Fernando Ferreira Carneiro

Saúde e ambiente: uma reflexão da Associação Brasileira de Pós-Graduação em Saúde Coletiva - ABRASCO

INTRODUCAO: O Brasil, apesar de sua extraordinaria biodiversidade e do enorme potencial instalado para desenvolver acoes integradas na tematica do ambiente, nao tem dado, do ponto de vista programatico, a prioridade que o tema ambiente merece. A Associacao Brasileira de Pos-Graduacao em Saude Coletiva-ABRASCO reconheceu a importância de organizar um Grupo Tematico Saude e Ambiente para, de maneira mais organizada, participar da luta pelo desenvolvimento sustentavel, atraves da acao politica no campo da saude coletiva, em busca de ambientes saudaveis e da promocao da saude. O OBJETIVO principal deste Grupo Tematico-GT foi contribuir para que o tema da saude ambiental seja internalizado no campo da Saude Coletiva. METODO: O Grupo escolheu tres eixos para discussao em uma oficina do V Congresso Brasileiro de Epidemiologia, em Curitiba, no ano de 2002. O RESULTADO do debate ocorrido foi apresentado segundo tres eixos: identificacao do campo teorico-conceitual em Saude Ambiente; a politica de saude e ambiente; o caminho metodologico. A CONCLUSAO foi apresentada no formato de uma agenda do GT para o bienio 2002-2004.

The precarious livelihood in waste dumps: a report on food insecurity and hunger among recyclable waste collectors

OBJECTIVE: This study estimated the prevalence of food insecurity, social vulnerability factors, and health risks in recyclable material collectors who work at the dump. METHODS: A census was performed of the collectors families living on five blocks near the dump of the Complementary Industry and Supply Sector, Brasilia, Federal District, known as Cidade Estrutural. Sociodemographic data about sanitation, social programs, housing, labor, and food security were collected during home interviews. RESULTS: A total of 204 households composed of 835 residents and 286 collectors was studied. Ninety-three percent of the households had piped water, 65% had sanitation and almost all had electricity. But the presence of rats and cockroaches occurred in 90% of the households. A third of the workers reported being sick, but 44% of the families were not visited by community health workers because not all blocks were covered. Based on the food insecurity scale and the reporting of eating foods picked from the garbage by 55% of the respondents, a total of 75% of the households were exposed to food insecurity. According to the criteria of the Bolsa Familia Program, 52% of the households were eligible, but not all were enrolled: the undercoverage was 44%. The need of other inclusion criteria for social programs, in addition to income, to identify populations surviving precariously in extreme poverty, hunger, and demeaning work is discussed. CONCLUSION: The social and environmental vulnerability of this population, subject to hunger and disease, is serious. The Brasil sem Miseria (Brazil without Poverty) program will not be capable of eliminating poverty while these subhuman conditions remain unresolved.

O verde da economia no campo: desafios à pesquisa e às políticas públicas para a promoção da saúde no avanço da modernização agrícola

Neste ensaio, e feita a pergunta de quem deve, pode e quer promover a saude no campo hoje. Foi eleito, prioritariamente, o campo da ciencia e o das politicas publicas como foco de dialogo. Configurou-se oito licoes aprendidas sob a perspectiva dos direitos a saude a um ambiente saudavel, aqui compartilhadas: (1) para alem de um risco quimico isolado, a relacao entre agrotoxicos e saude deve ser estudada no contexto da modernizacao agricola conservadora; (2) e necessario e urgente que se proceda ao desvelamento dos agravos a saude relacionados aos agrotoxicos; (3) o Estado tem tido significativa eficacia no apoio ao agronegocio e significativa ineficacia nas politicas sociais de garantia de direitos dos trabalhadores e da populacao; (4) setores da sociedade ligados as organizacoes do campo vem desempenhando importante papel na politica publica de combate aos agrotoxicos e de protecao da saude; (5) e importante que os estudos contribuam para a desconstrucao dos mitos que sustentam o modelo da Revolucao Verde; (6) se esta diante do desafio de contribuir na construcao de um paradigma emergente de ciencia, fundado no compromisso etico-politico com os mais vulneraveis; (7) comunidades camponesas vem construindo alternativas agroecologicas de vida no semiarido.

