Mafia’s Most Dangerous Bullets: The Close Link Between Mafia and Health

Written by: Andrea Domenici, LLM International Crime and Justice, University of Turin

There is a close link between mafia and health and it is not a matter of only bullets and bombs.

Often the public reaction to Mafia groups takes place only on occasions of bloodshed, especially when these acts involve people who were able to direct public attention for their efforts against these criminal organizations. In Italy the cases of Judges Falcone and Borsellino were emblematic; the killing of the two magistrates and their bodyguards by the mafia created general indignation in the public opinion with the effect of extensive and engaging street demonstrations and the State was forced, both on a legal than an operational plan, to deal with decision against the problem of Cosa Nostra in Sicily.

While forces and men were conveyed on the island, the same attention was not used in other parts of Italy, especially in Calabria, where an even more impervious kind of mafia, ‘ndrangheta, was developing with an unprecedented trail of killings and impoverishing of the land.[1] While the ‘ndrangheta embellished, Calabria has become one of the poorer regions of Italy. Low services, democracy distorted by organized crime with votes on accomodating people, unemployment, lack of the sense of State, favors rather than rights.[2]

But not only bullets kill in a territory of this kind.

In the 2008 World Health Organization report “Closing the gap in a generation” identified best procedures to increase life expectancy and access to health services, while reducing differences between territories.[3] The analysis starts from some circumstances of daily life (equitable start in life with regard to education, attention to build a flourishing living environment with emphasis on participatory urban governance and improving urban living conditions, fair employment and decent work, social protection, fair financing, market responsibility, gender equity, inclusion for voice in the political impowerment etc.) that are systematized with some structural drivers (the nature and degree of social stratification in society; biases, norms, and values within society; global and national economic and social policy; processes of governance at the global, national, and local level).

The conclusion of the report is that where there is less social justice, i.e. where there is not a fair and rational distribution of economic assets and rights,[4] then there is a greater possibility for the population of contracting diseases and increases the risk of premature death. Collective action is therefore necessary that may involve building social institutions and adopting regulations that both deliver people’s needs for housing, education, food, employment protection, environmental protection and remediation, and social security, and correct for market failure.[5]

Now, applying the same markers of the report, let’s think about a region where the State is no longer able to speak effectively in areas such as justice, finance, education, health, security. That region becomes fertile territory for the settlement of mafia.

In fact, when the population lives completely outside the control of the institutions, there’s the birth of extra legal services of Government, protection, job search where mafia finds its reason to exist because can ensure protectionism against ruthless competition, career access with methods based on clientelism, forms of protection, rapid resolution of disputes with less-than-legal policy.[6]

As it known mafia economy is not the market economy; the law of the mafia is different, faster, more effective and efficient, but certainly not promoter of economic and social equity, but based on the dominance and control of a territory in absence of criteria of competition, merit, ability.

Physical violence is the most obvious outburst of a mafia system, especially when it has yet to define and fully settle, but the malaise that this brings on the health of the population is worse and without bloodshed, but characterized by a slow and almost imperceptible infiltration process in an area where State services are replaced by those of organized crime.

When the civilian population realizes it, it is too late and it is already addicted by a proceeding in such this way with the consequence to find difficult to react to this lack of social justice in the daily life.
Social justice is therefore the key word because in an area permeated by mafia dishonesty, this becames a malaise for the society with the result that the risk of death will be premature, there will be a greater chance of falling ill and the quality of life will be lower. These are not just scholarly words, this in fact is reality. In 2007, in Calabria, the Governor of the region declared a “state of emergency” in the health care system, after corruption as a result of the mafia infiltration, bled hospital budgets dry.[7]
The mafia doesn’t kill only with bullets, and our responses must be awareness, education, civic sense, transparent markets, access to employment, legitimization of institutions, informational pluralism, participation, and good governance.[8]

[1] Nando dalla Chiesa, La convergenza, Melampo editore, 2010, pg.54; Nicola Gratteri, Antonio Nicaso, Fratelli di Sangue, mondatori, 2011, charters VI and VII pg. 51 – 64

[2] Relazione Annuale Direzione Investigativa Antimafia 2001

[3] World Health Organization, Comnmission on Sociale Determinats of  Health FINAL REPORT: Closing the gap in a generation, 2008

[4] Justice as Fairness: A Restatement, John Rawls, 2001 Harvard University Press edition, pg. 42

[5] Stiglitz JE (2006). Making globalization work. New York, WW Norton

[6] Federico Varese, Mafie in movimento, Princeton University Press, 2011, pg. 269

[7] Michael Day, Mafia corruption puts Italian healthcare system in “state of emergency”, Mail Online, December 12, 2007,  available at:

[8] Nando dalla Chiesa, La convergenza, Melampo editore, 2010, pg. 268 – 270