Health promotion in Italy. Policies on sport and physical activity in the 21st century

Abstract 
Regular physical activity and sport are prerequisites for a healthy and balanced lifestyle. Indeed, regular exercise improves quality of life and contributes to individual and collective well-being. In addition to reducing the risk of disease and slowing down the ageing process, active habits also bring economic and social benefits by reducing the burden on national healthcare systems. Such practises reduce health risks and create systemic and subjective benefits with significant welfare policy implications. In societies where the right to health increasingly depends on individual resources – economic, cultural and relational - the role of public policy becomes increasingly important. This study analyses the main policies to promote physical activity and sport in Italy in the 21st century. It analyses the 20th century. Firstly, the continuities and discontinuities with policies at EU level are highlighted. It then analyses the constitutional recognition of sport as a fundamental right through Law 1/2023, which amended Article 33 of the Italian Constitution. Based on theories of structural inequality, this reform will be critically analysed for its concrete effects on access to sport, especially for marginalised groups (women, migrants, people with disabilities). It analyses whether this ground-breaking legislation has translated the EU recommendations on sport as an instrument of integration into concrete measures or exacerbated existing inequalities.

Finally, the study assesses whether this symbolic milestone has marked a real turning point in national strategies to promote physical activity by analysing case studies of local interventions and their outcomes.

Keywords: Constitutional law, Health promotion, Italy, Physical activity, Sport policies  

1. Introduction 
The concept of health promotion, as recognised in the international debate, goes beyond the mere promotion of a healthy lifestyle and becomes a fundamental component of public policy. Its main objective is to reduce inequalities within the population through systemic interventions aimed at creating health-promoting conditions^1,2. Health promotion is based on joint actions involving different sectors of society, especially those related to the social determinants of health³, complex factors that influence health and go far beyond the role of the health system^4,5. The current challenges in ensuring adequate health conditions for the population are prompting the scientific community and policy makers to address a variety of factors. This requires the development of innovative public policies that encourage new ways of promoting health and stimulate educational processes aimed at promoting healthy lifestyles^6,7.               

Health is therefore a complex concept whose protection must be embedded in a complex network of subjective and objective factors⁸. Its maintenance requires a holistic approach that includes planning and reorganization through defined protocols and targeted strategies^9,10. In this context, sport and physical activity are proving to be important tools for improving the well-being of all age groups¹¹. Indeed, regular physical activity and sport are basic prerequisites for a healthy and balanced lifestyle that improves quality of life at both an individual and collective level⁸.

In addition to reducing the risk of chronic diseases and slowing down the natural ageing process, an active lifestyle also has a significant positive impact on containing the economic and social costs to national healthcare systems^12,13. Behaviours that include physical activity and sport reduce health risks and bring benefits at both subjective and systemic levels, with significant implications for social policy¹⁴. In a society where the right to health is increasingly seen as an individual right, often dependent on economic resources and cultural and relational capital, the role of public policy in ensuring equity and access becomes even more important^10,15.

However, access to physical activity and sport remains deeply unequal. Socio-economic status, cultural capital and spatial factors significantly shape participation opportunities. Individuals living in disadvantaged urban or peripheral areas, as well as women, migrants and people with disabilities, often face structural barriers that limit their access to sport.

In this perspective, sport cannot be assumed as inherently inclusive; rather, it may reproduce existing social inequalities unless supported by targeted and redistributive public policies.

This paper will analyze the main policies to promote physical activity and sport that have been implemented in Italy in the 21st century. In the first phase, we will highlight the main policies promoted by the European Union that have provided a framework for national strategies^16,17. Attention will then turn to the recognition of sport as a fundamental right, which will be enshrined in the Italian Constitution in 2023, and examine the socio-educational and political implications of this important institutional step¹⁸. Finally, an attempt will be made to understand whether this symbolic date represents a real turning point in the strategies for promoting physical activity and sport throughout the country by analyzing some concrete practises and important interventions.  

2. Methodology
The article adopts a qualitative research design combining a structured literature review and a documentary analysis of policy and legal sources.

