Her hoarse voice charged with melancholy and strong personality made her a Sicilian icon of the twentieth century, much like the writer Leonardo Sciascia, the poet Ignazio Buttitta and the painter Renato Guttuso, who counted all three among her admirers.

In 1951, after experiencing the Sicily of Leonardo Sciascia's Candido, Rosa left her village at the age of 24 for Tuscany, settling in Florence, where she worked as a domestic servant.

Uprooted from her native land, she started her artistic career at 39, through Dario Fo who made her star in one of his shows, Ci ragiono e canto.

Often composed in dramatic style, her songs depict Sicily, as her friend Leonardo Sciascia describes, as "violent, tender, bitter, sweet, full of ambiguities".

Rosa Balistreri died in Palermo in 1990 at the age of 63, but her work survives and is modernized through the interpretations of Serena Rispoli, Carmen Consoli, and especially Etta Scollo who, accompanied by the Sicilian Symphony Orchestra, performs her most iconic songs,[citation needed] such as "'U cunigghiu", "I pirati a Palermu" or "Cu ti lu dissi".