Commentary

Mapping the determinants of health in Pescarola (Bologna, Italy)

A collective action-research on health, bodies and territories 

INTRODUCTION 

We were in the middle of 2020 when we decided, as the Center for International and Intercultural Health (CSI), based in Bologna (Italy), to join the project “The Other Front Line. Global Voices for Social Justice”. Ever since that day, we have aimed to co-facilitate and enable life stories of some inhabitants of Pescarola. Pescarola is an area we have been engaged with since 2015 that is characterized by a high index of vulnerability and socio-economic fragility. The path we took with the street journalists let us jointly examine in depth the impact of social determinants and inequalities on people’s life stories and on their health and wellbeing, especially after and during the pandemic. Therefore, we decided to continue this research on the social determinants of health by creating a printed collective map to communicate the close relation among the body (social and individual), health and territory. More particularly, we focused on the inhabitants of the Agnucchi-Zanardi low-income housing complex within Pescarola. 

MY HEALTH IS MY WEALTH

We firmly believe both in life stories and collective maps as communicative tools for advocacy action towards social and health services, public institutions, inhabitants and local associations. Putting these tools together allows us to give value and understand better not only the significant places emerged for each story, but also the emotions linked to them; that’s the reason why we decided to start the process through body maps. We aim to use the process of body mapping to visually represent intimate aspects of people’s lives, their bodies, and the context they live in using drawing, painting, or other art-based techniques. Using different arts-based techniques, body mapping encourages people to visually depict “their personal experiences on a life-sized outline of their body”¹. Starting from the outline of the body, we asked participants to represent and place inside and outside their body shape their most significant places, whilst talking about how they felt and what these spaces meant to them. The final product of this process is a literal picture of people’s personal story and emotions. 

Before engaging with inhabitants, we tried the activity ourselves. Only after this did we invite asked about ten inhabitants to join the project. To engage them, we used a chat aimed at acknowledging the existing resources in Pescarola, how these were used, and – at the same time – what was missing and what led people not to use the existing resources. We identified eight of the most relevant social determinants of health to initiate and guide the mapping: we began from their own house and then talked about jobs, income and where social relations take place; we mapped the spaces for hobbies and free time, the ones for shops, associations, social and health services necessary for their physical and psychological health. At the same time, we tried to understand if they were satisfied or not by these determinants. We also tried to comprehend how public spaces – like parks and squares – were perceived, how and how much they use these public spaces including public transportation on a daily basis, or how they move in general. We asked to talk, draw or write about these places, and how they feel about these: where they like to spend the time, where they feel good and where they feel insecure, what is significant for them in Pescarola, in the rest of the city of Bologna and in Italy – many of them aren’t in fact born in Bologna, and still consider home the place where they were born. The aim was to unveil motivations, choices and emotions related to each place.  

FROM PERSONAL CARTOGRAPHY TO COLLECTIVE MAPS 

After creating the body maps, we tried to transpose them in the territory of Pescarola and surroundings to identify key places and resources in a cartographic map. Then we worked again only within the research team to compare the products of the meetings with the inhabitants, and to highlight the relations among body, health, territory and the relations among social determinants of health and life stories. At this point, we decided to involve an environmental architect and a specialized graphic artist in the project, so that we could design the final handmade map together.  

After this last step, with the final product of the research, we asked the participants to join us in a workshop aimed at sharing the experience, and to create a presentation of the research project and to present the map to the inhabitants of Pescarola.  

This map, moreover, will be printed and distributed to the local inhabitants, and to social and health services and associations of the area, bringing forth a process of advocacy towards institutions and services. 

LEARNING BY DOING  

Our research has indeed brought us to a deeper comprehension of the social or wider determinants of health, and of the relation between and among the inhabitants and the neighborhood they live in, its associations, services and shops. The project also facilitated the knowledge of the resources in the territory by the inhabitants and of the need of some of them by the institutions, underlining the importance of the social determinants of health. In this sense, the project meant that inhabitants got improved knowledge about the available resources including available services, and the service providers got a better idea of inhabitants needs 

Our “Speaking Map” can be conceived as a powerful practical technique for getting input – (i.e. it really builds on participatory methods in a different powerful way), as well as a tool necessary to stand out, highlighting the role of the social determinants of health in the reproduction of inequalities; at the same time, it can be perceived as a different “lens” through which to look at people’s and territories’ health.  We also believe that the map can be a useful tool to make local associations, social and health services, and public institutions aware of the inhabitant’s point of view on their territory and life, and the consequences of the social determinants of health on people. Hence, we believe the map can be a tool for advocacy actions towards local institutions and services, a tool that can guide one in understanding the needs and resources of the territory, as well as ‘bringing into dialogue’ the different points of view, thus facilitating actions for social and political change.  

THE SPEAKING MAP 

The ‘Speaking Map’ is the title chosen for the final map to suggest its own purpose, that is narrating the territory of Pescarola, starting from the social determinants and their impact on health and inequalities. This is a map that speaks of the daily reality of the inhabitants, of their needs, difficulties and resources, as well as a map that speaks to the institutions and services to trigger moments of confrontation and dialogue aimed at promoting policies to improve the housing, the social, the cultural and the environmental context. 

The map starts starting from a brief contextualization of the ACER Agucchi-Zanardi compartment and the area of Pescarola, compared to the city of Bologna, and is then divided into 6 textual sections, each aimed at specifying the main social determinants used in the action-research, that are: 

1\ environment and public space 

2\ housing 

3\ social and educational services 

4\ local realities and commercial activities 

5\ personal relationships 

6\ work and income 

Associated with the texts, there are 5 cartographic maps, drawn in order to visually describe the Agucchi-Zanardi ACER compartment, highlighting some of its criticalities and possibilities. At the center of the map, we have chosen to represent a “social body”, to point out the different types of relationships that occur between the inhabitants (mutual support, isolation, racism, quarrels…) – described by the fifth text. 

The end result of all this information is therefore a map, which in Jerry Brotton’s² definition is both a physical object and a graphic document, a written and visual document. Our map, like all maps, is at the same time a surrogate for the physical space it wants to represent, since it constructs what it represents through a series of abstract graphic signs that can represent borders, frontiers, centres and margins… in this sense, a map does not so much represent the real world as it produces it through the imagination. 

Our ‘Speaking Map’ can therefore be read as a creative act that, by trying to give a graphic meaning to life stories, territorial resources, inter-personal relationships and social determinants, guides the beholder and the reader into the microcosm of the Agucchi-Zanardi compartment and its inhabitants. Despite the fact of reality that the map tries to reproduce, we ask those who use it to bring with them a little imagination…