This fall’s regional elections in Emilia-Romagna, Umbria, and Liguria have highlighted both continuity and change in Italy’s political landscape. While the center-right coalition maintained its ground in Liguria, the center-left achieved notable victories in Emilia-Romagna and Umbria. Voter turnout, however, has emerged as a critical factor to consider for the upcoming events, with significant declines across all three regions raising questions about political engagement and representation. Healthcare also confirms its specific political weight in the electoral debate. 

Implications for national politics 

These regional elections highlight important shifts within Italy’s political landscape. The center-left’s victories in Emilia-Romagna and Umbria demonstrate its ability to regain ground in key regions, providing momentum that could strengthen its position ahead of future general elections. These results, probably for the very first time since 2022 national elections, showed a competitive opposition capable of challenging the center-right’s dominance in specific areas, particularly where local issues such as healthcare have resonated strongly with voters. For the ruling coalition, the outcomes present a nuanced picture. The victory in Liguria, albeit narrow, underscores the center-right’s continued capacity to retain key strongholds and maintain control over 13 of Italy’s 20 regions. However, the losses in regions like Umbria, coming from a center-right government, reflect challenges in addressing voter concerns on issues such as governance and public services. These results signal both opportunities and risks for Italy’s major political blocs moving forward. 

The role of healthcare in shaping the vote 

Healthcare emerged as a pivotal role in these regional elections, reflecting its critical status as a cornerstone of public policy and governance. In Emilia-Romagna, the center-left’s success was driven by widespread approval of the region’s robust healthcare system, particularly its management during the COVID-19 pandemic, which highlighted continuity and efficiency. In Umbria, dissatisfaction with the incumbent administration’s handling of healthcare, including reduced access in rural areas and pandemic-related shortcomings, fueled the center-left’s victory. Stefania Proietti’s campaign focused on reinvigorating local healthcare services and improving access, striking a chord with disillusioned voters. It is no coincidence that following this victory, the Secretary of the Democratic Party, Elly Schlein, emphasized healthcare as the top concern of citizens and the driving force behind the center-left’s victory. 

Liguria’s healthcare debates revolved around hospital closures and funding challenges. The center-right’s Marco Bucci balanced these criticisms with promises of targeted reforms and fiscal responsibility, retaining voter trust despite strong opposition. The prominence of healthcare across all three regions underscores its growing salience as a policy domain under electoral scrutiny. As Italy grapples with an aging population and the long-term impacts of the pandemic, the demand for innovative, equitable, and sustainable healthcare solutions is becoming increasingly urgent. These election outcomes may prove a mandate for regional and national leaders to prioritize healthcare reforms, addressing systemic inefficiencies while safeguarding accessibility and quality of care for all citizens. 

Emilia-Romagna: a stronghold reaffirmed 

In Emilia-Romagna, historically a bastion of the left, Michele de Pascale secured a decisive victory for the center-left coalition, garnering 56.77% of the votes. His opponent, Elena Ugolini from the center-right, received 40.07%, reaffirming the region’s progressive leanings. However, the declining voter turnout—46.42% compared to 67.67% in 2020—raises questions about political engagement even in regions with established political identities. 

In terms of policy perception, a key factor in this victory was Emilia-Romagna’s robust healthcare system, often cited as one of Italy’s best cases. De Pascale’s campaign effectively leveraged the region’s management of healthcare services, particularly during the COVID-19 pandemic, emphasizing continuity and stability in public health policies. 

Umbria: A competitive shift  

Umbria’s election produced one of the most surprising results of the year. Stefania Proietti, representing the center-left, defeated the incumbent Donatella Tesei of the center-right with 51.56% of the vote against 46.17% (the result was initially expected to be a tight head-to-head). This marks a significant shift for a region that had previously leaned conservative and comeback to its historic center-left positioning. 

Healthcare again played a pivotal role. Criticism of the Tesei administration’s handling of the pandemic and cuts to local healthcare services provided Proietti with a compelling narrative of change. The center-left’s promises to invest in local hospitals and improve healthcare access resonated with voters in smaller towns and rural areas, traditionally strongholds of the right. 

Liguria: Stability for the Center-right amid challenges 

In Liguria, elections held in late October saw Marco Bucci of the center-right narrowly defeat Andrea Orlando of the center-left, with 48.77% to 47.36% of the vote. This race was particularly contentious, following the resignation of former center-right President of Region Giovanni Toti amid a corruption scandal. Despite the victory, the center-right faced a strong challenge, with the Democratic Party emerging as the most-voted single party at over 27%. 

Bucci’s campaign capitalized on his track record in urban development, particularly his leadership in rebuilding the Morandi Bridge, and his vision for economic growth through investments in the port of Genoa. Healthcare and environmental controversies, such as the proposed regasification plant in Vado Ligure, challenged the center-right, but Bucci managed to balance promises of fiscal responsibility with targeted healthcare improvements, resonating with urban and suburban voters. Voter turnout, at a low 45.9%, mirrored national trends but didn not reduce the impact of the government coalition’s resilience and its continued relevance in Italy’s political landscape. 

Conclusions 

These regional elections highlight a complex and shifting political landscape in Italy. While the center-left has demonstrated its ability to regain ground in key regions, the center-right remains a resilient force, maintaining its hold on most Italy’s regions two years after national elections. Healthcare policy will likely continue to influence political discourse at both regional and national levels. For the government and the opposition alike, the message from voters is clear: addressing public concerns about local governance is crucial to securing political legitimacy and public trust. As Italy heads into a pivotal period of policymaking and electoral strategy, these regional elections serve as a reminder of the intricate interplay between local issues and national ambitions. For political actors and policymakers, the challenge lies in translating electoral mandates into tangible improvements in citizens’ lives—also considering critical areas such as healthcare.