Paper short abstract:

This paper wants to explore the malfunctions and critical conditions of the community healthcare system in the city of Bologna (IT), focusing on the fieldwork experience in one marginalized area of the city and on the consequences of its lack of general practitioners (GPs).

Paper long abstract:

Based on the data collected during a multi-method action-research project aimed at mapping and tackling health inequalities in the city of Bologna (2017- ongoing), this paper would like to explore the current collapse of the community healthcare system, enhanced by the pandemic. In particular, we would like to focus on how the healthcare system reproduces inequalities through the placements of the proximity health services, implementing the exclusion of the already oppressed groups. Specifically, the main concern revolves around the distribution of general practitioners (GPs) in some disadvantaged areas of the city of Bologna, focusing on a specific one where we have a longer term fieldwork experience (Pescarola).

Due to the legal form of recruitment of GPs by the Italian National Health System, the latter cannot allocate GPs to a specific area. This generates a gap in how GPs are distributed throughout the city, with a relative lack of GPs in the most disadvantaged areas. It also generates barriers in accessing primary care services, leading to an overload of the emergency room system, already stretched due to lack of staff. The result is a mechanism that systematically enhances social and health inequities, often leaving people to overlook their health needs. Moreover, this system also tends to undermine the relationships between citizens and public institutions, increasing a sense of neglect and mistrust among the inhabitants. In the end, this paper would also like to show the possibility of some experimental devices and tools that can affect the distribution of GPs.