Articles / Artículos 171 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

Health education and medical anthropology in Europe: the cases of Italy and Spain

Educación sanitaria y antropología médica en Europa: los casos de Italia y España

Josep M. Comelles1, Isabella Riccò2, Aida Terrón Bañuelos3, Enrique Perdiguero-Gil4

1Doctor of Medicine, ABSTRACT The aim of this article is to compare the development of health education PhD in Anthropology. Professor Emeritus of Social in Italy and Spain from the point of view of the role played by medical anthropology in Anthropology, Universitat both countries. The context is provided by the changes in the concept of health education Rovira i Virgili, Tarragona, advocated by the UN technical agencies, especially the World Health Organization and Spain. * Unesco, during the second half of the twentieth century. Despite their many similarities, 2 Master’s degree in Cultural Italy and Spain underwent different political evolutions over the last century. Therefore, Anthropology and Ethnology. Research fellow student, it is interesting to compare both cases and the influence the social sciences had in health Universitat Rovira i Virgili, education initiatives. In order to assess the role of medical anthropology, the 1958 launch Tarragona, Spain. * and the development of the Centro Sperimentale per l’Educazione Sanitaria (Perugia, 3PhD in Pedagogy. Tenured Italy), which was at the forefront of health education in Europe until the 1990s, was re- professor of History and Education Theory, constructed through oral sources. After a brief description of the scant initiatives regarding Universidad de Oviedo, health education existing in the Spain of the dictatorship, the influence of the Perusine Oviedo, Spain. * anthropologists on Spanish health education during the democratic transition is evaluated. 4Doctor of Medicine, KEY WORDS Anthropology, Medical; Health Education; History, 20th Century; Italy; PhD in Medicine. Full Spain. Professor of History of Science, Universidad Miguel Hernández de Elche, Alicante, Spain. * RESUMEN El objetivo de este artículo es comparar el desarrollo de la educación sanitaria en Italia y España desde el punto de vista del papel jugado por la antropología médica en ambos países, en un contexto marcado por los cambios en el concepto de educación sanitaria que propugnaron los organismos técnicos de las Naciones Unidas, en especial la Organización Mundial de la Salud y la Unesco, durante la segunda mitad del siglo XX. A pesar de sus similitudes como países, Italia y España tuvieron evoluciones políticas muy diferentes durante el siglo pasado, por tanto, es interesante comparar ambos casos y la influencia que tuvieron las ciencias sociales en las iniciativas de educación sanitaria. Para valorar el papel de la antropología médica, mediante el uso de fuentes orales, hemos reconstruido la puesta en marcha, en 1958, y el desarrollo del Centro Sperimentale per l’Educazione Sanitaria (Perugia, Italia), que estuvo en la vanguardia de la educación sanitaria en Europa hasta los años noventa. Tras una breve descripción de las escasas iniciativas sobre educación sanitaria en la España de la dictadura, evaluamos la influencia de los antropólogos perusinos en la educación para la salud española durante la transición democrática. PALABRAS CLAVES Antropología Médica; Educación en Salud; Historia del Siglo XX; Italia; España.

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 172 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

INTRODUCTION development of European health education and active in promoting participation. Its guiding principles impacted the health ed- Health education is a social intervention ucation proposals conducted in Spain from aimed at the conscious and permanent the 1960s onwards, once the period of iso- change in attitudes in order to address lation imposed by Franco’s dictatorship was health problems. This discipline pre- over, and during the so-called “democratic supposes the knowledge of the cultural transition” that began after dictator Francisco heritage of the group and the identifi- Franco’s death in 1975.Using the resource cation of its subjective interests, and of oral history, we analyze here the devel- requires overcoming group resistances opment of the Perusine center in the context to intervention. [Translation of the ori- of the evolution of health education at the ginal: L’educazione sanitaria è un inter- global level, considering that no other history vento sociale, che tende a modificare exists to help us understand this evolution. SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 consapevolmente e durevolmente il Further on, we analyze how the CSES pro- comportamento nei confronti dei pro- posals were recovered in the Spain of the blemi della salute. Essa presuppone la democratic transition, after the failed attempt conoscenza del patrimonio culturale to implement them in the Spanish educational del gruppo discente e la focalizzazione system during the sixties. Finally, we study dei suoi interessi soggettivi, e richiede la how the historical trajectory of the CSES, rimozione delle resistenze opposte dal since its creation to the Jakarta conference, gruppo stesso all’intervento. (Alessandro has contributed to explain the evolution of Seppilli, 1964)](1) this topic in the international agenda. An important part of this article includes In this article, we analyze the devel- a series of audio and video interviews and a opment of health education and the role focus group conducted in March 2014 with played by social sciences, especially an- some foundational members of the CSES: thropology, in its development in Italy and Maurizio Mori (who died in 2016), Maria A. Spain between the end of World War II Modolo, Anna Ferrari, Tullio Seppilli (who and the Jakarta Conference on health pro- died in 2017), and Lamberto Briziarelli. motion held in 1997.(2) Health education was developed in that period focusing on specific guidelines aimed at promoting the popularization of health and participation of citizens, social collectives, hygienism in italy and spain neighbors, workers, ethnic minorities and indigenous peoples. At that time, the project demanded an articulation with empirical so- Since the end of the 18th century, Italy and ciology and social and cultural anthropology. Spain, similarly to all other European states, Italy and Spain are interesting cases because have developed health strategies which in- health education was to develop in political clude the popularization of health and public contexts that evolved inversely. In Italy, health policies. According to George Rosen’s fascism, which started in 1924, shifted to research,(3) the health policies of France, democracy after World War II. In Spain, the the United Kingdom and Germany have democratic system was disrupted by fascism become points of reference in the evolution in 1936 and was not restored until 1977. In of the “medicalization process.” However, Italy, the Centro Sperimentale per l’Educa- the specific features of these countries do zione Sanitaria (CSES) [Experimental Center not necessarily correlate with the events for Health Education] in the city of Perugia that occurred in more peripheral countries, (Italy) was launched at the end of the 1950s, and thus, it is not possible to automatically becoming a benchmark institution in the extrapolate those chronologies and models.

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 173 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

Every modern State has cultural specificities the beginning of the 20th century were poor – which include politics, laws and even the or very poor, depending on the area. economy – and thus, adjustments of a dia- In both peninsulas, from the 17th century lectical nature are made to these general pro- onwards, a remarkable number of books in cesses both within the state framework and vernacular languages about the popular- at the regional scale. Principal adjustments ization of medicine were published. These include the non-homogeneous and non-co- books offered practical solutions to health etaneous implantation of capitalism, the problems or were a collection of the mis- chronology of the development of modern leading superstitious practices or popular constitutionalism and the effects of both on prejudices that could be obstacles to “good the cultural consequence that we know as practices” based on reason and medical the “medicalization process,” which includes knowledge. different types of actions ranging from legis- By the end of the 18th century, the lation to the influence of social communica- density of physicians in both peninsulas was tions media and the daily practices of health remarkable, due to the existence of the mu- professionals and institutions. The “cultural” nicipal conductio, a contract that dated back nature of such a process would explain its to the late Middle Ages between the local varied evolution in terms of state, regional municipality and the physician, which in and local variables. In the Italian and Iberian Italy gave rise to the figure of the condotto,(4) peninsulas – Spain and unified Italy – this and would end up becoming a public officer evolution is interesting due to the features in Spain. The day-to-day of these local physi- that both countries share: their regional cul- cians was charged with the weight of trans- tural complexity, their uneven development mitting knowledge regarding personal and of capitalism, certain political variables and public hygiene, as well as a relative capacity the pace at which the medicalization process to influence politically in favor of the dissem- developed. ination of hygiene practices, partly using eth- However, Spain and Italy are very dif- nographic tools – medical topographies and ferent. The former evolved from an imperial social medical reports – to bring the situation State that until 1714 included the south of the into relief. During the 19th century, contents Italian peninsula, Sicily and Sardinia. From related to physiology and notions of hygiene 1812 onwards, it began a slow transition began to be included in the primary edu- process towards modern constitutionalism, cation setting. Finally, both countries used which was not consolidated until the end of mass propaganda resources, especially from the 1830s, under a model inspired by French the first half of the 20th century, although an Jacobinism. Conversely, unified Italy is a in-depth study on the subject was only con- modern res publica project, the union of areas ducted in Spain.(6) with very diverse regional traditions and cul- With respect to the cultural diversity un- tural policies. The Italian Enlightenment im- derstood as an obstacle to medicalization, plemented specific health policies in several the cases of Italy and Spain before 1945 did of its territories(4) whereas social medicine in not follow identical patterns, despite them Spain did not formally develop until the end both being unitary states. In Italy, the po- of the 19th century.(5) Both countries share litical commitment of many condotti with substantial regional differences regarding the the new kingdom, especially in the peasant development of capitalism – such as the north regions, led them to develop a keen interest of Italy, Catalonia and the Basque Country – in the popular knowledge related to health along with underdeveloped regions such as and disease(7,8,9,10) and gave rise to the devel- the southern region of Italy and the south of opment of folk medicine.(11,12) Their interest the Iberian Peninsula. Moreover, they also was consolidated by the practical value that share the fact that the health conditions of the the folklore di guerra,(13,14) acquired during working classes and the agrarian proletariat at the First World War, when the military

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 174 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

recruitment brought to the forefront the continuo, umile, stabile, produttivo, che need to manage the huge cultural and es- mantiene solo nel mondo contadino le pecially linguistic diversity in Italy within antiche tradizioni dei valori della razza the context of a unitary state. Italian anthro- italiana. (Seppilli T, 2014, min. 16:05, II)] pologists decided to use the name demo- logia (“demology”) to describe the history The idealization of peasant life as the of popular traditions and the cultural wealth melting pot of the Italian razza impacts the and diversity of their demos,(15,16) a concept ideal construction of the peasantry present in very similar to that of the pueblo español coetaneous Spanish fascism,(20) but does not (“Spanish people”) proposed by the Spanish exclude its articulation with modernity – in republican folklorists of the 19th century,(17) fact rather quite the contrary: which responded to the need to both know and protect that history. In both cases, it The populist side of fascism promotes was an attitude different from that adopted health surveys, vacation, organizations SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 by France with its cultural homogenization through which the labor union can policies imposed “from above.” Before the negotiate with the employers, and some- Second World War, Gramsci’s theorization times even win. [...] During fascism the regarding the significance of folklore as sub- “mutuas” [support institutions] were altern culture(18,19) responded to the political created for workers who had no health and cultural debate related to diversity and coverage, as not all of us had coverage… implied an acknowledgment, not just as [Mussolini] had opened many hospitals a survival of the past, but as a dynamic re- and launched campaigns against malaria ality dialectically articulated with the Great and tuberculosis. Hospitals were public Cultural tradition. Such recognition of the and there could even be more than value of cultural diversity was not negated one in a province, but there was only by Italian fascism (1922-1943), which dis- one psychiatric hospital per province. tinguished the cultural and political popolo [Translation of the original: Il lato popu- [people] from its biological razza [race]: lista del fascismo porta a inchieste sani- tarie, di vacanza, le corporazioni in cui A healthy people must have a healthy il sindacato operaio può dialogare con race. The people’s health is a guarantee quello padronale e qualche volta vince. of race, because the victory of fascism […] Nel fascismo sono nate le mutue con depends on a healthy race. It is inter- alcune professioni che non erano coperte, esting, because Italian fascism refers non tutti ce l’avevano […] ha creato molti above all to the world of peasants, that ospedali, ha fatto campagne soprattutto is, according to Mussolini the virtues contro malaria e contro tubercolosi. and abilities of the Italian race are those Gli ospedali sono sempre stati statali of the peasants: a modest, stable and potevano essercene anche più di uno in productive way of working that still pre- ogni provincia, mentre quelli psichiatrici serves the ancient traditions and values erano provinciali. (Seppilli T, 2014, min. of the Italian race. [Translation of the ori- 39:00, II)] ginal: ...un popolo sano deve avere una razza sana. La salute popolare diventa Thus, the implementation of occupa- una garanzia della razza, perché la vit- tional accident insurance and the opening toria fascista passa attraverso una razza of the Cassa nazionale di previdenza per la sana ed è interessante perché poi il raz- vecchiaia(4,21,22,23) were understood as agents zismo italiano fa riferimento al mondo of propaganda seeking to consolidate the contadino soprattutto, cioè le doti e le hegemony of the regime.(24) The influence virtù della razza italiana sono quelle dei of Italian fascism on the Spanish regime is contadini secondo Mussolini, un lavoro acknowledged(20,25,26) in the modernization of

