- 1 Although this article is the result of joint research and reflection, the introduction and section (...)
1The Italian Western Alps, as well as many mountain areas and rural European territories in general, are experiencing a demographic season characterized by a significant ageing of the population, due to the intertwining of multiple factors. While, on the one hand, the improvement in quality of life and life expectancy for the elderly population is certainly relevant, equally significant are the outcomes of mobility phenomena that often result in the young component of the population leaving the valleys to pursue their professional and life paths in urban or peri-urban areas (Augère-Granier, McEldowney, 2020). As highlighted by the most recent reports released by the European Commission, the ageing of the population is a particularly relevant phenomenon in the dynamics of demographic change involving the European population. This is demonstrated by the interest shown not only in terms of research, but also in the development of policies that such a scenario requires (European Commission, 2023a; 2023b). As it can easily be guessed, the attention of the policymakers, both at a European and at a national level, is particularly focused on the sphere of health, well-being and personal care.
2This essay aims to offer some anthropological and sociological considerations, starting from an Italian case study, that of Chiusella Valley, a mountain area in the Piedmontese Prealps. The organization of the National Health System (Servizio Sanitario Nazionale) has been going through a process of change for some years now, especially as far as primary and territorial care is concerned (Maciocco, 2019; Brambilla, Maciocco, 2022). Furthermore, this area is now undergoing a significant evolution with the application of the socio-health policies promoted in response to the emergency due to the Covid-19 pandemic, which in Italy have found a framework in the so-called National Recovery and Resilience Plan (Piano Nazionale di Ripresa e Resilienza). In this regard, it seems particularly relevant to investigate how the effects of this process of change manifest in a territorial context characterized by elements of peripherality and marginality.
- 2 In English “Chiusella Valley Laboratory”. All translations from Italian are by the authors.
3In the first section of this article, we will present the theoretical and methodological framework of our investigation, as well as its institutional and territorial setting. The study is part of a multidisciplinary research-action project called “Laboratorio Valchiusella2”, promoted by the University of Turin, which aims, on the one hand, to integrate the socio-anthropological context into nursing education and, on the other hand, to foster the understanding of the community and valley’s healthcare needs in the complex post-pandemic era. Starting from the observation of a local scenario characterized by decade-long processes of deindustrialization, of decrease and remodelling of social-health services and of a noticeable ageing of the population, we will offer, in the second part, a socio-anthropological and territorial framework of the valley, and show the important role it plays in the valley’s complex healthcare system. In the third section, we will present the results of our ethnographic research to then answer, in conclusion, the questions that underpin our perspective: how do changes in health policies in Chiusella Valley intertwine with the characteristics of the local sociocultural fabric? And, above all, how does this context conditions the ways in which the inhabitants of the valley manage, on a personal, family and community level, the delicate ageing phase?
4Over the last five years, Chiusella Valley, in the Province of Turin, has become the subject of a research-action project, promoted by the Ivrea Branch of the Degree Course in Nursing of the University of Turin. The laboratory interconnects fieldwork research with academic teaching, with the aim of identifying a mountainous territorial context in which to experiment innovative didactic paths for future nurses. This project stems from the awareness of the need for a health service that increasingly valorizes health promotion actions taking a strong territorial perspective.
5In marginal areas, and mountainous ones in particular, problems in terms of health and, more generally, of psycho-physical and social well-being often emerge only when they reach a critical point (Christensen et al., 1998; Osti, Bock, 2016). As already discussed by scholars at the national level, the awareness of the importance of the relationship between health and territorial systems is now solid (Maciocco, 2019; Primary Health Care, 2021; Brambilla, Maciocco, 2022; Forum Disuguaglianze Diversità, 2024) and it is evident how this relationship can be particularly critical when the territorial dimension is characterized by the elements of marginality typical of mountainous areas: dispersion of settlements, progressive weakening of territorial medicine, strong structural problems of the public transport network. The marginalization process involving vast portions of the Italian mountains has been, over the last few years, the subject of both anthropological research (Zanini, Viazzo, 2020) and of a series of theoretical and political proposals developed around the National Strategy for Inner Areas (Strategia Nazionale per le Aree Interne – SNAI). These studies point out that inequalities in the access to essential services closely affect citizenship rights, like the right to health. In fact, citizenship rights decrease when the distance to urban centres where these services are provided increases (Carrosio, 2019, p. 69). This leads to a significant impoverishment in terms of social inclusion and of quality of life for the population residing in the most fragile areas.
