• Between 2004 and 2021, avoidable mortality declined in almost all Italian regions, withreductions of up to 30%, but with strong territorial differences.• Northern regions have reached very low levels, comparable to European standards, while theSouth continues to record higher values, with Campania as the most critical area.• The Covid-19 pandemic temporarily interrupted the positive trend, revealing structuralweaknesses and exacerbating regional inequalities.