Search

Descrizione dell'approccio metodologico e del processo di ricerca-azione nell'ambito di un progetto cittadino di analisi e contrasto delle disuguaglianze in salute.

BACKGROUND: since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consistin of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services. OBJECTIVES: to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them. DESIGN: the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated. SETTING AND PARTICIPANTS: residents in the city of Bologna aged 18 years in the period 2011-2015, grouped into 90 statistical areas. RESULTS: a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence. CONCLUSIONS: an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

since January 2017, a multidisciplinary research group, involving the Local Health Authority, the Municipality, and the University of Bologna, carried out a city-wide action-research project on health inequalities consisting of an ecological study over the years 2011-2015 based on indicators that are routinely available within health and social services.to document existing geographical inequalities in health outcomes and use of healthcare services in the city of Bologna (Emilia-Romagna Region, Northern Italy), with the aim to suggest policy action to tackle them.the results of the first phase of the above-mentioned project were reported: five related to the social determinants of health (exposure) and five related to the social determinants of ill-health (outcomes). For each municipal statistical area, the distribution of the exposures as well as rates and Bayesian Relative Risks of the outcomes were plotted on the city map. To evaluate the association between social determinants and health outcomes, Spearman correlation coefficients were estimated.residents in the city of Bologna aged=18 years in the period 2011-2015, grouped into 90 statistical areas.a North-South divide was apparent for most of the socioeconomic and ill-health indicators, with a high concentration of adverse outcomes in the North-Western part of the city. Adherence to cancer screening represented an exception, being greater in the areas with higher proportion of unfavourable health outcomes. An inverse association between education level and health outcomes was found. Low family income was weakly to moderately correlated with health outcomes. Proportion of residents in council houses and of the teenage foreign population showed a moderate to strong association with all outcomes, but mortality and screening adherence.an ecological analysis based on data that are routinely collected by local health and social institutions can be effective in revealing the geographical patterns of health inequalities. When accompanied by strategic choices aimed at bridging knowledge and action, this approach may facilitate the direct engagement of local actors towards health equity.

Background A large body of literature shows how lower socioeconomic classes have higher incidence of mortality and morbidity, and how worse health outcomes linked to barriers in accessing healthcare particularly affect the most vulnerable groups. Despite such evidence, in many a context health inequalities have continued to increase. Processes that better link knowledge with action are therefore needed. Methods An interdisciplinary, interprofessional, interinstitutional group was created involving the Public Health Department and the Center of International Health of Bologna. In 2017-19, the group carried out a project to document and tackle local health inequities, structured in two phases: a first one of quantitative analysis of health inequalities using routinely available data, and a second one of qualitative research in selected areas of the city. An action-research approach was embedded throughout the project, with periodic evaluations to ensure progress towards the intended results. Results Phase 1 results show significant differences in terms of disease burden and service use between the North, East and West periphery of the city compared to the center and South. These differences mirror the urban distribution of wealth/deprivation, measured through different indicators (education, income, presence of immigrant population). Results also show concentration of the worst health outcomes and healthcare access indicators in some areas of the city, which also have higher presence of social housing. Phase 2, started in January 2020, is using phase 1 results to inform both a qualitative analysis and a participatory process in 6 areas of the city selected among those with worst health indicators. Conclusions Our experience shows that addressing the issue of health inequities through a mixed-method, multi stakeholder and action-research approach may lead to greater integration of research findings and evidence into healthcare policy and practice, towards health equity. Key messages Working across disciplines, roles and institutions may bring added value to the complex field of health inequities, when approached with the aim of moving from knowledge to action. Relying on routinely available data may open a route for the replication of our experience and for its use to monitor the impact of interventions aimed at reducing health inequities.

This article reports on a community-based action-research project initiated in July 2014 by the Centre for International and Intercultural Health. The project aims at promoting health through empowerment and community participation in a low-income suburban area of the city of Bologna (Pescarola). Based on an in-depth analysis of the ethnographic material collected (field notes, interviews, focus groups, meeting transcripts), this article focuses on critical moments of the action-research process, which made us reflect on our role and status in relation to other actors in the field, particularly community members. Specifically, we focus on the opening and development of a community space and on the potential and critical issues inherent to the action-research methods we used, such as community care, creative workshops, and theatre. These methods constitute both answers to the needs that emerged from the initial phase of the research (loneliness and lack of social connections), and strategies to investigate health needs together with the community. Our work shows how, in contexts of marginalisation, the material and symbolic conditions for people’s participation in a collective space, and the very presence of a ‘community’, cannot be assumed, rather they need to be constructed with the people as a central part of the health promoting action.

La crisi pandemica ha reso sempre più attuale ed urgente una riflessione, in scala intraurbana, sulle modalità di organizzazione delle nostre città. In quest’ottica il volume intende proporre all’attenzione del lettore il tema dei quartieri urbani affrontandolo da un punto di vista sociologico. Nei primi due capitoli viene delineato il framework teorico ed analitico del neighborhood approach, che consente di contestualizzare il capitale sociale in una dimensione urbana differenziata al suo interno, riconoscendo la specificità dei luoghi e dei territori in cui la vita collettiva si organizza. Nei capitoli centrali la riflessione, declinata in termini più applicativi, si focalizza sul tema della spazializzazione dell’edilizia residenziale pubblica e del mix sociale nella città di Bologna; sulle pratiche e sulle strategie residenziali nel quartiere di Scampia (Napoli), da cui emergono dinamiche di un mercato immobiliare informale di affitti popolari. Il volume prosegue con una ricerca-azione sul tema del neighborhood effect e dell’equità al diritto alla salute nel contesto urbano bolognese ed il capitolo conclusivo è dedicato alla città sostenibile e all’importanza che i quartieri assumono nel fronteggiare la sfida globale rappresentata dal cambiamento climatico.