The literature review focuses on international and European scholarship on health promotion, sport policies and social inequalities, selected through databases (Google Scholar) using keywords such as “physical activity”, “sport policies”, “health inequalities” and “Europe”.

The documentary analysis concerns Italian and European policy documents produced between 2000 and 2025 (laws, decrees, EU policy frameworks, institutional reports). Sources were selected based on their institutional relevance, regulatory impact, and continuity within policy cycles.             

The focus on the 21st century is justified by the emergence of new governance models in sport, characterised by Europeanisation processes, neoliberal reforms of public administration and the increasing integration between sport, health and social policies.

Moreover, this period includes the constitutional reform of 2023, which represents a critical juncture in the Italian policy trajectory.    

3. Policies and actions in Europe in the 21st Century  
Following Roscoe Pound’s classic distinction between law in the books and law in action, this article distinguishes between the formal recognition of sport within legal frameworks and its actual implementation through policies and practices.

This distinction is crucial to assess whether the constitutionalisation of sport in Italy has produced concrete effects in terms of access, participation and reduction of inequalities. The European Union’s policy to promote sport and physical activity has only recently been introduced. Until the 2000s, they were almost completely absent or fragmented¹⁹. Since the 1990s, citizens’ participation in sporting activities has been increasingly supported to promote healthy and active lifestyles. This process has led to a development in European policy that has begun to promote sport at different levels – social, cultural and economic.

A turning point was the 2007 White Paper on Sport, the first comprehensive EU document on the subject, which emphasised the central role of sport in the growth of the European Commission and set out strategies and actions at European level²⁰. The White Paper emphasises the importance of sport both as a means of personal fulfilment and as a means of promoting active citizenship through social participation²¹.

The document states:
This initiative marks the first time that the Commission is addressing sport-related issues in a comprehensive manner. Its overall objective is to encourage debate on specific problems, to enhance the visibility of sport in EU policy-making and to raise public awareness of the needs and specificities of the sector. The initiative aims to illustrate important issues such as the application of EU law to sport²⁰.

The social value of sport was already recognized in the Nice Declaration (2000). It states that the EU, although it has no direct competence, must recognize the educational and cultural functions of sport and protect its ethical and solidarity role²⁰.

In this perspective, sport is seen as a tool to reduce social and health expenditure:         
• Reduce social and health expenditure by improving public health and quality of life, especially for the elderly population.
• Strengthen territorial cohesion by breaking down generational, social and ethnic barriers.
• Improve employability by promoting the development of skills and specialisations in national and European production systems.  

The Lisbon Treaty (2009) gave the EU special powers in the field of sport and recognised its unique character as a voluntary activity with social and educational functions. Since then, the EU has been promoting the European dimension of sport, fairness, open competition and cooperation between organisations, supporting funding programmes such as Erasmus+ and defining common positions at international level²². The priorities identified relate to three main areas: social, economic and political-legal (European Parliament n.d.).

The first post-Treaty cooperation framework was the Work Plan for Sport 2011-2014, which recognized sport as a sector of support and coordination contributing to the Europe 2020 objectives for sustainable and inclusive growth. The plan promoted dialogue with the sport movement, international cooperation and the integration of sport in health, education and social development²³. Three priority areas were identified:
• Integrity and values (anti-doping, education, prevention of violence and intolerance, health, social integration).
• Socio-economic dimension (sustainable funding policy, rules for state aid, regional development, employment).
• Organisation (good governance, special features of sport, mobility of athletes, protection of minors, broadcasting rights and intellectual property).

The 2014-2017 work plan consolidates the results of the first plan and recognises that sport plays a strategic role that goes beyond the game and physical performance: it is seen as a complex phenomenon, a bearer of values, a factor of integration and a dynamic economic and productive sector. This vision requires participatory and coordinated decision-making processes involving institutions, sports organisations and civil society.

In the 2017-2020 Work Plan, the EU strengthened cooperation between Member States and the Commission, emphasising the value of volunteering in sport as a tool for social cohesion and informal learning^24,25.

