Roshanak Mehdipanah

Supervisors:Dr. Carme Borrell & Dr. Carles Muntaner

Universitat Pompeu Fabra & Agència de Salut Pública

URBAN RENEWAL & HEALTH:

The eff ects of the Neighbourhoods Law on health and health inequalities in

Barcelona

INTRODUCTION

JUSTIFICATION

OBJECTIVES

STUDY 1

STUDY 2

STUDY 3

DISCUSSION

CONCLUSION

RECOMMENDATIONS

DISSEMINATION

INTRODUCTION

Over 50% of the world’s population lives in urban areas.1

Focus is back on cities and in specific the physical and social makeup of their neighbourhoods and communities.

For a neighbourhood to achieve health & health equity:

Must provide access to basic goods, Encourage social integration, Promote good physical and psychological wellbeing, Be protective of the natural environment.

URBAN HEALTH & HEALTH EQUITY

1UN-HABITAT (2010) State of the world’s cities 2010/ 2011-cities for all: bridging the urban divide. United Nations Human Settlements Programme 4–17.

URBAN HEALTH

PHYSICAL ENVIRONMENT

URBAN HEALTH &PHYSICAL ENVIRONMENT

URBAN HEALTH

SOCIALENVIRONM

ENT

URBAN HEALTH &SOCIAL ENVIRONMENT

Urban planning and health concerns date back to the 19 th century where overcrowding and unsanitary conditions began as a result of growing industrial cities.1

Urban renewal’s (regeneration) goal is to improve physical infrastructure, promote social integration and increase economic gain within an area intervened.2

Urban renewal has evolved to also address some of the social problems and promote sustainability.3

URBAN PLANNING & RENEWAL

1 Barton H. (2005) “Introduction to the concept of healthy urban planning”. Found in Built Environment: Theme issues – Planning healthy towns & cities. WHO Collaborating Centre for Healthy Cities and Urban Policy 30(4). 2 Spaans M. (2004) The implementation of urban regeneration projects in Europe: Global ambitions, local matters. J Urban Design, 9(3):335-3493 Arbaci S. & Tapada T. (2013) Social inequality and urban regeneration in Barcelona city centre: reconsidering success. Eur Urban Reg Stud,19(3): 287-311.

Specific projects have highlighted the link between urban renewal projects, health and health inequalities:

Increased accessibility to services and resources (healthy food outlets) through transportation improvements.1

The creation of green spaces leading to an increase in physical activity.2

Housing renewal resulting in a decrease of asthma among children.3

URBAN RENEWAL, HEALTH &HEALTH INEQUALITY

1 RydinY.et al. (2012) Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet/UCL, London. 2 Mitchell R. & Popham F. (2008) Effects of exposure to natural environment on health inequalities: an observational population study. Lancet, 372: 1655-1660.3 Howden-Chapman P (2008) Effects of improved home heating on asthma in community dwelling children : randomised controlled trial. BMJ;337

URBAN RENEWAL &HEALTH FRAMEWORK

URBAN RENEWAL PROGRAM

PHYSICAL INFRASTRUCTURE

SOCIAL INTEGRATION

ECONOMIC GROWTH

LIVEABILITY

SOCIO-ECONOMIC

MAKEUP

POPULATION TURNOVER

HEALTH &

HEALTH INEQUALITY

A conceptual framework of the link between urban renewal and health/health inequalities.

POLITICAL CONTEXT

Urban renewal policies are complex because: Context in which the intervention is carried out in, Actual projects undertaken, Implementation of the policy, Variability in the outcomes.

This complexity results in diffi culties to do evaluations because: Limited availability and reliability of data related to

intervention for health and socioeconomic indicators, Heavy reliance on quantitative analysis, Dominated by method driven as opposed to theory driven.

The inability to establish clear causal pathways makes the applicability to other situations more diffi cult.

EVALUATION OF URBAN RENEWAL, HEALTH & HEALTH INEQUALITIES

THE NEIGHBOURHOODS LAWLLEI DE BARRIS

Goal: to improve neighbourhoods in Catalonia, Spain while addressing social issues, especially in deprived areas.

The initiative consists of partial funding

from the regional government to selected

municipals with urban renewal proposals.

143 neighbourhoods across Catalonia

have participated in the initiative.