6From the very first pilot phases of the laboratory, starting in 2018, we highlighted the usefulness of imagining a teaching setting that would allow future health professionals to understand the health needs expressed by marginal communities. Some elements of marginality, defined by territorial, social, economic and demographic characteristics (Carrosio, Osti, 2017), can be detected in Chiusella Valley and are the result of an economic and social historical trajectory marked by the legacy of the mining industrial past. As we will discuss later in the paper, the mutualistic experiments connected to the mining past, as well as the “post-mining” (Pusceddu, Zerilli, 2024) valley, have been later shaped by the significant presence of the Olivetti factories, and by the recent process of deindustrialization that followed the closure of the Olivetti in the 1990s.
7It is in this context that our laboratory takes place. It develops through a participatory co-designing path that sees, alongside the academic component, the participation of many different actors such as local administrators and stakeholders of the third sector. A fundamental characteristic of the workshop is its immersive dimension. Indeed, it does not take place within a “classic” healthcare facility, but “on the field”, in local communities. Students are didactically accompanied by Roberta Clara Zanini, lecturer in Medical Anthropology and co-author of this article, as well as by Lucia Pavignano, lecturer in Family and Community Nursing (Zanini, 2022; 2023). The aim of the experimentation is to promote, among the nursing students, the skill to “act anthropologically” (Cornwall, 2018). This implies to understand the socio-demographic and cultural context and to develop the awareness of the importance to position themselves within the local social fabric. It also aims at encouraging the students to imagine their future profession as a work of community development, capable of promoting social and relational capital and fostering a “community of care” (Care Collective, 2020).
8Starting in the spring of 2021, two researchers, co-authors of this article, joined the nurses-in-training and made their expertise, respectively in the fields of medical anthropology and of the sociology of the territory, available to the laboratory. Their ethnographic investigation, that we present in this paper, explored informal caregiving experiences in Chiusella Valley and was aimed at understanding the intimate nuances of caregiving in a context characterized by institutional deficits. Moreover, the research investigated the significant role played by family members and non-professional volunteers in enabling older individuals to cope with ageing and illness.
- 3 In addition to the interviewees, members of local institutions and administrations also participate (...)
9In addition to the practice of participant observation typical of the intensive anthropological research, which lasted a total of eight months between spring 2022 and summer 2023, 44 in-depth interviews were carried out with a series of privileged interlocutors, identified throughout the valley among those who had personally experienced being a caregiver or care recipient in the family environment. We paid particular attention to the theme of ageing and to the problems connected to cognitive decline. The interviews were divided into three sections: the family and personal history, the caregiving experience (as caregiver or care recipient), and the elements that facilitated/hindered caregiving in Chiusella Valley’s context. The target population was obtained in a non-probabilistic manner, consistent with the methodological assumptions and aims of the research, by reasoned choice and snowball sampling3.
10The theoretical framework that underpinned the investigation brings three interconnected trajectories into dialogue. The conceptual pillar based on the anthropology of care (Gómez, 2015; Quaranta et al., 2018) has been enriched by reflections on local socio-demographic dynamics provided by the dialogue between the territorial perspective and the study of marginal areas (Magnaghi, 2020; Battaglini, 2024; Mela et al., 2024). Moreover, our theoretical frame finds further elements of nourishment in the most recent research within Alpine Studies, mainly on the topics of demographic dynamics and of the changes in the composition of the Alpine population (Varotto, 2020; Viazzo, Zanini, 2022; Zanini, 2023). Analysing the practices and micro-politics of care in a small-scale context allowed us to conduct an ethnography of the valley as a whole, and to observe its social and demographic stratifications as well as the complex political and cultural dynamics that link the valley to the closest urban centres.
