Social Policy & Administration issn 0144 5596 DOI: 10.1111/j.1467-9515.2007.00600.x Vol. 42, N o. 2, A pril 2008, pp.

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Activation and Local Welfare in Italy: Trends and Issues

Lavinia Bifulco, Massimo Bricocoli and Raffaele Monteleone

Abstract
This article deals with the development of local welfare in Italy and is grounded on a research project focusing on activation as a main feature of change in Italian social policies. Along with decentralization processes, many Italian regions have been acting as policy laboratories, developing and testing very different approaches according to their political attitude. On the one hand this results in a fragmented policy landscape which is difcult to recompose, and, moreover, in growing inequalities in the Italian welfare system. On the other hand, it opens opportunities for experimentation on institutional and organizational structures on a regional scale, creating a variety of practices for research and policy analysis. In the article we rst describe the main trends in national social policies, with a specic focus on the dynamics of change referring to activation. We will then focus on a pilot programme which is aiming at the promotion and implementation of innovative practices in health and social care services in Friuli-Venezia Giulia, a region in which there is a signicant orientation towards enhancing social citizenship and enforcing the central position of the public actor. We investigate how the dynamics of territorialization and personalization, implied by the programme, trigger specic logics and practices of activation. Finally, referring to this case study, we propose an analytical overview of some relevant issues in the development of local active welfare in Italy.

Keywords Activation; Integration; Italy; Local welfare; Social citizenship; Territorialization Introduction As various authors remark (Geldof 1999; Van Berkel and Mller 2002; Barbier 2002; Borghi and Van Berkel 2007), the perspective of activation embraces disparate meanings and dynamics which are not always consistent with one other and expresses and combines different versions and reformulations of social citizenship:

Address for correspondence: Lavinia Bifulco, Dipartimento di Sociologia e Ricerca Sociale, Universit di Milano-Bicocca, via Bicocca degli Arcimboldi 8, 20136 Milano, Italia. E-mail: lavinia.bifulco@unimib.it
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the commercial version, linked to the model of the market (Crouch et al. 2001), which characterizes citizenship as the freedom to choose and acquire services offered in the quasi-markets by several competing public and private providers (Le Grand and Bartlett 1993); the moralizing version, hingeing on responsibilization, that ties access to social goods and services to compulsory requirements regarding work, ones own well-being and that of dependent family (Handler 2003); the version of participation in collective decisions, which can mean both commitment to the community, within a neo-communitarian kind of perspective (Mileva 2004), and the assertion of citizens political right to enter the public domain of decision-making (de Leonardis 1998); the version marked by the capabilities approach (Sen 1992), which represents the most difcult challenge for the old and new conceptions of citizenship since it stresses at the same time that people possess capabilities to a different extent (on which the effective exercise of entitlements depends), and that entitlements are necessary for ensuring peoples freedom to be and to do. Against this background, this article deals with activation in Italy as a key feature of the development of local welfare. First, we illustrate the main trends in national social policy, with a specic focus on the dynamics of activation. We will then focus on a pilot programme, which was launched in 2005 in Friuli-Venezia Giulia Region with the aim of developing innovative practices in health and social care services. Referring to the case study, we will discuss some issues of what we will refer to as local active welfare in Italy.