Approximately 1.3bill ion euros invested.

City of Barcelona: 15 of 73 neighbourhoods have participated. 10% of Barcelona’s population (1.6mill ion).

Source: Departament de Política Territorial i Obres Públiques (2009)

THE NEIGHBOURHOODS LAW

Public space

Rehabilitation

Equipment

New Technologies

Sustainability

Gender equality

Social programs

Accessibility

The Neighbourhoods Law expenditure of projects within each of the seven focus areas.

41.5%

11.3%

31.4%

1.4%

2.2%

2.1%

6.5%5.7%

Source: Departament de Política Territorial i Obres Públiques (2009)

THE NEIGHBOURHOODS LAW &HEALTH FRAMEWORK

A conceptual framework of the link between the Neighbourhoods Law and health/health inequalities.

NEIGHBOURHOODS

LAW

PHYSICAL INFRASTRUCTU

RE

SOCIAL INTEGRATION

ECONOMIC GROWTH

LIVEABILITY

SOCIO-ECONOMIC MAKE UP

POPULATION TURNOVER

HEALTH &

HEALTH INEQUALITY

PUBLIC SPACES

NEW TECHNOLOGY

GREEN SUSTAINABILITY

REGENERATION

EQUIPMENT INSTALLATION

GENDER EQUALITY

SOCIAL PROGRAM

EMPLOYMENT IN NEIGHBOURHOODS

HEALTH IN NEIGHBOURHOODS

POLITICAL CONTEXT

THE NEIGHBOURHOODS LAW &HEALTH FRAMEWORK

A conceptual framework of the link between the Neighbourhoods Law and health/health inequalities.

NEIGHBOURHOODS

LAW

POPULATION TURNOVER

HEALTH &

HEALTH INEQUALITY

PUBLIC SPACES

NEW TECHNOLOGY

GREEN SUSTAINABILITY

REGENERATION

EQUIPMENT INSTALLATION

GENDER EQUALITY

SOCIAL PROGRAM

EMPLOYMENT IN NEIGHBOURHOODS

HEALTH IN NEIGHBOURHOODS

POLITICAL CONTEXT

Traffic safetyWalkabilityAestheticsSecurity

Employment Education

Social cohesion

PHYSICAL INFRASTRUCTU

RE

SOCIAL INTEGRATION

ECONOMIC GROWTH

JUSTIFICATION

Urban renewal policies are becoming priorities for cities but continue to not consider health and health inequality.

There is evidence of positive links between initiatives and health, but it remains limited.

Furthermore, evidence on health inequalities remains sparse mainly due to complexities discussed.

Our study is the fi rst in Spain and among the fi rst in Europe to use a mixed-methods approach to study this relationship.

Such studies are needed to raise the importance of including health and health inequality in the planning, implementation and evaluation of urban renewal programs.

OBJECTIVES

GENERAL OBJECTIVE To study the eff ects of an urban renewal policy, the

Neighbourhoods Law, on health and health inequalities.

SPECIFIC OBJECTIVES To evaluate the perceptions of neighbours towards the

eff ects of recent changes in their neighbourhoods on their wellbeing. (Study 1)

To evaluate the eff ects of the Neighbourhoods Law on the health and social class inequalities in health of residents in intervened neighbourhoods. (Study 2)

To explore how urban renewal programs are linked to health and health inequality and discuss some of the complexities. (Study 3)

RESEARCH APPROACH

QUANTITATIVE COMPONENT

QUALITATIVE COMPONENT

THEORY-DRIVEN APPROACH

STUDY 12010 - 2012

STUDY 1

OBJECTIVE To evaluate the perceptions of neighbours towards the

eff ects of recent changes in their neighbourhoods, including the Neighbourhoods Law, on their wellbeing from two Barcelona neighbourhoods using Concept Mapping methodology.

STUDY 1. METHODS

Concept Mapping is a non-traditional qualitative method that provides a conceptual framework that depicts how a group or a population perceives a particular situation.1

Six steps carried out in three sessions with participants.

BRAINSTORMINGSTRUCTURING OF

IDEASINTERPRETATION

OF MAPS

Step 1: PreparationStep 2: Generation of statements

Step 3: Structuring of statementsStep 4: Representation of maps

Step 5: Interpretation of mapsStep 6: Utilization of maps

1 Trochim , W. (1989) An introduction to concept mapping for planning and evaluation. Special Issues of Eval Program Plan 12, 1-16.