The most recent intervention is the Council Resolution on the EU Work Plan for Sport 2024-2027, which aims at a strategic and cross-sectoral approach involving sport, health, environment, digitalization and sustainability, with a particular focus on global crises and international cooperation. The plan promotes research, sustainable major events, sports tourism and mental health and introduces monitoring systems and platforms for the exchange of best practises²⁶.

To summarise, the EU policies outlined between the first and second decade of the 2000s provided a framework within which national strategies, such as those in Italy discussed in the following paragraph, are also positioned and developed.   

4. Sports Policies in Italy in the years 2000-2010  
The growth of sport in Italy is the result of a pluralistic vision that strengthens its role in terms of public planning and intersectoral co-operation at different levels - regulatory, executive and supervisory.

Italian sports policy in the 2000s represents an important moment of transition, characterized by the progressive institutionalisation of sport and the strengthening of the role of the state in its regulation. The most important measure at the beginning of the decade was Law no. 376 of 14 December 2000, which came into force on 2 January 2001 and introduced for the first time a legal definition of doping that preceded the measures provided for in the Lisbon Treaty by several years, stating that “sporting activity is aimed at promoting individual and collective health [. ] and may not be practised using techniques, methods or substances [. ] which could jeopardise the physical and mental integrity of athletes²⁷”.

This regulatory framework reflects the increasing convergence between sport, public health and control mechanisms and illustrates how sport has become the subject of state regulation: athletes are no longer just competitors, but also subjects of health protection, surveillance and criminal liability in the event of offences. This process is in line with a European and global trend towards the medicalization and regulation of sport, which restricts the autonomy of sports federations, which until the 1990s regulated doping issues internally. The logic of surveillance introduced by this law reflects what Michel Foucault would call the biopolitics²⁸ of the competitive body: The athlete’s body becomes a terrain of control and normalization in which health and performance are balanced by technical and legal apparatuses.

This regulatory framework can be interpreted through a Foucauldian lens as part of a broader biopolitical strategy, in which institutions seek to regulate populations by promoting norms of health, discipline and performance.

In this perspective, sport becomes a key site of governance, where bodies are not only protected but also monitored, optimised and normalised according to medical and legal standards. Physical activity is thus framed not merely as a personal choice, but increasingly as a social expectation linked to responsible citizenship.

This shift reflects a broader transformation in contemporary societies, where the management of health is progressively individualised, while remaining embedded in institutional and regulatory frameworks.

At the same time, Italy tackled the problem of the financial instability of football clubs in the early 2000s (in 2002 to be precise) with the adoption of the ‘Save Football’ decree. This decree introduced an extraordinary measure that allowed clubs to spread the cost of player transfers over ten years and claim their devaluation against tax, with the stated aim of ensuring the stability of a sector of strategic importance to the country’s economy and image²⁹. This measure highlights a crucial tension in Italian sports policy: football, the country’s most important sport, becomes the subject of extraordinary economic policy measures that penalize its symbolic and financial weight. This confirms how, since Pierre Bourdieu, the sociology of sport has interpreted professional sport as an autonomous social field that is, however, strongly intertwined with economic logic and state interests³⁰. The government’s intervention, even if it was justified by the emergency, reveals a “politicization” of football and its transformation into a national public good, with repercussions that go beyond the sporting sphere and affect the construction of consensus and collective identity³¹.

At the same time, the reform of CONI in 2002 marked a decisive step in the redefinition of the institutional structure of Italian sport by recognizing the Italian National Olympic Committee as a legal entity under public law and strengthening its strategic role in the promotion of sport and the management of relations with international federations and bodies. This reform is part of a broader governance process in which sport is seen as a public policy area and planning and control instruments similar to those in health and education policy are introduced. The early 2000s also saw the creation of Coni Servizi S.p.A. (2002), a public company set up to manage operational and logistical activities, which was transformed into Sport e Salute S.p.A. in 2019. This strengthened the link between the state and the promotion of sport through centralised funding and sports projects³². This development testifies to the progressive managerialisation of sports policy, which is evolving from an “associative”’ administration to a corporate logic in line with the neoliberal transformation of public administration.