Saúde ambiental e desigualdades: construindo indicadores para o desenvolvimento sustentável

Despite its progress in terms of socio-economic indicators, Brazil is still unequal, which is due to an unequal and exclusionary historical process. In this paper we selected the Human Development Index - HDI and other social, economic, environmental and health indicators to exemplify this situation. We selected the municipalities that had the lowest HDI in the country in 2000 comparing their evolution over time between 2000 and 2010 by means of indicators linked to the economic, environmental and social pillars of sustainable development. These municipalities have an HDI classified as low (<0.500), and correspond to countries such as Laos, Yemen, Haiti and Madagascar. At national level, data for the decade show a significant improvement in economic indicators (decrease from 23% to 8.9% of people living on less than a quarter of the minimum wage); social indicators (increase from 86.5% to 90.2% of literacy in women), and the environmental indicator associated with access to the water grid, which also improved to a lesser extent (increase from 81% to 85%). It was concluded that in order to achieve sustainable development with quality of life, the improvement of sanitation and education indicators should be a priority for Brazil.

Saúde de famílias do Movimento dos Trabalhadores Sem Terra e de bóias-frias, Brasil, 2005

OBJETIVO: Evaluar las condiciones de salud de familias relacionadas al Movimiento de Trabajadores Rurales Sin Tierra de Brasil y de trabajadores rurales jornaleros. METODOS: Se realizo estudio comparativo de tres poblaciones: asentamiento e acampamento del Movimiento de Trabajadores Rurales Sin Tierra, y familias de trabajadores rurales jornaleros, en 2005. Fueron colectados los datos referentes a caracteristicas sociodemograficas y familiares por medio de cuestionarios aplicados a 202 familias y realizadas observaciones estructuradas y discusiones en grupo. Se realizo analisis factorial discriminante para verificar diferencias entre las comunidades. RESULTADOS: Las tres comunidades presentaron una media de 89%, caracterizandose como grupos distintos entre si en terminos de sus condiciones de vida y salud. Los trabajadores rurales jornaleros presentaron un alto indice de inseguridad alimenticia (39,5%), casi el doble de la proporcion entre las familias acampadas y cuatro veces mas que las asentadas. Con una renta variable y baja, las familias de jornaleros estaban mas expuestos a los plaguicidas si comparados a los asentados y acampados. La produccion animal desarrollada por todas las familias asentadas fue una caracteristica determinante, al contrario de las familias de jornaleros que practicamente no contaban con esa posibilidad en la ciudad. Segun la percepcion de las familias asentadas y acampadas, el Sistema de Salud no ha atendido las necesidades de salud de la mayoria de ellas, principalmente por la dificultad de acceso a los servicios. Para ese grupo, la atencion a sus necesidades se da despues de reclamaciones y presiones sobre los gobiernos. CONCLUSOES: Segun la percepcion de las familias del Movimiento de los Trabajadores Rurales Sin Tierra, el hecho de ser del Movimiento y estar organizado mejora sus perspectivas de salud, en comparacion a los jornaleros. Los resultados de la modernizacion conservadora en el campo brasileno ha empeorado las condiciones de vida de los trabajadores rurales jornaleros generando una superexplotacion del trabajo humano, mientras que la Reforma Agraria ha hecho posible una mejor calidad de vida y salud para las familias, cuando comparadas en las areas estudiadas.OBJECTIVEnTo assess the health conditions of families from the Landless Rural Workers Movement and temporary rural workers.nnnMETHODSnThe research involved a comparative study of three populations: a settlement and a camp linked to the Rural Workers Movement, and the families of temporary rural workers in a city of Southeast Brazil, in 