STUDY 1. METHODS

ROQUETES

SANTA CATERINA Y SANT PERE

“One change that has occurred within my neighbourhood in recent years that has affected my

family’s or my wellbeing is…”

Group 1: Neighbourhood Association & Community Center (N=14)

Group 2: Senior Day Center (N=12)Group 3: Youth Center (N=19)

STUDY 1. RESULTS

Average cluster rating map of the importance of changes perceived by participants in the Casc Antic day center.

Decrease of economic activity

Abandoned areas

Sense of insecurity

Accessibility by car

Cleaning and repair of streets

Neighbourhoodrelations

Reform of buildings and plazas

Public events and spaces

Community and senior centers

Cluster Layer Layer Value 1 2.99 to 3.22 2 3.22 to 3.44 3 3.44 to 3.67 4 3.67 to 3.89 5 3.89 to 4.12

STUDY 1. RESULTS

Average cluster rating map of the importance of changes perceived by participants in the Casc Antic day center.

Decrease of economic activity

Abandoned areas

Sense of insecurity

Accessibility by car

Cleaning and repair of streets

Neighbourhoodrelations

Reform of buildings and plazas

Public events and spaces

Community and senior centers

Cluster Layer Layer Value 1 2.99 to 3.22 2 3.22 to 3.44 3 3.44 to 3.67 4 3.67 to 3.89 5 3.89 to 4.12

STUDY 1. RESULTS

Cluster: Reform of buildings and plazasABSOLUTE

VALUEPOSITIVE

VALUENEGATIVE

VALUEThe installation of elevators in some residential buildings.

4.29 4.29 0

The replacement of sheds for new apartments. 4 3.14 0.86

The improved liveability throughout the neighbourhood.

3.86 2.57 1.29

The reform of the Community Center. 3.71 3.71 0

The repair of some building facades. 3.71 3.71 0

The re-urbanization of sidewalks and streets. 3.71 3.29 0.43

The reform and re-opening of the Santa Caterina market.

3.57 3.43 0.14

The reform of the central plaza, Pou de la Figuera. 2.71 1.71 1The replacement of old benches with new single-person benches.

2.29 1.14 1.14

AVERAGE 3.51 3.03 0.49MEDIAN 3.71 3.29 0.29

Reform of buildings and plazas

Statements within the cluster, reform of buildings and plazas with corresponding rating values and effect

STUDY 1. RESULTS

Decrease of economic activity

Abandoned areas

Sense of insecurity

Accessibility by car

Cleaning and repair of streets

Neighbourhoodrelations

Reform of buildings and plazas

Public events and spaces

Community and senior centers

Somewhat negativeVery negative

Very positiveSomewhat positive

Average cluster rating map of the importance and effects of changes perceived by participants in the Casc Antic day center.

STUDY 1. RESULTS

Decrease of economic activity

Abandoned areas

Sense of insecurity

Accessibility by car

Cleaning and repair of streets

Neighbourhoodrelations

Reform of buildings and plazas

Public events and spaces

Community and senior centers

POPULATION &SOCIAL CHANGE

URBAN RENEWAL PROJECTS

Somewhat negativeVery negative

Very positiveSomewhat positive

Average cluster rating map of the importance and effects of changes perceived by participants in the Casc Antic day center.

STUDY 22011-2013

STUDY 2

OBJECTIVE To evaluate the eff ects of the Neighbourhoods Law on

the health of residents (women and men) of intervened neighbourhoods in the city of Barcelona and on the social class inequalities in health within these neighbourhoods.

STUDY 2. METHODS

Pre- (2001, 2006) and Post- (2011) intervention periods.

A comparison group of non-intervened neigbourhoods with similar socio-economic indicators based on Census 2001.

Data from Barcelona Health Surveys with population being over the age of 15.

Poor self-rated health and mental health prevalence were described for each sex by neighbourhood group and survey year.

Poisson Regression robust models were used to estimate prevalence ratios and their 95% CI, introducing the interaction between survey year and group.

