Ilona Blue

Individual and contextual effects on mental health status in São Paulo, Brazil

Objectives: There is evidence that mental health status is partly determined by socioeconomic status. Recent research in the U.K. has highlighted the importance of place or context as a health determinant. This study aimed to analyze both individual socioeconomic variables and area of residence as potential risk factors for mental ill health. The objectives were to determine whether the effects of key explanatory variables on mental health status varies by area of residence and whether area of residence has an independent effect on mental health status once other key variables have been controlled for. Methods: The study used data collected as part of the Brazilian Multicentric Study of Psychiatric Morbidity. Data from a cross-sectional survey carried out in three socioeconomically contrasting sub-districts in Sao Paulo, Brazil, was used. The main outcome measure was mental health status as measured by the Questionario de Morbidade Psiquiatrica de Adultos (QMPA). Results: The results demonstrate that, even after key individual socioeconomic variables were controlled for, area of residence had a statistically significant effect on mental health status. Discussion: A possible explanation for the effect of area of residence relates to the social and physical features of places and their subsequent impact on health. Conclusions: It is important for mental health research to acknowledge the potential importance of the effect of area of residence on health, particularly in relation to developing new mental health promotion initiatives.

From healthy city projects to healthy cities

This paper discusses experience to date with the formulation and implementation of Healthy City projects in the South. After describing the origin of the Healthy Cities movement and what constitutes a Healthy City project, it reviews the experience of Healthy City initiatives in Fayoum (Egypt), Quetta (Pakistan) and Campinas (Brazil). It then discusses the roles of three critical stakeholders: international agencies (and how their support should facilitate local action rather than dictate it); local government staff and politicians (and the difficulties in getting their sustained support); and citizens and grassroots organizations. It ends by discussing how the real success of any Healthy City project is when it ceases to be a project, because the system it set up to ensure that health issues are given priority, to involve all stakeholders and to ensure that all sectors recognize that their role in healthy cities becomes part of the structure of local governance.

Linking health policy and social policy in urban settings: the new development agenda

Introduction Rapid urbanization in developing countries has prompted debate on urban health research and policy in the last decade. Due to the fact that poverty (in both relative and absolute terms) is the root cause of most of the burden of disease in cities and that changes in urban social relations also contribute to ill health, the debate has also included consideration of social factors in health. This paper briefly describes urbanization in developing countries, summarizes recent urban health research, examines changes in health policy in cities in developing countries, discusses the main themes of current social policy (using the new development agenda of the UK aid programme as an example), and considers the new linkages that are required between health policy and social policy in order to address urban health problems.

Urban inequalities in mental health: the case of São Paulo, Brazil

This paper describes how the number of people suffering from mental ill-health has been under-estimated in urban areas in Africa, Asia and Latin America. It also explains how the complex range of factors that contribute to mental ill-health, and the ways in which they interact, remain poorly understood. It then describes the findings from research on mental health in three sub-districts of São Paulo City: one with relatively poor quality housing and low-income households, one predominantly middle-class with better housing and one with high-class housing and high average incomes.

Social exclusion: a review and assessment of its relevance to developing countries.

Social exclusion is a relatively new term currently in use in Europe to describe both the circumstances of marginalization and the processes that lead to marginalization. Social exclusion tends to be rooted in multiple forms of deprivation, related to issues such as employment status, housing, rights, education, gender or race, and is thus comprehensive in nature. There is an ongoing debate regarding the relevance of the concept to developing countries: given the differences in social and economic development between developed and developing countries, some critics argue that social exclusion is not an exportable concept. This paper seeks to review these arguments and analyze the policy implications, suggesting a possible way forward using the Sustainable Livelihoods Framework, involving multi-dimensional programs that prioritize human development and welfare, and which address exclusionary processes.

Violent death in young people in the city of São Paulo, 1991–1993

This paper aims to describe the principal causes of violent deaths among young people in the city of São Paulo, Brazil. Data from routine mortality statistics were used in the analysis. Young males were found to have a dramatically increased risk of death from violent causes especially those resident in lower income areas of the city. Possible explanations for these findings include economic instability generating social and cultural inequalities.