Active Welfare in Italy Generally speaking, the notion of activation is used in the European policy discourse with reference to the social inclusion of people through the labour market. This notion as Geldof (1999) argues indeed has divergent roots. Besides the reference to employment and social assistance, the notion may be referred to the eld of social work. In this domain, activation is related to a broader perspective of social inclusion which is not only based on access to the labour market but is synonymous with working towards emancipation, creating opportunities for those involved and encouraging participation (Geldof 1999: 17). Even if it is far less common, this is the meaning given to the notion of activation assumed by some measures in certain European countries (Hvinden 1999), reecting the well-known mechanisms through which isomorphic impulses are ltered and adapted to specic institutional contexts. As far as Italy is concerned, three main aspects are to be considered. First, the welfare-to-work model has been weak in affecting the structure of Italian welfare. This structure is characterized by the weakness both of traditional passive as well as of active employment policies, showing a high fragmentation of unemployment protection policies, the absence of a national system of income support and a weak connection between social assistance and labour (Paci 2005). This situation is inuenced by some well-established factors. An important one is familism (Saraceno 1994; Esping-Andersen 1999). Still today,
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family and kinship networks have the core responsibility in supporting the individual and protecting him/her from social risks. Also, the deciency in social rights affects a large share of welfare interventions and services such as, for example, the ght against poverty (Mingione 2000). Moreover, signicant problems derive from an institutional architecture characterized by a low degree of integration between the various levels of government, as well as by the uncertainty over regulations (Ferrera 1996). Second, while in other countries the discourse of activation tends to focus on participation in the labour market, in Italy relevance is also given to the previously recalled perspective rooted in social work. Paci (2005) highlights for Italy some tendencies in the direction of an active welfare based on empowerment, oriented to promote and enlarge the citizens autonomy and substantive freedoms. The enhancement of the citizens role may occur with reference to services as well as to decision-making processes, setting in this way a grounding for practices of active citizenship. Such a kind of active welfare provides the possibility of developing capabilities which, according to Sen (1992), entail peoples freedom to be and to do as well as their voice over choices that concern their life. Third, an approach to active welfare based on empowerment occurs within a welfare structure which is affected by uneven and contradictory processes of change. However, this approach has been signicantly inuenced by the reorganization of social policies developed after the second half of the 1990s, and by the national reform of social services passed in 2000 (Bifulco and Centemeri forthcoming). Generally speaking, the reform is very important because it is the rst comprehensive measure on social services since the end of the nineteenth century. In fact, social services and interventions were affected for a long time by territorial inequalities and a high degree of discretion in choices. The reform addresses two main and connected objectives: 1. to promote the well-being of all citizens according to a principle of selective universalism; 2. to assign precise powers to the state while setting conditions for a decentralized and negotiated public action. With reference to the rst objective, the reform introduces LIVEAS, namely basic standards of social services, which x the typologies of supply that has to be guaranteed across the entire nation. To target the second objective, the reform promotes a new governance architecture that allocates politicaladministrative responsibilities to state, regions and municipalities on a principle of vertical subsidiarity. This recalls a model of social citizenship in which the state is to guarantee a principle of (selective) universalism while the local governments are called to take into account the specicities of people and places. In this respect, the reform aims at overcoming the limitations of excessive localism by positively combining local autonomy and national regulation. A key element is the very close association between local and active. From this point of view, we witness the development of a local active welfare that is based on the involvement of citizens and on a concept of territory, which highlights the role of local resources and networks in action. This
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orientation allows the overcoming of the traditional relationship between social services and citizens, which is marked by two main characteristics: xing citizens in the position of passive recipients and narrowly predening categories of needs. With reference to decision-making, local or municipal welfare is supposed to provide the space for a negotiating model of governance involving local communities in the design, management and implementation of policies. This model is based on some instruments for governance, among which the most important is the Piano di Zona (Area Plan) by means of which municipalities should plan the local system of social services and interventions via citizens participation. The implementation of the reform has encountered several problems. The basic standards in the provision of social services introduced by the reform do not correspond to demandable rights and they have not been xed yet. Moreover, in 2001 a constitutional reform, enacted in the name of devolution, gave the regions legislative powers on social services1 (Fargion 2005). As a consequence, the regions can adopt laws that not only differ greatly from one another but are also in conict with the reform. This risks increasing inequalities between regions. Therefore, the Italian path to active welfare displays some distinctive features. Uncertainty as to rights, resources and rules can make active citizenship somewhat frail. At the same time, the relatively loose structure of relations between the centre and the local level may foster new ways of thinking about social policies and putting them into practice.

