Photo by Negative Space, Stocksnap.io

During my ethnographic research in Milan between 2018-2019, from interviews with patients and doctors, consulting regional, national and EU reports, and participation in hospital meetings, I learnt about the development of digital health in the city of Milan, the region of Lombardy, and across Italy. Digital or mobile health (mHealth) has been developing in and across Italy in recent years[i]. Since 2016, a few regions such as Lombardy, Emilia-Romagna, and Tuscany have been particularly active in this field, and Lombardy’s activity in digital healthcare is above the national average.[ii] Developments in this area have since been impacted by the coronavirus pandemic during 2020, in Italy, and in Lombardy in particular, which saw the highest number of cases in Italy in early 2020. Digital technologies have played a significant role during the pandemic in a number of core areas relating to health from regional and national healthcare access communication and delivery and nascent public-private partnerships, to the everyday experience of lockdown. Amid the pandemic, the country has witnessed an increase in state engagement with the digital, including a range of public-private partnerships that, for example, offer ‘digital solidarity’ packages to citizens[iii] and seek to warn against ‘fake news’ about the virus that has been shared across social media. In March 2020, the Italian Ministry of Health published a warning list of ten particularly pertinent ‘fake news’ items about the coronavirus that were circulating across the Italian social web, urging the public to be vigilant about this issue.[iv]

During my broader ethnographic research studying ageing, care, and smartphones in Milan, I found that formal and informal policies and practices exist within a nexus of an emerging digital health scene ‘from above’, and a diverse adoption of digital practices by people of different ages and backgrounds ‘from below’. Amongst research participants who were smartphone users, googling for information about health and using WhatsApp to communicate with and care for others, for example, could be popular activities not wholly distinct from broader uses of smartphones for care and communication. Concurrently, these practices could also go hand in hand with the spread of mis/disinformation[v].

As such, although Milan and Lombardy are leading sites within Italy for healthcare and digital innovation, a range of factors continue to affect the equity of healthcare access, delivery and uptake, online and offline; such as income, socio-economic factors, regional location, and language; and these factors all play a role in the differentiated experience of living and ageing with smartphones in Milan that I explored during my research in Italy, and which are core themes in my forthcoming book as part of the ASSA book series with UCL Press, Ageing with Smartphones in Urban Italy: Care and Community in Milan and Beyond (2021).

References

[i] The uptake of mHealth in Italy has been reported as steady while slower than in other European countries such as Estonia and Denmark. Kostera, Thomas. 2019. ‘Digital health – Europe is moving at different speeds’. The Digital Patient (blog), 25 April. https://blog.der-digitale-patient.de/en/digital-healtheurope/. Accessed 23 November 2020.

[ii] See Postelnicu, Leontina. 2019. ‘Q&A: How Italy is working to digitise healthcare’. Healthcare IT News, 23 October. https://www.healthcareitnews.com/news/europe/qa-how-italy-working-digitise-healthcare. Accessed 23 November 2020.

[iii] In Italy during the Covid-19 pandemic in 2020, ‘digital solidarity’ packages were offered to bridge some of the socio-economic and digital gaps highlighted and perpetuated by the virus, at a time when digital practices of care and communications had taken on heightened significance. See Agenzia per l’Italia Digitale. 2020. ‘Solidarietà Digitale al servizio di studenti e commercianti’. Solidarietà Digitale. https://solidarietadigitale.agid.gov.it/#/. Accessed 21 November 2020.

[iv] See Ministero della Salute 2020 Salute (Ministry of Health). ‘Covid-19, occhio alle bufale’. http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4380. Accessed 23 November 2020.

[v]The distinction between misinformation and disinformation has been defined in terms of intentionality. The former describes the sharing of information regardless of intention, while the latter involves the intention to mislead, misinform and/or manipulate. See: https://www.dictionary.com/e/misinformation-vs-disinformation-get-informed-on-the-difference/ and https://en.unesco.org/fightfakenews

Photo of a Milan street, by Shireen Walton

As part of the ASSA project, I carried out ethnographic research an inner-city neighbourhood in Milan, where I lived for 16 months. During this time, I became involved in a range of local activities where I came to meet and know people over time, experiencing different aspects of daily life, offline and online. This included joining a Multicultural Centre that carries out social activities and provides social support in the area, a multigenerational women’s choir, and attending social events such as collective meals where people bring food and drinks to share together. During this time I lived in a casa di ringhiera apartment building, a type of popular housing built around the turn of the 20^th century, and this formed a socially rich and immersive way of experiencing daily life, and sharing time with neighbours. The friendships I developed over time came to inform my ethnographic research on ageing, and my unfolding understanding of care and community in this context, which is the subject of my forthcoming monograph with the ASSA book series with UCL Press, Ageing with Smartphones in Urban Italy: Care and Community in Milan and Beyond.

The urban and digital ethnographic research methodology developed during my research builds upon scholarship that highlights the interrelatedness of urban life and digital media and communications (e.g. Georgiou 2013, Lane 2019). ‘Following the thing’ (Marcus 1995) with the smartphone and its related social and digital networks and infrastructures, I came to learn more about multiscalar networks in and across the city (Caglar and Glick Schiller 2018), the country, and transnationally, while looking at social media, maps, bespoke apps, and photo-sharing. I also keenly observed the smartphone as a material object, curious as to why some people adorned the object with physical stickers or photographs of grandchildren, or personalised their screensavers in certain ways, engaged with the smartphone, photos or apps with particular attitudes or in light of various moral or socio-ethical frameworks. Looking further at and inside the smartphone with research participants provided an opportunity for elicitation in interviews and discussion with research participants concerning practices, attitudes and evaluations, as part of a broader discussion of everyday lives, relationships, and experiences.

Fieldwork photo by Shireen Walton

In short, the smartphone was both an object of study and contained within it multiple site(s) of study. Spending time on my own smartphone ultimately formed a significant part of how I engaged with urban digital ethnography in practice[i] – both sited in place and virtually augmented, all the while keeping present over months of research (and continuing to be connected during the present times of the Covid-19 pandemic), with research participants and friends in Milan and various ‘affective economies[ii]’ within variously distributed physical and virtual spaces and places.

References

Ahmed, Sara. 2004. ‘Affective Economies’. Social Text 22 (2): 117–39.

Caglar, Ayse, and Glick-Schiller, Nina (2018). Migrants and City-Making: Dispossession, Displacement, and Urban Regeneration. Durham: Duke University Press.

Georgiou, Myria (2013). Media and the City: Cosmopolitanism and Difference. Cambridge: Polity.

Lane, Jeffrey (2019). The Digital Street. Oxford: Oxford University Press.

Levitt , P and Glick Schiller, N. (2004). ‘Conceptualizing Simultaneity: A Transnational Social Field Perspective on Society’. The International Migration Review 38:3. pp. 1002-1039.

Marcus, George, E. (1995). ‘Ethnography in/of the World System: The Emergence of Multi-Sited Ethnography’ in Annual Review of Anthropology 24, pp. 95-117

[i] For further discussion of this kind of approach, see also Jeffrey Lane’s (2019) urban digital ethnography with young people and about social media in a Harlem neighbourhood in The Digital Street.

[ii] Affective economies is a term used by Sara Ahmed to describe how emotions do things, such as align individuals with communities—or bodily space with social space—through the very intensity of their attachments. See Ahmed, Sara. 2004. ‘Affective Economies’. Social Text 22 (2): 117–39.