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 175 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

the peasantry(27) as well as in the field of labor “demology”, but rather a cultural and aca- and trade unions(28) in social action(29,30) and, demic marginality of folklore.(20,25,38) mainly, in the Compulsory Sickness Insurance Francoism sought to impose itself on the (SOE) [Seguro Obligatorio de Enfermedad].(33,36) popular classes through cultural hegemony, Italian fascism did not imply breaking ties with which was mostly in the hands of the Church the State – as Primo de Rivera’s dictatorship and certain organic intellectuals(20,39) who did (1924-1930) – and part of the social ac- were not necessarily fascists. Many of them tions of fascism continued in the republican combined their membership in the Falange Italy of 1947.(34) with Catholic thought, especially after the In the Spain before 1931, health pol- defeat of the fascisms in 1945. This organic icies were quite modest due to the economic discourse considered folklore and cultural weakness of the State,(5,34) with the exception diversity as “costumbrismo” [a depiction of specific sectoral and regional actions. The of everyday manners and customs] and as Second Republic (1931-1939) made a re- “survivals” – matters not to be taken into markable effort to develop public health(36) account in public actions. Folk medicine, and a new compulsory primary education, developed in Spain and prompted by Italian which included “school hygiene” until folk medicine during the first half of the 20th 1938.(37) During the Civil War, with several century, was awarded the same judgment. areas coexisting under the constitutional Studies devoted to the popular management government, Francoist Spain defined itself of health and disease continued to address as a “New State,” inspired primarily by the these matters as “superstitions” that medicine Portuguese Novo Estado. With the republican and science should acculturate, as fossils of defeat, the State as it was understood disap- a past that only hindered the medicalization peared and was replaced by another entity process. The contributions to folk medicine that was organized around a single political appearing in periodical publications were in- party, the Falange Española Tradicionalista de cluded in the curiosities or medical human- las Juntas de Ofensiva Nacional Sindicalistas ities sections.(40) An exception to this is the (FET de las JONS), which later became the interesting manual Folk medicina [Folk med- National Movement [Movimiento Nacional], icine] by Antonio Castillo de Lucas, which uniting all the sectors that had supported was also aimed at physicians.(41) the coup d’état. The health professionals The fact that Spanish doctors considered and teachers most deeply committed to re- folk medicine as a “survival”(42) is explained publican ideals fled into exile, were purged, by the hegemonic nature of a distinctly organ- or subsisted in various ways. The free and icist clinical medicine, and by the absence compulsory education implemented by the of empirical sociology, which was incom- Second Republic was not reestablished until patible with the official scholastic sociology, the end of the sixties.(37) and of social and cultural anthropology, Franco’s Spain intended to crush the cul- absent from the university until the 1970s. tural diversity of the country and impose the However, the international literature of this ideal of “Through the Empire to God” [Por el latter field, which was translated into Spanish Imperio hacia Dios],(17,20) with a discourse cen- mainly in Mexico and Argentina, was known tered on the Great Tradition, and dismissive of to some doctors. Many others had access to “regional peculiarities.” Hence, the Museum the information in the original languages of of the Spanish People [Museo del Pueblo publication. Nevertheless, the relativism of Español] project, founded by the Republic, empirical social sciences clashed with the was suspended and folklore and ethnology ideological assumptions of the Francoist studies were associated with prehistory, an- culture and national Catholicism, not fitting chored in the concept of German positivist into the schemes advocated by clinicians, folklore of the 19th century. Therefore, there who practically ignored the international were no equivalents to the Italian studies in developments in sociomedical sciences.(43)

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 176 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

These were disciplines belonging to the realm From the San Francisco Conference of the “humanities” that a learned physician (1945) to the Jakarta Conference should eventually become familiar with, (1997): the global hegemony of local though they did not have any practical imple- participation in health mentation in the hegemonic disease-centred approach. This medicine was endorsed by The idea of a new “health culture” de- the regime as an instrument of social pro- veloped between 1945 and the World Health paganda, in order to gain the support of the Organization (WHO) conference in Jakarta masses. Therefore, it can be considered that in 1997(2) – with the participation of the both in Francoist Spain and fascist Italy Food and Agriculture Organization (FAO), UNESCO and UNICEF in their respective ... only a part of power is coercion, and fields of competence. This idea was based on another part is violence; no power can a discourse of social participation at the local be sustained if it does not have a part of scale and was key in the education field and SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 hegemony [Translation of the original: il later in the health promotion field, so as to potere è solo in parte coercizione, solo be extensively spread to rural areas, neigh- in parte violenza, nessun potere si man- borhoods, workplaces, and in schools.(45) Italy tiene se non ha un lato di egemonia. immediately joined the project,(4) while Spain, (Seppilli T, 2014, I)]. despite its efforts to conceal the delay, took a decade to join due to its international iso- Antonio Gramsci’s writings on folklore,(19) lation resulting from its fascist political profile. the role of organic intellectuals,(18) the ques- Francoist Spain continued to be an uncom- tione meridionale(44) [the Southern question] fortable international partner. Many interna- and his views on subaltern peasant cultures tional recommendations did not reach the as a product of articulations and transactions Spanish citizenry because of their ideological tied into – despite the theoretical distance incompatibility with the regime. between Marxism and British structural func- This period was also characterized by tionalism – were an attempt to understand the increasing role played by mass commu- and value popular knowledge and, on this nications media. Initially, written information basis, to open up major channels of com- (newspapers and magazines)(49) prevailed; munication in the field of health education. however, very rapidly, radio and television(50) From 1945 onwards, this would help to es- (from 1960 onwards) took over. tablish a dialogue among Italian Marxist an- In 1951 the Union Internationale pour l’Ed- thropology, British cultural anthropology and ucation Sanitaire de la Population (UIESP)(51) the public health specialists committed to was founded as a consequence of: the new health education projects. However, in Spain, this dialogue was not possible due ... the meeting of people of different to the incompatibility existing between the origins: an American man, a Russian ideologists of the regime, Marxism and cul- woman, an Italian man (Canaperia) and tural relativism, as well as the consideration a French man that was returning from of popular knowledge as “survivals” with Africa. A group of individuals not defined validity only among ignorant people. We politically but influenced by post-war will examine this matter one step at a time. reconstruction [Second World War], First, we will provide an overview of the which led them to create this interna- global panorama of health education before tional union, a popular feeling against the the Jakarta conference. Second, we will ad- devastation caused by war and dictator- dress the Italian case and then proceed to the ships. The Anglo-Saxon world that had Spanish case. defeated Germany and Japan was vested with an idea of freedom that would later lead to the Cold War, tearing everything

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 177 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

apart. However, at the time of the Yalta the experiences of the so-called “therapeutic agreements and immediately after, with communities” in mental health. As Briziarelli the driving force of the British Labor comments in his interview, it is a confluence government, which was key to victory, characterized by a period of radical demo- Churchill won the war but lost the elec- cratic reconstruction after the defeat of fascist tions. The Labor Party came to power regimes, which also coincides with the be- and Beveridge drafted the plan. And it ginning of the massive spread of European was then that this story began, this inter- welfare states. Furthermore, it also corre- national group that founded the UIESP sponds with the wide hegemony of social de- within the WHO in support of people’s mocracy and Christian democracy in Europe. freedom over their health. [Translation of The goal of health education, as it was the original: ... dall’incontro fra persone di then understood, was to advance toward diversa natura: un americano, una russa, citizen empowerment on the basis of local, un italiano (Canapera) e un francese che integrative work attentive to cultural diversity, tornava dall’Africa. Un gruppo di soggetti had the support of ethnographers and social non politicamente definiti, ma ispirati alla scientists,(52) coordinated by the WHO and its ricostruzione del dopo guerra. Questo regional offices as well as, the FAO food-re- fu quello che spinse questi personaggi a lated issues and UNICEF and UNESCO in creare questa unione internazionale. Era educational matters.(53) In the educational un sentimento popolare contro i disastri field, the outdated concept of “school hy- della guerra e delle dittature. Il mondo giene” was replaced by that of “school health anglosassone che aveva sconfitto la education.” To that end, institutions were re- Germania e il Giappone, sulla scia della quired to adapt themselves to an education vittoria, fu investito da un’idea di libertà, and health that respected local attitudes and che poi finirà quando, con la Guerra knowledge based on ethnographic and his- Fredda, si rompe tutto. Ma al momento toriographic records. This was becoming in- degli accordi di Yalta e subito dopo sulla creasingly common in America,(54,55,56,57) but spinta del governo laburista inglese che fu not in Europe, due to the absence of a profes- la chiave di volta, Churchill vince la guerra sional applied anthropology.(46,58,59) ma perde le elezioni. E il partito laburista The WHO Conference(60) in Alma-Ata in prende il governo, con Beveridge che fa il 1978 formalized the pivotal role of primary piano. E lì c’è questa storia, questo gruppo health care; however, it was the 1986 Ottawa di persone internazionali che presso Conference(61) that incorporated the health l’OMS fonda la UIESP per la liberazione promotion and education agenda that had delle persone sulla salute. (Briziarelli L, been developed in the last quarter of the 2014, min. 23:54)] century and which was based on the con- struction of healthy public policy, the cre- The role of the UIESP’s conferences was ation of environments that supported health, indeed relevant for almost half a century, the reinforcement of community action, the largely because of the unrelenting profes- development of personal skills and the reori- sional commitment of its members who entation of health services. A decade later, advocated for a health education model this task list was revised: that aimed to establish criteria of horizon- tality rather than hierarchical models based Comprehensive approaches to health on imposition. Moreover, the search for development are the most effective. commitments with local social agents was Those that use combinations of the five emphasized, employing a philosophy that [Ottawa] strategies are more effective could be called participatory. These ideas co- than single-track approaches. Particular incide in time with “participatory action-in- settings offer practical opportunities for tervention” methodologies, as well as with the implementation of comprehensive

