Analysing Regional Sustainability Through a Systemic Approach: The Lombardy Case Study

The intrinsic complexity of the sustainability concept challenges research towards more sophisticated ways to model and assess the dimensions underlying it. However, currently adopted modelling techniques and indicators frameworks are not able to give an integrated assessment through the different components of sustainability, providing incomplete visuals of the reality that they aim to catch. This paper tries to assess how the INSURE methodology can provide a contribution in the analysis of sustainability through indicator frameworks, describing its application to the Lombardy region (Italy). Developed on the course of a 6th European Framework Program – financed project to measure sustainability in the European regions, the methodology provides two distinct sustainability representations, based on a quantitative “top-down” System Dynamics model and on a qualitative “bottom-up” System Thinking approach. The models are then linked to a hierarchical indicator framework setting policy priorities. The overall objective is thus to create a set of regional indicators, adapting the models of regional sustainability to different policy agendas. The purpose of the paper is twofold: defining a new approach to sustainability appraisal, and assessing how the Region is holistically behaving towards sustainable development. Starting from a basis analysis of the main shortcomings highlighted by the use of most adopted methodologies, the paper will verify the contribution given by the INSURE methodology to research in the fields of modelling and indicators approaches, providing insights over methodological adjustments and the results obtained from the application to Lombardy. The conclusions will show how the methodology has tried to overcome identified constraints in current models, like the strong dependence on existing datasets of the obtained representations, the under-coverage of “immaterial factors” role and the scarce integration between sustainability dimensions.ustainable Development, Regional Economics, Econometric and Input Output Models, Development Planning and Policy, Regional Analyses

How alternative food networks work in a metropolitan area? An analysis of Solidarity Purchase Groups in Northern Italy

Our paper focuses on Solidarity Purchase Group (SPG) participants located in a highly urbanized area, with the aim to investigate the main motivations underlining their participation in a SPG and provide a characterization of them. To this end, we carried out a survey of 795 participants involved in 125 SPGs in the metropolitan area of Milan (Italy). Taking advantage of a questionnaire with 39 questions, we run a factor analysis and a two-step cluster analysis to identify different profiles of SPG participants. Our results show that the system of values animating metropolitan SPG practitioners does not fully conform to that traditionally attributed to an alternative food network (AFN). In fact, considerations linked to food safety and healthiness prevail on altruistic motives such as environmental sustainability and solidarity toward small producers. Furthermore, metropolitan SPGs do not consider particularly desirable periurban and local food products. Observing the SPGs from this perspective, it emerges as such initiatives can flourish also in those places where the lack of connection with the surrounding territory is counterbalanced by the high motivation to buy products from trusted suppliers who are able to guarantee genuine and safe products, not necessarily located nearby

Perspective study: governance for C2C

This perspective study will serve as frame of reference for follow-up activities and exchanges both within and outside the Cradle to Cradle Network (C2CN) and it aims to reflect the current challenges and opportunities associated with implementing a Cradle to Cradle approach. In total, four perspective studies have been written, in the areas on industry, area spatial development, governance and on the build theme

What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

The Lombardy Health Care System

In the very recent past, the Lombardy health care system - established on the quasi-market model – has caught the interest of researchers and politicians in different OECD countries1. The merits of the model, compared to other Italian regional models, are the control of health care spending and the balanced budget, in a frame of good quality of services and patient choice. This paper stems from a literature review and tries to analyse the evolution of this regional system, the institutional path that brought to the implementation of the model, its theoretical basis, its merits and criticism. The period considered ranges from 1997, when the reform was enacted, to 2010.quasi-market, health care system, Italian NHS reforms.