During the same period, sport also became a lever for youth and regional policy: in 2006, the Department for Youth Policy and Sporting Activities was set up within the Presidency of the Council of Ministers, only to be abolished in 2008, with its tasks being reallocated between the Department of Sport and the Ministry of Youth³³. The change in responsibilities reflects the historical difficulty of defining a stable national framework for sport, which is often fragmented between public organizations, associations and local administrations. At the same time, more and more attention is being paid to inclusion: In the 2010s, the ‘Sport and Suburbs’ fund (2016) allocated 100 million euros for the modernisation of facilities in disadvantaged areas, indicating a redistributive policy that has its roots in the organisational reforms of the 2000s³⁴. The Italian University Sports Centre (CUSI) has also launched projects such as ‘CUSI Network’ and ‘SPONC!’, which promote sport and well-being as a means of social inclusion, especially for young people and people with disabilities³⁵.

The decade 2000-2010 thus marks the transition from a largely self-regulated sports system to a genuine public sports policy. However, the institutional fragmentation that characterises the sports policy of this decade shows the lack of a coherent centralized strategy, which is compensated by sectoral interventions and a progressive delegation to public companies and technical bodies. This underlines the vision of sport as a tool for integrated public policies: health, education, economy and social cohesion are interwoven in a framework that anticipates current policies that are increasingly orientated towards integration, the local environment and sustainability.

The Italian turning point in sport came in the following decade, as will be explained in the next paragraph, when sport became one of the rights protected in our Constitution.

Between 2000 and 2025, Italy experienced significant political instability, with alternating centre-left, right-wing, technocratic and populist governments.

However, the analysis suggests that sport policies have shown a relative continuity across political cycles, mainly due to:
• European policy constraints.
• institutional path dependency.
• the growing recognition of sport as a public health tool.

While minor variations can be observed (e.g. funding priorities, governance models), no clear ideological rupture emerges.
This supports the hypothesis that sport policy operates as a “low-conflict” policy domain, relatively insulated from partisan polarisation.   

5. Sport as a Fundamental Right in Italy: A Constitutional Innovation with Profound Ethical, Social and Intercultural Implications     
On 20 September 2023, the Constitutional Law (no. 1/2023) was finally passed, adding a new paragraph to Article 33 of the Fundamental Laws of the Italian Republic: “The Republic recognises the educational and social value of sport in all its forms and its role in promoting physical and mental well-being”³⁶.

The inclusion of sport in the fundamental rights of the Italian Constitution in 2023 represents an extraordinary legal innovation that marks the transition from a sport understood as a leisure activity to a pillar of human dignity and collective well-being. Although the international recognition of sport as a human right dates back to the second half of the 20th century, with explicit references in the United Nations Universal Declaration of Human Rights and other international charters³⁷, its formalisation at constitutional level in Italy marks an unprecedented turning point in the national legislative landscape. This step is not merely symbolic, but establishes a binding obligation for the state, strengthens legal protection and redefines collective expectations of sport. This is in line with a global trend that aims to overcome the idea of sport as a self-regulated regime and instead subject it to ever stricter legal control.

From a comparative perspective, the explicit constitutional recognition of sport remains relatively rare in Europe. While several countries promote sport through legislation and policy frameworks, only a limited number have formally incorporated it into constitutional texts.

This positions Italy within a broader European trend toward recognising sport as a public good linked to health, education and social cohesion, albeit with different legal intensities.

Constitutional recognition is important in several respects. Firstly, it transforms the promotion of sport from an opportunity into a genuine, inviolable right by imposing on the State the obligation to remove obstacles to its full realisation and to guarantee adequate conditions for its general practise. In this way, the right to sport receives a more solid and stable protection, which places it above changing political priorities and consolidates its central position in the legal system and in public policy. This development is in line with the fundamental values of dignity, equality, non-discrimination and the right to health, which sport is called upon to promote³⁷. It is no coincidence that sport has long been guaranteed in various constitutional contexts, partly in response to popular demands for greater democratisation and state support³⁸.