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 178 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

strategies. These include mega-cities, Secretary General of the Italian Communist islands, cities, municipalities, local com- Party [Partito Comunista Italiano] (PCI), munities, markets, schools, the workplace, Palmiro Togliatti: and health care facilities. Participation is essential to sustain efforts. People have ... with the driving force of the WHO to be at the center of health promotion and of post-war left-wing movements, action and decision-making processes the Comitato di Liberazione Nazionale for them to be effective. Health learning in Alta Italia submits an initial proposal fosters participation. Access to education for a national health service, just after the and information is essential to achieving Beveridge Plan. Based on a project of the effective participation and the empow- Convegno San Pellegrino, a first draft of erment of people and communities.(2) the Servizio Sanitario Nazionale is issued, in which people’s participation is con- In practice, Jakarta implied a substantial templated. [Translation of the original: SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 change in direction,(62) placing less emphasis ... sotto le spinte dell’OMS e dei movi- on local aspects and highlighting individual menti di sinistra subito dopo la guerra, responsibility and the role of communication il Comitato di Liberazione Nazionale in and the media, which would later have con- Alta Italia, formula una prima proposta di sequences in Italy and Spain. servizio sanitario nazionale, subito dopo il piano Beveridge. E poi in un progetto del Convegno San Pellegrino emerge una The Centro Sperimentale of Perugia and prima linea d’idea di Servizio Sanitario health education in democratic Italy Nazionale, in cui c’è dentro l’idea della partecipazione della gente. (Briziarelli L, 2014, min. 03:11)] There were two unique features of the center: the first was that health edu- The proposal of the Italian left was as- cation was strongly linked to services, sociated with a long-term project in which especially education and health ser- Ernesto de Martino (1908-1965), an anthro- vices, it was not just an activity charac- pologist and historian of religions, would terized by good will. The second was play a relevant role. De Martino was then a that working towards health education member of the PCI and one of the foremost implied working towards health reform, Italian intellectuals. According to Seppilli, his that is, toward a new health system. comrade and former student: [Translation of the original: Le singo- larità del centro erano due: la prima è A controversy had arisen in Società, che l’educazione sanitaria è fortemente the theoretical journal of the [Italian legata ai servizi, non è una attività di Communist] party, regarding the sig- buona volontà, in particolare al servizio nificance of the subaltern classes, of scolastico e sanitario. La seconda è che popular culture. Together we constructed lavorare per l’educazione sanitaria signi- this initial tentative structure of Marxist ficava implicitamente lavorare per la anthropology in Italy, which later on led riforma sanitaria, per un nuovo sistema to, from an empirical point of view, the sanitario. (Mori M, 2014, min. 04:00)] important research conducted by De Martino. [Translation of the original: The publication in 1945 of Cristo si è Era cominciata la polemica su Società, fermato a Eboli by the doctor Carlo Levi(63) sulla rivista teorica del partito [PCI], sul and La questione meridionale by Gramsci(44) significato delle classi subalterne, della incorporated popular culture into the agenda cultura popolare, costruimmo insieme of the Repubblica Italiana, in part through the questa prima struttura di un tentativo di

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 179 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

antropologia marxista in Italia che poi this meeting, the possibility of building portò, da un punto di vista empirico, alla health education centers in the different grande ricerca di de Martino. (Seppilli T, countries was established. In Italy a 2014, min. 23:33, I)] center was founded in Milan (that lasted a few years) and another in Perugia [...] Shortly before, in 1948, Panizzini’s which found a supportive environment Medicina popolare in Italia(64) and De Martino’s because Alejandro Seppilli was then at Il mondo magico(65,66) had been published. the Institute of Hygiene in the University While Pazzini still accepts magic as “pre- of Perugia [...] The aim was to incor- technique,” De Martino considers it a social porate the center into the university practice of resistance and not a “survival,” a and the local entities (municipalities, sort of bricolage necessary for everyday life. provinces and regions). [Translation of Being familiar with it was crucial for under- the original: Nel 1951 a Londra ci fu standing local culture and implementing med- un incontro internazionale con atten- icalization strategies that accepted its efficacy: zione ai paesi post guerra. A questo con- vegno partecipò il medico provinciale di Addressing the topic of popular med- Perugia. In questo incontro si stabilì che icine was too general, we had to define si potevano costituire dei centri di edu- the social class and the conditions cazione sanitaria nei vari paesi. In Italia under which it operated. A research se ne fondò uno a Milano (durato pochi field rooted in the 19th century emerged, anni) e uno a Perugia […] che trovò but it developed in a new direction, ambiente favorevole perché all’Istituto because we were working under the d’Igiene dell’Università di Perugia, c’era assumption that popular medicine was Alessandro Seppilli. […] L’intenzione era not superstition, but had an empirical quella di avere dentro l’università e gli basis. Ritual became part of its efficacy. enti locali (comuni, provincia, regione). [Translation of the original: Lavorare (Modolo MA, 2014, min. 17:00)] all’idea della medicina popolare era un po’ generico, bisogna vedere quali classi In the next two decades, the Italian health sociali in quali condizioni. Venne avanti education model was based, in practice, un settore di ricerche che aveva le radici on two institutions: one that was located nell’ottocento, ma andava sviluppandosi in Milan and was mainly oriented toward in una nuova direzione, perché noi lavo- “social communication, radio and signage” ravamo nell’ipotesi che la medicina (Briziarelli L, 2014 min. 14:00), and the other popolare non fosse superstizione, avesse in Perugia, which assumed a different role, delle basi empiriche. La ritualità era una as it mainly promoted concerted action with parte dell’efficacia. (Seppilli T, 2014, local left-wing authorities: min. 35:06, I)] ... following the international guide- De Martino, in La terra del rimorso, incor- lines of the 3rd World Conference on porated social workers and psychiatrists,(67) Health Education held in Rome (1954), which was exceptionally rare in Europe. The along with the doctor of the Province of new Repubblica wanted to solve the problem Perugia and with the support of Carlo of citizens’ access to health services, espe- Alberto Canaperia, General Director cially those in the subaltern groups: General of the Ministry in Rome [...] Canaperia created the Italian Council In London, in 1995, there was an inter- of HE [health education], of which national meeting focused on post-war [Alessandro] Seppilli was one of the countries. One of its attendees was the most important figures. Papaldo, a pro- doctor from the province of Perugia. In fessor from Rome, was the president.

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 180 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

He limited himself to promoting HE on popolazione, lavoro con la gente attra- the radio, the newspapers and in adver- verso il contatto con i medici di base, tising signs; however, there was no spe- con le ostetriche, con gli infermieri, in cific project. The difference introduced questo modello che diventerà il modello by Seppilli from the start was making del CSES che però non trovavano nel great efforts in training personnel for this resto del paese un grande consenso. specific function, adopting person-cen- Il modello del centro era diverso dal tered models, building direct rapport modello del Centro di Educazione della with people, working with people by Popolazione a Milano. A Perugia la establishing contact with general prac- scelta era quella di utilizzare mezzi di titioners, midwives, and nurses, in this comunicazione bidirezionale e cercare model that was to become the CSES il contatto con la gente. Questa era la model, but which did not reach great grande differenza che caratterizzava il consensus in the rest of the country. nostro modello che cominciava a deli- SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 The model of the Perugia center was nearsi sotto la direzione della Modolo, different from that of the Population Maurizio Mori, Ferrari e altri. Il nostro Education Center in Milan. In Perugia, impegno fu quello di creare un modello the choice was to use bidirectional com- di formazioni degli operatori che fosse munication media and to seek contact trasferibile nei rapporti con la gente di with people. This was the great dif- tipo bidirezionale, lavoro di gruppo, ference that characterized our model discussione di gruppo come strumento. and which started to be outlined under (Briziarelli L, 2014, min. 12:39)] the direction of Modolo, Maurizio Mori, Ferrari and others. Our commitment was Milan and Perugia represent two com- to create a model for the training of our plementary strategies in the development of professionals that could be transferable international health education. To choose in a bidirectional bond with people, that one or the other often depended on the could include group work, and group profile of their founders and their social and discussion as an instrument. [Translation political commitment as well as their com- of the original: ... sulla scorta delle mitment to health. In the Perusine case, the indicazioni internazionali della III initiative came from public health specialist Conferenza Mondiale di Educazione Alessandro Seppilli (1902-1995): Sanitaria a Roma (1954), insieme al medico provinciale di Perugia, con He spoke German, he was born under l’influsso di Carlo Alberto Canaperia, the Austro-Hungarian government and Direttore Generale al Ministero a Roma had studied German for the Physiology [...] Canaperia aveva creato il Comitato exam. He was culturally very German, Italiano di ES (Educazione Sanitaria) di and very Austrian in his way of life, rigid cui [Alessandro] Seppilli era una delle regarding schedules, work and manners persone importanti, il presidente era of doing things. He was a liberal and un Prof. romano Papaldo, però si limi- became a socialist when he returned tavano a ragionare di ES con messaggi to Italy. He was even a liberal in spirit. attraverso radio, giornali, manifesti, a I was very close to him, we traveled mandare in giro segnali, ma non c’era abroad together; he was very much un progetto. La differenza che introduce interested in social problems; however, Seppilli da subito fu quella di fare un in his political training, he was closer grosso sforzo formativo del personale to the liberals than to the socialists. He per questa specifica funzione, adot- was a libertarian, a liberal in the 19th tando modelli di approccio nei confronti century sense of the word, but he was della gente, un approccio diretto con la very open-minded and respected other

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 181 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

people’s opinions. He was an aristocrat dire, bisognava ascoltarli e questa era and paid little attention to ignorants – la ragione per la quale era aperto alle not the poor, but the stupid. However, opinioni, al confronto. […] Di antica tra- he believed that those having important dizioni igienista, fa negli anni cinquanta things to say had to be listened to, and una apertura di natura politica verso la this was the reason why he was open parte sociale della medicina e dell’i- to opinions and to discussion [...] Being giene, sotto la spinta delle innovazioni traditionally a hygiene specialist, in che venivano dal mondo internazionale the 1950s he implemented a policy of della OMS dei movimenti di sinistra che political openness regarding the social agitavano la nazione dopo la guerra. side of medicine and hygiene, under the Seppilli che intanto era sindaco di influence of the innovations that were Perugia, socialista, recepisce questi ele- taking place in the international world of menti di tipo culturale e li inserisce sia the WHO and the leftist movements that dentro l’Istituto d’Igiene come forma de were shaking up the country after the war. insegnamento per gli studenti sia come While Seppilli was the socialist mayor of impresa parallela all’interno dell’Istituto Perugia, he absorbed these cultural ele- d’Igiene per svolgere azioni di tipo edu- ments and incorporated them into the cativo e anche di ricerca. Inizialmente Institute of Hygiene both as teaching solo di tipo educativo. […] Seppilli material for the students, and also as a dedicava la sua attenzione soprattutto parallel challenge to develop educa- al CSES, spostando l’igiene tradizionale tional and research activities. Initially, verso nuove frontiere: educazione sani- these activities were only educational taria, promozione della salute ed epi- [...] Seppilli was especially interested demiologia, ambiente, prevenzione, in the CSES, moving traditional hygiene una igiene che era soprattutto tecnica. toward new frontiers: health education, (Briziarelli L, 2014, min. 29:00)] health promotion, epidemiology, envi- ronment, prevention, a particularly Alessandro Seppilli, born in Trieste technical take on hygiene. [Translation (Austro-Hungarian Empire) in 1902 and of of the original: Lui parlava tedesco, era Jewish origin, was a charismatic figure until nato sotto l’indirizzo austro-ungarico, his death in Perugia in 1995, due to his sci- aveva studiato tedesco per fare l’esame entific, academic and political influence. di fisiologia, era di cultura mitteleuropea He was married to anthropologist Anita e nella sua impostazione ordinaria Schwarzkopf, who also contributed to his in- era un austriaco, rigido negli orari, nel terest in lavoro, nella forma. Era un liberale e diventò socialista quando tornò in Italia. ... approaching the understanding of Era un liberale anche nello spirito. Io gli diversities, respectfully teaching about sono stato molto vicino, abbiamo viag- the exchange among the different giato insieme, siamo andati all’estero, professions, so that the others could lui era apertissimo ai problemi sociali, understand that health care education ma come formazione politica era più involved establishing relationships vicino ai liberali che non ai socialisti. with different people, given the level Era un libertario, un liberale nel senso of closure that existed in Italy. There ottocentesco del termine, però aveva was a culture that was still very much una grande apertura mentale rispetto tied to professional power. [Translation alle opinioni degli altri. Era aristocratico of the original: ... cercava di avvicinarsi e considerava poco gli ignoranti, non i alla comprensione delle diversità, di poveri, ma la gente stupida, però tutti educare con molta dolcezza i rapporti coloro che avevano cose importanti da con diverse professioni, cercando di far