Comparison neighbourhoods

Intervened neighbourhoods

2006 20110%

5%

10%

15%

20%

25%

30%

WOMEN

2006 20110%

5%

10%

15%

20%

25%

30%

MEN

STUDY 2. RESULTS

1.25 (0.69 - 2.27)

1.93* (1.23 - 3.01)

0.95 (0.69 - 1.31)

0.86 (0.58 - 1.27)

Trends in age-standardised prevalence of poor mental health by neighbourhood groups.

Intervened Comparison

*p<0.05 **p<0.01 ***p<0.001. Numbers shown correspond to Prevalence Ratios calculated using 2006 as reference year

2006 20110%

5%

10%

15%

20%

25%

30%

35%

40%

45%

WOMEN

2006 20110%

5%

10%

15%

20%

25%

30%

35%

40%

45%

MEN

STUDY 2. RESULTS

0.74*(0.56 - 0.97)

1.07 (0.85 - 1.35)

0.53*** (0.36 - 0.78)

1.04 (0.77 - 1.41)

Intervened

*p<0.05 **p<0.01 ***p<0.001. Numbers shown correspond to Prevalence Ratios calculated using 2006 as reference year

Trends in age-standardised prevalence of poor self-rated health by neighbourhood groups.

Comparison

2006 20110%

10%

20%

30%

40%

50%

60%WOMEN - COMPARISON

STUDY 2. RESULTS

Manual ManualNon-manual Non-manual

Intervened Comparison

Trends in age-standardised prevalence of poor self-rated health by neighbourhood group and social class.

0.72* (0.53 - 0.97)

*p<0.05 **p<0.01 ***p<0.001. Numbers shown correspond to Prevalence Ratios calculated using 2006 as reference year

2006 20110%

10%

20%

30%

40%

50%

60%WOMEN - INTERVENED

STUDY 2. RESULTS

Manual ManualNon-manual Non-manual

Intervened Comparison

Trends in age-standardised prevalence of poor self-rated health by neighbourhood group and social class.

2006 20110%

10%

20%

30%

40%

50%

60%MEN - COMPARISON

*p<0.05 **p<0.01 ***p<0.001. Numbers shown correspond to Prevalence Ratios calculated using 2006 as reference year

2006 20110%

10%

20%

30%

40%

50%

60%MEN - INTERVENED

0.45*** (0.29 - 0.69)

STUDY 32013 - 2014

STUDY 3. OBJECTIVES

Article 3. Exploring complex causal pathways between

urban renewal, health and health inequality using a theory-

driven approach. R. Mehdipanah, A. Manzano, C. Borrell, D.

Malmusi, M. Rodríguez-Sanz, J. Greenhalgh, C. Muntaner, R.

Pawson. Social Science & Medicine (Under 2nd review).

OBJECTIVE To explore how urban renewal programs are linked to

health and health inequality and discuss some of the complexities associated with these causal pathways using a theory-driven approach.

STUDY 3. METHODS

Theory-driven approach allows the development of links between the program, its outcomes and the context in which it was carried out in.1

Requires a full understanding of the program and its goals while having a constant consideration of the contextual settings in which they are implemented. 2,3

Flexible in methods used and encourages both quantitative and qualitative data as long as they serve to confirm, refine or dismiss the mechanisms studied.2

In the case of this study, we took a realist evaluation approach. 1Chen H.T. (2012) Theory-driven evaluation: Conceptual framework, application and advancement. Evaluation von Programmen und

Projektenfüreine Kultur2Pawson, R. & Sridharan, S. (2010). “Theory-driven evaluation of public health programmes”. In Killoran A., Kelly M.P. (Ed) Evidence-Based Public Health: effectiveness and efficiency, Oxford University Press, Oxford UK. 3Donaldson S. et al. (2003) Theory-driven evaluation in action: lessons from a $20 million statewide Work and Health Initiative. Eval Program Plan, 26, 355-366.

STUDY 3. RESULTS

Two proposed causal pathways linking urban renewal to health & health inequality.

12

STUDY 3. RESULTS

1

Urban renewal programs increase access and availability of resources and opportunities for neighbours.

Two proposed causal pathways linking urban renewal to health & health inequality.

STUDY 3. RESULTS

2

Health and health inequalities will improve if neighbours use and adapt to the changes produced by the intervention.

Two proposed causal pathways linking urban renewal to health & health inequality.

STUDY 3. RESULTS

Open Spaces: Areas that allow residents to participate in public spaces, promote social interaction and are accessible by all compared to private areas.

