Health, nutrition, and cities are the themes of "Estudos Avançados" #109
The three dossiers that make up Estudos Avançados #109, launched last month, maintain the journal's tradition of "addressing current themes of social relevance, combining the communication of research results with public debate," in the words of editor Sérgio Adorno. The themes covered by this issue are "Health Promotion", "Food Security," and "Cities and Technologies". The intention, as always, is to collaborate with the "formulation and implementation of government policies aimed at overcoming problems that affect quality of life and reducing social inequalities." The digital version is now available, free of charge, at the Scientific Electronic Library Online (Portuguese only)
The interdisciplinarity of the analyzes is demonstrated in the opening article of the first dossier, entitled "Cardiovascular Health and Housing: An Important Dialogue Held in Precarious Settlements in São Paulo." Authored by experts in geography, urbanism, and pathology, the study analyzed data from residents of São Paulo who died due to diseases of the circulatory system from 2010 to 2016 or were hospitalized through the Brazilian public health service (SUS) due to the same illnesses from 2011 to 2016. The type of housing settlement of individuals (subnormal, precarious, or regular), age, and sex have been taken into account.
The difference in cardiovascular health between the three types of settlements assessed through the proportions of hospital admissions and mortality rates has shown that almost 1.7 million people in São Paulo are at a great disadvantage in relation to the remaining 85% of the population .
Although precarious housing is "the cause or a determining factor of many physical and mental pathologies," another study in the dossier demonstrates that "the legal health framework in Brazil restricts or even prohibits the use of health resources in housing issues, delimits the composition of health teams to medical-hospital professions, as well as does not consider the use of resources from other budgetary functions in the provision of housing for specific health purposes."
Such delimitations should be removed in situations where there is scientific evidence that the housing issue is a social determinant of health, according to the recommendation of the article "Why Investment and Focus on Housing Issues are Also a Measure of Health."
Vulnerability
One must also consider the multiple vulnerabilities of peripheral territories, which makes intervention in these spaces a challenge that needs to be faced from the logic of complex problems, as "they do not have a single, linear solution to overcome them," warns a third study. Based on work developed by the Tide Setubal Foundation on the outskirts of São Miguel Paulista, in São Paulo, the article "Intersectoriality and Urban Improvements in the Outskirts of São Paulo: The Case of São Miguel Paulista" proposes that intersectorality should be promoted from the public budget, impact measurement, and community protagonism.
The dossier also presents a study on the history of ideas regarding the conditions for the development of individuals. The article "Education, Health, and Progress: Discussions on Environmental Effects on Child Development (1930-1980)" shows how there was a "strong association between promoting the development of individuals and social progress" in the covered period.
"It was understood that public investments in creating better health and education conditions for children would favor the country’s advancement." School was seen as "an environment conducive to the healthy development and civilization of children."
In terms of health, this development perspective has become vulnerability in many peripheral areas where the control of the territory is exercised by organized crime. The situation is exemplified in a study of a basic health unit located in an area dominated by drug trafficking.
Based on a field diary and open interviews with different interlocutors in the territory of a peripheral health unit in a medium-sized municipality in the state of São Paulo, the work pointed out that, "given the absence or insufficiency of the State in territories of social vulnerability, trafficking can function both as an agent of precarious working relationships between health teams and the community, and as a provider of support and protection mechanisms for the population, mediation, and management of the population's daily relationships, including their relationship with health equipment.
Health Promotion
Even in the face of countless social vulnerabilities, it is necessary to find ways to promote health. It becomes relevant to understand the different interpretations of health promotion, despite the fact that the field is going through a process of institutionalization and strengthening. An article by public health experts discusses these interpretations, whose diversity demonstrates the need to delve deeper into some topics, such as the role of the health sector, behavioral change, and individual approaches, according to the researchers.
In their study, they present other ways of understanding these themes through the contribution of workers, primary care managers, and experts on the issue. The idea is to "expand the possibilities of practicing health promotion in primary care".