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 182 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

capire che l’educazione sanitaria com- sanitaria e andai dal medico provin- portava la relazione anche con persone ciale. […] L’OMS aveva dato una borsa diverse, c’era una tale chiusura in Italia. di studio per Londra, la presi io e andai C’era una cultura ancora molto collegata a Londra, al Health Education Center of al potere della professione. (Ferrari A, London. Feci un anno lì. La cosa che mi 2014, min. 34:00)] aveva colpito molto era che si lavorava molto in gruppo. Nel ‘57 io tornai e si Alessandro Seppilli’s attitude was built decise di diffondere questa storia dell’e- upon his academic expertise and his work as ducazione sanitaria tra operatori sanitari a hygiene specialist before his exile in Brazil, e scolastici e si decise di fare il corso as well as upon the experience in human in- estivo, perché a Londra facevano un teraction that he gained during his exile as di- corso estivo per personale dei servizi. rector of a pharmaceutical company. There is L’anno dopo lanciammo il corso, la no doubt that once back in Italy and involved OMS ci aiutò mandandoci il mio tutor SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 in the CSES project, his ability to manage a di Londra, John Burton, che parlava ita- team of young people was one of the keys liano perché aveva sposato una italiana. for the development of the institution. One of (Modolo MA, 2014, min. 21:00)] these young people speaks to this: The combination between Burton’s British I arrived at Perugia in 1954, after earning pragmatism and the social commitment of the my medical degree. I began to attend the 1950 Italian left made it possible to incorporate hygiene course in my fifth and sixth year. I got in touch with professor Seppilli ... a wide breadth of ideas and an because of my thesis. After graduating, attitude of openness toward a HE [health he told me that I could work in health education] model, which was unknown education and I contacted the provincial here, except for what was being built doctor. […] The WHO was to award in Perugia. Immediately, we started a scholarship to go to London, which I to interact with people, both because won, so off I went to the Health Education Seppilli encouraged us in that direction, Center of London, where I spent one and also because public health had year. One of the things that caught my begun to wage a battle against social attention was that group work was diseases in the sixties, and interventions common practice. In 1957, I returned were implemented against tuberculosis, to Italy and we decided to promote the trachoma, rabies and actions were ini- subject of health education among the tiated for the prevention uterine and cer- health professionals, so we organized a vical cancer. We started to advertise our summer course, because in London they activities, something that was unusual always organized a summer course for for HE, because we used to go to the health service professionals. A year later towns and show movies and then we we launched the course and the WHO explained what had to be done in order supported us by inviting my London to detect cancer. [Translation of the ori- tutor, John Burton, who spoke Italian ginal: … idee molto aperte e aprí tutto because he was married to an Italian un modello di ES che non conoscevamo woman. [Translation of the original: Io qui, salvo quello che si stava costruendo venni a Perugia nel 1954, dopo che mi qui in Perugia. Cominciammo subito laureai in medicina. Cominciai a fre- un’azione con la gente perché sia per quentare il corso d’igiene, quinto e sesto Seppilli che spingeva in questa direzione anno. Contattai il prof. Seppilli per una sia perché negli anni ‘60 la sanità aveva tesi. Una volta laureata, Seppilli mi disse avviato una lotta contro le malattie che potevo occuparmi di educazione sociali, quindi c’erano interventi contro

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 183 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

la tubercolosi, il tracoma, la rabbia scientists that supported the SPD, which e cominciavano gli interventi per la was rare and difficult to find in the UIESP prevenzione dei tumori della cervice because nobody had ever mentioned uterina. Cominciammo a fare propa- health education regarding the workers’ ganda che non era proprio ES, perché health problems, they left it all to the andavamo nei paesini, la sera proiet- International Labor Organization (ILO) tavamo una pellicola e dopo spiegavamo in Geneva. [Translation of the original: come si doveva fare per lo screening del … avevamo con il modello anglosassone cancro. (Briziarelli L, 2014, min. 09:00)] un rapporto di amore e odio perché noi recepivamo moltissimo dalla cultura Undoubtedly, the Italian model – that che si formava a livello europeo, soprat- readily incorporated the Marxist critical an- tutto dalla parte inglese laburista, non thropology discourse and was reluctant to dalla parte americana. Quindi avemmo accept the structural-functionalism of the sempre un contatto e un’inspirazione English-speaking world(46) – helped forge the da alcune parti degli scienziati inglesi, identity of the CSES: molto meno dagli americani e invece avemmo stretti rapporti intellettuali ... we had a love-hate relationship with con i canadesi che avevano dei modelli the Anglo-Saxon model, because we avanzati vicino ai nostri e con quella used to greatly nurture ourselvess from parte di olandesi e tedeschi che erano the overall European culture, particu- tutti vicini ai movimenti socialdemo- larly from the British Labor Party, but cratici. Attraverso l’UISEP noi avevamo not so much from the USA. Therefore, due tipi di atteggiamenti. Uno: svilup- we were always in contact with and got pavamo un modello italiano di tipo inspiration from the British scientists but socialdemocratico avanzato sul pieno much less from the US ones. Instead, della riforma sanitaria e della parteci- we had a close intellectual relationship pazione della gente, ma gli elementi with the Canadians, who had advanced culturali di informazione di educazione models that were similar to ours, as well sanitaria erano quelli che venivano dalle as with some Dutch and German scien- punte avanzate di tipo Nord Europeo. tists that sympathized with the social Era una relazione di amore e odio perché democratic movements. Through the noi combattevamo come militanti della UISEP we adopted two types of atti- sinistra l’influenza americana, ma anche tudes. On the one hand, we developed quella del governo inglese, ma gli spiriti an Italian model with social democratic culturali delle avanguardie culturali characteristics, which made its way che venivamo dall’Inghilterra erano forward while the health reform was in anche le nostre, ci lavoravamo insieme. full bloom and with the participation of El Bundeszentrale für gesundheitliche the people, but whose cultural elements Aufklärung di Köln era con noi vicino of health information and education perché era diretto da scienziati vicini were those coming from places such as al SPD, che era una cosa assai rara e the north of Europe. It was a love-hate difficile nella UISEP perché mai aveva relationship because we fought as mil- parlato di educazione sanitaria per i itant leftists against the US and even the problemi sanitari dei lavoratori perché British influence, but the spirit of the cul- li lasciava tutti a la OIT di Ginevra. tural avant-gardes coming from England (Briziarelli L, 2014, min. 48:30)] was similar to ours, we were together in this. The Bundeszentrale für gesund- The summer course of the CSES that heitliche Aufklärung of Cologne was was inaugurated in 1958(68) was, for many also close to us because it was run by decades, a point of reference in Europe. Its

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 184 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

annual gatherings not only accepted Italian People from all over Italy came to study students, but also a great number of students about health education and what it was from other parts of the world, including about. My father [Alessandro Seppilli] Spaniards from the sixties onwards. The had the idea that it was necessary to be appeal of the course was that acquainted with anthropology to study health education. Thus, anthropology ... it was based on the Socratic method was included in health education cur- (that was implemented in London) – I ricula in 1956. Every summer I gave an see today that many groups are recov- extensive seminar, a debate on anthro- ering the Socratic dialogue – and it was pology, to explain what it is and what its organized in ten days. We launched a purpose is. A short time later, I published call and a lot of people came, around 60 a work about the WHO, the first work people. We worked in groups. There was addressing the contribution of cultural an introductory class in the morning, and anthropology and health education; SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 then two hours of group work to discuss thereafter, a collaboration started, which what each person did individually in their has continued ever since. [Translation own work and what was or was not appli- of the original: Venivano da tutta Italia cable. In the afternoon, we worked on delle persone a studiare cosa voleva communication, we had to create some- dire l’educazione sanitaria e mio padre thing for publication (flyers, banners, [Alessandro Seppilli] ebbe l’idea che per films). The course focused on one topic, studiare l’educazione sanitaria bisogna a specific problem (nutrition, mental conoscere l’antropologia e così l’antro- health, among others). [Translation pologia entra nel 1956 nei programmi of the original: ... il corso era fondato di educazione sanitaria e io facevo tutti sul metodo socratico (che usavamo a gli anni, d’estate, una lunga lezione, un Londra), sto vedendo che molti gruppi dibattito sull’antropologia, cos’è, a cosa stanno rilanciando il dialogo socratico, serve e pubblicai poco dopo quell’altro organizzato in 10 giorni. Facemmo un lavoro su l’OMS, il primo lavoro sul bando e venne molta gente, circa 60 contributo dell’antropologia culturale e persone. Si lavora in gruppo, la mattina l’educazione sanitaria e da lì cominciai si faceva una lezione di inquadramento, una collaborazione che va avanti fino ad poi due ore di lavoro di gruppo per oggi. (Seppilli T, 2014, min. 31:00, I)] discutere sulle cose che ognuno faceva nel proprio lavoro e se si potevano The course structure was similar to that applicare o no. E il pomeriggio era sulla of the participatory model developed by comunicazione, si doveva produrre un the British, and consisted of an introductory qualche cosa per pubblicare (flanello- seminar and, above all, workshops, practical grafie, manifesti, filmine). Il corso aveva and participatory activities that were articu- un tema, un problema specifico (alimen- lated in tazione, salute mentale etc.). (Modolo MA, 2014, min. 31:00)] ... thematic clusters. An ordinary day included a class that was delivered by However, the incorporation of the social anyone of us (Paolo Bartoli, Riccardo sciences, especially medical anthropology, Romizzi and me). Tullio Seppilli gave into the world of hygiene and classical public the inaugural class on medical anthro- health, was a totally unprecedented event pology and we took turns delivering in Europe. The anthropological contribution classes on cultural models of health and to the formation of health professionals was disease, cultural learning and dissemi- indeed uncommon in the academic tradition nation, data collection techniques in the of European public health. community, and communication. Then,

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 185 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

we conducted group work through work- avanti nel tempo il nostro approccio shops and especially through discussion era molto critico, noi invitavamo i par- of different experiences regarding specific tecipanti a considerare da un punto di topics. I coordinated the group about vista culturale i loro stessi modelli anche labor and birth, in which many Spaniards quelli che loro consideravano scientifici. participated. We were totally immersed (Falteri P, 2014, min. 05:54)] in group work (from 10 am to 6 or 7 pm). We worked a lot on medicalization pro- Although anthropology always occupied cesses, prevention in the health field and a prominent place, which Tullio Seppilli on the political significance of the work, always preserved, contradictions still emerged which we believed was the main road regarding the expectations of the anthropolo- to medicalization; the shift of medicine gists on the one hand, and of public health from disease to health and normality specialists on the other: were the foundations of the power of social medicine, because by dealing We did not always agree with Tullio, who with prevention we dealt with everyday was more of a scientific doctor than we life (eating, sexuality). Eventually, our were. With the hygiene specialists, we approach became very critical, we had the feeling that our anthropological invited the participants to think of their approach was a sort of ornament, that own models from a cultural point of we were just chit-chatting and that the view, including the scientific models. true and important matters were those [Translation of the original: ... lavori di addressed by the hygiene specialists. We gruppo tematici. Le giornate compren- never dared to venture into the field of devano una lezione frontale di qualcuno the specialists in hygiene, but, while on di noi (Paolo Bartoli, Riccardo Romizzi e the one hand, they did assign us a very io). Tullio Seppilli faceva la lezione inau- important role, on the other hand, the gurale di antropologia medica e noi ci impression was clear that a hygiene spe- alternavamo su modelli culturali di salute cialist could become a bit of an anthro- e malattia, apprendimento e circolazione pologist. In this regard, Tullio was less culturale, tecniche di rilevazione nella sensitive, I don´t know if it was because ricerca di comunità, il tema della comu- he was the son of a hygiene specialist nicazione. Poi si entrava in gruppo, dove or because of his training. That was the c’erano delle esercitazioni, ma soprat- reason why those working in this field felt tutto confronto tra esperienze intorno a a little like missionaries. There was this certi temi. Io gestivo un gruppo sul parto feeling of: “we arrived, we healed them e la nascita, erano presenti molti spa- and saved everybody”; on the one hand gnoli. C’era un’immersione nel lavoro di you promote health, on the other hand gruppo tutto il giorno (dalle 10 alle 6-7 you medicalize society. [Translation di sera). Lavoravamo molto sui processi of the original: In questo, spesso, non di medicalizzazione, la prevenzione nel andavamo d’accordo con Tullio che era campo della salute anche il significato molto più medico scientifico di noi! Con politico, ma da lì a poco noi la abbiamo gli igienisti avevi la sensazione che la considerata come la strada maestra della prospettiva antropologica fosse un po’un medicalizzazione, lo spostamento della ornamento, che tutto sommato noi medicina progressivo dalla malattia alla facessimo delle chiacchiere perché poi salute e alla normalità era la base del le cose vere e importanti fossero i temi dominio della medicina nel sociale, dell’igiene. Mentre noi non ci siamo mai perché occupandosi di prevenzione, ti azzardati ad entrare nel campo degli occupavi della vita quotidiana (alimenta- igienisti, loro sì, da una parte ci davano zione, sessualità). Man mano che andava uno spazio notevole, ma dall’altra la

