{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T16:06:07Z","timestamp":1774541167462,"version":"3.50.1"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T00:00:00Z","timestamp":1774483200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>This study examines the future stability of Italy\u2019s 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\u2019s 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\u2019s NHS and promote an equitable society.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1790700","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:40:31Z","timestamp":1774539631000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Birth rates and migration: an AI and One Health approach within the Italian National Health System"],"prefix":"10.3389","volume":"14","author":[{"given":"Francesca","family":"Zappacosta","sequence":"first","affiliation":[{"name":"Department of Political Sciences, Sapienza University of Rome","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bal\u00e1zs","family":"Majt\u00e9nyi","sequence":"additional","affiliation":[{"name":"Department of Human Rights and Politics, Faculty of Social Sciences E\u00f6tv\u00f6s Lorant University (ELTE)","place":["Budapest, Hungary"]},{"name":"Research Affiliate CNR-ISGI","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessio","family":"Laconi","sequence":"additional","affiliation":[{"name":"Department of Law, University of Florence","place":["Florence, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Di Nardo","sequence":"additional","affiliation":[{"name":"Chair of Pediatrics, Department of NESMOS, Faculty of Medicine and Psychology, University of Rome Sapienza c\/o Sant\u2019Andrea University Hospital","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pasquale","family":"Parisi","sequence":"additional","affiliation":[{"name":"Chair of Pediatrics, Department of NESMOS, Faculty of Medicine and Psychology, University of Rome Sapienza c\/o Sant\u2019Andrea University Hospital","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Polese","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Mental Health and Sensory Organs NESMOS, Sapienza University of Rome","place":["Rome, Italy"]},{"name":"UOD of Childhood Neuropsychiatry, Sant\u2019Andrea University Hospital, Sapienza University of Rome","place":["Rome, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"101206","DOI":"10.1016\/j.lanepe.2024.101206","article-title":"The Italian health data system is broken","volume":"48","year":"2025","journal-title":"Lancet Regional Health Eur"},{"key":"ref2","volume-title":"Death instinct and knowledge","author":"Fagioli","year":"2019"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1521\/pdps.2024.52.3.276","article-title":"A primer on human birth theory","volume":"52","author":"Polese","year":"2024","journal-title":"Psychodyn Psychiatry"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1504\/IJENVH.2019.108680","article-title":"From animal instinct to human birth theory: an entangled path","volume":"9","author":"Conti","year":"2019","journal-title":"Int J Environ Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.neuroscience.2016.05.042","article-title":"Early-life experiences and the development of adult diseases with a focus on mental illness: the human birth theory","volume":"342","author":"Maccari","year":"2017","journal-title":"Neuroscience"},{"key":"ref6","volume-title":"Gravidanza e nascita. L'identit\u00e0 del bambino e il rapporto con i genitori","author":"Chambers","year":"2025"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/07347332.2025.2559636","article-title":"Blood biomarkers and medication response following group psychotherapy as an add-on treatment in refractory idiopathic myelodysplasia","author":"Polese","year":"2025","journal-title":"J Psychosoc Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s12910-021-00624-4","article-title":"Something must happen before first breath","volume":"22","author":"Polese","year":"2021","journal-title":"BMC Med Ethics"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"933426","DOI":"10.3389\/fnint.2022.933426","article-title":"The newborn's reaction to light as the determinant of the brain's activation at human birth","volume":"16","author":"Polese","year":"2022","journal-title":"Front Integr Neurosci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1080\/10463283.2014.957578","article-title":"Living in a multicultural world: intergroup ideologies and the societal context of intergroup relations","volume":"25","author":"Guimond","year":"2014","journal-title":"Eur Rev Soc Psychol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.copsyc.2019.06.010","article-title":"Cultural diversity and its implications for intergroup relations","volume":"32","author":"Verkuyten","year":"2020","journal-title":"Curr Opin Psychol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1177\/1088868318761423","article-title":"The relationships of intergroup ideologies to ethnic prejudice: a meta-analysis","volume":"23","author":"Whitley","year":"2019","journal-title":"Pers Soc Psychol Rev"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.1016\/S0140-6736(21)01733-5","article-title":"The