Social and Health Care Services: Activation and Integration In active welfare policies that developed in Italy from the late 1990s, changes affected both the substance of policies and their operational aspects (Borghi and Van Berkel 2007). A key role is played by the criterion of integration of policies and services. Integration is conceived as a device to enforce citizens rights in terms of social protection as well as to mobilize institutional and social resources and make them consistent with one other in territorial contexts. Although, with respect to integration, different services will be involved, the coordination of social and health services has a prominent role. In some regions, the implementation of the 2000 reform has had a knock-on effect and provided the opportunity to place at the top end of the political agenda questions relating to the organization of health and social-health services. However, most regions have experienced many difculties in achieving this kind of integration, which is one of the most important and uncertain aspects in the construction of local welfare. Integration had for the rst time been proposed by the National Health Reform back in 1978 which was a trailblazing venture with reference not only to Italy. The reform instituted a universalistic national health system and gave a central role to the social dimension of health needs and to territorial services as alternatives to hospitals. Moreover, grasping the opportunities given at that time by the institution of the regions (in 1975), the reform chose the path of decentralization, thus empowering the role of the municipalities and the regions themselves. The Unit Sanitarie Locali (USL: Local Health Units) were introduced as
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municipality-based territorial operative structures deputed to engage in planning as well as managing services. The problems related to the integration of social and health services reect the histories and institutional characteristics of the two sectors. Unlike welfare and social services, health in Italy is an area of social rights with a corresponding (though unevenly structured) system of services over the whole of the country. The developments in this system have shown lack of continuity and inconsistencies caused by various reorganizations that have been undertaken following changes in the political sphere (Maino 2001). The main stages include (Neri 2006): 1. in the early 1990s, the introduction of mechanisms of managed competition inspired by the UK model of quasi-markets; 2. at the end of the 1990s, the shift to a model of managed cooperation; 3. in 2001, the assigning of legislative powers to the regions as a result of the same constitutional reform investing the social services.2 The separation between nancing and provision (which is the basis of managed competition) has taken place. Concurrently, corporatization has been put into action, involving hospitals and Local Health Units.3 Although they have kept their public character, these structures have been transformed through the introduction of organizational models taken from the private sector. Today, this is one of the cases of applying New Public Management that, in Europe, mostly corresponds to the UK model. However, the ways in which this model has been implemented show signicant regional differences in terms of regulative and organizational dynamics. In some cases, the regional actor plays an important role in making decisions (on spending priorities, standards of services and so on) which bind private providers, sometimes negotiating these choices at the territorial level. In other cases, the model of negotiated planning involves both public and private actors. We also nd many different patterns of relations with citizens. Some are strongly oriented towards enforcing citizens as consumers; in other contexts more emphasis is given to the promotion of citizenship.

Territorialization and Individualization Localization and territorialization are concepts that need to be distinguished. In outline, localization indicates the more general, overall change in the scale of policies. Decentralization and territorialization make up two specic sides to this change. While the former puts the relations and structure of politicaladministrative power in the forefront (Ferrera 2005), the latter stresses the places and contexts in which policies come to life and considers them on each separate occasion or simultaneously as resources, targets, carriers and settings of public action. As has been observed by Moreno and McEwen (2005), changes in welfare in Europe are related to the territorial dimension of politics, in particular as regards the weakening of the nation state. In many cases, these changes underlie the attempt to install a closer relationship between policies and territories. There are various reasons for this attempt. The idea that in a territory interventions
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and competences should be made consistent with one another has gained importance since sectorial approaches to social exclusion have been increasingly seen as ineffective. This idea lies at the heart of the experiments carried out in the domain of local development (Magnatti et al. 2005), which have exploited territories as carriers of the capacity for action and mobilization or, more briey, as actors (Le Gals 2002). Territorialization of social policies may take on very different forms. Quite common are the actions targeting disadvantaged areas and based on a principle of positive discrimination which is questioned by several authors (Castel 2003; Mayer 2006), while a number of critical positions are arising on the ways in which national policies develop between place and people (Donzelot et al. 2003). The possibility that reference to the territory may facilitate the involvement of subjects in their life contexts, thereby bolstering both social cohesion and the democratic nature of collective choices, is only one side of the picture. The other side is the development of a citizenship based, not on equality, but on the disparity between limited life contexts with different amounts of resources (Saraceno 2005; Garca 2006). A concept linked to territorialization is that of individualization, which is also charged with ambiguity (Castel 2003; Van Berkel and Valkenburg 2007). Valkenburg (2007) summarizes the different meanings of policy individualization as: (a) individualization of entitlements when faced with the changes in family patterns; (b) personalization, that is, the spread of tailor-made interventions; (c) direct cash transfers to recipients, conceived as consumers; (d) the shift from state responsibility to the individual responsibility of citizens, in particular for unemployment; (e) the need to acknowledge and promote citizens ability to reect and formulate an independent life project. In Italy, as elsewhere in Europe, territorialization and individualization have a strong inuence in redening social policies at the local level. However, it would be more exact to speak in the case of Italy of a re-territorialization and re-individualization. As mentioned above, already in the late 1970s the setting up of the national health system had given emphasis to the approaches centred on the complexity of a subjects health needs and the relations between a subject and his/her life environment. To this end, a highly structured institutional architecture close to citizens had been planned and in part realized. Today, obviously, the context is different and there are new challenges. A particularly delicate question is whether and how it is possible to reconcile the universalistic framework of health rights with devolution. In other words, is it possible to achieve local rather than localistic welfare and how would this effectively be brought about?