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 186 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

sensazione era molto netta che anche scontro tra medicina popolare e ufficiale l’igienista può fare un po’ l’antropologo, a partire dalle prime specializzazioni su questo Tullio era meno sensibile, non che si erano diffuse capillarmente nel so se perché figlio di un igienista o per la territorio: ostetricia e pediatria. (Falteri P, sua formazione. [Per questo] coloro che 2014, min. 31:47)] lavoravano in questo ambito si sentivano un po’ missionari, c’è un elemento: “arri- This permitted them, even with the lim- viamo noi, vi salviamo e vi facciamo itations that they observed, to set as their stare tutti in salute”, da una parte pro- main goal that of changing the attitudes of muovi la salute dall’altro medicalizzi la health professionals, offering critical training società. (Bartoli P, 2014, min. 30:00)] regarding social and cultural variables. In Perugia: Bartoli, an anthropologist, highlights an important consequence of the anthro- We have always been convinced that SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 pologists’ doubts regarding a process that, medicine could not be truly social if finally led not so much to relativism but physicians did not receive the important rather to the deepening of the medicalization cultural contribution of the humanistic process. Thus an intense debate about “med- disciplines, which is not about teaching icalization” was generated, which has been a little cultural anthropology, medical increasingly present in the medical anthro- psychology and medical sociology, but pology agenda since the end of the twentieth about creating a space in the students’ century(69) and that responded to the fear medical mind that enables them to that the labour market of the anthropolo- consider the patient not as a person on gists could be absorbed by the hygiene spe- a stretcher but as a social being. This cialists.(70) However, the anthropologists that was what we believed. We wanted the worked at the CSES student to understand that there was a part within the human being that ... introduced the concept of medical- was not strictly clinical and that a phy- ization, but insisting that the meaning sician should take that into account [...] was neutral. We spoke in terms of cog- Although, in fact we never succeeded in nitive models, of medical behaviors in this respect, we could never change this the population; it was not necessarily objectively. With Modolo we worked negative, it was taking into account what both in medicine and in the training was going on. Those were times when courses for the health professionals, Paolo and I were doing field research near introducing humanistic and social disci- Lake Trasimeno about the coincidences plines. And we introduced these courses and discrepancies between popular mainly for the non-medical staff rather and official medicine, based on the first than for the physicians. In my course, specialties that had widely emerged in we used to send students to study in a the territory: obstetrics and pediatrics. specific neighborhood, in factories or [Translation of the original: ... presentare in a peripheral health service, so that il concetto di medicalizzazione insi- they could understand, through this stendo però che il significato era neutro, knowledge of the situation, many other ne parlavamo nei termini di modelli things that they didn’t know because they cognitivi, di comportamenti medici della were always in the hospital. We could popolazione, non era necessariamente do it, but it was always very difficult. negativo, era aver presente quello che [Translation of the original: ... noi siamo stava accadendo. Anni in cui io e Paolo sempre stati convinti che la medicina facevamo ricerca sul campo vicino al non poteva essere veramente sociale lago Trasimeno a proposito dell’incontro se i medici non avessero ricevuto una

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 187 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

importante aggiunta culturale da parte cultura sviluppata dal centro di educa- delle discipline umanistiche, che non zione sanitaria di Londra, di Edimburgo era solo insegnare un po’ di antropologia e quella irlandese. Era la stessa che noi culturale, psicologia medica, sociologia portavamo in Italia, erano elementi scien- medica, ma di creare nella testa dello tifici e tecnici, noi li introducevamo nei studente medico uno spazio per consi- nostri e vi mettevamo elementi politici derare il paziente non un uomo sul letto e quindi questi stranieri lavoravano con da visita, ma un uomo sociale, questo noi volentieri perché noi portavamo era il nostro ragionamento, cercavamo avanti questo discorso politico attraverso di far capire allo studente che c’è una una società internazionale di politica parte non strettamente clinica dell’uomo sanitaria, era un’associazione sanitaria che deve essere considerato dal medico. di scienziati studiosi di sanità pubblica […] Questo in realtà non è stato mai rag- e cultura sanitaria, tutti di sinistra, che giunto, non si è mai avuto un cambia- portavano avanti un discorso di sanità mento oggettivo. Io e la Modolo abbiamo pubblica nel senso socialista. (Briziarelli lavorato sia in medicina che nei corsi di L, 2014, min. 56:00)] formazioni del personale sanitario intro- ducendo discipline umanistiche sociali, The difference came from the personal quindi abbiamo introdotto questi corsi attitude and the political commitment of più a livello di personale non medico the hygiene specialists and anthropologists che medico, nel mio corso gli studenti that collaborated in that task, as they under- venivamo mandati a studiare un quar- stood that in Southern Europe “the topic of tiere, una fabbrica, un servizio periferico prevention had a very strong political value” in modo che preparassero, attraverso (Bartoli P, 2014, min. 1:38) that implied questa conoscenza del terreno, qualcosa che loro non sanno perché loro stanno ... collaboration with the movement of solo in ospedale. Lo abbiamo fatto però educational cooperation in the field of sempre con grande fatica. (Briziarelli L, the school, teachers, and educators in 2014, min. 01:05:00)] the health services. The method was participatory and was related to group Despite this differential factor, that of the work. I was in charge of an anthropology critical addition of the social sciences, the group that was attended by teachers and main training areas continued to be linked to educators from all over Italy and who formed territorial groups. [Translation ... the culture developed in the health of the original: ... collaborazione con il education centers of London, Edinburgh movimento di cooperazione educativa and Ireland. It was the same culture nel campo della scuola, degli insegnanti, that we brought into Italy that included degli educatori dei servizi. Il metodo era scientific and technical elements that partecipativo, legato ai lavori di gruppo, we introduced and to which we added io tenevo un gruppo di antropologia a political elements; at that time those cui venivano insegnanti, educatori da foreign professionals worked very will- tutta Italia e formavano gruppi territo- ingly with us, because we supported riali. (Falteri P, 2014, min. 03:43)] this political discourse through an inter- national society on health policy; we Unlike US culturalism, which un- were a scientific organization made doubtedly gave rise to the initial impulse for the up of public health and health culture development of the anthropological discourse scholars, all of us leftists, who supported in Perugia, the Perusine discourse could have a public health discourse in the socialist a critical perspective related, on the one hand, sense. [Translation of the original: ... la to Italian Marxist critical anthropology and,

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 188 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

on the other hand, to the significance that the affinamento dei nostri modelli di lavoro. political commitment had in the emancipation Tanto è vero che organizzammo per i of the subaltern classes. For that reason, social sindacati corsi di formazione sulla tutela participation actions included: della salute che erano vere e proprie azioni di educazione sanitaria nei con- ... politics, local institutions, labor fronti dei consigli di fabbrica e dei lavo- unions and workers. In the sixties we had ratori. Il CESS entrò nel sociale, però already established a strong relationship recepiva anche dal sociale elementi e with the union of metal-mechanic che ci aiutavano a tirar avanti il nostro workers in Terni and Perugia, the union tipo di discorso che era difficile perché of ceramic workers in Perugia and the non veniva accettato dalla medicina uffi- union of textile workers. Our ideas were ciale né dalla igiene ufficiale. Era facile sustained by this relationship and we per noi quando consegnavamo i risultati could transmit the type of work that we delle nostre indagini, parlare con i lavo- SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 conducted to the factory workers, which ratori e spiegare cosa succedeva. Con i also helped us to improve our working ceramisti di Deruta lavorammo molto models. We even organized health per capire il grado di danno prodotto care training courses for the unions, dal piombo e per portare avanti le loro which were truly health care actions rivendicazioni. Era un mescolamento di for the factory committees and workers’ lavoro, tra lavoro tecnico d’igienista e councils. The CESS entered the social politico di istruire e far sì che i lavoratori sphere, and in turn received important acquisissero conoscenze per supportare elements from the social sphere that la loro lotta contro il padrone. (Briziarelli helped us move forward with our dis- L, 2014, min 19:23)] course, which was difficult because it was not accepted by the official areas of The apparent political radicalism of the medicine or hygiene. When we shared project was itself an obstacle. Despite the the results of our research, it was easy debates concerning health participation, for us to speak with the workers and commitment to the local posed problems for explain to them what was going on. We generalization, thus leading to worked a lot with the ceramist workers of Deruta in trying to understand the ... the scant dissemination of our ideas. level of damage caused by lead and People came from all over Italy but the helping them put their claims forward. model did not spread. There were no It was a combination of, on the one other places where the same project was hand, technical public health work and implemented. The greatest resistance on the other hand, the political work of came from the hygiene specialists, who educating and helping the workers gain not only did not accept the proposal knowledge for carrying out their struggle but outright rejected it. They battled against their employers. [Translation of against both [Alessandro] Seppilli and the original: ... la politica, le istituzioni his hygiene specialist students, they did locali, i sindacati e i lavoratori. Già negli not accept health education as a scientif- anni 60 noi avevamo forti legami con il ically validated instrument. Science for sindacato dei lavoratori metalmeccanici them was numbers, tables and statistical a Terni e a Perugia con i ceramisti, i significance, the opposite of qualitative lavoratori della Perugina, il tessile e in discourse, which for them was ridic- questo rapporto trovavamo sostegno ulous, when now we know it is essential. alle nostre idee e portavamo il tipo di The situation was difficult, it was a fight, lavoro che facevamo con gli operai but we were fighters. [Translation of the nelle fabbriche e ci serviva anche come original: ... idee si irradiarono poco.