In addition to strengthening legal protection, the elevation of sport to a constitutional right also changes policy for health and well-being. Sport is recognised not only as a tool for primary and secondary prevention, but also as an essential component of an individual’s quality of life and psychophysical well-being.

This recognition obliges institutions to consider it as a priority social investment that can have a long-term impact on the reduction of inequalities and the economic sustainability of health systems.

The constitutional value of sport is also reflected in its ethical, educational and integrative function. Indeed, sporting activity is a privileged vehicle for the transmission of fundamental values such as respect, solidarity and a sense of responsibility. The concept of fair play summarises these principles and makes them a model of civil coexistence³⁹. Sport teaches respect for rules and authority, self-control and the ability to accept competition, thus contributing to citizenship education. However, sport is not free from ethical problems, as phenomena such as doping, corruption and discrimination show. In this context, constitutional recognition requires an even stronger commitment to ensuring integrity, fairness and transparency, including through the role of ethics committees and supervisory bodies^40,41.

Sport is also a powerful social catalyser. Participation in sport strengthens the sense of belonging to a community, strengthens social bonds and promotes cohesion by creating spaces for socialising and cooperation⁴². At the same time, it requires discipline, perseverance and the ability to overcome difficulties, qualities that make it a tool for personal and collective growth⁴³.

In today’s multicultural context, sport is ultimately an extraordinary means of integration and intercultural dialogue. Its ability to overcome linguistic, ethnic and religious barriers makes it a common space for interaction and mutual understanding. Educational experiences and local projects show how it promotes the integration of migrants, provides safe spaces for socialisation and strengthens people’s mental well-being^44-46. Traditional games and Olympic activities also promote intercultural skills and values of respect and demonstrate the ability of sport to contribute to dialogue and cohesion⁴⁷. From this perspective, the constitutional amendment of 2023 heralds a new era in which sport becomes an intrinsic right of the individual and a collective responsibility, with far-reaching transformative effects.   

6. From Constitutional Recognition to Practice: A Transdisciplinary Approach to Sport   
The inclusion of sport in the Italian Constitution in 2023, which enshrines the “educational and social value of sport in all its forms and its promotion of physical and mental well-being”, has sparked a heated debate about its real impact as a turning point in strategies to promote physical activity and sport across the country. On the one hand, there are several elements that support the idea of significant change and emphasise how the amendment has shifted the ‘axis’ of political and institutional discourse. Concrete initiatives such as the promotion of specific calls for proposals by the Department of Sport for social cohesion, urban regeneration, the inclusion of people with disabilities and the promotion of active lifestyles, including “Sport e rigenerazione urbana [Sport and Urban Regeneration]”, “Alimentiamo lo sport [Let’s Feed Sport]” and “Avviamento allo sport delle persone con disabilità [Introducing People with Disabilities to Sport]”⁴⁸, indicate a renewed operational commitment. This commitment is further strengthened by the allocation of approximately 700 million euros from the PNRR for sports infrastructure, although the distribution has shown a concentration on provincial capitals, which risks small municipalities being left behind. The introduction of a national census of sports facilities aims to fill a knowledge gap that is essential for effective policy⁴⁹. These efforts, combined with the publication of studies such as the “Rapporto Sport 2024 [Sport Report 2024]” by Sport e Salute S.p.A., which outlines the new issues related to the new Article 33 and places the constitutional reform at the centre of the public discourse on sport and health, and a lively legal and critical debate on the law, also in relation to the “risks of its trivialization” if it is not accompanied by adequate implementation through simple laws, a regulatory framework and resources^50,51, show that the new constitutional framework is being taken seriously as a catalyst for a renewed commitment and greater legitimacy of sports policy. The evolving sports regulations, such as Legislative Decree 36/2021 and the changes relating to the recognition of sports organizations, which will apply from 2023, show a ‘sensitivity’ to the timing of the entry into force of the constitutional reform and illustrate how legislation is attempting to adapt to the new context.