Fig. 1. Chiusella Valley in relation to the urban centre of Ivrea
Author: Cristina Del Biaggio. Map background: Openstreetmap
11Chiusella Valley has a surface area of 143 km2 and an extension of 25 km within which there are eight small municipalities located between 481 and 827 mamsl (metres above mean sea level). The conformation of the territory is heterogeneous and ranges from peaks that reach 2700–2800 mamsl to the plain of Ivrea (250 mamsl), making it consistent with the definition of “middle mountain”, i.e., those areas of medium altitude that, despite not having the typical morphological features of high mountain, nevertheless present qualitative aspects of what Mauro Varotto calls “mountainousness” (2020). As far as socio-cultural and political relations are concerned, the territory is marked by substantial differences between the upper and lower parts of the valley, with the lower part more easily connected to the main urban centres and the upper valley more isolated in terms of infrastructure and disadvantaged in terms of social conditions. Particularly rich from a geological point of view, the valley had an important mining history, which determined the development of the local economic and infrastructural system. Mining, mainly related to the extraction of silver and iron, became one of the main activities from the second half of the 19th century until the first part of the 20th century. It ended in the late 1960s (Dematteis, 2011, p. 29), parallel to the development of the Olivetti factory in the neighbouring town of Ivrea, which offered a new possibility of employment. So, the proximity of the Olivetti factory and the spread of small manufacturing activities in the area influenced the slowing down of the historical process of depopulation that during the same years involved a good number of rural, hill and mountain Italian territories (La Rosa, 2022).
12Today, there is a limited and declining mining activity, solely linked to the diorite quarries located in the municipalities of Traversella and Vico Canavese. The deindustrialization process and the consequent decline of Olivetti entailed yet another challenge for the resilience of the local demographic and economic landscape. If between the end of World War II and the beginning of the 1970s the number of inhabitants, albeit with some fluctuations, remained stable at around 6 to 7,000, the decline of Olivetti led to a clear drop in the following years: at the beginning of the 1990s, the area counted only around 4,400 inhabitants4, while over the last five years, though, Chiusella Valley has shown a certain demographic dynamism. Since 2018 there has been a slight increase in the population due to the arrival of new inhabitants, coming from national and international urban and metropolitan areas, that counterbalances the out-migration5.
13Currently, the main economic activities involve the primary sector and are mainly related to livestock farming (cattle, sheep, goats and fish) and family-run agriculture. Both activities engage a large proportion of youth employment (Fracassi, Re, 2016). Although the area does not attract mass mountain tourism, having mostly small accommodation facilities, the valley represents an interesting location for slow tourism, outdoor sports, and activities related to wellness, such as those proposed by the Damanhur Community Federation (Palmisano, Pannofino, 2022). Slow tourism is promoted alongside with local gastronomic products, biodiversity and the material and intangible cultural heritage of the rural-mountain context.
14From the demographic point of view, in line with what has been observed in other mountain territories, the population of Chiusella Valley is ageing. The average age of the population living in the eight municipalities is 50.5 years (with a median value of 50.3), compared to the rest of the Province of Turin with a value of 47.8, and the entire Piedmont Region with a value of 47.96. Another useful tool for understanding the ageing of the population is the old-age index7, that in Chiusella Valley has a value of 306.1, much higher than those of the Province of Turin (228.9) and of the Piedmont Region (232.9)8. The sizeable presence of older people clearly directs the demand for services in the field of care and assistance, which is mainly oriented towards a need to support chronicity and ageing. However, the access to these services can be a critical issue, since they are mainly situated in Ivrea—40 minutes by car—or, for the specialized health services, in Turin, which is more than an hour’s drive. Moreover, the lack of an efficient network of public transport amplifies the difficulties to access services for people who do not possess a car.
- 9 There are two Mutual Aid Societies that carry out many mutual initiatives of health promotion and p (...)