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 189 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

Venivano qui da tutte le parti d’Italia, respect, but for many hygiene specialists però il modello non si propagava. Non this was hard to understand. [Translation si creavano altri punti in cui si faceva of the original: ... gli aspetti qualitativi la stessa cosa. La resistenza più grossa della ricerca li accettavano ma non li fu quella degli igienisti perché non solo capivano molto, non veniva colta l’im- non accettarono le proposte, ma le rifiu- portanza del metodo qualitativo. Era tarono, fecero guerra sia a [Alessandro] meglio un questionario somministrato Seppilli che ai suoi allievi igienisti, non a 100 persone che non una intervista accettarono che l’educazione sanitaria semi-strutturata di tipo qualitativo fatta a fosse uno strumento scientificamente un guaritore. Questo non ci è stato mai validato. La scienza per loro era quella detto esplicitamente, però la sensazione dei numeri, delle tabelle, la significa- era questa che la scienza non si fa con tività, invece il discorso di tipo quali- il dato qualitativo, naturalmente noi non tativo, oggi ormai siamo tutti d’accordo negavamo l’importanza del dato quan- che sia indispensabile, era ridicolo. La titativo, del dato statistico, diciamo che situazione fu difficile, era una lotta, non dice tutto, io non vedo nessun con- ma eravamo combattenti. (Briziarelli L, flitto, però per molti igienisti questa cosa 2014, min 18:00)] non era facile di capire. (Bartoli P, 2014, min. 42:47)] A second obstacle was the quantitative radicalization of the health professions and It was difficult for the academic anthro- the public health approach. The Perusine pologists to adapt themselves to the needs of model was based on an ethnographic, qual- health education. In this sense, the CSES lost itative and local perspective, which for the influence in the nineties: public health professionals implied a pro- fessional reformulation and a much more We agreed because, as it was known, we relativistic and respectful attitude towards had perceptions of health education that the subjects of the intervention. Training in were very open. However, there was a ethnographic techniques was much more strong dialectical tension that gave out complex and presented personal costs and in the end. We could not go any further, educational difficulties. Despite the presence and little by little the experience of the of the social sciences in the summer courses, experimental center came to an end. I the shortness of the interventions enabled ac- was the director of the center for many ceptance of years although I did not participate much in the course. The relationships ... the qualitative dimension of the remained but the course gradually lost its investigation […] but they did not really momentum. [Translation of the original: understand it, they did not understand Andavamo d’accordo perché avevano the importance of qualitative method. concezioni, come è noto, di educazione A questionnaire to be answered by sanitaria molto aperta, ma nel merito 100 people was better for them than a c’era una dialettica molto forte interna, semi-structured interview with a folk alla fine si è esaurita, più in là di tanto healer using the qualitative method. non potevamo andare avanti e poi man This was never explicitly said, but the mano si è spenta anche l’esperienza del feeling was that for them science was centro sperimentale. Io sono stata molti not done with qualitative data. We cer- anni nel direttivo del centro pur non par- tainly accepted the importance of quan- tecipando più al corso, i rapporti sono titative data, statistical data, but for us rimasti, però il corso si stava a mano a that was not enough, as not everything mano spengendo. (Falteri P, 2014, min. was reflected. I saw no conflict in this 48:00)]

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 190 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

Undoubtedly, the crisis of the CSES was called “Folletos para medicos” [Brochures model coincides with the ideological for physicians] which published 76 titles changes that occurred after the Ottawa and aimed at physicians between 1944 and 1964, Jakarta conferences. The precepts of the under the seal of the General Health Office. latter conference led to a sort of pragmatic Although several of these publications were action that implied a lesser degree of social, aimed at the general population, their actual personal and political commitment. For that dissemination is unknown, and therefore, it reason, this section can be concluded with is impossible to evaluate their impact on the the dialogue between Paóla Falteri and Paolo health behavior of the population.(77) Bartoli in Perugia in the spring of 2014: The most interesting attempt in this re- spect during the 1941-1959 period was the Bartoli: I would like to know why program of divulgadoras rurales [rural female the interest in anthropology has health promoters] of the Sección Femenina suddenly come to an end [Io vorrei [Women’s Section] of FET & JONS, along the SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 capire perché all’improvviso l’in- lines of the so-called barefoot doctors. This teresse per l’antropologia è svanito. project trained young women to work in (Bartoli P, 2014, min. 41:10)]. rural communities in programs that included childcare, good eating habits and hygiene Falteri: Paolo, don’t be silly, it’s because recommendations. Most of these women our approach was critical, though were recruited from the same communities in a constructive sense [Paolo sei un where they lived, as the women coming po’tonto, perché il nostro approccio era from the cities were not easily inserted into critico anche se in senso costruttivo. these contexts.(77) Moreover, in contrast to (Falteri P, 2014, min.41:25)] these modest programs, there were actions to extend the coverage of the SOE [Compulsory Sickness Insurance], which was limited to HEALTH EDUCATION IN FRANCO’S providing medical and health care services to SPAIN: from rural promoters those insured.(33) to ADOLFO MAILLO Spain did not join the Union inter- nationale pour l’Education sanitaire de la Population – today de International The new Francoist state maintained Union for Health Promotion and Education several health and educational proposals of the (IUHPE) – until 1959. When it finally joined, Second Republic to help fight hunger, child the General Health Office (DGS) began to mortality and infectious diseases. However, publish specific Brochures in their series health education was never a priority be- about international organizations,(78) as well cause the authorities of the General Health as about Claire E. Turner’s work on health Office (DGS) Dirección[ General de Sanidad] education in schools.(79) The main Spanish were skeptical about its effectiveness.(71) They contribution to the IUSSP was the organi- designed ads and promoted radio broad- zation of its 6th Conference in Madrid in casts(72,73,74) and, above all, they published two 1965, which was held in the headquarters of book collections. The first collection, called the Organización Sindical Española [Spanish “Al Servicio de España y del Niño Español” Trade Union Organization], an emblematic (ASENE), [At the Service of Spain and Spanish institution of Francoist Spain. This event was Children] published 311 books between 1938 considered an image strategy to give visibility and 1964(75) and reflected a nationalist and to the regime. The international participation pronatalist rhetoric. Its main goal was mor- was important: tality reduction, professional training and pro- paganda. Several of these books mentioned Seppilli had no relation with the Spanish health education.(76) The second collection but had a good relationship with the

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 191 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

Portuguese and Brazilian scientific de Enseñanza Primaria (CEDODEP), [Center world, because he had always written for Orientation and Didactic Documentation reviews and articles for a Brazilian in Primary Education], a technical insti- journal that was also published in tution that was in charge of implementing Portugal. In the 1966 conference held the reform of Francoist primary education. in Spain he met Bosch Marin, a pedia- In this reformist context, Maíllo was in- trician, who later became the president terested in the health education of school of the Unión Internacional de Educación children.(83) He believed in an interdisci- Sanitaria [International Union for Health plinary health education approach and that Education]. Marin was open-minded, such teachings could not be restricted to he was not a Franco supporter although school curriculum contents, as he was in- he had been introduced as a part of the fluenced by the Perusine summer course(68) Francoist structure. The Conference was and by his readings of anglo-saxon anthro- held in the Casa de Falange [House of the pology and sociology.(84) Recent studies(85) Phalanx] and in the trade unions. There consider that his attitude was the result of his we met an enthusiastic and lively group wide field experience in rural communities, of people from Argentina and Brazil, where he first worked as a teacher, and later who brought a gust of fresh air into the within the sphere of literacy campaigns. He conference to which the regime offered believed that peasants could be illiterate but no opposition. [Translation of the ori- not uncivilized and that it was necessary to ginal: Seppilli non aveva relazioni con first do work that included local dimensions gli spagnoli, però le aveva con il mondo in geographical, economic, sociological or scientifico portoghese e brasiliano cultural terms before launching any literacy perché per tutta la sua vita fece recen- programs. A previous knowledge of the local sioni e articoli per una rivista brasiliana sphere could enable “community-based edu- che c’era anche in Portogallo. In Spagna cation.” Maíllo was the ideologist behind the alla conferenza del ‘66 aveva legato con educational action related to the opening of quello che diventò il presidente dell’U- public spaces for watching television in the nione internazionale di Educazione alla rural communities (Tele clubs).(86) His ideas Salute, Bosch Marin, che era un pediatra. had little impact due to the contradictions Una persona aperta, non era franchista, that such model implied during Francoism anche se fu presentato come un uomo and due to the arrival of a new generation of dell’apparato franquista. La conferenza academic technocrats into Spain. si tenne nella Casa della Falange, nei sindacati. Noi andammo lì e trovammo un mondo molto vivace: argentini, bra- Perugia during the Spanish transition to siliani che portarono nella conferenza democracy venti nuovi che il regime non impedì. (Briziarelli L, 2014, min. 45:00)] The limitations of Francoist health ed- ucation, except for the nutrition education The conference had little impact on activities introduced in the sixties,(87,88) high- Spanish health policies. Coinciding with lights the gap existing between Spain and the the event, a collective work on health ed- developments in other European countries. ucation(80) was published, with the par- Franco’s regime opted for Social Security, a ticipation of pedagogue Adolfo Maíllo disease-centred healthcare approach which (1901-1995),(81) the mastermind behind was criticized(89) and yet upon which the the attempts to import the new model of regime constructed legitimacy. From the “school health education” during the sixties. sixties onwards, this insurance engendered a (82) Maíllo was then the director of the Centro debate that would end in the health reform of de Orientación y Documentación Didáctica the democratic transition.(90) The new health

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 192 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

organizational scheme did not fully break related to medicine or similar concerns in away from the curative healthcare proposed the journal Jano: Medicina y Humanidades, by the Francoist model,(91) despite the crit- between 1985 and 1995, was indeed signif- icism regarding the role that primary health icant. The publication was distributed at no care and health education should play in it charge to physicians throughout the country. and which sought to align the Spanish reform The connection between these sectors with Alma Ata’s guidelines. and professional anthropology in Spain took Health education played a marginal a long time to be established due to the slow role in the debates of the seventies, a situ- pace with which anthropology was institu- ation which started to change with the cre- tionalized in the country.(92) Between 1988 ation of the Ministry of Health in 1977. At and 1989, at the request of Lluis Salleras the beginning of the eighties, renewed ideas along with Ignasi de Juan Creix, the Institut on health education emerged. During that Català de la Salut organized in Barcelona decade a third of the CSES summer course a course, in which public health specialists SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 attendees were Spaniards: and medical anthropologists such as Paolo Bartoli,(93) Eduardo Menéndez, Oriol Romaní The participation of the Spaniards was and Josep M. Comelles participated. This stimulating; most of them were women course continued to be delivered in different who had lots of energy, and a desire to cities of Spain, while the medical anthro- do and to change things that was much pology of Italy sponsored the postgraduate stronger than in Italy during those years training project of the Universitat Rovira i of transition. Sometimes they were Virgili in Tarragona, in 1994. even more competent. [Translation of The CSES was a remarkable teaching insti- the original: ... era entusiasmante la tution for an entire generation of specialists in partecipazione degli spagnoli, in gran public health and community nursing, with the parte donne, avevano un’energia, un most progressive of profiles. In the 1990s, the desiderio di fare e di cambiare molto progressive Spanish public health specialists superiore agli italiani, in quegli anni di stated, in private, that the CSES model was a transizione, spesso erano anche più pre- thing of the past. Nevertheless, two decades parati. (Falteri P, 2014, min. 15:00)] later many of them are still active in institu- tions such as the Sistema de Asesoramiento y They provided an element of action to Recursos en Educación para la Salud [SARES, the classes; sometimes students are a System of Consultancy and Health Education little passive, you speak and they just Resources] of the Government of Aragón,(94) listen; but they were different, there was while local community health services keep much more liveliness and participation this flame alive. with them around [Translation of the original: ... hanno aportato un elemento di attività, spesso gli allievi sono un po’ Conclusions passivi, tu parli e loro ascoltano, mentre con loro c’era molta più effervescenza. (Bartoli P, 2014, min. 16:30)] In the eighties and nineties we traveled all throughout Italy to the USLs [Unità Some of them stayed for a longer time. Sanitaria Locale, from Italian, Local Later, local entities in Madrid, Zaragoza and Health Units], which are currently called other cities organized local courses. The an- ASL o AUSL [Azienda Unità Sanitaria thropology contents in those courses were a Locale], but then they never called us novelty to the Spanish professionals. For many again; in Italy there was a strong interest of them the role played by the publication of for prevention and health education but some 65 articles on anthropological topics now this interest has waned [Translation

