Luciano Magaldi Sardella and Matteo Mantuano

The relationship between built environment and population health has received substantial scholarly attention, yet the role of public art as health infrastructure remains curiously underexamined in global health. The Stramurales International Street Art Festival founded by local artist Lino Lombardi in Stornara, Puglia, in Southeastern Italy, provides evidence that participatory street art is not merely about aesthetics but is a public health strategy operating at the nexus of cultural rights and community mental health.

We argue that when conceptualized through the framework of international human rights law—particularly article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) guaranteeing the right to health, and article 15 enshrining the right to participate in cultural life—street art interventions merit recognition as determinants of social health deserving both protection and replication.

Structural violence and the mental health toll of rural decline

Southern Italy’s Mezzogiorno region has experienced a “self-reinforcing spiral of decline“: economic contraction precipitates youth emigration which accelerates infrastructure deterioration and economic downturn, thereby driving further migration. Between 2002 and 2017, Southern Italy lost approximately 2 million residents to internal and international migration, with young adults aged 15-34 constituting the overwhelming majority.

This phenomenon is what Johan Galtung termed “structural violence”—systematic arrangements that prevent individuals and communities from realizing their full potential. Research in environmental psychology demonstrates that deteriorating built environments correlate with elevated stress, social isolation, and worsening mental health.

Stornara, an agricultural municipality of approximately 6,000 residents embodied this trajectory until 2018, when local artist Lino Lombardi established Stramurales. What emerged transcends conventional cultural tourism initiatives, constituting instead an art-based public health intervention grounded in participatory democratic structures.

Participatory art as health intervention: the Stramurales approach

Stramurales’ success resides not in street art deployment per se—numerous municipalities commission murals as tourism amenities—but rather in its fundamental democratic mechanisms. Three foundational elements distinguish the approach: voluntary property owner participation, with no coercion on owners to offer their walls for transformation; democratic content selection through annual community voting on festival themes and mural proposals; and inclusive governance via Stornara Life APS, an open-membership association which prevents elite capture.

When residents voluntarily offer walls and vote on content, they perform acts of material and psychological investment, signaling belief that their community possesses a viable future. This restoration of collective agency—the belief that residents can shape their hometown’s trajectory rather than merely witnessing decline—breaks the spiral of deterioration.

From a public health perspective, this participatory architecture operationalizes what the World Health Organization terms “community empowerment”: processes enabling communities to increase control over determinants affecting their health. Stramurales impacts mental health in multiple ways: it immediately transforms the environment and creates visible evidence that contradicts narratives of decline; participatory decision-making restores collective efficacy, and international artist engagement demonstrates external validation of community value.

Improved mental health outcomes

The measurable impacts substantiate public health claims. Between 2020 and 2025, tourism revenue increased 25% despite pandemic disruption. New businesses opened, creating employment alternatives to emigration. Personal anecdotes are revealing: for example, Rita Gensano returned reluctantly in 2017 to provide parental care and now works as a tour guide and describes Stornara as “the coolest town in Italy”.

Mental health improvements in other festival towns include residents reporting renewed pride in their community, decreased social isolation through festival participation, and restored optimism about collective futures.

Stramurales operationalizes economic, social and cultural rights. Over 150 murals have been created by artists from around the world, available for everyone to enjoy at no cost. The democratic selection mechanisms ensure genuine participation in cultural policymaking.

Street art as visual health activism

Several murals explicitly engage health and human rights themes. Alaniz Niz’s “Refuge for All Migrants” represents exploited African agricultural workers; Sabotaje al Montaje’s “Turning Our Backs on Migration” challenges exclusionary migration policies; Devil Art Design’s “African Child at Sunset” portrays migrant youth seeking dignified futures.

These works might be termed “visual health activism”—addressing social determinants of health through human rights advocacy. Migration policies that deny basic rights create health vulnerabilities such as restricted access to healthcare, hazardous working conditions, and psychological trauma from discrimination. These murals perform public health functions addressing residents’ mental health and systemic injustices which affect vulnerable populations’ health outcomes. The art becomes simultaneously therapeutic for the host community and advocacy for populations whose health rights face systematic violation.

Street art festivals require only modest financial requirements, voluntary engagement and community participation, strategic use of social media for marketing, democratic decision-making, and integration of local narratives with global artistic practices.

State obligations under ICESCR article 15 to “take steps…to conserve, develop and diffuse culture” should support community-driven cultural initiatives that demonstrably impact health outcomes. As recent analyses of pandemic governance emphasize, future health law reforms must address not only biomedical preparedness but also underlying vulnerabilities in community resilience and social cohesion. Street art operating through participatory structures directly strengthens these dimensions.

Conclusion: Toward art-based public health interventions

The Stramurales case compels reconsideration of what constitutes health infrastructure. Walls covered with democratically selected art and created with genuine community participation demonstrably improve community mental health while operationalizing cultural rights enshrined in international law. The modest financial investment required to support such cultural projects should come from public health budgets—particularly for communities experiencing decline where traditional economic development approaches have failed.

The question is not whether art can function as health intervention—Stramurales demonstrates that it can. Rather, the question is whether health policymakers and human rights advocates possess the imagination to rethink health infrastructure, recognizing that effective mental health interventions may require canvases and community participation, not clinics or prescriptions.

Luciano Magaldi Sardella is a Phd/MBA holder and Professor of Global Health and Human Rights, European Open University, Germany.

Matteo Mantuano is Professor of Social Sciences and Psychoeducational Health, Unitré University of Milan, Italy.