15Nonetheless, Chiusella Valley, as many other mountain areas in Italy, is a place of encounters, exchanges, contaminations and reworkings. The various villages, while maintaining a strong singularity and sense of territorial belonging, share a long history of opportunities, conflict, development and marginality within the processes of “deterritorialization” and “despatialization” of local and global flows (Magnaghi, 2020, p. 184). The encounters are also made possible by the presence of numerous associations (e.g., Proloco, mutual aid societies, community walking groups, self-organized cultural groups and the local popular music bands), by the considerable mutualistic heritage inherited from the local mining history9 and by practices of collaboration, both formal and informal, widespread throughout the whole territory and among the different age cohorts. These initiatives attest of a high associative vitality and civic activism and of a strong proactive interest and attention to the territory and its people.
16We interviewed 44 people, 21 caregivers and 23 care recipients, all residents of the valley. Although they differ in many aspects, the care stories we collected all share similarities: heavy reliance on private healthcare services; decisive role of communities and pre-existing acquaintances in the care pathway; strong attachment to the inhabiting habits, and the difficult integration of professional and family caregiving. Moreover, the perceived shortage of institutional healthcare services in the valley was a cross-cutting element within the experiences of the people we encountered.
17The interviews often centred around the theme of residence: the home was seen as the cornerstone of a nurturing social network essential for improving the health conditions of individuals in difficulty. When it becomes necessary to care for a relative, in many cases family members choose either to move back to Chiusella Valley or to move their relatives into their own home. This is effectively witnessed by Edoardo, a 50-year-old man from Turin, who moved to the valley with his wife to be near his mother-in-law who was no longer able to live alone:
When my wife’s mother was widowed, we didn’t feel like leaving her alone here. We sold the house in Turin, renovated her childhood home, and came to stay here with her. (Interview with Edoardo, held on 07/06/2022 at his home)
18Edoardo underwent back surgery after moving to Chiusella Valley and went through a period of hospitalization while his wife was caring for her mother. During the interview, he described the difference between going through a period of convalescence in the city and in Chiusella Valley:
I think that living in the valley offers a higher quality of life and also help for recovery. My wife has been a huge help in the sense that here you have to cut wood, bring up pellet packs. I always did everything, but when I had surgery, she started doing it… So, the bulk of the help came from her. Then I had other help, especially on the moral side. Everybody greets you, everybody knows you here—and that doesn’t exist in the city. It goes beyond just saying ‘hello’. In the apartment building where we spent 20 years in Turin, we knew four families by sight. Here I know everyone. (Interview with Edoardo, held on 07/06/2022 at his home)
19As highlighted by Edoardo’s experience, convalescence in Chiusella Valley can be challenging from a practical standpoint—such as the need to cut and transport firewood for heating—but rewarding from a moral perspective. A similar experience—that of moving to a new home to support a relative in need—is shared by Francesco, a man born and raised in the valley who runs the local mini-market and whose mother-in-law began suffering from dementia at old age:
20We had my wife’s mother moving in with us. She used to live on the top floor, without elevator, and a very steep flight of stairs. My wife went to live with her for six months, but after that we saw that there was no possibility of recovering independence. So, we said, ‘Let’s take her home’ and we equipped ourselves here… The doctor made the request for us to have that special bed which lifts on its own, to raise her better, but after a month they delivered the bed and not the mattress. (Interview with Carla and Francesco held on 06/01/2022 at their home)
21During the interview, Francesco chooses to share a significant episode that, in his view, exemplifies how the National Health Service supports family members who care for their loved ones. After carrying out extensive renovations to their home to allow his mother-in-law to live comfortably with them, Francesco and his wife requested a motorized orthopaedic bed through their general practitioner. This aid, which would have made it easier for Francesco and his wife to move his mother-in-law from the bed, arrived, but only partially: the bed frame was delivered, but not the mattress. As a result, the aid remained unusable. In this sense, the National Health Service supports family caregivers, but only partially. The ambivalence of the National Health Service in the experience of family caregivers emerges as a central theme throughout the interviews: on the one hand, it is necessary and indispensable; on the other hand, it is difficult to understand and to activate. In the next piece, is Carla, Francesco’s wife, speaking:
We went to several specialists… initially we went to Ivrea Hospital, to the neurology department, then you ask yourself, ‘Did they tell us how things really are? Did they suggest the best therapy?’ so we went for private visits, always on our own initiative because you would talk to a friend who would say, ‘go to this one who is outstanding…’ The National Health Service recognized my mother 100% disability three years ago, but since I am self-employed, it didn’t change anything for me. I have tried to ask for financial support many times, but I get discouraged because every time they ask stupid questions and treat us badly. (Interview with Carla held on 06/01/2022 at their home)
22Several key elements emerge from Carla’s account: the desire to guarantee the assisted person the best possible treatment; an exhausting therapeutic itinerary, made up of passages with several professionals in different cities; the bureaucratic and emotional burden of activating aids. None of this is exclusively characteristic of mountain settings, but the territorial remoteness of Chiusella Valley exacerbates the perceived fatigue, not only in caring for an older relative—a factor that may involve, as seen, a return to the valley and a readjustment of habits or housing conditions—but also in living one’s own ageing. This has been witnessed with concern by Gian Paolo, 71 years old, born and raised in the upper valley, strongly passionate about his territory, who had a sudden health problem while he was at home, at night:
I got scared. The roads here are so narrow and uphill, that those who are not used to it have a hard time getting there. Once I went out on the street to help an ambulance to reach my neighbour’s house. Inside me [when I got sick] I thought ‘if the ambulance does not arrive, from here I go out with the coffin, but I do not even know if the hearse passes…’. (Interview with Gian Paolo, held on 17/05/2022 at his home)
23The pandemic, clearly, has worsened the situation, as shown by Fabiano, a 74-year-old man coming from the upper valley, who lives alone and suffers from cataracts. Under care in the ophthalmology department of the Ivrea Hospital, Fabiano started going to appointments in 2019 with the help of neighbours who accompanied him, due to his difficulty in using public transport, which was scarce and hard to coordinate with the appointment times, but that was made even more problematic by his vision problem. Though, due to the safety measures implemented to prevent the spread of the virus, he found himself postponing his follow-up appointments for long periods:
I started seeing less in November 2019. My general practitioner prescribed several tests to confirm it was cataracts and gave me some eye drops. In March, I was supposed to go for some tests to decide whether or not to have surgery, but usually, when I go to the ophthalmologist, since they put drops in your eyes, I go with someone. But, since I couldn’t travel with people unless they were family, I postponed it and used the drops that I got from the pharmacy, even though they weren’t the right ones. I then had the surgery in July. (Interview with Fabiano, held on 16/03/2022, at his home)
24These experiences confirm what Giarelli and Vicarelli underlined concerning the recent trends of the Italian National Health Service, namely the absence of a prevention proposal and a lack of connection between the hospital and the territory:
The pandemic exposed a structural gap between primary care and the rest of care (hospital and high specialization) but also a gap between primary care and the rest of the system responsible for responding to the health needs of the population. […] The pandemic also highlighted the rift between the health and social systems. (2021, p. 65)
25In such a scenario, the resources that allow for the construction of a social fabric that supports older people in their ageing process and in the critical moments that this entails are based on what we could call the “mutualistic capital” of the valley. This dates back to 1884, when the Società di Mutuo Soccorso degli Operai di Brosso (SOMS) (Workers’ Mutual Aid Society of Brosso) was founded. The foundation of the workers’ society consolidated the previous experience of the miners’ mutual society which, as in many mining communities in the Alps and elsewhere, represented an essential resource to support miners and their families in precarious situations (about impacts of mining industries on socioeconomic structures in mountainous territories, see also McCann in this issue). The economic restructuring that followed the closure of the mine led to a paradoxical situation, as the mutualistic habits of the valley were in fact supplanted by the strong company welfare promoted by Olivetti. Only later, during the process of deindustrialization and economic decline due to the closure of the Olivetti factories, was there room for a recovery of the mutual capital of the valley and for a new consolidation not only of the activities of the two Mutual Aid Societies, but more generally of the informal practices of self-mutual aid.