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 193 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

of the original: Noi negli anni 80-90 as three of the most important reformers, giravamo in tutta Italia nelle USL ora si Henderson, Lenninger and Collière(96,97,98) chiamano ASL o AUSL, ma poi non ci earned their PhDs in anthropology. Today, it hanno chiamato più da nessuna parte, is not surprising to find Alessandro Seppilli’s c’era nel paese un’attenzione molto forte definition of health education, included in ai temi della prevenzione e dell’educa- this article, in Spanish manuals and text- zione sanitaria, mi sembra che quest’at- books about medicine and community tenzione sia venuta meno. (Falteri P, nursing.(99) 2014, min 01:01:20)] From a historical perspective, the CSES was a cutting-edge endeavor and a point of The over four decades of perspective of- reference in a brilliant period in the history of fered by Paola Falteri highlight a substantial public health in general and health education change that intensified after the Jakarta in particular. Between the San Francisco Conference and which brings to the forefront Conference and the Jakarta Conference in the progressive, subaltern nature of the local 1997, we may consider that the hegemony participatory projects that were so important of social democratic and Christian social in the 1950s. It cannot be denied that in the thinking, with wide demands for democratic foundational projects, the presence of phy- radicalization, helped encourage collective sicians was extremely important, whereas civil action at the local scale, in contrast to community nursing has evidently gained individual empowerment.(62) The influence ground in the last decades. In the initial CSES, in the conceptualization of health education medical anthropology was taught to fill a for- was clear. mative gap in social sciences. It was essential From the perspective of applied social to compensate the growing biologicism in sciences in Europe, the CSES was an avant- medicine, but above all to offer research garde and innovative experiment due to its tools based on ethnography that were very explicit and critical incorporation of anthro- important to understanding local cultural di- pology into its agenda. The paternal-filial versity. In the years when the Perusine centre relationship between Alessandro and Tullio was launched, medical anthropology stricto Seppilli cannot be reduced to an accidental sensu did not exist as such.(95) Applied an- relationship. Alessandro Seppilli, whose wife thropology from the United States and pro- was Anita Schwarzkopf, also an anthropol- gressive pedagogy were imported critically ogist, first approached anthropology with to substantiate health education, which was the aim of finding out the contribution that innovative in Europe. this social science could make to the under- This scenario has changed greatly, es- standing and diagnosis of local health con- pecially due to the role assumed by com- cerns. Tullio Seppilli knew how to construct munity nursing in health education and an organic narrative rooted in his mentor health promotion, precisely as one of the Ernesto de Martino, who went beyond the effects of Alma Ata and of the goals outlined boundaries of the relativism that characterized in the Ottawa and Jakarta Conferences. In US cultural anthropology. Furthermore, his the new community nursing and in public followers, who were involved in the CSES health manuals, the social sciences, both so- project, had no objections to responding to ciology and medical anthropology, occupy the demands of applied anthropology made a central role in the conceptual definition by health care professionals, in view of their and theoretical synthesis. From the instru- political and social commitment. mental point of view, other methods such as Possibly, in Europe, only Italy had the grounded theory have in part taken the place right conditions to carry this innovative ini- of ethnography. They include contents and tiative forward. The rigid academicism of techniques that are present in the academic European medicine and anthropology of those curricula of general nursing study curricula, days could only be broken with the renewed

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 194 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

social commitment of professionals, both physicians and other health professionals as well as academic anthropologists. The impos- sibility of such commitment and participation account for the failure of health education in the late years of Francoism and its late success during the Spanish democratic transition. SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

ACNOWLEDGMENTS 3. Rosen G. De la policía médica a la medicina social: ensayos sobre la historia de la atención a la This research was funded by the Ministry of salud. México: Siglo XXI Editores; 1985. Economy and Competitiveness of Spain through the projects “De la propaganda sanitaria a la edu- 4. Cosmacini G. Storia della medicina e della cación para la salud: ideología, discursos y saberes sanità in Italia: dalla peste nera ai giorni nostri. en la España de Franco (1939-1975)” HAR2012- Roma: Laterza; 2015. 34588 [From health propaganda to health edu- 5. Rodríguez Ocaña E. La constitución de la cation: ideology, discourse and knowledge in medicina social como disciplina en España Franco’s Spain] and “Reforma sanitaria y pro- (1882-1923). Madrid: Ministerio de Sanidad y moción de la salud en el tardofranquismo y la Consumo; 1987. transición democrática: nuevas culturas de la salud, la enfermedad y la atención” HAR2015- 6. Castejón-Bolea R, Perdiguero-Gil E, Piqueras- 64150-C2-1-P (MINECO/FEDER, UE) [Health Fernández JL. La imágenes de la salud: cartelismo reform and health promotion in the final years of sanitario en España (1910-1950). Alicante: Instituto Francoism and the democratic transition: new cul- Alicantino de Cultura “Juan Gil Albert”, Consejo tures of health, disease and care]. Our thanks to Superior de Investigaciones Científicas; 2012. Tullio Seppilli (who died in 2017), Paolo Bartoli, Paola Falteri, Maria A. Modolo, Anna Ferrari, 7. Diasio N. La science impure: anthropologie et Maurizo Mori (who died in 2016) and Lamberto médecine en France, Grande-Bretagne, Italie, Pays- Briziarelli, all of whom used to or currently work Bas. Paris: Presses Universitaires de France; 1999. or collaborate with the Centro Sperimentale per l’Educazione Sanitaria of Perugia (Italy). 8. Bartoli P. Farmaci e sacramenti: Organizzazione sanitaria e parroci di campagna nella seconda mettè del’Ottocento. Sanità, Scineza e Storia. 1985;2:121-140. REFEREnces 9. Comelles JM. Da superstizione a medicina po- 1. Seppilli A. Educazione sanitaria: Lezioni e con- polare: La transizionae da un concetto religioso a ference. Perugia: Università degli Studi di Perugia; un concetto medico. AM: Rivista della Società Ita- 1964. liana di Antropologia Medica. 1996;(1-2):57-87.

2. Organización Mundial de la Salud. Declaración 10. Comelles JM. From superstition to folk me- de Yakarta sobre la promoción de la salud en el dicine: The transition from a religious to a me- siglo XXI [Internet]. 1997 [cited 8 Sep 2016]. Avai- dical concept. Medical Anthropology Theory. lable from: http://tinyurl.com/lkxczj5. 2016;3(2):269-305.

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 195 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

11. Bartoli P, Falteri P. La medicina popolare in 27. Marias Cadenas S. Por España y por el campo: Umbria dalla fine dell’800 ad oggi: permanenze la Sección Femenina en el medio rural oscense e transformazioni. In: Pastore A, Sorcinelli P, (1939-1977). Huesca: Instituto de Estudios Al- (eds.). Sanità e Società Emilia-Romagna, Toscana, toaragoneses; 2011. Marche, Umbria, Lazio Secoli XVI-XX. Udine: Ca- samassima; 1987. p. 167-208. 28. Pons Pons J, Vilar Rodríguez M. Labour re- pression and social justice in Franco’s Spain: the po- 12. Bronzini GB. Antropologia e medicina po- litical objectives of compulsory sickness insurance, polare: Note sugli studi dei positivisti italiani. La 1942–1957. Labor History. 2012;53(2):245-267. Ricerca Folklorica. 1983;(8):13-17. 29. Cenarro Lagunas Á. La Sonrisa de Falange: 13. Cirese AM. Cultura egemonica e culture sub- Auxilio Social en la guerra civil y en la posguerra. alterne: Rassegna degli studi sul mondo popolare Barcelona: Crítica; 2006. tradizionale. 2a ed. Palumbo: Palermo; 1973. 30. Richmond K. Las mujeres en el fascimo 14. Cocchiara G. Storia del folklore in Italia. Pa- español: la sección femenina de la falange lermo: Sellerio; 1981. 1934-1959. Madrid: Alianza Editorial; 2004.

15. Angioni G. Une démo-ethno-anthropologie? 31. Instituto Nacional de Previsión. Alocución del Des pères fondateurs aux problèmes actuels. Eth- Sr. Ministro de Trabajo sobre el Seguro de Enfer- nologie Française. 1994;24(3):475-483. medad. Madrid: Instituto Nacional de Previsión; 1953. 16. Cuturi F. Nuevas tendencias en los principales países de Europa Occidental: Italia. Anales de la 32. Aznar S. Las fronteras de los Seguros Sociales. Fundación Joaquín Costa. 1989;(6):84-91. Madrid: Publicaciones del Instituto Nacional de Previsión; 1942. 17. Comelles JM, Prat J. El Estado de las Antropo- logías: Antropologías, folclores y nacionalismos en 33. Vilar-Rodriguez M, Pons-Pons J. The intro- el Estado Español. Antropologia. 1992;(3):35-61. duction of sickness insurance in Spain in the first decades of the Franco dictatorship (1939-1962). 18. Gramsci A. Los intelectuales y la organización Social History of Medicine. 2012;26(2):267-287. de la cultura. México: Nueva Visión; 1975. 34. Rodriguez-Ocaña E. La asistencia médica co- 19. Gramsci A. Cuadernos de la Carcel 4: Literatura lectiva en España hasta 1936. In: Historia de la y Vida Nacional. México: Juan Pablos Editor; 1986. acción social pública en España: beneficencia y previsión. Madrid: Centro de Publicaciones, Mi- 20. Gallego FG. El evangelio fascista: la formación nisterio de Trabajo y Seguridad Social; 1990. p. de la cultura política del franquismo (1930-1950). 321-361. Madrid: Crítica; 2014. 35. Fonio C, Agnoletto S. Surveillance, repression 21. Giorgi C. Le politiche sociali del fascismo. and the welfare state: Aspects of continuity and Studi Storici: Rivista Trimestrale dell’Istituto discontinuity in post-fascist Italy. Surveillance & Gramsci. 2014;55(1):93-108. Society. 2013;11(1/2):74-86.

22. Giorgi C. L’Istituto nazionale fascista di pre- 36. Atenza Fernández J, Martínez Pérez J, (eds.). El videnza sociale: temi e problemi. Le Carte e la Centro Secundario de Higiene Rural de Talavera Storia. 2003;IX(2):165-174. de la Reina y la sanidad española de su tiempo [In- ternet]. Toledo: Junta de Comunidades de Castilla- 23. Taroni F. Politiche sanitarie in Italia. Roma: Il La Mancha; 2001 [cited 26 Oct 2016]. Available Pensiero Cientifico; 2011. from: http://tinyurl.com/kygk8ka.

24. Vinci S. Il fascismo e la previdenza sociale. 37. Terron Bañuelos A, Comelles JM, Perdi- Annali della Facoltà di Giurisprudenza di Taranto. guero-Gil E. Schools and Health Education in 2011;IV:709-729. Spain during the Dictatorship of General Franco (1939-1975). History of Education Review. 2017 25. Thomàs i Andreu JM. La Falange de Franco: (en prensa). fascismo y fascistización en el régimen franquista, 1937-1945. Barcelona: Plaza & Janés; 2001. 38. Casero E. La España que bailó con Franco: Coros y danzas de la Sección Femenina. Madrid: 26. Gil Pecharromán J. El Movimiento Nacional: Nuevas Estructuras; 2000. 1937-1977. Barcelona: Planeta; 2013.

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 196 Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E.

39. Morán G. El maestro en el erial: Ortega y shows. Actes d’Història la Ciència i la Tècnica. Gasset y la cultura del franquismo. Barcelona: 2014;7:17-34. Tusquets; 1998. 51. Modolo MA, Mamon J. Long way to Health 40. Perdiguero-Gil E, Comelles JM. Folklore Promotion Trough IUHPE Conferences 1951-2001. médico y educación sanitaria en las dos primeras Perugia: Interuniversity Experimental Centre for décadas del Franquismo. In: Campos Marínn R, Health Education; 2001. Gonzaléz de Pablo A, Porras Gallo I, Montiel L, (eds.). Medicina y poder político. Madrid: So- 52. Dorolle P. Ethnologie et problèmes sanitaires. ciedad Española de Historia de la Medicina; 2014. Revue Internationale de la Croix-Rouge et Bu- p. 289-293. lletin international des Societes de la Croix-Rouge. 1953;35(412):301–16. 41. Castillo de Lucas A. Folkmedicina: medicina popular, folklore médico, etnomedicina, de- 53. World Health Organization. Teacher pre- moiatria etnoiátrica. Barcelona: Dossat; 1958. paration for health education. Report of a Joint WHO/UNESCO Expert Committee [Internet]. 42. Perdiguero E, Comelles JM. Medicina popular, Geneva: World Health Organization; 1960 (Tech-

SALUD C OLE CT I V A . 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 compromiso profesional y educación sanitaria en nical Reports Series No 193) [cites 26 Oct 2016]. España. Scripta Ethnologica. 2014;(XXXVI):7-40. Available from: http://tinyurl.com/kbh4e2r.