Frames and Features of the Research Regionalization is the political-administrative architecture which in Italy institutionalizes the many aspects of active welfare, particularly with reference to the relations between state, market and civil society, the position of citizens and the existing typology of citizen and local community involvement. An underlying frailty within the general framework is borne out by the spending on the social sector by the municipalities. The latest available data,
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for 2004 (ISTAT 2007), conrm the well-known gap between the regions: in the north and centre of the country the annual per capita spending on social services and interventions (services for families, the elderly, the disabled; residential care structures; economic benets) is above the national average (circa 92.4 euros) with a peak at 135.2 euros, while in the southern regions it is below the average with a minimum gure of around 27 euros. Another common element has to do with the composition of the supply (Carrera 2005). In 2003, an analysis of 100 municipalities revealed that social services are primarily based on category and residence, targeting in particular the children, the elderly and the disabled. Moreover, faced with policy orientations centred on promotion, interventions of the reparatory type are still predominant (ibid.). Diversication is the chief feature of the structure and modes of governance in the social sector. As to the regional level, a recent national survey (Cepiku and Meneguzzo 2006) points to an uneven political geographical picture, in which the coordinating mechanisms are based in some cases on hierarchy and in others on the market or networks. The fact is that the reform and its instruments can be translated in a number of different ways. This may, of course, promote processes of situated learning but can also lead to localistic dynamics. While it is impossible to produce a general overview of such recent and differentiated developments, we may nevertheless recall and focus on some issues and questions rising from the implementation of active welfare through a case study. Our research was based in Friuli-Venezia Giulia, a region in the north-east of Italy with a tradition of strong public intervention in social policies, especially in the area of health. Other characteristic features are: (a) the central role of the public sector, even in provision; (b) a political and institutional culture oriented to recognition of social rights; (c) a widespread and structured social and health care service system; and (d) the strong presence of third sector organizations working in the elds of social rehabilitation and job insertion (Mauri 2007). The region of Friuli-Venezia Giulia shows a peculiar typology of local welfare, which hinges on the role of the public subject and is permeated by a political culture aiming to make social citizenship effective. The attempt is to produce a change in welfare (based on integration, territorialization, individualization and activation) that neither dismantles nor reduces social protection but, on the contrary, intends to improve it. Moreover, the case displays the opportunities and the problems that arise for active welfare in Italy as a consequence of certain national traits, especially concerning the relation between the central and local levels and the institutionalization of social entitlements. We focus in particular on the HabitatMicro-Areas, Health and Community Development programme. It is an experimental programme that was rst conceived in Trieste, the regions main city. Precisely due to its experimental nature, the programme clearly reveals some of the potential and the frailty in the establishment of active welfare. Our research is based on the analysis of documents, ethnographic observation and a series of interviews with public managers and social and health-care services workers. In order to analyse
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the implementation of the programme, we have investigated the institutional and organizational processes, with specic focus on the personalization and territorialization of interventions; the relationships among the different actors, institutional and not; and the implications in terms of meanings, dynamics and effects of activation. Before illustrating the case study, it is necessary to mention some signicant moments in the development of welfare in Friuli-Venezia Giulia, such as the experience of de-institutionalization that was developed in the psychiatric sector in the 1970s, which was particularly extensive in this region. The strategy of closing mental hospitals, along with the organization of a system of territorial services as an alternative to internment, deeply transformed both the role of patients and psychiatric competences in the technical/administrative area and in the whole of the health sector. The effects of this process resulted in the national psychiatric reform of 1978 and were then embedded in the law setting up the national health system. This experience may be regarded as a reference point and benchmark for the present dynamics. Further developments within the region were the broad-based partnerships between public services and third sector organizations, especially those working on job insertion. These partnerships, too, reveal unusual features such as the fact that the active members of social cooperatives are themselves disadvantaged persons. Also, we have to point out that regional policy-makers pay special attention to health care costs, taking into consideration both the criterion of sustainable expenditure and the appropriateness of treatments to the real needs of the population.4 From this point of view, the main problem is to balance the relationship between expenditure on health and that on social services (at present the latter is one-tenth of the former). In a region with a high ageing rate, this aim implies reducing resources for clinical interventions and increasing them for territorial and home-based care aimed at long-term pathologies, degenerative diseases and disabilities.