26The words of Gian Paolo, a central figure in one of the two mutual aid societies, are effective in understanding this aspect:
We have been supporting each other in the valley since the 1800s, when the mines were in operation the SOMS played a fundamental role for the miners’ families. We haven’t lost this habit, but when Olivetti was here it wasn’t necessary, there was no need. When Olivetti closed, we rediscovered a model of mutuality and support that was deeply rooted in our customs. We struggled a bit to get the organization of activities back on track, but we went back to doing what we knew how to do. (Interview with Gian Paolo, held on 17/05/2022 at his home)
27The care network activated in the situations that have been shared with us is broad and multifaceted. It centres around the family members, who arrange their own time, economic resources, living habits and work possibilities to care for their loved ones. Alongside them, professional health workers can be mobilized, sometimes in distant locations. In case of severe health events, the care network is temporarily redirected towards the hospital, and then back home during the rehabilitation. During the recovery phase at home, neighbours who stop by to say hello or who temporarily assist the person to give his or her caregivers time to take care of their own health are also part of the support network, perhaps unknowingly. Our interviews highlight the presence of a supportive community, both local and familial, that is ready to be activated when it has been well maintained over time by the sick person and their family members, as attested by Armando, 67 years old, born and raised in the valley, who underwent knee surgery due to bone cancer that left him bedridden for six months:
In my opinion, people came to see me also because I am someone who has always been very active in the valley, in the associations. I have always given a hand. In my opinion, these places can only work this way, if everyone gives something. (Interview with Armando, held on 07/03/2022 at his home)
28Armando emphasizes that care is a shared responsibility, rooted in active participation and mutual support. In his opinion, for a community that lives in marginal areas such as mountainous regions to thrive, all members need to contribute and invest in each other’s well-being.
29Another issue emerging from the experiences of our interlocutors is the presence, outside of the valley, of a universe of healthcare professionals who, in the best cases, support this network, but in the worst cases, weigh it down. In fact, the care network can be made up of support administrators who discourage relatives from pursuing the path of state funding, or health professionals who are unable to clearly explain to the relatives of a person who is no longer self-sufficient what is the best thing to do. In Italy, about two million people forgo medical visits or examinations due to difficulties in accessing services (Giarelli, Vicarelli, 2021, p. 119). This is confirmed by the challenging experience of one of our interviewees. Tobia is a 54-year-old local entrepreneur and caregiver for both of his parents: his mother, Maria, suffering from Alzheimer since 2016, and his father, Aldo, still alive and affected by dementia:
I managed to keep my mother here until she broke her femur. I never moved her from her environment. I kept all her things in order, so that every morning she knew where things were. Then she broke her femur, in the first Covid, so we took her to the Emergency Room. She left [the house] talking, recognizing me, answering me, and she came back a mummy. From then on, she lived another six months, then she died. (Interview with Tobia held on 13/04/2022 at his home)
30In Tobia’s account, there is a lacerating before and after: a pre-hospital phase, where his mother was semi-independent, and a post-hospital phase where the situation worsened dramatically. After the passing of his mother, Tobia now looks after his father, suffering from dementia. He adopted with him the same system developed with his mother, maintaining his father’s living situation unchanged. According to Tobia, maintaining lifelong habits and constant contact with nature greatly contributed to his father’s well-being. Currently, Tobia is his sole caregiver, after he ceased contact with the doctors:
The diagnosis came from the neurologists at the hospital in Ivrea, for both mum and dad. But then with Dad I told them to piss off, because during Covid they pretty much made me do the diagnoses over the phone. At one point I said ‘Guys, who is the doctor here? Me or you? Either get off your ass and come over here and examine him or give me a chance to take him there, because that’s enough by phone now’. And then I interrupted the exchange. Now [my father] is physically fine, he has no problem. Actually, now that we have cut out the medication, he is serene and happy, he eats and moves more than before. (Interview with Tobia held on 13/04/2022 at his home)