Public spaces linked to health and health inequalities:

Increased opportunity for physical activity.1

Circulatory disease mortality lower in populations that have access to such public spaces. 2

Features within these open spaces can increase social interaction. 3

1 Rydin Y et al. (2012) Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet/UCL, London.2 Mitchell R. &Popham F. (2008) Effects of exposure to natural environment on health inequalities: an observational population study. Lancet, 372: 1655-1660.3 Borja J. & Muxi Z. (2001) Espai Públic: Ciutat I Ciutadania. Diputació de Barcelona, Barcelona.4 Kearns A. et al. (2009) Regeneration and health: Conceptualising the connection. J Urb Regen Ren 3(1): 56-76.

STUDY 3. RESULTS

Causal pathways for the renewal of public open spaces – Pou de la Figuera

MECHANISMS

OUTCOMES

CONTEXT

INTERVENTION

Social

Interaction

Safety &

Security

Accessibility

Children’s playground

Soccer & Basketball

courts

Community garden

Benches around plaza

Planted trees

Changes in Health

+/-Health

Inequality

Population composition

History

DISCUSSION

GENERAL FINDINGS

The Neighbourhoods Law has had positive eff ects on the health and health inequalities of residents.

Neighbours perceived the majority of the Neighbourhoods Law’s interventions as positive and important for their wellbeing.

Poor self-rated health improved in neighbourhoods intervened for both men and women especially in the manual classes compared to those not intervened.

Poor mental health remained constant in both men and women while it increased in the non-intervened group.

Urban renewal programs increase resources and create opportunities in a neighbourhood, but neighbours must use and adapt to these changes in order to benefit optimally.

DISCUSSION

What do these results mean?

Whose health does urban renewal programs aff ect?

How do urban renewal programs aff ect health and health inequalities?

Why do urban renewal programs aff ect health and health inequalities?

WHOSE?

In the fi rst four years the Neighbourhoods Law was estimated to aff ect approximately 10% of the population.1

Results from both quantitative and qualitative studies and existing evidence indicate that not all neighbours have benefitted equally:

Interventions can be population specific.

1Departament de Política Territorial I Obres Públiques – DPTOP (2009) La Llei de barris: Una aposta collectiva per la cohesió social. Generalitat de Catalunya. Spain.

WHOSE?

AGE Younger populations focus more on employment services,

activities, play areas. Older populations focus more on accessibility, social spaces and

safety.

GENDER Both women’s and men’s health outcomes improved.

SOCIAL CLASS Manual social class generally benefi tted more than the non-

manual social class.

WHOSE?

POPULATION TURNOVER

The Neighbourhoods Law, did not contain a housing renewal component.1

Risk of displacement by the law was addressed through the promotion and protection of social housing in the areas intervened.

In the Catalonia context, a large proportions of owners versus renters with deeper roots in neighbourhoods. 2

In our quantitative study, we saw no signifi cant diff erences in populations with more than 5 years living in the neighbourhood and with total population.

However, displacement can become an issue with the eff ects of the current economic crisis.

1Kearns A. & Mason P. (2013) Defining and Measuring Displacement: Is relocation from restructure neighbourhoods always unwelcome and disruptive? Housing Studies, 28(2): 177-2042Nel·lo O. (2011) The five challenges of urban rehabilitation. The Catalan experience. Urban Research & Practice. 4(3): 308-325

HOW?

One change that has aff ected my wellbeing is… Each reply forms a hypothesis of how the Neighbourhoods

Law aff ected the wellbeing of residents:

In Roquetes, the installation of outdoor escalators and elevators was recognized as important and positive for neighbours’ wellbeing.

The removal of a physical barrier. The improvement of accessibility to resources.

HOW?

One change that has aff ected my wellbeing is… Each reply forms a hypothesis of how the Neighbourhoods

Law aff ected the wellbeing of residents:

In Roquetes, the installation of outdoor escalators and elevators was recognized as important and positive for neighbours’ wellbeing.

The removal of a physical barrier. The improvement of accessibility to resources.

POPULATION & SOCIAL CHANGEURBAN RENEWAL PROJECTS

PHYSICAL ENVIRONMENT

SOCIAL ENVIRONMENT

HOW?

