Has Google locked down Health? Reopen the market with SEOZoom
Take a close look at that volatility graph in the SEOZoom Observatory: that almost flat line for “Health” tells us much more than just technical stagnation, because it certifies the way in which Google oversees a complex sector, where medical information and business are inextricably intertwined.
The financial stakes are defined by the €46 billion in private healthcare spending, driven by pharmaceutical e-commerce, which grew by 9% last year. But search volumes tell another story, one of millions of queries about symptoms and treatments where you almost always find the same brands. Google has frozen the SERP because it knows that in this sector, trust is the main currency, and only by guaranteeing unassailable sources can it maintain its monopoly on such vital traffic. If users do not trust the answer to their “symptom,” they will not open their wallets and will never make a transaction for the “medication.”
Now this structure must withstand the impact of ChatGPT Health and new clinical assistants that are trying to disintermediate research, but they will have to make their way into an already occupied field—it is no coincidence that healthcare is also the sector where the AI Overview boxes appear most often.
For your brand, the consequence is drastic: the margin for action and visibility has been drastically reduced, and classic strategies based on pure optimization are obsolete, superseded by a vertical approach based on authority and brand oversight. You can no longer try your luck with generic keywords; you have to circumvent the obstacle or use the same lateral moves that Google is forced to accept to feed its own AI.
Web and Health, what the data tells us
The de facto privatization of Italian healthcare is certified by the Monitoraggio della Spesa Sanitaria (Healthcare Expenditure Monitoring), the financial document with which the State General Accounting Office tracks the economic flows of the healthcare system each year. The ministerial tables show that out-of-pocket expenditure — the money that citizens pay directly out of their own pockets without going through the ticket or public reimbursement system — has broken through the €46 billion ceiling. Patients are no longer waiting to be treated: faced with the (often biblical) waiting times of the public service, they are becoming active payers who seek alternatives, evaluate costs, and decide independently where to allocate a budget that now competes with that of food expenditure.
This capital is quickly shifting to digital channels, which are draining market share from physical stores. This is confirmed by IQVIA — the multinational company that processes healthcare big data and monitors the sales volumes of thousands of Italian pharmacies and parapharmacies in real time — which, in its latest tracking of pharmaceutical e-commerce, reports consolidated growth of 9% per annum. The composition of the shopping cart dictates the strategic line: digital sales are concentrated in the self-medication sectors, where competition is fierce, namely supplements, SOP (Senza Obbligo di Prescrizione, or non-prescription) products, and over-the-counter (OTC) drugs.
We are facing a total overlap between health and commerce—the user is not looking for the “molecule,” but rather a quick solution to the problem. Google reads these financial signals and reacts by raising its defenses even further: where the economic and health risk is so high, the algorithm blocks access preventively. A site ranked on the first page for these keywords automatically becomes a money-making machine, which is why the algorithm has stopped rewarding technical optimization or fresh content, and the only metric that matters is the seller’s historical reliability. If you are not a recognized brand or a pharmacy with an impeccable track record, it keeps you out of the door so as not to take any risks.
The search engine is effectively the “triage” of the healthcare system.
The interesting data for digital marketing comes from Istat: 46% of Italians use the web to search for information on symptoms, diseases, and treatments before even contacting a doctor. The operational implication is clear: almost one in two Italians uses Google as their primary diagnostic tool.
Most of these search sessions arise from an urgent need for information, which usually precedes commercial intent. The user types their symptoms into the search bar (“stomach pains”, “itchy hands”) and expects an immediate answer that decodes their discomfort.
Here, Google bypasses the general practitioner and the pharmacist, becoming the absolute first point of contact between the patient and the healthcare system. It is a huge volume of information traffic, which precedes any intention to purchase: those searching do not yet have their credit card in hand, they have an urgent need for reassurance and are deciding, at that precise moment, who to trust.