2005. Information relating to sociodemographic characteristics and families were collected by means of questionnaires that were put to 202 families. In addition, structured observation and group discussions were used. A discriminative factor analysis was carried out to confirm differences between the communities.nnnRESULTSnThe three communities scored an average of 89%, which implies that they are distinct groups and supports the hypothesis that there are real differences between them when it come to health and lifestyle conditions. There was a high rate of food insecurity (39.5%) among temporary rural workers, almost double that of families who were camping and four times greater than those living on settlements. Temporary rural workers salaries were low and fluctuate, meaning that they were more exposed to pesticides than the families living on settlements or in camps. A striking characteristic of families living on the settlement was that they all practiced animal rearing, unlike the families of temporary rural workers, practically none of whom were able to do so in the city. The perceptions of most families who were living on settlements or in camps were that the Brazilian Health System had not been meeting their health needs, mainly due to access difficulties. For this group, their needs are met only after making complaints to and putting pressure on governors.nnnCONCLUSIONSnThe view held by families from the Landless Rural Workers Movement was that the fact that they belonged to the Movement and were better organized meant their health was better than that of temporary rural workers. The conservative modernization of rural Brazil has led to worse conditions for temporary rural workers, while Agrarian Reform has allowed for a better quality of life and improved health conditions among families, when compared in the areas under study.OBJETIVO: Avaliar as condicoes de saude de familias ligadas ao Movimento dos Trabalhadores Rurais Sem Terra e de boias-frias. METODOS: Realizou-se estudo comparativo de tres populacoes: assentamento e acampamento do Movimento dos Trabalhadores Rurais Sem Terra, e familias de boias-frias, em Unai, MG, em 2005. Foram coletados os dados referentes as caracteristicas sociodemograficas e familiares por meio de questionarios aplicados a 202 familias, e realizadas observacao estruturada e discussoes em grupo. Realizou-se a analise fatorial discriminante para se verificar diferencas entre as comunidades. RESULTADOS: As tres comunidades apresentaram uma media de 89%, caracterizando-se como grupos distintos e reforcando a hipotese de que sao realmente diferentes entre si em termos de suas condicoes de vida e saude. Os trabalhadores boias-frias apresentaram um alto indice de inseguranca alimentar (39,5%), quase o dobro da proporcao entre as familias acampadas e quatro vezes mais que as assentadas. Com uma renda variavel e baixa, os boias-frias estavam mais expostos aos agrotoxicos se comparados aos assentados e acampados. A producao animal desenvolvida por todas as familias assentadas foi uma caracteristica marcante, ao contrario das familias boias-frias que praticamente nao contavam com essa possibilidade na cidade. Segundo a percepcao das familias assentadas e acampadas, o Sistema Unico de Saude nao tem atendido as necessidades de saude da maioria delas, principalmente pela dificuldade do acesso aos servicos. Para esse grupo, o atendimento de suas necessidades se da apos reivindicacoes e pressoes sobre os governos. CONCLUSOES: Segundo a percepcao das familias do Movimento dos Trabalhadores Rurais Sem Terra, o fato de ser do Movimento e estar organizado melhora suas perspectivas de saude, em comparacao aos boias-frias. Os resultados da modernizacao conservadora no campo brasileiro tem agravado as condicoes de vida dos boias-frias gerando uma superexploracao do trabalho humano, enquanto que a Reforma Agraria tem possibilitado uma melhor qualidade de vida e saude para as familias, quando comparadas nas areas estudadas.

