Authors: Ofelia Altomare
Event: 2019 TheMHS Conference
Subject: Building a Healthy Community in a City that Cares
Type of resource: Conference Presentations and Papers
Ofelia Altomare is the director of District No.3, Health Services Agency of Trieste. She manages the project Habitat Micro – Areas, an innovative model of integration between services and communities, and has worked for 37 years in nursing and in the management of health services, both in hospitals and in local services. Ofelia comes from Trieste, a city in northern Italy, where Franco Basaglia started the great transformation of practice in mental health.
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 my talk on The “Habitat-Microareas Programme” (HM) which has been running in Trieste since 2006, implemented by Local Health Authority of Trieste (ASUITs), local Municipalities of Trieste and Muggia, and the Public Housing Agency. These are a relevant example of integrated action to improve health and living conditions in a vulnerable urban neighborhood.
Microareas are aggregated territories (quarters, districts or group of houses) incardinated in the four Health Districts of the Public Health Authority , with between 500 and 2500 inhabitants and most of the houses are public housing. Currently in Trieste there are sixteen Microareas. Each Microarea has a coordinator, identified as Community Health Manager with a specific Job Description.
The HM Project allows the production of bundles of innovative, integrated, place-tailored public services. The public services are designed and implemented by aggregation of local agents and knowledge, through participatory community building approaches.
The HM Programme is targeted to the local community as whole; a community that lives in a 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 organization and supply of services, and more generally to the activation of processes of empowerment and inclusion, which impact both the individual and the community.
Individual objectives are:
- 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 individualized health facility);
- consolidate the coordination between several services that act on the same individual or a family.
Community objectives are:
- strengthen home care and reduce 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 people and old age group );
- promote social cohesion and social capital development and mutual cohesion through strategies and initiatives of mutual-aid between non professional actors, so as to reinforce the individual skills and overcome the personal and family related problems;
- facilitate the development of collaboration and proactive participation of the citizens through, for example, initiatives such as neighborhood committees or 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.
We had a conference on this topic in Trieste recently. 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 and 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 is generated, the better problems can be resolved, and therefore less undesirable effects such as inappropriate hospitalizations can be expected.
[Local Health Authority in Trieste – ASUITs - is organized in 4 Health Districts, Departments (Prevention, Mental Health, Dependence, Cardiovascular Diseases) and Cattinara Teaching Specialized Hospital]