Edizioni FrancoAngeli - Last issue of SALUTE E SOCIETÀ (2/2011)

Editoriale

Wed, 15 Nov 2011 8:00:00 GMT

Giovanni Moro

Introduzione

Wed, 15 Nov 2011 8:00:00 GMT

Maria Augusta Nicoli, Vittoria Sturlese, Leonardo Altieri
Are users of health services "consumers" or "citizens"? What does citizen participation really mean? Why are citizenship and participation so strictly bond? This essay attempts to answer these questions. An effective participation guarantees the rights’ respect. There are several important and creative participation experiences in the health services. Participation, though, is not always "citizens activism". It is often ambiguous and useful to the aims of "management activism".

Citizenship rights, participation, collective health

Wed, 15 Nov 2011 8:00:00 GMT

Leonardo Altieri
After briefly tracing the principal steps of citizenship concept’s development, this article illustrates the pre-eminence of social participation as a citizenship "practice". Then, it analyses either the potentialities and limits of deliberative approaches, set in to promote new forms of health citizenship, or the critical aspects of the relation between the health system and the users that can erode the exercise of citizens’ social rights. In relation to the critical aspects emerged from our review, the representative deficit, the influence of participatory action on decision makers and the little interest in evaluating participation effectiveness are accurately analysed. In conclusion, the main challenges of citizenship in the health system area are highlighted.

The social participation as a citizenship’s practice in the health care systems

Wed, 15 Nov 2011 8:00:00 GMT

Mauro Serapioni
We’re living in times of deep and fast changes that are silently importing into the everyday lives of people new and heavy difficulties. The ideology of no limits and the underlined compulsion to capture all the opportunities, produce a breathless every-day-life, far away from the real ability of many families who (also before the recent financial crisis) are dealing with the difficulty to get the account square. These difficulties produce weakness and illness (particularly depression) especially for a particular social group that could be defined as "impoverished middle class" or "new vulnerable". The area of the new vulnerable not only is shifting into poverty, but also, in relationship with the concept of citizenship, shows a growing hostility towards all that is "established" (State, local authorities, third sector and trade unions). Established institutions are, in fact, simply not representatives and this could means be more sensible to those political languages that try to simplify the reality. The participatory process set up in the last years around the complexity of the social issues, health, environment and urban planning, could be read as valid opportunity to engage, activate and maintain these resources. But this is possible only using appropriate methodological tools able to reinforce the contemporary forms of democracy (now so far to be strong and participate). This requires the spreading of new capabilities among operators and managers of the public and no-for-profit sector. But also an effort for the University that may fill the delete of skills in this field.

New vulnerabilities as an opportunity to reshape participation models

Wed, 15 Nov 2011 8:00:00 GMT

Gino Mazzoli
The paper presents the materials collected in two paths of action-research about the changes taking place in health care services, which have provided moments of the debate between management and health professional (Open Space Technology), and then moments of work in small groups; specifically the paper addresses the way in which the management and the professionals working in health care services reconstruct the conflicts between different "levels" of the organization (management, clerical, staff in contact with the users, ecc.), and between the organization and citizens. From this process emerges a complex picture of the relationships involved, arising from the end of an ideal agreement with the mission (of "public service"), a general reassessment of the professional hierarchy, a different attitude of the users, ecc. These elements call to rethink in a different way the "bridges" between the "levels" identified by witnesses; that is, to rethink the forms of mutual exchange between them, necessary if we want to maintain the provision of a "common service", and acted in the name of the community (in terms of common values and resources).

Characters in search of a mediation in the hard world of health care organization

Wed, 15 Nov 2011 8:00:00 GMT

Vincenza Pellegrino
This essay describe the evolution, in terms of mission and practices, of the voluntary organizations that operate into the Italian’ social and health services, also called "third sector", during the last fourty years. This evolution has been affected from the prevailing welfare state model that has changed from the so called "welfare state" (’70-’80) to a "welfare community" model (twenty century). So during this evolution the voluntary organizations have undertaken an important role into the participation’ process, as a resource of the community, contributing to the decision making (from local to national level). The participation’ process imply the development of new involvement strategies finalized to the growth of different kind of partnership inside the community; the essay finally outlines the main results of the process, in terms of strengths and weaknesses.

Participation of voluntary associations and community development

Wed, 15 Nov 2011 8:00:00 GMT

Renato Frisanco
This essay describe the evolution, in terms of mission and practices, of the voluntary organizations that operate into the Italian’ social and health services, also called "third sector", during the last fourty years. This evolution has been affected from the prevailing welfare state model that has changed from the so called "welfare state" (’70-’80) to a "welfare community" model (twenty century). So during this evolution the voluntary organizations have undertaken an important role into the participation’ process, as a resource of the community, contributing to the decision making (from local to national level). The participation’ process imply the development of new involvement strategies finalized to the growth of different kind of partnership inside the community; the essay finally outlines the main results of the process, in terms of strengths and weaknesses.

If we say "common services" what do you see?