Accidents at work and living conditions among solid waste segregators in the open dump of Distrito Federal

The work of recycling solid waste segregators allows a precarious livelihood, but triggers a disease process that exacerbates their health and well-being. This study aimed to estimate the prevalence of occupational accidents at the open dump in the Federal District and its associated factors. Most segregators have had an accident at work (55.5%), perceived the danger of their working environment (95.0%) and claimed they did not receive personal protective equipment (51.7%). Among other findings, 55.8% ate foods found in the trash, 50.0% experienced food insecurity at home and 44.8% received Bolsa Família. There was a statistically significant relationship between work accidents and perception of dangerous work environment, household food insecurity and the presence of fatigue, stress or sadness (p < 0.05). On the other hand, the fellowship between the segregators was associated with a lower prevalence of accidents (p < 0.006). Women are the majority of the segregators (56.5%) and reported more accidents than men (p < 0.025). We conclude that the solid waste segregators constitute a vulnerable community, not only from the perspective of labor, but also from the social and environmental circumstances. To reverse this situation, effective implementation of the National Policy of Solid Wastes is imperative, in association with affirmative policies to grant economic emancipation for this population.

Sentidos e métodos de territorialização na atenção primária à saúde

Territorially-based participative analytical methodologies taking the environmental question and work into consideration are essential for effective primary health care. The study analyzed work and environment-related processes in the primary health care area and their repercussions on the health of workers and the community in a rural city in Ceara, whose economy is based on agriculture for export,. It sought to redeem the area and the proposal of actions focused on health needs by the social subjects through the making of social, environmental and work-related maps in workshops within the framework of action research. Examining the situation from a critical perspective, based on social participation and social determination of the health-disease process with regard to the relations between production, environment and health, was the most important step in the participative map-making process, with the qualitative material interpreted in light of discourse analysis. The process helped identify the health needs, the redemption of the area, strengthened the cooperation between sectors and the tie between the health of the worker and that of the environment, and represented an advance towards the eradication of the causes of poor primary health care services.

El cuestionamiento de la institucionalización de la Educación Popular en Salud en el SUS

No contexto da implementacao da Politica Nacional de Educacao Popular em Saude, aprofundam-se a analise e reflexao sobre o processo de institucionalizacao da Educacao Popular em Saude no Sistema Unico de Saude. Identifica-se e problematiza-se a compreensao dos atores do campo da educacao popular sobre o processo de institucionalizacao, suas potencialidades, riscos e desafios. Configura-se em uma pesquisa qualitativa realizada por meio de entrevistas semiestruturadas e analise bibliografica. Conclui que a institucionalizacao da educacao popular em saude configura-se em uma aposta e que seu exito dependera do reconhecimento e respeito a historicidade e ao conjunto dos saberes, praticas e lutas do campo popular na saude.

Desafios para a construção da 'Saúde e Ambiente" na perspectiva do seu Grupo Temático da Associação Brasileira de Saúde Coletiva

Health and Environment is the nucleus of knowledge and practices surrounding the relations between society and nature, mediated by the mode of production and human labor, which help to understand the determination of the health-disease process of different social classes and groups. This paper discusses the challenges to build this field from the perspective of its Thematic Group of the Association of Collective Health. The three core themes of the 2nd Brazilian Symposium on Environmental Health are taken as the theoretical framework for analysis. A timeline of the groups trajectory, in its historical context, helps to identify the contemporary challenges. Among the main challenges identified, the challenge of building an interdisciplinary, intersectoral and participatory scientific practice, which could build knowledge and dialogue with social movements, is highlighted.

Questioning the Institutionalization of Popular Education in Health in the Unified Health System (SUS – acronym in Portuguese)

No contexto da implementacao da Politica Nacional de Educacao Popular em Saude, aprofundam-se a analise e reflexao sobre o processo de institucionalizacao da Educacao Popular em Saude no Sistema Unico de Saude. Identifica-se e problematiza-se a compreensao dos atores do campo da educacao popular sobre o processo de institucionalizacao, suas potencialidades, riscos e desafios. Configura-se em uma pesquisa qualitativa realizada por meio de entrevistas semiestruturadas e analise bibliografica. Conclui que a institucionalizacao da educacao popular em saude configura-se em uma aposta e que seu exito dependera do reconhecimento e respeito a historicidade e ao conjunto dos saberes, praticas e lutas do campo popular na saude.