Rethinking social and health services in internal areas Participatory processes in Casentino

Internal areas are defined as those territories consisting of municipalities “significantly distant from centres offering essential services” (Barca, Casavola & Lucatelli, 2014, p. 5), conditions that favour depopulation and cycles of abandonment. In this context, a Health Community Lab (HCL) was set up in Casentino with the aim of identifying the needs of the population and local stakeholders and co-producing useful recommendations for the reorganisation of social and health services. The HCL promoted collaboration between the various stakeholders - local administrators, the health district, the local health authority, health professionals, associations and Third Sector Organisations, and the resident population - focusing on issues such as the accessibility of the area around the Casa della Comunità di Bibbiena (Bibbiena Community Centre) and the organisation of social and health transport services managed by voluntary organisations. The project methodology included a detailed context analysis, including a mapping of Third Sector Organisations (TSOs) active in Casentino, which was conducted between September and December 2024, and an urban, microclimatic and outdoor comfort analysis. A co-creation workshop and a final evaluation of the project through questionnaires were also organised. The main results highlight a number of critical issues. At the regional level, the need to travel long distances to access advanced hospital facilities is further accentuated by the inefficiencies generated in Tuscany by the adoption of zoning into three large areas as a tool for managing healthcare service bookings. At the municipal and zonal level, critical issues have emerged regarding public transport connections to the future Community Health Centre (CdC) in Bibbiena, which are still weak, and the lack of parking spaces. At the same time, important opportunities are emerging, such as the development of integrated mobility (shuttles on demand, e-bikes, park & ride facilities), the promotion of shared territorial governance among the ten municipalities of Casentino and the strengthening of the role of civil society in health and social-health transport. Policy recommendations suggest investing in services, green infrastructure and local connections - both municipal and inter-municipal - geared towards proximity; promoting synergies between healthcare, territorial planning and mobility through collaborative and place-based strategies; and strengthening participatory governance through permanent forums involving multi-level actors.