One change that has aff ected my wellbeing is…

PHYSICAL ENVIRONMENT

SOCIAL ENVIRONMENT

LIVEABILITY

SOCIO-ECONOMIC

MAKEUP

Each reply forms a hypothesis of how the Neighbourhoods Law aff ected the wellbeing of residents:

In Roquetes, the installation of outdoor escalators and elevators was recognized as important and positive for neighbours’ wellbeing.

The removal of a physical barrier. The improvement of accessibility to resources.

WHY?

• Economic means.• Lifestyle preferences.

WHY?

PLACE-BOUND

Individual characteristics:• Age• Gender• Socio-economic position• Health status

WHY?

USE & ADAPTATION: Neighbours can increase the eff ects of urban renewal.

The presence of neighbourhood associations in program planning and evaluation can empower neighbours to make decisions on the status of their neighbourhoods. 1 ,2

Such groups can impact the wellbeing of residents by addressing issues with production and distribution of specifi c resources throughout the neighbourhood that may be otherwise. 1

Roquetes is a good example of this the strong involvement and participation of neighbours throughout the entire process.

1Matheson A., et al. (2009) Complexity, evaluation and the effectiveness of community-based interventions to reduce health inequalities. Health Prom J. 20:221-2262Pasarin et al. (2010) Community health: integration of primary care and public health competencies. SESPAS report 2010. Gaceta 24(S1): 23-27,

STRENGTHS & LIMITATIONS

Strengths Mixed-methods approach to study the eff ects of a

complex urban renewal intervention and its eff ects on health and health inequalities.

Study serves as a strong example of how structural policies can aff ect health and health inequalities despite incorporating these outcomes in the planning and implementation of these laws.

Limitations Census tract boundary changes between the pre and

post periods in order to accommodate for population growth and political reasoning.

Heavy reliance on the Barcelona Health Surveys where samples are representative of the general population but often size did not permit for subpopulation analysis.

CONCLUSIONS

GENERAL CONCLUSIONS

The majority of projects within the Neighbourhoods Law were perceived as positive and important to the wellbeing of neighbours.

On the contrary, population and social changes in these neighbourhoods were largely observed as negative and important.

The incorporation of neighbours’ perspectives is critical for understanding better the compositional and contextual factors in a neighbourhood.

The division found in the maps of the concept mapping, provided support for the concepts of liveability and population turnover found in the conceptual framework.

GENERAL CONCLUSIONS

In both women and men, self-rated health improved in the neighbourhoods intervened by the Neighbourhoods Law, especially those within the manual social classes, compared to non-intervened neighbourhoods with similar socio-demographic characteristics.

Similar results as above were seen for the mental health status of women in the intervened neighbourhoods.

The Neighbourhoods Law appears to moderate further increases in poor mental health observed in men from the comparison group.

Although urban renewal programs may improve opportunities and resources in a neighbourhood, residents must use and adapt to these changes in order to benefi t optimally.

A focus on theory is needed to explore potential causal pathways linking urban renewal to health outcomes.

RECOMMENDATIONS

Health and health inequality outcomes should be included in the evaluations of urban renewal programs conducted.

A thorough understanding of contextual and compositional factors in which the intervention was carried out is essential in order to understand the infl uence it may have on the outcomes attained.

In the case of the Neighbourhoods Law, information from this dissertation can be used to lobby political groups to allow for the continuation of such interventions.

Furthermore, future urban renewal policies should take into account potential eff ects on health and health inequality at both the planning and evaluation phases resulting in the need for intersectoral work.

RECOMMENDATIONS

DISSEMINATION

KNOWLEDGE TRANSFER

KNOWLEDGE TRANSFER

KNOWLEDGE TRANSFER

VIDEO

THANK YOU

CARME BORRELL & CARLES MUNTANERMAICA RODRIGUEZ-SANZ & DAVIDE

MALMUSIALL THE CO-AUTHORS

SESIS SALUT ALS BARRIS & SALUT COMUNITARI

UNIVERSITY OF LEEDS, UKROQUETES PLA COMUNITARI & TON I GUIDA

C.C. CENTRE DE DIA CASC ANTIC & PALAU ALOS

CROMAENRIC CREMADES & ORIOL NEL·LO

THE NEIGHBOURS OF ROQUETES & S.CATERINA