that science is a socially negotiated and politically contested enterprise. Confronted with the discourse and the knowledge structures for management of health, the folk of this area, informed by tradition and the media, continually create an event-based grammar. New information about health and illness stimulates continuous restructuring of all the information, slowly changing the discourse as grammatical elements are added, deleted, or reenvironed. As knowledge structures are dismantled, their complexity is ignored and the discourse surrounding them is mapped onto new events, as we have described for evolving therapeutic choices in diagnostics, in ethnopharmacology, in psychoanalytic therapies, and in modifications of notions of nutrition and of preventive medicine.
At any point in time the health care system for any individual or group is metastable. What remains relatively stable is the mechanism that generates change. For Ascoli Piceno and environs these generators are grounded in the religion (Catholicism), in attitudes toward authority, and in the culturalhistorical substratum of ideology and values regarding health and illness. Since January 1980 all Italians have been entitled to health insurance under the provisions of the Servizio Sanitario Nazionale. The persistent distrust of government, indifference to politics, and lack of belief in the honesty and capability of bureaucrats ( Banfield 1958) should interest observers as physicians, patients, and their families negotiate the new health care system.
Balena Secondo. 1979. Ascoli nel Piceno. Ascoli Piceno: Edizioni Turistiche, 97-100.
Banfield Edward. 1958. The Moral Basis of a Backward Society. Glencoe, Ill.: Free Press.
Berselli Aldo. 1961. "La Restaurazione e le società Segrete nelle Marche". In L'Apporto delle Marche al Risorgimento Nazionale. Atti del Congresso della Storia30 Settembre-2 Ottrobre 1960.