Building a healthy community in a city that cares

By June 26, 2019 No Comments

On 13 May 1978, the Italian Parliament approved Law 180, universally known as ‘Basaglia Law’ after the name of the leader of the anti-institutional movement which promoted this radical community mental health care reform. The reform of mental health in Trieste has permeated all health care, particularly the system of territorial health.

Accessible health services, income security, decent living/working conditions, the development of social and human capital are universal conditions for promoting healthier, more equitable and prosperous societies. However, inefficiency and/or social exclusion problems are context dependent and require interventions which are tailored to the characteristics and needs of different places. Therefore, a sustainable development policy aiming to provide opportunities for all – with access to basic services, housing, energy, transportation etc. – requires place-based long-term strategies.

I will focus on The “Habitat-Microareas Programme” running in Trieste since 2006, implemented by Local Health Authority of Trieste (ASUITs), local Municipalities of Trieste and Muggia,  and the Public Housing Agency, which are a relevant example of integrated action to improve health and living conditions in vulnerable urban neighbourhood.

Microareas are aggregated territories (quarter, district or group of houses) incardinate in the four Health Districts of the Public Health Authority[1],  with between 500 and 2500 inhabitants and most of the houses are  public houses; actually in Trieste there are sixteen Microareas. Each Microarea has a coordinator, identified as Community Health Manager with a specific Job Description.

Habitat-Microareas Project allows the production of bundles of innovative, integrated, place-tailored public services. The public services are designed and implemented by aggregation of local actors and knowledge, through participatory community building approaches.

The target of the HM Programme is the local community living in quantitatively defined socio-demographic contexts, territorially delimited, in which all the resident population is proactively involved and not only the population that presents specific social and health problems.

In this perspective, the HM objectives concern a complexity of issues related both to the organisation and supply of services, and more generally to the activation of processes of empowerment and inclusion, which impact on the individual or the community.

Individual objectives:

  •  support people in accessing health, social health and social services, paying particular attention to the most vulnerable (monitoring of situations at risk);
  •  strengthen health protection through the proximity of social and health services, to which the residents can easily access and with the presence of different professionals in the sector (monitoring and individualised health facility);
  •  consolidate the coordination between several services that act on the same individual or a family.

Community objectives:

  • strengthen the home care and reduce the hospitalisation, and in healthcare protected structures through the implementation of preventive services;
  •  prevent distress through the care and assistance of the most vulnerable social groups (school children, young and old);
  •  promote the social cohesion and the social capital development and mutual cohesion thanks to strategies and initiatives of mutual-aid between non professional actors, so as to reinforce the individual skills and overcome the personal and familiar problems;
  •  facilitate the development of collaboration and pro active participation of the citizens through,for example, support for initiatives such as neighbourhood committees or the collaboration with associations or other social entities operating in the urban community.

Overall, the approach adopted aims to develop the Community, enhancing the local welfare boosting the synergies between the services request and the public and/or private resources available at micro level.

Web had a conference on this Topic in Trieste lately. The conference was a great opportunity to compare other National and International experiences, starting from the presentation of the outputs of two researches carried out to evaluate the health and social efficiency of HM Program. In fact, Local Health Authority of Trieste (ASUITs), local Municipalities of Trieste and Muggia,  and the Public Housing Agency sand the research promoters signed The Trieste Declaration: The Healthy Community.

The outputs demonstrate that the programme has activated positive relations that can better address the social, relational and residential issues that could jeopardise health. It has generated health-producing social capital. More social capital better the problems are faced, therefore less undesirable effects such as inappropriate hospitalisations.


Ofelia Altomare


S70(A): KEYNOTE Q&A: Ofelia Altomare



[1]        Local Health Authority in Trieste – ASUITs – is organized in 4 Health Districts, Departments (Prevention, Mental Health, Dependence, Cardiovascular Diseases) and Cattinara Teaching Specialized Hospital