The HabitatMicro-Areas, Health and Community Development Programme The key idea of the HabitatMicro-Areas, Health and Community Development programme is that reference to a small scale could be strategic in facilitating processes of integration among the issues at stake and in giving consistency to conditions for making citizenship and local communities active. The programme was rooted in the experience of a previous project launched in 1998 and called Habitat. At that time, the Local Health Company (ASL), the municipality and the Public Housing Agency (ATER) had reached an agreement with the third sector in order to develop actions on some disadvantaged housing estates. The ve selected areas were representative in terms of the main problems of social and spatial exclusion in the city and since the city is affected by a high ageing rate, the inhabitants involved were mostly the poor and disadvantaged elderly. Activities were aimed at joint actions on places and people, gathering social interventions, health care services, and rehabilitation of housing and public spaces. The core of the experiment was the social caretaker service:
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managed by social cooperatives and run as a neighbourhood service, it kept inhabitants and different actors in touch. Year after year, this rst experience consolidated to the point that the ASL decided to enhance it. In fact, day-by-day actions of the Social and Health Care Districts5 linked up with an emerging regional policy debate on the development and innovation of local welfare. A new programme Habitat Micro-Areas, Health and Community Development was launched in 2005, when the ASL, the municipality and ATER decided to develop further and invigorate the Habitat project. The programme aims to improve living conditions through interventions on health promotion, social disease prevention and improvements in the physical environment. Nine so-called micro-areas were selected as pilot areas in the citys four districts according to two criteria: the micro dimension corresponding to a number of inhabitants between 1,000 and 2,500 and a preference for disadvantaged public housing estates. Altogether, the micro-areas are inhabited by 16,000 people (out of a city population of 245,000). In 2006, the region launched the Micro-WIN (Micro-Welfare Innovations) programme, which is currently attesting micro-areas as places where innovative actions and measures for local welfare are being explored. The regional programme encourages the development of such projects over the whole regional territory. We must underline, however, that the original experimentation in Trieste our main focus is by now the most advanced in the region, also due to the particular organization of its health services. In fact, the ASL in Trieste has been developing the programme on an existing and consolidated territorial system in which, for example, a seven-day nursing service is active 12 hours a day with 24-hour availability. The different departments of the ASL (mental health, addiction, prevention) and specialist structures (oncology, cardiovascular and diabetes centre) work on-site throughout the territory. In this respect, the programme stresses the territorial vocation of health services in Trieste and the broad network of relationships between the public and the third sector (especially social cooperatives), which shows a deep-rooted capacity for cooperation. Given that the aim of the programme is to promote peoples health in their life contexts through the personalization of interventions, the ASL singled out some specic goals for each micro-area: to reach a high degree of knowledge on health problems of local inhabitants; to oppose institutionalization (and optimize interventions to encourage people to stay at home); to increase appropriateness of treatments and services; to promote self-help action within the community; to enhance cooperation between public, for-prot and non-prot organizations; to improve coordination between different services working for the same individual or family. For each micro-area, selected priorities are dened. Furthermore, each district has appointed a micro-area manager (mainly chosen among nurses highly
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experienced in home services), and on-site centres have been opened for the programme in accessible and recognizable locations on the estates. Involved in the programme are also staff operators of the districts, of the social cooperatives and of the municipality.

Activating Local Welfare We will now further illustrate how the dynamics of territorialization and personalization implied by the programme trigger specic rationales and practices of activation.
