Birth rates and migration. An AI and One Health approach within the Italian National Health System

This study examines the future stability of Italy’s health and social systems in the context of demographic decline. The Italian healthcare system, grounded in a universalistic and public model, founded on the principle of equity, is undergoing a phase of instability. The COVID-19 pandemic represented a critical rupture, exposing systemic weaknesses, territorial disparities, infrastructural inadequacies, the rigidity of financing mechanisms and the lack of reform regarding citizenship rights for foreign residents. An inductive, interpretive approach was adopted, starting with data analysis from Italy’s population dynamics as of 1 January 2025, including births and deaths among citizens, growth of the foreign residents, and total social security contributions collected by the National Institute for Social Security. The analysis considered three major immigration reports, several academic articles from the legal, social, and medical fields, Constitutional Court Judgment No. 192/2024 on regional autonomy, and Mission 6 of the National Recovery and Resilience Plan within the framework of the Next Generation EU. The issuance of long-term visas and easier access to citizenship for foreign residents foster a more equitable society and can enhance the long-term sustainability of the Italian National Health System by offsetting demographic decline, lowering the median age, and stabilizing social security contributions. The success of such measures depends on integration policies and the efforts to combat racial discrimination. The findings highlight the need for citizenship and integration policy reforms and a governance framework consistent with the One Health approach. These measures would enhance the sustainability of Italy’s NHS and promote an equitable society.