We will design a participatory dynamic to bring the voices of those most affected by health and social inequalities at the heart of decision-making. 20 people will be empowered to use their life experience to raise awareness on the social determinants that shape people’s health and co-design a new health and social intervention (Microarea). 4 public meetings will provide a space for information, joint discussion and participatory decision-making on the priorities for health and wellbeing.

Pescarola, a peripheral and marginalized area of the city of Bologna, northern Italy.

The current public services and third sector approach to health & social needs in Pescarola is top-down, not equity-oriented nor guided by the experience of those living the problems. This contributes to, rather than contrasting, the feeling of marginalization and disconnect from public services and civic resources that residents experience, as well as the inequalities within the area and related social tensions. A pilot intervention (Microarea) is starting, with a community nurse and 2 social workers charged of integrated social & health care and community health promotion, but is not fully equipped to engage the population as active partners and not just as users. This risks to be a missed opportunity in terms of reverting the trends of inequality and marginalization of the area.

The area of Pescarola has a population of around 4.600 people, of which around 1.100 live in council houses. People living in council houses have significantly lower than average annual income and are more often of foreign origin, and qualitative research we conducted in recent years shows that they carry a much heavier burden of inequality. Moreover, health indicators reveal high numbers of people with complex health needs (poorer physical and mental health, history of addiction) that are often unaccounted for by local services. For these reasons the project - while open to all those living in Pescarola - will mainly target council houses residents, with a specific consideration for intersectional axes of disadvantage (e.g. gender+disability, ethnicity+social isolation).

LIFE STORIES FOR CHANGE: 20 council houses residents (community health experts-CHEs) will participate in 6 workshops on using lived experiences on health and its determinants to inform health policies & programs. In between workshops they will be supported to co-produce their life stories for change individually or in small groups. They will then take part in 4 workshops with Microarea health & social workers to orient the Microarea intervention.
ALL FOR HEALTH: 4 public meetings will promote dialogue among CHEs, residents, civil society organizations, Microarea workers & decision-makers on:
- Participatory health needs analysis: local issues/priorities will be analyzed collectively (participatory mapping & ranking)
- Microarea co-design: residents & organizations will be introduced to the Microarea and provide input (video screening, open space technology)
- Community-based monitoring & planning: progress made by the Microarea will be reviewed for improvement (public hearings, community score cards)
- Patients’ experience review: residents will be given information on health & social services and voice their views (word café)
HEALTH FOR ALL: We will produce a participatory documentary with CHEs to give visibility to the process and issues raised. This will be used to advocate for the inclusion of participatory dynamics in the Microareas and other health interventions.

At the end of the project, we expect the following results to be achieved:
- residents know, understand and can relate to the Microarea as a positive resource in the territory
- residents can voice their opinions and concerns with regard to matters concerning their health and how to improve it
- residents are active in proposing and implementing activities to promote health in their area
- Microarea workers, local services and institutions are sensitized regarding the importance of listening to and empowering local communities to promote health and equity more effectively
- lessons learned and recommendations on participation for health promotion and decision-making are documented and taken into account while planning the Microarea of Pescarola and future Microareas in town.

To succeed in promoting active citizenship for health, we will work with:
1) Local communities, in order to:
- provide critical tools to reflect on the social determinants that affect their health
- inform on local public services and the new Microarea intervention
- sensitize on the importance of raising their voice to improve health and its social determinants (including through institutional response to needs)
- raise confidence to do so through continuous support.
2) Microarea workers, decision-makers and civil society organizations, in order to:
- sensitize on the importance of community participation in improving local services, policies and interventions & related outcomes
- capacitate on the use of spaces and mechanisms for community participation and health promotion.

We are 14 experts in public & community health, medical anthropology, social & political sciences who believe that health and wellbeing are only possible in a more just and equitable society. We are deeply connected to Pescarola where we work since 2014, when we conducted an action-research to map and address the local determinants of ill-health. Showing the comparative disadvantage of the area, the research motivated us to continue working to support the empowerment of local residents and the responsiveness of institutions to peoples’ needs. Our activities - including community therapy, social theatre, grassroots journalism and residents’ committee support - have all contributed to deepen our understanding of the local reality and our relationship with the people who live and work there.

Coordination- 3000 EUR
Personnel- 22000 EUR
Materials- 3200 EUR
Services (video making, graphic design, external facilitator)- 6800 EUR

Are you aware of similar experiences (using lived experiences to engage vulnerable population groups in having a say on what affects their health and orient public services and third sector interventions accordingly) that we could reach out to in order to exchange and learn from them?