Focusing on places: territorialization The rst steps in the programme saw a team of operators who decided to focus on a housing estate consisting of ve-oor buildings with no lift and in a bad state of decay. The aim was to increase their knowledge of the inhabitants problems and needs through direct contact. Most people knew nothing about the Social and Health District. While for some people a nurse knocking with no notice at the door was quite a positive surprise, many others were difdent and even hostile. Over the summer, the operators decided to change their approach in reaching out to the inhabitants. A large yellow beach umbrella was placed in the estates main square to draw peoples attention and the operators sat waiting under it. They looked as if they were both wasting their time and taking their time. Little by little, inhabitants came up to the umbrella, some bringing a chair and others a drink. They started to question the operators and tell them their own stories. Sitting in the square became a stratagem for focusing on some lines of action which eventually proved to be crucial for the development of the programme itself. Today, three years later, on the same estate the micro-area base is located in a dwelling made available through a partnership with the Social Housing Agency. When you enter the base, you do not really understand where you are. What you see is a fully equipped, colourful kitchen with a fridge containing ice-cream and sparkling wine, a living room with a sofa and a pressure gauge on the table. In general terms, the programme was developed along the lines of those area-based policies which generally aim at promoting action in a specic territory in order to recombine what policies have been keeping separate. Implementing this approach has meant going into the streets: We go where people live, we dont wait for them to come to the Health District (Project unit chief ). The operators aim at more effective and efcient forms of action outside the territorial health centres, being present on site in the places where people live. Moreover, they work in close connection with the already-operating local services, which means that no new structure is added. The programme redenes the setting of services: the territory is no longer the place where single cases are detected and dealt with but the arena in which citizens demands and resources are displayed (de Leonardis and Monteleone 2007). This is made possible by local visibility and by the presence of health services provided by the programme, which imply a far better accessibility to 152
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services, especially for those who could be most at risk of having their right to health denied. In fact, micro-areas are intended as devices for exploring what is not working in ordinary organizational practices and what needs to be reorganized. They also imply an intentional exposure of the institution to a redenition of its tasks and, thus, to the dynamics of institutional reexivity (no possibility of choosing: everything enters the micro-areas base). In a way, the programme is tackling the perverse effects of the policies themselves. Indeed, processes which have exposed public housing areas as distressed neighbourhoods are typically the result of institutional action. In fact, with the overall aim of providing an answer to the demand for affordable housing, a whole set of measures have been introduced for the selection of tenants, the allocation of dwellings and the regulation, management and maintenance of housing units, which have signicantly inuenced the social transformation processes and the decay of these neighbourhoods (Bricocoli 2007). Focusing on people: personalization In the micro-areas programme, territorialization is associated with personalization of interventions. In fact, dealing with health conditions and the life context of inhabitants implies the development of personalized projects. One of the rst preliminary activities was supported by the ASL Fund and Control Department, which draws up micro-areas health condition proles by analysing the health expenditure data for each area and for each item (pharmacological, diagnostic, hospitalization). Also, micro-area managers and operators had access to data on heavy users. With this information they could plan home visits to these people in order to verify the effectiveness of the intervention and, if necessary, to devise a personalized project. Home visits have been useful for updating and revising the databases of the ASL Fund and Control Department and, moreover, they have helped to foster a relationship based on trust between people and operators which has eventually led people to provide further information on the most disadvantaged inhabitants. A tailor-made, personalized project requires intensication of the connection between different resources, both institutional and personal. This is the case, among others, of an intervention concerning a 68-year-old woman who has suffered a stroke and is only able to move around with the aid of a walking frame. Living alone on the fth oor of a building with no lift, she was unable to leave her home by herself. Thanks to the intervention of the micro-area manager, the Social Housing Agency relocated her in a at on the ground oor, which meant that she became independent again. In the meanwhile, the micro-area manager activated the procedure to obtain a care benet that can be used to pay an unemployed next-door neighbour to be her carer. In this case, though the main intervention is on living conditions, at the same time the care benet works as a job insertion intervention and becomes, more generally, a tool to develop social resources in the neighbourhood. Lately, the programme has begun to tackle the problem of the institutionalization of the aged in homes for the elderly. New solutions are being sought for those who can no longer live at home alone. In one micro-area, a social housing at was made available to accommodate four elderly people (common living