Algorithmic blocking as a defensive response
The search bar now acts as a mandatory hub that channels private spending toward specific hospitals, online pharmacies, or professionals. Google has realized that managing these queries means arbitrating critical economic transactions and has decided to lock down the results: it cannot afford to convey scams or incorrect advice in a market that moves the GDP of a small nation.
The operational consequence is a sector that has had a virtually immobile SERP for over three months, in which Google sacrifices source variety to ensure path security, strictly applying YMYL (Your Money Your Life) protocols. These standards impose extreme security requirements, which push the “relevance” of the keyword into the background in order to prioritize the authority of the source and its correspondence with the user’s intent. The engine prefers to show, even repeatedly, an institutional portal or a large certified hospital group because it cannot risk sending healthcare traffic to an affiliated site without absolute guarantees.
Google’s defensive choices have left a visible scar in the data, and you only need to open the SEOZoom Observatory to notice the anomaly: while the Italian web is undergoing continuous shocks, the graph for the Health sector is a flat line, with an average volatility pegged at 5.3%. It is a ‘political’ stalemate: while in other markets Google uses volatility to test new sources, here it has stopped experimenting and frozen the hierarchies.
The rubber wall and the barrier to entry
In any other market, Google uses volatility as a quality tool: it mixes the results (the old “Google Dance”) to test new sources, measure user satisfaction, and reward those who publish better content. In the Health sector, this mechanism seems to be deliberately turned off.
The engine has identified a small circle of trusted domains—defined as “Truth Partners”—and assigned them an algorithmic “immunity pass.”
The rules of SEO do not apply here: there is a “barrier threshold” based on historical authority. The top ten spots in the sector are occupied by a digital oligopoly of “untouchable” brands with Zoom Authority (ZA) above 83, which share the entire Italian traffic: general encyclopedias (Wikipedia and Treccani), historical vertical publishers (MyPersonalTrainer), physical hospital groups (Humanitas, Gruppo San Donato, and Santagostino), and the inevitable Big Tech platforms, including social media. Any SEO strategy that ignores this barrier to entry is doomed to fail: Google favors the stability of these giants over any new players.
Healthcare ignores the rules of other markets
The extent of the block only becomes clear when the data is put into perspective. Compare that 5.3% with the graphs for sectors such as News, Tourism, or Fashion, where volatility is much higher, or in any case with intense variations both upwards and downwards.
In Fashion or News, the rule of freshness (QDF – Query Deserves Freshness) applies: users want the latest trends or breaking news, so Google is forced to constantly change the SERP to keep up with the present. In Health, on the other hand, the rule of seniority applies: users are looking for a cure that is as valid today as it was yesterday – and a high ZA value quantifies decades of history, institutional backlinks, and authority.
The “Time” factor has therefore been deactivated in favor of the “Authority” and ‘Trust’ factors, which are two of the levers of the framework E-E-A-T: the domains that occupy the organic Top 10 for health today are the same as six or twelve months ago because they have passed years of validation and “attention.”
AI Overview does not reshuffle the cards
It is therefore not surprising to discover that Google applies the same security protocols to generative responses as it does to classic SERPs. Our Observatory certifies that the health sector boasts the highest penetration rate in AI Overview: 41.9% of relevant queries trigger an AI response, the highest value on the entire Italian web.
Here too, the algorithm opts for preventive security, relying on sources it considers unassailable and applying strict selection criteria based on pre-existing trust.
Google’s AI does not invent medical answers, it summarizes them. To generate reliable snapshots and avoid the infamous “hallucinations” on clinical topics, the LLM model needs to anchor itself to reliable data—the so-called grounding, anchoring to facts and sources deemed trustworthy. Here more than elsewhere, then, Google uses organic results as a “reservoir of truth” to feed the generative response and considers mainly those domains that have already passed the entry barrier of the traditional SERP to be valid.