The work methodology has included semi-structured interviews with experts and consultation with municipal managers and workers in primary care using the electronic form FormSUS. 13 experts were interviewed between November 2017 and February 2018. The interviewees joined the Working Group on Health Promotion and Sustainable Development (GTPSDS), linked to the Brazilian Public Health Association (ABRASCO), "a group that defends action in social determination and does not restrict itself to risk and protective factors for chronic non-communicable diseases (NCDs)".
Another study in the dossier has analyzed the impact of the implementation of cycle paths in the city of São Paulo on the practice of leisure-time physical activities and the correlations of this practice with high blood pressure rates. A group of 1,431 people have been evaluated, living within a maximum of 1 km of cycle paths. The work highlights the need to improve environmental conditions (implementation of cycle paths, for example) in areas of greatest socioeconomic need in the city in order to generate greater opportunities to practice physical activity and the consequent reduction in rates of high blood pressure and other chronic diseases.
Well-being
Improving quality of life is also the subject of another article, which brings together notions of well-being in four main matrices: that of indigenous worldviews, that of the Latin Americanist utopian thought, the state-owned one, and the socio-environmental one. According to the authors, these matrices "hold convergent aspects among themselves, forming a common core that emulates new philosophical, economic, and political proposals as alternatives to the model of life, work, and relationship with the environment produced by neoliberal capitalism."
The autonomy of people under guardianship is also discussed in the dossier. A study by researchers in the field of law examines the possibility of substitute consent in the context of health in cases of people in a guardianship situation to determine whether the legal representative of people with disabilities would also be allowed to decide on existential aspects.
The dossier ends with an article on the socio-environmental reality of implementing reverse medication logistics to minimize drug contamination and achieve the relevant Sustainable Development Goal. The study highlights control, monitoring, and environmental education actions to reduce the impacts of pharmaceutical waste and promote sustainability.
Nutrition
The first article in the dossier entitled "Food Security" aims to contribute to the analysis of the current scenario on food insecurity in Brazil, based on studies carried out by two IEA research groups (Nutrition and Poverty, and Planetary Health) in partnership with the AgriBio Axis of the Center for Artificial Intelligence (C4AI) at USP.
The contribution of agricultural production to improving this scenario in cities is explained in an article about the results of the debate Urban Agriculture and Food and Nutritional Security: Organic Food in School Food, which took place at the 11th Service, Research, and Public Policy Seminar. The event was organized by the Nutrition and Poverty Research Group and the Urban Agriculture Study Group, both based at the IEA.
The set of texts includes the analysis of a practical health and food care project for families with children and adolescents in situations of malnutrition. The work dealt with the "short production-commercialization chain" of food to support project actions involving families with children and adolescents served by the Nutritional Recovery and Education Center (CREN).
A recent topic in the spectrum of eating habits, flexitarianism, is also present in the dossier, with a study on the factors that lead flexitarians to different levels of reduction in meat consumption.
Urbanism
Through a 2009 municipal law, strategies for adapting to climate change and disaster management were established in the city of São Paulo. The initial article in the dossier entitled "Cities and Technologies" analyzes the effectiveness of the legal framework of this policy, its articulation with other relevant standards and environmental law, and how its governance has been constructed.
Climate change and other factors, such as El Niño, have a direct impact on water availability, as demonstrated by the current drought affecting several municipalities in the Amazon, which lack policies and structures to face the problem. Hence the importance of municipalities having greater participation in the National Water Resources Management System (SINGREH), warn the authors of the article "Water Governance in Brazil: What is the Role of City Governments?".
In addition to weak participation in the system, researchers indicate that municipalities do not have a policy on water resources. Another problem highlighted is the fact that legal reforms regarding water resources tend to further weaken the role of municipalities in the SINGREH.
Nature-based solutions are also present in the dossier, for instance in an article that addresses the integration of this type of solution in a brownfield revitalization project. Brownfield is an underutilized and degraded urban area whose transformation provides benefits to the population.