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spaces and private single rooms). There will be a treatment project and individual assistance for one, while the ASL services (home nursing, rehabilitation, etc.) will intervene as usual. Which activation? Within single micro-areas local actions are open to change, and quite often it is up to citizens themselves to reframe the sense and the carrying out of interventions. An experiment called social kitchen, set up to distribute meals to the disadvantaged and run by a social cooperative, turned into a cookery course held by a retired chef living in the micro-area. To begin with, the traditional intervention focused on the socializing role of collective meals; then people organized themselves and completely changed the setting so that now they feel much more actors in a creative action than passive recipients. A course of soft gymnastics followed a similar development. At rst, the course was held in various locations (gyms, micro-area bases and clubs) by physiotherapists for old people in need. The response was very positive. Now the project has evolved into self-organized groups of people who meet to take exercise or organize walks and excursions. Micro-areas often play the role of an incubator for different kinds of self-organized initiatives, such as groups of citizens organizing open parties, small markets or sporting events. All these practices seem to implement in a positive form the overall goal of overcoming the need for specialized interventions by transferring competences to ordinary citizens. More and more actions of social protection are combined with those for social promotion. In one micro-area, a newly created association is reclaiming open spaces, which for a long time have been used as rubbish tips. It then takes care of their regeneration and conservation. Many inhabitants take part in these efforts by planting trees and owers. In another area, people advanced their own proposals for the upgrading of a square, which at the moment is for most of the time a trafc-congested junction. The idea of activation lying at the heart of the programme presupposes a full accomplishment of social citizenship, in particular with respect to wellbeing and health rights. This is only one of the possible interpretations of activation and it is usually the least applied in European welfare states (Clarke 2005; Johansson and Hvinden 2007). It stresses the aim of increasing citizens participation along two connected lines. The rst focuses on the necessity to transform situations of deprivation by developing individual capabilities for action and for voice. The second stresses the need to involve local communities in choices concerning them. In the Trieste case, both lines are connected to experiences which have been developed in local social policies. Social-health rehabilitation services have been, for a long time, adopting methods aimed at making people autonomous so that they can obtain both their social protection and freedom rights. The involvement of civil society organizations in services planning has paved the way for practices of discussion and collaboration between public institutions and local communities in a horizontal subsidiarity frame. Processes of formalized negotiation now extend to a large number of non-prot associations (some 160 in the city of Trieste) and witness the density of actors engaged and its relevance in the development of social capital. 154
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The micro-areas programme sets in motion various processes related to this idea of activation. In general, all of them aim at creating rather than presupposing conditions to make activation possible by strengthening the organizational fabric both on the demand and on the supply side. One important process is that which is putting public housing tenants in a condition to become inhabitants who are able to play an active role in organizing and managing their own living context. Thanks to door-to-door activity for the benet of heavy users, some inhabitants have been involved in personalized health projects. This leads to more equity and counterbalances situations either of isolation or of overuse of medicines and services. The growing possibility for people to access a service, the circulation of information and the creation of places where people can meet are now visible results. It does not happen because a host of operators has gone in, but because people themselves produce information, notice situations, give help, participate and talk about their own stories. In this sense, the programme gives people a voice, the chance to speak, to protest and to plan (Massiotta 2006).