Analysing regional sustainability through a systematic approach: The Lombardy case study

The intrinsic complexity of the sustainability concept challenges research towards more sophisticated ways to model and assess the dimensions underlying it. However, currently adopted modelling techniques and indicators frameworks are not able to give an integrated assessment through the different components of sustainability, providing incomplete visuals of the reality that they aim to catch. This paper tries to assess how the INSURE methodology can provide a contribution in the analysis of sustainability through indicator frameworks, describing its application to the Lombardy region (Italy). Developed on the course of a 6th European Framework Program financed project to measure sustainability in the European regions, the methodology provides two distinct sustainability representations, based on a quantitative 'top-down' System Dynamics model and on a qualitative 'bottom-up' System Thinking approach. The models are then linked to a hierarchical indicator framework setting policy priorities. The overall objective is thus to create a set of regional indicators, adapting the models of regional sustainability to different policy agendas. The purpose of the paper is twofold: defining a new approach to sustainability appraisal, and assessing how the Region is holistically behaving towards sustainable development. Starting from a basis analysis of the main shortcomings highlighted by the use of most adopted methodologies, the paper will verify the contribution given by the INSURE methodology to research in the fields of modelling and indicators approaches, providing insights over methodological adjustments and the results obtained from the application to Lombardy. The conclusions will show how the methodology has tried to overcome identified constraints in current models, like the strong dependence on existing datasets of the obtained representations, the under-coverage of 'immaterial factors' role and the scarce integration between sustainability dimensions

Making governance work in the healthcare sector: evidence from a “natural experiment” in Italy

The Italian Health Care System is a public health system which provides universal coverage for comprehensive and essential health services through general taxation. Since the early 1990s, a strong decentralization policy has taken place in Italy and the State has gradually ceded its jurisdiction to the 20 Italian Regions. These Regions now have the political, administrative, and financial responsibility for the provision of health care to their residents. This shift of power has created some interregional differences in the quality of healthcare services. However, eight Italian Regions have adopted the same Performance Evaluation System (PES) since 2008. It was designed and implemented to monitor about 160 indicators. The Regional Network has offered valuable information and the opportunity to adopt managerial tools that can be used to drive performance improvement and achieve equity. This paper firstly describes the methodology followed by the eight Regions in defining their priorities and setting their targets, relying on the multidimensional data the Inter-Regional Performance Evaluation System provides. It secondly enquires how some Regions have applied and adapted this methodology to their characteristics and strategies

Gender disparities in Italy from a Human Development Perspective

(1) All citizens have equal social dignity and are equal before the law, without distinction of sex, race, language, religion, political opinion, personal and social conditions. (2) It is the duty of the Republic to remove those obstacles of an economic or social nature which constrain the freedom and equality of citizens, thereby impeding the full development of the human person and the effective participation of all workers in the political, economic and social organisation of the country.* Sixty years after the first political election in which women voted in Italy (1946), and considering that the Article 3 of the Italian Constitution reminds the role of the republic to promote formal (art. 3.1) and substantial (art. 3.2) equality of Italian citizens, the aim of this paper is to analyse, which is situation of the gender disparities in Italy and how such disparities are distributed among Italian regions. In order to quantify such disparities a comprehensive framework for assessment is required. First, we will compare at national and regional level traditional indicators as income per capita, employment and educational level. Secondly, adopting a human development perspective, we will build some regional Gender Human Development indices with the aim to catch the disparities in terms of capabilities for men and women. Finally to better understand our results, we will build an index of empowerment using data concerning number of seats in national parliament and regional assemblies, in order to catch such existing disparities from a different point of view. In our opinion, the gender disparities in the empowerment dimension and the gender disparities in the other social dimensions are mutually reinforcing, where lack of equally distributed political power corresponds to less gender-related policy actions, and therefore wider disparities in daily life.Gender disparities, Human Development, Empowerment

Local sustainable development and well-being/quality of life. An application of the capability approach at regional level

This paper has a twofold aim: the former is to focus on the concept of well-being/quality of life and its relationships with local sustainable development and the latter is to apply the capability approach at regional level. More specifically, one wants to analyse if sustainable development at a local level serves to better understand both the formation of well-being and/or quality of life. The instrument which will allow us to verify the operational value of the capability approach is the building of a multidimensional synthetic index of sustainability. This index will consists of aggregating a set of variables of different nature from the socio-economic to the environmental ones. It may be considered an alternative to the conventional indices, which are normally founded on GDP, and will be applied to the Italian regions. After having standardised each variable so to make them homogeneous, the methodology proposed, which will allow us to gather and compare the Italian regions according to the higher or lower level of quality of life, is the Wroclaws Economic School taxonomic method. The results obtained may represent an information tool for targeting and zoning sustainable development measures which aim at improving well-being/quality of life at a local level.