2. Some consideration about Italian population

On the other hand, fertility in many countries, and particularly in Italy, reaches such low levels that the prospects of a recovery, in terms of quantity, now seem impractical, unless of socio-

In this context, most likely, from the point of view of demographic and social, he is starting a new era in which the main actors on the global stage will certainly be different from those in

Surely, however, this situation has generated fears and concerns about the future of the population, especially for some signals that in the course of 2015 were recorded in Italy, such as the surge in mortality, especially with regard to older ages, where some observers have linked this phenomenon to a reduction in public spending in the health sector, a situation that would have penalized, certainly, the older age groups. On closer analysis, however, we realize that, precisely due to aging of the population of elderly, quotas have gradually increased, causing a swollen available to die, with the same probability of

We are at the dawn of a new world, and the population of the planet will be substantially transformed over the next 30–40 years, according to the latest update made by the World Bank (World Population Prospects: The 2015 Revision. New York: United Nations). The world population has reached 7 billion people in 2015 and will rise to 9 billion around 2050, an

But the most significant fact is that few countries will contribute to more than half the increase worldwide, especially this will be due to the contribution of India, Pakistan, Nigeria, Ethiopia,

The World Bank, which had already produced in the 1980s of the projections that had left the whole world into turmoil, when it predicted that the world population would reach 20 billion people already in 2020, has, as a precautionary measure, developed based on the assumption that projections fertility decline through woman from the current global level of 2.5 children to 2.1, from now until 2050. Population of the 49 least developed countries is growing still faster than the rest of the world, at a pace of 2–3% a year, as published by the

While it is expected that the population of developing countries as a whole will increase from 6 billion today to 7.9 billion in 2050, the population of more developed regions will not change

The latter would have had to decrease to 1.15 billion were it not for the projected net rate of migration from developing countries to developed countries, which provides for the annual

Also, according to the projections of the World Bank, the scenario is even more disheartening for Europe, as a whole, in fact, to the middle of the twenty-first century the population of the old continent not even reach 8% of the world's population and, even more worrying, this will be characterized by a high seniority, against the rest of the world, however, will feature a very

the field today, with completely obscure scenarios and still in the making.

demographic upheavals rather unlikely.

16 Advances in Health Management

increase due mainly to developing countries.

the United States, Congo, Tanzania, China, and Bangladesh.

shift of about 2–2.5 million people over the next 30–40 years.

death.

Population Division.

young population

much, passing from 1.23 to 1.28 billion.

The demographic structure of population of all developed countries, and especially that of Italy, has been shaped, as is stated in any book of demographic analysis, by the effect of great transformations that have powered the path of evolution in the twentieth century in general and since the end of the Second World War in particular.

Great structural movements that have characterized the evolution of the Italian population in the long term were initially that of the demographic transition, then the era of baby boom and finally the low-low fertility.

The demographic transition,<sup>1</sup> in fact, marks the passage of a population from an archaic development model, characterized essentially by high levels of fertility and mortality, a structure of particularly young age and a hierarchical disorder between parents and children [1]<sup>2</sup> (the latter dying before the former in large numbers) to a model of modern development, with values 10 of birth rates and death rates particularly low (and stable), a structure of much older age, and with the restoration of a more normal hierarchical order in the chronology of deaths between children and parents.

In the completion of the demographic transition process, the values of the quotients of natality and mortality pass from rather high levels, even around 40–60% to much lower values which, at the end of the process, can reach values even around 7–8% (Figure 1 and Table 1, as regards Italy). This underlines a transformation of the vivacity of the natural movements: before the transition, the situation is characterized by many births and many premature deaths (with a large number of children deaths); after the transition, the situation is characterized by fewer births but with the lengthening of life span [2] due to the collapse of mortality in younger ages (known as infant mortality).

In case of the birth rate, the reduction process is uniquely determined by the inexorable reduction in births and by an important increase in procreation age of the mother (but also of

1 Scheme generalized by the trend of birth rates and death rates in the period of the demographic transition.

2 Livi Bacci, which emphasizes how this problem was actually at the base of the high birth rates. In essence, the couples (or families) produced more children in order to guarantee in the long term the survival of at least some of them, given the high level of mortality during childhood.

Figure 1. Evolution of natality and mortality quotients in Italy, 1862–2015.<sup>6</sup> Source: our elaboration on ISTAT's data. 6 Figure loosely based on and adapted from Iaquinta [7].

the father) [3–5]3 4 especially the "primiparous mother," whereas in case of the reduction path of mortality ratios and therefore mortality in general, there are many factors involved in its determination, because mortality is distributed in all age groups with a gradually increasing incidence.

The baby boom, however, which takes place temporarily at least in Italy around the end of the demographic transition process, is a typically Italian phenomenon. In this phenomenon, because of the contraction due to the traumatic effects of the Second World War, strong economic expansion of the 1960s is associated with a sharp increase in births such as to reach the point to return to pre-conflict levels, in the presence, however, of a period in which the mortality (especially infant mortality) lowering effect keeps alive a large number of births well beyond that found previously [2].