evolution of the Italian National Health Service","volume":"398","author":"Ricciardi","year":"2021","journal-title":"Lancet"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1080\/07360932.2022.2036625","article-title":"The Italian National Health Service: universalism, marketization and the fading of territorialization","volume":"51","author":"Bifulco","year":"2022","journal-title":"Forum Soc Econ"},{"key":"ref15","volume-title":"Demographic balance of the resident population and demographic indicators","year":"2026"},{"key":"ref16","volume-title":"14th report on the immigration economy: the economic consequences of demographic recession","year":"2024"},{"key":"ref17","volume-title":"Statistical dossier on immigration 2024","year":"2024"},{"key":"ref18","volume-title":"22nd annual report of the reception and integration system (SAI)","year":"2024"},{"key":"ref19","volume-title":"Judgment No. 192 of 3 December 2024 on the Legislation on Differentiated Autonomy (Law No. 86 of 26 June 2024)","year":"2024"},{"key":"ref20","volume-title":"Migrants\u2019 contributions to Italy\u2019s welfare","year":"2017"},{"key":"ref21","volume-title":"The effects of immigration in developed countries: insights from recent economic research","author":"Edo","year":"2018"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejpoleco.2020.101932","article-title":"Health spending in Italy: the impact of immigrants","volume":"65","author":"Bettin","year":"2020","journal-title":"Eur J Polit Econ"},{"key":"ref23","volume-title":"Il nostro manifesto [CoNNGI Manifesto 2025]","year":"2024"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.healthpol.2022.12.012","article-title":"European immigrant health policies, immigrants\u2019 health, and immigrants\u2019 access to healthcare","volume":"127","author":"Dourgnon","year":"2023","journal-title":"Health Policy"},{"key":"ref25","volume-title":"7th GIMBE report on the National Health Service","year":"2024"},{"key":"ref26","volume-title":"Sociology of migration","author":"Ambrosini","year":"2021"},{"key":"ref27","volume-title":"Human rights of asylum seekers in Italy and Hungary: Influence of international and EU law on domestic actions","author":"Zappacosta","year":"2019"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"127","DOI":"10.17394\/113098","article-title":"Cittadinanza e denatalit\u00e0: le sfide della politica. Una comparazione tra Germania e Italia [Citizenship and declining birth rates: the challenges of politics. A comparison between Germany and Italy]","volume":"1","author":"Villani-Lubelli","year":"2024","journal-title":"Dir Pubbl Comp Eur Riv Trimest"},{"key":"ref29","volume-title":"One health joint plan of action (2022-2026). Working together for the health of humans, animals, plants and the environment","year":"2022"},{"key":"ref30","author":"Guzzi","year":"2025"},{"key":"ref31","volume-title":"One health. Dal Paradigma alle implicazioni giuridiche [One health: From the paradigm to legal implications]","author":"Violini","year":"2023"},{"key":"ref32","volume-title":"Il PNRR e la riorganizzazione del Servizio sanitario nazionale. (The NRRP and the reorganisation of the National Health Service) Focus 3\/2025, 22","year":"2025"},{"key":"ref33","doi-asserted-by":"crossref","DOI":"10.55317\/9781784135324","volume-title":"Refugee protection in the artificial intelligence era. A test case for rights","author":"Forster","year":"2022"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.1016\/S0140-6736(15)60901-1","article-title":"Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation-lancet commission on planetary health","volume":"386","author":"Whitmee","year":"2015","journal-title":"Lancet"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1177\/00207314211024900","article-title":"The privatization of the Italian National Health System and its impact on health emergency preparedness and response: the COVID-19 case","volume":"51","author":"Buzelli","year":"2021","journal-title":"Int J Health Serv"},{"key":"ref36","first-page":"585","author":"Bobini","year":"2024"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"R556","DOI":"10.1016\/j.cub.2005.07.004","article-title":"Retinal development: second sight comes first","volume":"15","author":"Sernagor","year":"2005","journal-title":"Curr Biol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e3002909","DOI":"10.1371\/journal.pbio.3002909","article-title":"Trajectories of human brain functional connectome maturation across the birth transition","volume":"22","author":"Ji","year":"2024","journal-title":"PLoS Biol"},{"key":"ref39","volume-title":"Immigration can solve the demographic dilemma\u2014but not without the right policies","author":"Peri","year":"2020"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1790700\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T15:40:35Z","timestamp":1774539635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1790700\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,26]]},"references-count":39,"alternative-id":["10.3389\/fpubh.2026.1790700"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1790700","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,26]]},"article-number":"1790700"}}