Eldercare, immigration, and health care in Italy: How the Italian state creates and mitigates inequality

type="main" xml:id="sea212035-abs-0001"> This article considers the role of the Italian state as both a source of inequality and an institution that mitigates inequality. Fieldwork completed in Genoa in 2010 focused on the intersection of immigration policies, care work needs, and the informal economy revealed in the lives of immigrant in-home care workers. Genoa, the largest city in the region of Liguria, is the “oldest” city in Europe, in that 33 percent of the population is now older than 60 years of age. In Esping-Andersen's typology, Italy's Mediterranean-familialist-style welfare regime is characterized by a high dependence on family members to provide care, few state-supported services for elders, and a shortage of policies that reconcile care and work. This combination places the burden of care for family elders on female relatives, thus perpetuating gender inequalities. In Italy, the relatives of the elder needing care often shift their burden onto low-wage immigrant laborers. In households employing care workers in Genoa, examining how Italian state policies regarding eldercare maintain ethnic, class, and gender inequalities illustrates how state forces influence private realities. In addition, the well-established practice of regional autonomy has transformed the Italian national health care system, as it is manifest in the region of Liguria, into a sociocultural institution that mitigates inequality in health care access as it serves both citizens and immigrants. However, this institution also supports unequal working conditions in that it supports informal economic activity by maintaining the health of the low-wage, immigrant workforce critical to the well-being of the elders of this region.