<sup>3</sup> These concepts have already been widely anticipated and explored in numerous scientific papers, including, in particular, we point out P. Iaquinta—T. Traversa, Evoluzione della fecondità nelle società post-transizionali, the paper presented at the Giornate di Studio della Popolazione, Milano 20-22 febbraio 2001; P. Iaquinta, La fecondità in Italia. Integrazione ed omogeneizzazione dei dati con modellistica ARIMA, in G. Da Molin, Prospettive di ricerca, Collana "Saggi e Ricerche" del Dipartimento di Scienze storiche e geografiche, n 34, Bari, 2003; P. Iaquinta, Some consideration about fertility in Italy. Methodological Problems, International Area Review, Hankuk University of Foreign Studies, Korea, vol. 6, N. 2, Fall 2003. 4 Figure loosely based on and adapted from the text: P. Iaquinta, Crisi di mortalità: il contributo delle interruzioni volontarie di gravidanza, in P. B. Helzel – A. J. Katolo, Autorità e crisi dei poteri, Cedam, Padova, 2012.



Source: ISTAT, Data warehouse, 2017.

the father) [3–5]3 4 especially the "primiparous mother," whereas in case of the reduction path of mortality ratios and therefore mortality in general, there are many factors involved in its determination, because mortality is distributed in all age groups with a gradually increasing

Figure 1. Evolution of natality and mortality quotients in Italy, 1862–2015.<sup>6</sup> Source: our elaboration on ISTAT's data.

The baby boom, however, which takes place temporarily at least in Italy around the end of the demographic transition process, is a typically Italian phenomenon. In this phenomenon, because of the contraction due to the traumatic effects of the Second World War, strong economic expansion of the 1960s is associated with a sharp increase in births such as to reach the point to return to pre-conflict levels, in the presence, however, of a period in which the mortality (especially infant mortality) lowering effect keeps alive a large number of births well

These concepts have already been widely anticipated and explored in numerous scientific papers, including, in particular, we point out P. Iaquinta—T. Traversa, Evoluzione della fecondità nelle società post-transizionali, the paper presented at the Giornate di Studio della Popolazione, Milano 20-22 febbraio 2001; P. Iaquinta, La fecondità in Italia. Integrazione ed omogeneizzazione dei dati con modellistica ARIMA, in G. Da Molin, Prospettive di ricerca, Collana "Saggi e Ricerche" del Dipartimento di Scienze storiche e geografiche, n 34, Bari, 2003; P. Iaquinta, Some consideration about fertility in Italy. Methodological Problems, International Area Review, Hankuk University of Foreign Studies, Korea, vol. 6, N. 2, Fall 2003.

Figure loosely based on and adapted from the text: P. Iaquinta, Crisi di mortalità: il contributo delle interruzioni volontarie di

gravidanza, in P. B. Helzel – A. J. Katolo, Autorità e crisi dei poteri, Cedam, Padova, 2012.

incidence.

18 Advances in Health Management

6

3

4

beyond that found previously [2].

Figure loosely based on and adapted from Iaquinta [7].

Table 1. Live births in Italy, 1926–2015.

This effect made a high portion of births reach the adult age and hence it would be more appropriate to speak of living boom rather than baby boom; in fact, before the Second World War, about 30% of births did not reach the age of 5, in the 1960–1970s, this proportion already fell to about 3% [6], and in the future, thanks to the contribution of the infamous therapeutic interruption of pregnancy [7], it might fall very easily below 0.3–0.4%, reducing by hundred times the impact of mortality on the survival of the younger generations.

The great economic crisis of the Western world, which started at the beginning of the 1970s, constitutes actually the divide between an old and a new world, in which the powerful and extraordinary parameter of post-bellum development has to come to terms with a new world order.

Perhaps, for the first time, after the feast of progress and indiscriminate growth of the post-Second World War, the Western world is forced to come to terms with a new incumbent danger that hits it: the great oil crisis. This is a crisis, far from being just a purely economic one; in fact, it entails a reconsideration of the entire developed world, calling into question priorities and needs of the entire modern world.

To this situation, dramatic to some extent, countries react with a structural change which also involves the most basic units of social life, such as the family, featuring its new roles, its structure, and especially its composition.

It is at this point that takes shape in Italy the era of Low-Low Fertility [8], a time in which the level of fertility of Italian women reaches values which will not be in a position to ensure the replacement of generations (but similar events were experienced in France, Germany, and the Scandinavian countries).

The number of annual births in Italy precipitates from 1,016,000 births in 1964 to around 500,000 since the 1980s, inexorably sealing the fate of the Italian population in terms of both the reproductive capacity and the age structure, which is bound to have a lot of old people beyond any imagination.

Profound behavioral changes in the population, especially those quantitative ones, with respect to the demographic events, have an impact at easily recognizable intervals on the dynamic of labor market entry and exit, respectively, after 20 years in the case of entry and after 60 years in the case of exit.

This simple consideration opens new scenarios of the labor market: if it is true that in the 1960s there were births double those in the 1990s, roughly a quarter of a century later, these births (which, among other things, took place in the living boom era) will present themselves at the entrance of the world of work. Situation will be more regrettable when more or less after 30–35 years from this circumstance, these same generations will approach the exit threshold of the world of work, especially because the next generations born in the era of low-low fertility will not be so large as to ensure the replacement of those in exit.

This will highlight, in a short time, an irreversible condition: the number of people in exit will exceed by far that in entry into the labor market suffocated by the level of unemployment which these first five years of global economic crisis highlighted in a stringent way.