43. Campos J, Miguel J. Sociólogos-de-bata- 54. Aguirre Beltrán G. La medicina indígena. blanca y médicos-con-barba: Relaciones entre América Indígena. 1947;7(2):109-125. las ciencias sociales y la medicina en España. Revista Española de Investigaciones Sociológicas. 55. Aguirre Beltrán G. Antropología médica: sus 1981;15(81):133-141. desarrollos teóricos en México. Veracruz: Univer- sidad Veracruzana; 1994. 44. Gramsci A. La questione meridionale. Torino: Eunadi; 1945. 56. Caudill W. Applied anthropology in medicine. In: Kroeber A, (ed.). Anthropology Today. Chicago: 45. World Health Organization. Expert Com- Chicago University Press; 1953. p. 771-806. mittee on School Health Services: Report on the First Session [Internet] Geneva: World Health Or- 57. Paul BD. Health, culture and community: case ganization; 1951 (Technical Report Series No 30) studies of public reactions to health programs. [cited 26 Oct 2016]. Available from: http://tinyurl. New York: Russell Sage Foundation; 1955. com/knsdkz5. 58. Seppilli T. Contributo alla formulazione dei 46. Comelles JM, Riccò I, Perdiguero-Gil E. Tullio rapporti tra prassi igienico-sanitaria ed etnologia. Seppilli, l’éducation pour la santé et la fondation In: Atti della XLV Riunione della Società Italiana de l’anthropologie médicale italienne. Curare. per il Progresso delle Scienze. Roma: Tipografia 2014;37(2):85-99. Editrice Italia; 1955. p. 3-20.

47. Redondo Rincón MG. El Seguro Obligatorio 59. Comelles JM. Writing at the margin of the de Enfermedad en España: responsables técnicos margin: medical anthropology in Southern Europe. y políticos de su implantación durante el fran- Anthropology & Medicine. 2002;9(1):7-23. quismo. [Tesis de doctorado]. Madrid: Univer- sidad Complutense de Madrid; 2013. 60. Organización Mundial de la Salud. Confe- rencia Internacional sobre Atención Primaria de 48. Gil Pecharromán J. Con permiso de la auto- Salud, Alma-Ata, URSS, 6-12 de septiembre de ridad: la España de Franco (1939-1975). Madrid: 1978 [Internet]. Washington DC: Organización Temas de Hoy; 2008. Panamericana de la Salud [cited 8 Sep 2016]. Available from: http://tinyurl.com/kg8s8gv. 49. Comelles JM. Preocupaciones, enfermedades folk y educación en la Cataluña franquista (1939- 61. Organización Mundial de la Salud. Carta de 1959). In: Perdiguero-Gil E, Comelles JM, (eds.). Ottawa para la Promoción de la Salud [Internet]. Medicina y Etnografía en Cataluña. Madrid: Washington, DC: Organización Panamericana de Consejo Superior de Investigaciones Científicas; la Salud; 1986 [cited 2016 Sep 8]. Available from: 2015. p. 171-202. http://tinyurl.com/lp6lfcr.

50. Comelles JM, Brigidi S. Fictional encounters 62. Comelles JM. La dévolution au domaine du and real engagements: the representation of me- local des politiques étatiques de santé et de pro- dical practice and institutions in Medical TV tection sociale. In: Assier-Andrieu L, Sala R, (eds.).

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC health education and medical anthropology in Europe: the cases of Italy and Spain 197 SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196

La ville et les pouvoirs. Perpignan: Presses Uni- el franquismo: notas bibliométricas sobre el pro- versité de Perpignan; 2000. p. 539-556. grama “Al servicio de España y del niño español”. Asclepio. 2007;59(1):285-314. 63. Levi C. Cristo si è fermato a Eboli. Firenze: Eunadi; 1945. 76. Bosch Marín J, Blanco Otero M, Cañellas F, Bravo E. Salud y educación sanitaria. In: Al Ser- 64. Pazzini A. La medicina popolare in Italia. vicio de España y del Niño Español No 298. Trieste: Zigiotti; 1948. Madrid: Direccion General de Sanidad; 1962.

65. De Martino E. Il mondo magico: prolegomeni 77. Perdiguero-Gil E, Comelles JM. The weakness a una storia del magismo. Torino: Einaudi; 1948. of health education in the Francoist system. European Social Science History Conference 66. Bernardi G. Magia psicoterapeutica: Sul tema Session: Intersections between Health and Edu- del “rito e cambiamento psicoterapeutico” in E cation throughout the XXth Century. Valencia, 29 de Martino e G Bateson. La Ricerca Folklorica. de marzo-2 de abril de 2016. 1988;(17):37-41. 78. Bermúdez Pareja M. Sanidad internacional. 67. De Martino E. La terra del rimorso. Milano: Il Organización Mundial de la salud (Folleto para sa- Saggiatore; 1961. nitarios). Madrid: Dirección General de Sanidad; 1956. 68. Atti dell’1, corso estivo di educazione sanitaria: Perugia, 4-21 settembre 1958. Perugia: Centro 79. Turner CE. Preparación del maestro en edu- Sperimentale di Educazione Sanitaria; 1959. cación para la salud. In: Al Servicio de España y del Niño Español No 264. Madrid: Dirección Ge- 69. Morgan LM. The medicalization of anthro- neral de Sanidad; 1961. pology: a critical perspective on the critical- clinical debate. Social Science & Medicine. 80. De la Quintana P, Aracama Gorosabel JJ, 1990;30(9):945-950. Maillo A et al. Problemas de educación sanitaria: Curso desarrollado como contribución a la VI Con- 70. Comelles JM. El renacimiento de lo cultural ferencia de la Unión Internacional de Educación en el Estado del Bienestar. AM: Rivista della So- Sanitaria. Madrid: Publicaciones de la Sociedad cietà Italiana di Antropologia Mèdica. 2004;(17- Española de Higiene y Medicina Social; 1965. 18):87-108. 81. Maillo A. Curriculum Vitae: Hitos y huellas 71. Perdiguero-Gil E. Propaganda y “educación del camino (1901-1984). Madrid: Gráficas Im- sanitaria” en el ideario médico-social del Fran- presas; 1988. quismo a través de la revista SER. In: Perdiguero- Gil E, (ed.). Política, salud y enfermedad en 82. Terrón Bañuelos A. La educación sanitaria España: de la transición democrática al desarro- escolar, una propuesta curricular importada para llismo. Alicante: Editorial Electrónica de la Uni- la escuela española del Desarrollismo. Education versidad Miguel Hernández de Elche; 2015. Policy Analysis Archives/Archivos Analíticos de Políticas Educativa. 2015;23(19):1-31. 72. Jiménez Lucena I, Ruiz Somavilla MJ, Caste- llanos Guerrero J. Un discurso sanitario para un pro- 83. Maíllo A. Concepto y límites de la educación yecto político: La educación sanitaria en los medios sanitaria escolar. Vida Escolar. 1961;26:2-8. de comunicación de masas durante el primer fran- quismo. Asclepio. 2002;LIV(1):201-218. 84. Maíllo A. Antropología de las comarcas subde- sarrolladas y educación fundamental. In: La edu- 73. Bravo J. Algunas consideraciones sobre propa- cación en la sociedad de nuestro tiempo. Madrid: ganda en general y propaganda sanitaria en parti- Editorial Escuela Española; 1961. p. 247-264 cular. Madrid: DGS; 1951. 85. Mainer Baque J, Mateos Montero J. Saber, 74. Cayuela Sánchez S. Psiquiatría y educación poder y servicio: Un pedagogo orgánico del Estado: socio-sanitaria en la España franquista. In: Campos Adolfo Maíllo. Valencia: Tirant lo Blanc; 2011. Marín R, Gonzaléz de Pablo A, Porras Gallo I, Montiel L, (eds.). Medicina y poder político. 86. Maíllo A. Educacion popular y teleclubs. In: Madrid: Sociedad Española de Historia de la Me- Cultura y educación popular. Madrid: Editora Na- dicina; 2014. p. 307-311. cional; 1967. p. 289-331.

75. Salazar Agulló M, Martínez Marco, EBerna- 87. Trescastro-López EM, Bernabeu-Mestre J, beu-Mestre J. La salud materno-infantil durante Galiana-Sánchez ME. Nutrición y salud pú-

Salud Colectiva | Universidad Nacional de Lanús | ISSN 1669-2381 | EISSN 1851-8265 | doi: 10.18294/sc.2017.1196 198 COMELLES JM, RICCÒ I, TERRÓN BAÑUELOS A, PERDIGUERO-GIL E.

blica: políticas de alimentación escolar en la 93. Bartoli P. Antropología en la educación sa- España contemporánea (1931-1978). Asclepio. nitaria. Arxiu d’Etnografi a de Catalunya. 1989;7: 2013;65(2):26. 17-24.

88. Trescastro López EM, Trescastro López S. La 94. Gobierno de Aragón. Sistema de asesora- educación en alimentación y nutrición en el medio miento y recursos en educación para la salud escolar: el ejemplo del Programa EDALNU. Re- [Internet]. c2017 [cited 26 Oct 2016]. Available vista Española de Nutrición Humana y Dietética. from: http://tinyurl.com/l2ree3e. 2013;17(2):84-90. 95. Comelles JM, Martínez-Hernáez A. Enfer- 89. Comelles JM, Perdiguero-Gil E. Las resistencias medad, cultura y sociedad: Un ensayo sobre las al Seguro Obligatorio de Enfermedad (1942-1967): relaciones entre la antropología social y la me- la perspectiva de profesionales, trabajadores y ciu- dicina. Madrid: EUDEMA; 1993. dadanos. IX Encuentro de Investigadores del Fran- quismo: 80 años de la Guerra Civil Española; 10 y 96. Conti MJ. Enfermería y antropología: la lite- 11 de marzo de 2016; Granada, España. ratura internacional. In: Comelles JM, Martorell MA, Bernal M. Enfermería y antropología: Pade- SALUD COLECTIVA. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196 90. De Miguel JM. La sociedad enferma: Las bases ceres, cuidadores y cuidados. Barcelona: Icaria; sociales de la política sanitaria española. Madrid: 2009. p. 219-234. Akal; 1979. 97. Casadó L. Antropología y enfermería: Revisión 91. Comelles JM. De Girón de Velasco a Lluch: teórica y expectativas. In: Comelles JM, Martorell La constitución del modelo anglo-cubano-falan- MA, Bernal M. Enfermería y antropología: Pade- gista de Seguridad Social en España. In: Campos ceres, cuidadores y cuidados. Barcelona: Icaria; R, Montiel L, Huertas R, (eds.). Medicina, ideo- 2009. p. 235-245. logía e historia en España (siglos XVI-XXI). Madrid: Consejo Superior de Investigaciones Científi ca; 98. Lionetti R. Antropologia e professione infer- 2007. p. 377-388. meristiche. Brescia: Grafo Edizioni; 1987.

92. Perdiguero-Gil E, Martínez-Hernáez Á, Co- 99. Seppilli A. Educazione sanitaria e salute pu- melles JM. Medical anthropology in Spain: A blica. Sistema Salute. 2014;58(3):271-276. historical perspective. Jahrbuch fur Europaische Ethnologie. 2014;9:216-249.

CITATION Comelles JM, Riccò I, Terrón Bañuelos A, Perdiguero-Gil E. Health education and medical anthropology in Europe: the cases of Italy and Spain. Salud Colectiva. 2017;13(2):171-198. doi: 10.18294/sc.2017.1196.

Received: 30 October 2016 | Modifi ed: 12 January 2017 | Accepted: 6 Febraury 2017

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Attribution — you must attribute the work in the manner specifi ed by the author or licensor (but not in any way that suggests that they endorse you or your use of the work). Noncommercial — You may not use this work for commercial purposes.

http://dx.doi.org/10.18294/sc.2017.1196 This article was translated by María Victoria Illas.

Salud Colectiva | Creative Commons Attribution-NonCommercial 4.0 International License | BY - NC