lower figure. The phenomenon of unreported accidents should also be considered: the "Independent Observatory of Bologna on the fallen from work" believes that a high number of deaths at work escapes the statistics on the phenomenon [14]. This observatory includes in its data irregular workers, unreported deaths, and a portion of fatal injuries not ascertained by Inail. According to the independent Bolognese Observatory, 2019 would even have ended with 1437 workers who died at work: 701 in the workplace, 736 in transit; a figure double that of Inail.

**Figure 1.** *Variation in accidents.*

**Figure 2.** *Variation in fatal cases.*

*The Social and Health Impact of Accidents at Work: The Analysis of the Italian Case DOI: http://dx.doi.org/10.5772/intechopen.101501*

In any case, the accident phenomenon represents a very present reality for Italy and with the increase in accidents coinciding with the resumption of post-Covid economic activities, it appears important to initiate careful preventive action, which also concerns the culture of health at work itself. In this effort, it is also important to point out how risk factors are often linked to the rhythms imposed on the job and not only to a lack of attention to prevention. The data on the evolution of workrelated stress and related pathologies constitutes an interesting aspect in this sense (**Figures 1**–**3**).
