Promoting health equity through social capital in deprived communities: a natural policy experiment in Trieste, Italy

Abstract

The Trieste Habitat Micro-area Programme (HMP), an innovative social-health service policy, has offered a natural experiment to empirically evaluate the social mechanisms through which social capital may have an impact on health inequalities. To date, literature clarifying this causal chain is scanty. This empirical study tested the following hypotheses: H1) innovative social-health practices can activate social mechanisms intentionally and systematically so as to generate social capital; H2) such social mechanisms increase specific properties of social capital, in particular those influencing more vulnerable individuals’ relationships; H3) investing in these properties can enhance capabilities and, consequently, control over the health of more vulnerable individuals. The study was carried out during 2016–2018 and used both qualitative and quantitative methods. The qualitative part investigated the field experience of the HMP through interviews, focus groups and workshops with HMP professionals. The quantitative part assessed the effect HMP might have on these properties and the capacity to face health risks of more vulnerable individuals. Three samples, each of 200 individuals, residing in the target and in control areas were interviewed using a semi-structured questionnaire. One control sample was matched to the 200 treated subjects using a Propensity Score Matching. The results of the study suggest that the HMP intervention stimulated the development of empowerment, collaboration and interdependence among vulnerable people. This produced an increase in their social capital under several aspects, including enhanced trust, network extension and participation, cooperation and reciprocal help with neighbours, as well as improving their judgement on quality, timing and efficacy of the help received from institutions, relatives or friends. These findings show that socially shared relationships can create innovative local models of a universalistic generative welfare system, which would be both inclusive and able to enhance individual capabilities. These models could be disseminated and carried over to other contexts.

The Italian National Health Service: Universalism, Marketization and the Fading of Territorialization

“…It should be pointed out that there are some possibilities as well as experiences that differ from the abovementioned, which is obviously patchy and closely dependent on contextual factors and contingent variables (typically, the investment by local decision-makers). One of the best-known schemes is that of Micro-Areas, a program launched in Trieste in 2005, promoted by the Local Health Authority and based on the idea that on a small scale it is possible to embody both the integration of skills and the involvement of services, the third sector and citizens in choices relevant to well-being (Bifulco, Bricocoli, Monteleone 2008;Di Monaco et al, 2020). This idea was formalized through an agreement among the Health Authority, the Municipality and the Regional Agency for Public Housing which defined the guidelines for actions in neighborhoods counting on average between 1000 and 2500 inhabitants and characterized by the prevalence of public housing.…”

Die „gesunde Kommune“ im Lichte „großer Wenden“ – ein sozialökologisch fundiertes Ziel kommunaler Gesundheitsförderung (KoGeFö)

“…B. Habitatzerstörung, Wasser- und Luftverschmutzung). Sie gefährden das Sozialkapital [ 10 , 28 ], indem sie soziale Disparitäten verstärken (z. B. Zugänglichkeit zu „sauberen“ Umwelten).…”

“…Dort wird Umwelt aber auch geschaffen, die ein ungesundes Verhalten nahelegt. Das zeigt sich beispielsweise in Studien zur „adipogenen Umwelt“ [ 23 ] oder zur „deprivation amplification“ [ 10 ]. Der Zusammenhang von Umwelt und individuellem Verhalten war bereits in den 1920er-Jahren Gegenstand der „Chicagoer Schule der Soziologie“.…”

Needs to Create Healthy Living Environments—A Two-Stage Delphi Survey in Europe to Identify Facilitating Factors and Barriers in Municipal Health Promotion

“…To avoid widening this gap, it is particularly important to create frameworks and interventions that focus on disadvantaged and vulnerable groups to improve their health equity. Municipalities offer the chance to remedy this situation and to reach all people in their living environment with health-promoting measures [4,5]. As an umbrella setting, the municipality offers ideal conditions for health promotion, especially with regard to reaching vulnerable groups: on one hand, it is home to many different groups of people who can be reached by setting-based actions.…”