The evolutionary process of cities is approached in a philosophical and technological way. An article discusses some concepts created by French philosopher Michel Foucault (1926-1984), such as discipline and biopower, and applies them to the history of Brazilian urbanism, especially in the cases of Rio de Janeiro and São Paulo. Another text examines the technologies that have led to an urban revolution with the emergence of smart cities, due to the proliferation of continuously connected electronic equipment, which allows managing the urban structure in a more efficient and optimized way, say the authors.
The list below contains the names of the authors who have contributed with each one of the addressed themes:
Health Promotion
Cardiovascular Health and Housing: An Important Dialogue Held in Precarious Settlements in São Paulo - Ligia Vizeu Barrozo, Carlos Leite, Edson Amaro Jr., and Paulo Hilário Nascimento Saldiva
Why Investment and Focus on Housing Issues are Also a Measure of Health - Eduardo Castelã Nascimento, Wesllay Carlos Ribeiro, and Suzana Pasternak
Intersectoriality and Urban Improvements in the Outskirts of São Paulo: The Case of São Miguel Paulista - Mariana Almeida
Education, Health, and Progress: Discussions on Environmental Effects on Child Development (1930-1980) - Ana Laura Godinho Lima
Basic Healthcare in a Scenario of Vulnerability: Health Production and the Informal Governance of Drug Traffickers - Amanda Dourado Souza Akahosi Fernandes, Sabrina Helena Ferigato, Massimiliano Minelli, and Thelma Simões Matsukura
Health Promotion in Primary Care: The Role of the Healthcare Sector, Behavioral Change, and Individual Approaches - Fabio Fortunato Brasil de Carvalho, Marco Akerman e Simone Cynamon Cohen
Bike Paths, Leisure-Time Physical Activity and High Blood Pressure: A Longitudinal Study - Alex Antonio Florindo, Guilherme Stefano Goulardins, and Inaian Pignatti Teixeira
Between Desirable Utopias and Possible Realities: Contemporary Notions of Living Well - Gabriel Castro Siqueira, Bruno Simões Gonçalves, and Alessandro de Oliveira dos Santos
The Limits of Guardianship, and the Free and Informed Consent of People With Disabilities - Jussara Maria Leal de Meirelles and Ana Paula Vasconcelos
Reverse Medication Logistics in Brazil: A Socio-Environmental Analysis - Sara Raquel L. B. de Lima, Viviane Souza do Amaral, and Julio Alejandro Navoni
Food Security
Food Security: Reflections on a Complex Problem - Semíramis Martins Álvares Domene et al.
Healthy Diets, and Urban and Family Farming - Ana Lydia Sawaya et al.
In the Gaps of Everyday Life: Reflections on Professional Practices and Insights Based on Local Foodstuffs - Giulia de Arruda Maluf, Maria Paula de Albuquerque, Maria Fernanda Petroli Frutuoso, and Bernardo Teixeira Cury
What Influences Flexitarians to Reduce Meat Consumption in Brazil? - Mariele Boscardin, Andrea Cristina Dorr, Raquel Breitenbach, and Janaína Balk Brandão
Cities and Technologies
Adaptation to Climate Change and Disaster Prevention in the City of São Paulo - Ana Maria de Oliveira Nusdeo, Andresa Tatiana da Silva, and Fernanda dos Santos Rotta
Water Governance in Brazil: What is the Role of City Governments? - Valérie Nicollier, Asher Kiperstok, and Marcos Eduardo Cordeiro Bernardes
Nature-Based Solutions in Urban Brownfield Revitalization Projects: New Paradigms for Urban Problems - Evandro Nogueira Kaam and Amarilis Lucia Casteli Figueiredo Gallardo
On Foucault and Brazilian Urbanism: A Genealogy of Planning (c. 1850s-1945) - Joel Outtes
Cognitive Cities: Technological Utopia or Urban Revolution? - Marcio Lobo Netto and João Francisco Justo
Intrapreneurship and Innovation in Public Organizations: The Case of Brazil’s Census - Roberto Kern Gomes and Magnus Luiz Emmendoerfer