31There is ambivalence, in these life stories of caregiving and illness, between the lack of services that could have facilitated the caregiving experience and the pride in living in a place where the natural and social elements are present and vital. In this sense, the will and the necessity to care for loved ones, even with significant personal sacrifices, become a way to distance oneself from the rhythms and conditions imposed by contemporary society. According to Tobia, this is represented in its worst version by the city, and by doctors practising there, where the patient’s humanity and social relationships are neglected. He considers caregiving quite as a thread that unites him to a mythical past, where people used to collectively care for the sick, both in and outside the household. This is how Tobia describes his childhood, spent in close contact with animals, nature and elderly people:
You know, here in the valley there was a very active social life. People used to go home and visit the sick ones, not like in the city… Everybody knows you here, still today when I’m out with the tractor someone stops me and asks, ‘How is daddy?’. Then, spending as much time as possible outdoors, breathing, talking to people, meeting people, the more you relate the more you keep young. (Interview with Tobia held on 13/04/2022 at his home)
32According to Armando, this social fabric can still be cultivated with a conscious effort to open up to others:
When you open up, something always comes back to you. However, I think about who is more isolated. Those who live out of town, or those who don’t like to interact too much because of their character: who goes there to talk to them? Who finds out if they have any problems? (Interview with Armando, held on 07/03/2022 at his home)
33The openness to which Armando refers, and the benefit that comes from it, are not equally distributed. Although the local population is exposed to both structural phenomena of marginalization and inclusive local dynamics, the access that people have to caring resources is also conditioned by the way in which they have been able to position themselves within local social networks.
34The SARS-CoV2 pandemic had a profound impact on elderly people and their caregivers (Bianchetti et al., 2020). Home isolation led to a significant reduction in the level of activity, both physical and social, and the fear of contracting the virus often caused a postponement of medical treatment (Zanin, Zambianchi, 2022). Even before the pandemic, ageing and falling ill was a growing challenge for communities, particularly those located in mountainous areas. In such contexts, informal care networks are crucial for ensuring the well-being of older people, delaying institutionalization as much as possible and promoting independent and dignified living (Cerea, Melchiorre, 2021). In this essay, we focused on family networks as a support system for older people in Chiusella Valley during pandemic times. Our research has shown that the concrete effects of distance from healthcare resources on people’s lives vary according to their needs, vulnerabilities and available support networks. In this sense, marginality can emerge not solely from geographic distance, and from the territorial dispersion that characterizes mountain contexts, but also from fragile social fabric and systemic disconnections that leave certain needs unmet. People may experience “remoteness” even within physically accessible systems, if those systems fail to address specific, personalized needs. The pandemic intensified the processes of marginalization and leaved some individuals or families without adequate support, highlighting that remoteness is due to the misalignment between services and the specific needs of those who require them.
35As shown ethnographically, due to limited access to adequate public assistance, the inhabitants of the valley become responsible, where possible, for organizing their own home network in a post-hospital experience. The return migration of children to care for elderly parents—which is part of a larger experience of health migration (Tubertini, 2015)—is a significant phenomenon, which is part of a multi-sited care network arranged around the ageing person. This represents what Gómez defines as “arrangements” in his analysis of the technologies introduced to enable older people to continue living independently. Arrangements, following his definition, are a set of inextricably interconnected socio-material adjustments that make resources available for action (Gómez 2015, p. 93). It is thus important to investigate the capacity to build relationships of care since it allows connecting care practices to the political and historical dynamics that determine the isolation of this territory from health services. In Chiusella Valley, the role played by family networks is particularly significant, and this is also due to the structural and morphological peculiarities of the territory. Indeed, care relationships are influenced by social actors who are not physically present in the area—such as healthcare professionals engaged remotely during the pandemic—and by the territorial mutualistic actors that can support, encourage, or alter therapeutic pathways.
36In conclusion, we believe that the dynamics observed in this territory provide an image of a mountain context characterized by complex and structural processes of marginalization (both economically and in terms of services), counterbalanced, however, by particularly dense and consolidated local mutualistic habits, inherited from the mining past, and by the presence of a close-knit network of associations supporting the population. This complex network has proven to be essential for families who take care of their ageing relatives living in Chiusella Valley.