However, a cautious analysis suggests that in the short term the constitutional reform is more of a “steppingstone” than a fully realized turning point. The inherent slowness of the constitutional reform implementation processes, caused in part by the lack of a transition period and the delay in translating the constitutional principle into clear and binding implementing provisions, is a significant limitation^48,50. In addition, the ‘wait-and-see’ effect of policies with regulations and funding (such as the PNRR) already planned or launched before 2023 makes it difficult to isolate the direct causal impact of the constitutional amendment from a pre-existing development dynamic. In order to fully exploit the potential of this recognition, it is therefore necessary to consistently translate it into laws and implementation programmes, distribute resources fairly and strengthen planning and coordination capacities at all levels of government in order to overcome the challenges related to administrative culture and local capacities^48,50.

In this context, the full implementation of constitutional recognition requires that sport is not treated as a sectoral domain but analysed through a transdisciplinary approach.

Rather than being transdisciplinary, sport represents a complex social phenomenon that can be understood more effectively by integrating different perspectives - sociological, medical, educational and economic. A transdisciplinary approach allows researchers and policymakers to address the multifaceted nature of sport, overcoming disciplinary boundaries and fostering more comprehensive forms of knowledge and intervention⁵². This is particularly evident in the link between sport and public health, where exercise and physical activity are recognised as key factors in prevention and wellbeing. The concept of “physically active learning” demonstrates how education and health are inextricably linked and how physical activity can become an integral part of educational processes. Transdisciplinary research approaches have made it possible to address complex topics such as energy management in female athletes or injury prevention by combining medical, educational and social perspectives^53,54. From a sociological perspective, sport is also a social and economic phenomenon of growing importance that can influence cohesion, development and public policy⁵⁵. The sociology of sport in dialogue with the technological and human sciences enables us to understand how social changes influence the practise of sport and are in turn influenced by it. In the field of education, sport also contributes to the physical, cognitive, emotional and social development of individuals, and academic institutions play a crucial role in its promotion⁵⁶. From an economic and management perspective, the increasing complexity of sport requires skills that go beyond the technical field and encompass knowledge in the areas of economics, communication and law. Sport management is an interdisciplinary discipline that integrates several fields of knowledge and requires the collaboration of different actors⁵⁷. At the same time, the humanities and cultural studies have embraced the symbolic dimension of sport, which is understood as a reflection and mirror of cultures, values and identities. As a transdisciplinary phenomenon, sport is therefore not limited to the playing field, but interacts with health, education, economy and culture and plays a strategic role in building sustainable and inclusive societies. In this perspective, it contributes to the achievement of the Sustainable Development Goals and the promotion of collective well-being^58,59. Understanding and applying this transdisciplinarity inherent in sport is therefore crucial for translating the constitutional norm into real and systemic impact^60-62.          

7. Conclusions   
The path of sports policy in Italy in the 21st century is characterised by increasing institutionalisation, which found its highest expression in the constitutional recognition of the right to sport in 2023. This development is not a simple updating of regulations, but a profound redefinition of the relationship between sport and society. By elevating sport and physical activity to a fundamental right, the Constitution has enshrined the value of sport as a tool for dignity, health and integration.

The effects of this recognition are manifold. In the area of health, it strengthens the role of sport in prevention and the reduction of inequalities. On an educational and social level, it strengthens its ethical and intercultural function, which can promote cohesion, fair play and mutual respect. From a governance perspective, it provides a clear mandate for strategic planning and targeted investment that overcomes the fragmentation of the past.

If we understand sport as a transdisciplinary phenomenon, we can also fully realise its transformative potential. Its ability to connect different disciplines and tackle complex problems holistically makes it a driver of innovation and integration that can contribute to human development and social sustainability.

The challenge for the future will be to translate this constitutional recognition into concrete, widespread and accessible practises that guarantee every citizen not only access to sport, but also the full enjoyment of its benefits. Only through effective and widespread implementation will sport be able to fulfil its transformative potential and consolidate itself as a universal right and an essential tool for health, education and cohesion in today’s society.       

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