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.