In fact, the citations visible in the generative boxes coincide with the leaders of the organic ranking: encyclopedias such as Wikipedia or MSD Manuals, historical verticals such as MyPersonalTrainer, and large hospitals such as Humanitas or Gruppo Sant’Agostino, which appear as the most present sites in AI Overview in the general ranking as well.
ChatGPT Health as a game-changing variable
While Google freezes SERP to protect itself, OpenAI attempts to bypass the entire system with ChatGPT Health. Sam Altman’s strategy aims to create a dedicated, encrypted (HIPAA compliant in the US) environment separate from other chats, capable of connecting directly to the user’s personal data, such as medical records, wearable devices, and health histories.
The paradigm shift is radical. Google provides “general information” in the form of statistical answers that are the same for everyone, based on the indexing of public web pages—at the macro level, anyone searching for “headache” sees the same page as everyone else. ChatGPT Health offers personalized triage based on the analysis of private data: it analyzes your symptoms by cross-referencing them with your actual medical history. Users stop searching for a generic definition and start asking for a specific opinion on their blood values or the compatibility of a drug.
This approach threatens Google’s monopoly on first-level care. If users start to prefer an assistant who knows their blood values over a search engine that shows them a generic Wikipedia page, the status quo of healthcare traffic could quickly collapse. We will move from “searching for the best answer” to “analyzing personal data,” with all that this entails for those working in healthcare marketing.
The strategic crossroads: fight for the scraps or change sides
Faced with that 41.9% of space occupied by AI and that flat volatility, you have to ask yourself an honest question: does it make sense to invest budget to compete head-on in this SERP? The answer is entrepreneurial. If you search for “aspirin price,” AI responds directly. If you search for a specialist appointment, SEO tools often report “Zero Volume” because traffic is fragmented or local. Continuing to think in terms of generic “keywords” in this scenario means fighting for crumbs against giants who have secured their position.
You have two paths ahead of you. The first is to accept that generic informational organic traffic is lost and work to become the “technical source” that AI cites. The second, more radical and necessary, is to stop relying exclusively on Google and build a proprietary ecosystem where users search for you directly.
The only real defense is direct traffic
The $46 billion healthcare market will not disappear, it will only change course. If Google turns off the free organic traffic tap (“what is it”), you have to intercept demand elsewhere, even moving towards transactional queries (“who treats it” or “where can I buy it”). The immobility of SERPs is a clear signal: the space for free awareness is exhausted.
The survival strategy requires you to turn your site into a final destination. Work on social media, newsletters, and offline loyalty. You need to get patients to stop searching for “best cardiologist” (ending up in the AI or aggregator blender) and start searching directly for “Dr. Rossi cardiologist” or the name of your pharmacy.
In a locked market, the winner is whoever has contact with the customer. Google can hide your site from generic results, but it is forced to show you when the user types your brand into the search bar. Shift the battle from algorithm optimization to building your own audience.
The new frontier: optimizing for Personal Agents
The transition to personal assistants requires an acceleration of the technical standards that guide your work, especially in copywriting: systems such as ChatGPT Health will ignore persuasion even more and seek (only or predominantly) logic. AI doesn’t need hidden codes or complex markup to understand you—it directly analyzes your text and tries to extract clear cause-and-effect relationships. The problem today is that much of the health content is written to “pad it out,” full of unnecessary premises and ambiguities, and for an LLM, this is noise.
You need to write each paragraph as if it were a database record: clear subject, defined action, explicit consequence. Optimization becomes an exercise in semantic cleaning: remove doubtful adverbs, break up complex sentences, link each symptom to its cause and each treatment to its dosage without mincing words. The winner is whoever provides the AI with the most “chewable” data. If your text is ambiguous, the agent discards it to avoid hallucinations. If your text is a block of consequential facts, you become the primary resource that the assistant uses to build its personalized response.
The plan of attack to overcome the barriers with SEOZoom
Competing head-on with Humanitas or Wikipedia on generic keywords is budget suicide—those rankings are protected by historical trust, and Google will never give them up to a minor player.