Wed, 15 Nov 2011 8:00:00 GMT

A cura di Vincenza Pellegrino

Citizen participation in health care delivery in Toscana Region

Wed, 15 Nov 2011 8:00:00 GMT

Roberta Bottai, Marco Menchini
The Tuscany Region has assumed an important role in quality topic in order to keep patients experiences and views in healthcare choices, in order to have an integral improvement effort in the whole. In this context, several tools have been developed. The Charter of healthcare services is the document, where each healthcare local unit describes the offered services and the quality levels to be guaranteed. The patient can find and require it to the Public relations office in the healthcare local unit. Finally in order to develop this system, the following activities have been started and developed: The Health Services Guide - 2009, sent to all Tuscan Families; The Regional Observatory of Healthcare service’s Charter, an effective informative system able to relay many information from the different healthcare local units and to enable them to carry ahead improvement actions in order to face problems and patient’s satisfaction with regional resource; The Forum with the citizen associations and promotion of the patient’s rights, an other moment of comparison and participation, in order to ensure that patients have a say in improve local health services; the "Citizens Academy", which has the aim to educate citizens and patients to the health themes.

Network of networks for immigrants health

Wed, 15 Nov 2011 8:00:00 GMT

Salvatore Geraci, Chiara Bodini
Thirty years ago, in different parts of Italy, health and social workers active in No profit organisations, started opening outpatient primary care clinics for undocumented migrants, who did not have at the time the right to health care. At the beginning of the 1990s, these workers organised themselves in a National Scientific Society, named the Italian Society of Migration Medicine (SIMM), and started sharing different belongings, competences and experiences with the common goal of promoting the right to public health care for migrants staying in Italy, regardless of their legal status. Since then, SIMM has become a real policy network which positively affected the specific choices made in the field of public health policies. In the following years, the decentralisation process brought more decision-making power to the regional level, therefore SIMM decided to work for a participative bottom-up process aimed at creating territorial organisations, the Health and Immigration Groups (GrIS). In the paper, the history of this Society is described, together with the history of the national and local norms and policies on health and migration and of the increasing awareness of the role that civil society and professionals can play in shaping the policies. The main keys we propose to the readers can be summarised as follows: from medicine to health, from delegation to participation, from advocacy to empowerment.

Partecipation tools for the construction of community profile

Wed, 15 Nov 2011 8:00:00 GMT

Anna Marcon, Eno Quargnolo, Sonia Cicero, Barbara Calderone
The paper presents the process of construction of the Community Profile of Ravenna’s Province, held by municipalities and the local health authority. In particular it gives details about the ways of stakeholders’ involvement (local mayors and councillors, managers of social, health and educational public services, entrepreneurs, no-profit segment, union’s leader, the police corps, citizens...), and the different participation methods (face-to-face interviews, Word Cafè, questionnaires, workshops...). Finally it outlines the main results of the process, in terms of strengths and weaknesses.

Health is participation. Reflections on the method and the aim of the implementation of PePS in Cuneo Area

Wed, 15 Nov 2011 8:00:00 GMT

Franca Beccaria, Sara Rolando, Marcello Caputo, Maria Teresa Puglisi, Maria Grazia Tomaciello
This article describes the model adopted in the Cuneo area for the process of building Health Profiles and Plans between 2008 and 2010. It specifically explains how some methods were applied (namely focus groups, brainstorming and nominal groups) and provides some considerations of the concept of participation, defined as the end and means of the HPP building process but also as a remedy for many of contemporary society’s health problems.

Community empowerment for an integrated governance of pain

Wed, 15 Nov 2011 8:00:00 GMT

Laura Biagetti, Maria Calzolari
Ability to influence decisions about their lives, critical consciousness and participation are the cornerstones of the concept of empowerment. In light of these guidelines, and along them, is born and runs the project Empowerment of the community for the integrated management of pain. It aims to design and organizational tools that can improve the care and management of people with pain related to a chronic disease. The project, partially realized, and continuing today, has met with very positive feedback, especially in the implementation of the Open Space Technology (OST), the moment of innovative participation and comparison between all stakeholders involved in different ways in dealing with the pain and suffering in the course of disease. From sharing contributions that emerged, will be developed future improvement actions be put in place.

The active participation of patients and family members in the Health Care Service of Trento. The approach of "doingtogether" and the Patient’ Family Experts

Wed, 15 Nov 2011 8:00:00 GMT

Renzo De Stefani, Emanuele Torri, Kathleen Bertotti
The paper outlines user-oriented practices of Italian community psychiatry underlining the way they have been implemented in the Department of Mental Health of Trento. In particular, examples are given on specific activities based on the active involvement of users and family members within the framework of the approach known as "doing together". As most meaningful achievement of "doing together", it is described the experience of Expert Users and Family members (UFE) who work in all the areas of the Department alongside with mental health professionals, sharing their experiential knowledge. In addition, perspectives on the benefits of involvement of patients and families in a modern mental health service are discussed.

Health, right to health, and health justice

Wed, 15 Nov 2011 8:00:00 GMT

João Arriscado Nunes
This paper presents a preliminary approach to the heterogeneous and contingent processes by means of which health and the right to health are mutually constituted and defined. Two recent and contrasting manifestations of this dynamic are presented and discussed. The first concerns changes associated with the reframing, associated with neoliberalism, of health as an imperative, recentered upon individual responsibility, risk and prevention. The second, termed health justice, is associated with collective action by citizens, drawing on the discourse of rights and justice to claim recognition and care related to conditions affecting their health.

About health, right to health, and health justice

Wed, 15 Nov 2011 8:00:00 GMT

Anna Apicella

Right to health: a tangle of problems

Wed, 15 Nov 2011 8:00:00 GMT

Manuela Fioretti

The new board of the Sociology of Health and Medicine Section of the Italian Sociological Association

Wed, 15 Nov 2011 8:00:00 GMT

Paola Canestrini