Conclusion In this article, we have attempted to trace the trajectories of change that have developed in Italy around what we have called local active welfare. In the case study, we considered two main aspects of the regional context: the rst is the major political focus on social citizenship and the second, closely connected, is the role of the public sector. The micro-area programme aims at enforcing institutional responsibilities towards well-being. The actual on-site work is able to discover people who have remained unseen, forgotten by services, and unearth those questions left unanswered by prearranged actions or by territorial work itself. Another signicant aspect is related to expenditure. The programme is oriented towards the search for virtuous ways of rationalizing expenditures not simply by saving money but by investing it in more effective and efcient actions. Thanks to the micro-areas programme, many previously invisible situations and unknown problems and questions emerged, and could be identied and tackled. As a consequence, the overall expenditure has even been rising.6 However, besides its positive aspects, this kind of experimentation does also have some drawbacks. The rst is shared by many policies, which adopt a positive discrimination approach: they channel resources and innovative efforts in some selected areas rather than seeking a complete coverage of the territory. Another critical issue is the partnership between institutions. While the ASL and the ATER are overcoming some of the difculties, their relationship with the municipality is more problematic. Despite a formal commitment, the municipalitys department for social services invests very little, thus obliging the ASL to perform duties which are not within its area of responsibility. Moreover, as described above, in Italy social services are not based on rights. Consequently, there are different institutional rationales: while the ASL is engaged in putting the right to health into practice, the municipality has a much higher degree of discretion. On the whole, these problems reveal
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the difculty in integrating different institutional responsibilities within a specic territorial area in the lack of clear and xed regulation. Generally speaking, in Italy we may detect some tendencies in the direction of an active welfare based on the widening of citizens substantive freedoms and autonomy. Starting from the traditional welfare structure, a mix of continuity and discontinuity is entailed in these tendencies. On one side, some features of the Italian welfare model are persistent and motivate the actual weakness of welfare to work. On the other hand, the transformation in social policies that took shape in Italy from the late 1990s inuenced the system of constraints and opportunities. The case study conrms that regionalization may create favourable conditions for innovation even beyond the institutional hard core of the national Italian welfare model. Friuli-Venezia Giulia is, for example, one of the three regions that have approved an income support law, which at national level is still missing. Moreover, the described case highlights the way in which a specic form of activation may foster institutional activation. In comparison to some welfareto-work programmes of other European countries, the experience described shows some particular and even reversed features. Indeed, in this case citizens are not obliged to comply with xed rules in order to obtain benets. On the contrary, it is up to the public institution to create opportunities for citizens to develop their capabilities for action and for making choices. From this perspective, both the formally recognized social rights of individuals and the diverse social and institutional mechanisms that convert these rights into capabilities, including the capabilities for voice, are encompassed (Dean et al. 2005). In addition, the case demonstrates that active welfare may face the problem of resources with logic of investments rather than of reduction. The case therefore may be regarded as a laboratory, which allows for a rst in-depth investigation of some dynamics related to recent restructuring of the Italian welfare model. While the programme is in fact a quite advanced experimentation, in the national context it is not the only example of a search for new solutions to problems of Italian welfare. However, the case shows that the rise in Italy of an active local welfare based on empowerment occurs under ambivalent conditions. An important source of ambivalence is the frailty of the overall policy context. As already mentioned, the lack of social services rights is a relevant aspect of this frailty. The 2001 devolution reform in fact opened up opportunities for experimentation at a regional scale. At the same time, it perpetuated some inequalities in the Italian welfare system and increased the frailty of the national regulative framework. Regional decisions can have a signicant effect on social entitlements, yet some redistributive mechanisms can be guaranteed only at the national level. Moreover, the problem of resources must be taken into account. While at the local level there are attempts to invest and reconvert resources, after the approval of the reform in social services many questions have emerged with regard to the actual availability of funding from the central level. Lacking any control over resources, citizens activation can hardly be directed at a long-term strategy of promoting well-being. 156
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Beyond national specicities, a conclusion of a general nature that can be drawn from the case study is that in processes of activation there is a very ne line between weakening and strengthening social citizenship. From the results of our research, we can say that the local dynamics of institutional reexivity and learning are crucial for the ways in which this line is drawn or shifted. Certainly, for the reasons given so far, these important dynamics are very frail and entrusted to political managers and the abilities of local government. Yet, as the ASL general director says, this is not at all a motive for giving up: we help people to become citizens in their own neighbourhood. There is at least one institution saying: we are here, and we want to do something together. This denitely seems a further good reason to keep trying.

Acknowledgements We are grateful to Rik Van Berkel and Bent Greve for their comments on an earlier draft of this paper. Notes
1. Except for the essential levels, which remain under state control. 2. In 2000, moreover, a system of scal federalism was introduced into the health system. 3. The previously mentioned USL have been renamed in keeping with their entrepreneurial prole as Aziende Sanitarie Locali (ASL: Local Health Companies). 4. Friuli-Venezia Giulia is a so-called Special Status Region: its health spending is nanced from a regional fund. 5. ASL districts are deputed to ensure social-health integration in the territory within a rationale of associated planning between health services and municipalities. 6. This rise implies both the increase of territorial service expenses and the reduction of expenses for hospitals.

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