However, there is a technical necessity that the engine itself cannot ignore: it must feed its AI with fresh, vertical, hyper-specific, and, if possible, experienced data, which generalist giants often do not possess.
Abandon the idea of breaking down the front door and use SEOZoom to plan a systematic encirclement in five moves.
- Keyword Analysis: Avoid Dead Ends
Before you even think about “what” to write, you need to analyze “how” Google wants the answer. The algorithm interprets intent better than anyone else: if it has decided that a query is visual, if it shows videos, writing a text article is a waste of budget and time. Run a Keyword Analysis and ignore the volume to focus on the Feature SERP icons. For keywords such as “ankle bandage” or “how to put in contact lenses,” you will see video carousels or image widgets dominating: you have found a dead end for your blog. In that case, the perfect article is useless because the person wants to watch, not read. The right move is to work directly on your social channel, produce the multimedia format that Google is rewarding, and use it as a “satellite” to occupy space where your site cannot compete, then refer the user back to your proprietary hub for purchase.
- Opportunity Finder: strike where the giant is weak
If the intent is textual, you need to find a space within your realistic reach. Publishing giants are strong on generic definitions, but they have thousands of old, poorly maintained pages or pages that are out of focus on long tails and specific transactional queries. Opportunity Finder immediately brings to light the structural inefficiencies of competitors. Use it in competitive mode: scan the domain of a leader (e.g., my-personaltrainer.it) and isolate the keywords where it is performing poorly (from the second page onwards) or losing traffic. These are the “holes” in the network: topics where demand exists, but the giant’s supply is poor. That’s where you have a real chance. Fill that gap with vertical content that solves the problem better than your competitor’s forgotten page.
- Real experience: what AI can’t copy
Once you’ve found the gap, you need to fill it with something that AI can’t generate. Google introduced the E for Experience into the E-E-A-T framework for a specific reason: to distinguish between those who have “read” about a problem and those who have “experienced” it. While the generalist portal gives you the sterile textbook definition, you need to provide proof of the real thing. Include elements in your content that cannot be replicated synthetically: the original photo of the product on the counter (no stock photos), first-hand management of a specific case, practical details that only those who do this job every day know. This is your defensive moat. If your content is just correct information, AI will assimilate it and render it useless. If it is lived experience, it becomes an irreplaceable primary source.
- AEO Audit: win the battle of findability
Now you need to check if the tactic works in the present. Answer Engines such as AI Overview operate in RAG (Retrieval-Augmented Generation) mode and search the web in real time. This is a battle of findability: if you are not “retrieved” at the exact moment of the search, you do not exist for the user. The way it works plays in your favor: when the engine searches the web for answers, its “short-term memory” (Context Window) has the power to override its “long-term memory.” This means that if the signals your content sends today are strong, consistent, and authoritative enough—technically perfect and semantically unambiguous—the AI can ignore its past training and trust the fresh data you are providing. Use the AEO Audit tool to measure this instant performance. If the outcome is negative, the intervention is tactical: optimize the structure to be the best answer available and you will force the model to cite you, even if you are not the historical leader.
- GEO Audit: win the battle of probability
The long war is fought on memory. LLM models (the basic brain of Gemini or GPT) reason on data “frozen” in the past and work by statistical probability. This is a battle of probability. When AI does not have access to the web or has to complete complex reasoning, it literally has to “guess” who you are based on the statistical weights of its memory. This is the field of brand authority, and the GEO Audit diagnoses this deep identity. It tells you whether you are a solid entity or a blurred concept for AI. Unlike AEO, there are no quick fixes here—you can’t change the printed encyclopedia on command. A negative outcome indicates that you need to work on long-term brand governance: flood the web with consistent signals so that, the next time it is retrained, the model updates its statistics and recognizes you as a reference entity.
SEO for AI is all about striking this balance: you need to dominate the present (AEO) to be found immediately, while building your reputation (GEO) to teach the future who you are.
