Léo Heller

Who really benefits from environmental sanitation services in the cities? An intra-urban analysis in Betim, Brazil

The paper presents the findings of research in Betim (Brazil) which looked in some detail at the association between health and provision for water supply (including water quality, per capita consumption, regularity of supply, household hygiene practices and extent of indoor plumbing), waste water and excreta disposal, garbage disposal (including frequency of collection and quality of refuse storage by households) and provision for drainage. It shows the limitations in official statistics for such services - for instance in their inaccuracy regarding who is served and in their limited range (for instance the lack of attention given to service quality and to provision for drainage). It also shows how the population benefiting from these services is not necessarily the same as that connected to public systems. The paper ends with recommendations for public urban policies and for the collection of data and research to ensure that environmental sanitation services better address health risks.

Programa Nacional de Vigilância em Saúde Ambiental Relacionada à Qualidade da Água para Consumo Humano (Vigiagua): lacunas entre a formulação do programa e sua implantação na instância municipal

A avaliacao e o acompanhamento das acoes do Programa Nacional de Vigilância em Saude Ambiental Relacionada a Qualidade da Agua para Consumo Humano (Vigiagua) sao importantes para validar o processo de trabalho, identificar nos e sugerir mudancas objetivando o avanco do Programa. Trabalhos sobre o Vigiagua geralmente exploram aspectos quantitativos e metas atingidas, inexistindo uma avaliacao qualitativa sobre a sua implantacao na instância municipal. Assim, praticas rotineiras preconizadas pelo Ministerio da Saude referentes a identificacao e ao cadastramento das formas de abastecimento de agua, a espacializacao e ao compartilhamento de informacoes, intraorganizacional e intersetorialmente, sao analisadas por meio de falas captadas em entrevistas com profissionais do Vigiagua em tres municipios de diferentes portes populacionais. Recorreu-se ao metodo da analise de conteudo de Bardin (1994) para o tratamento e a analise dos relatos, que revelou persistir dificuldades para cadastramento e vigilância a instalacoes de abastecimento de agua, a nao realizacao de series temporais, a deficiencia de instrumentos de georreferenciamento e a integracao incipiente entre setores. Ainda, a integracao entre a pratica dos profissionais do Vigiagua e da Vigilância Epidemiologica e incipiente nos tres municipios, restringindo-se basicamente a situacoes de surto. A implantacao muito recente do Vigiagua aponta para a importância de avaliacoes visando, assim, seu aprimoramento.

Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil

Infection with the hepatitis B and C viruses may occur through contact with infected body fluids, including injury with infected sharps. Collectors of domestic or healthcare wastes are potentially exposed to these infections. The aim of this article is to investigate the risk factors associated with the prevalence of hepatitis B and C viruses (HBV and HCV) infection among domestic and healthcare waste workers in Belo Horizonte, Brazil. A cross-sectional study of hepatitis B and C infection was conducted from November 2014 to January 2015, through blood sample collection and interviews about socio-demographic factors with 61 workers exposed to healthcare waste (‘exposed’) and 461 exposed only to domestic wastes (‘unexposed’). The prevalence of antibodies to HCV (Anti-HCV) antibodies was 3.3% in ‘exposed’ workers and 0.9% in ‘unexposed’, and of antibody to hepatitis B core antigen (Anti-HBc) was 9.8% and 5.6% in ‘exposed’ and ‘unexposed’ workers, respectively. Only 207 (44.9%) of those exposed to domestic waste and 45 (73.8%) of those handling healthcare waste were effectively immunised against hepatitis B virus (HBV). Exposures to domestic waste and to healthcare wastes were associated with similar risks of infection with HBV. The risk of hepatitis C virus (HCV) infection was marginally higher among healthcare waste workers compared with domestic waste workers, probably because of needlestick accidents owing to deficient sharps management systems. Immunisation against hepatitis B and screening tests to ensure the success of vaccination should be a condition for recruitment for both groups of waste workers.

The human right to water and sanitation: a new perspective for public policies

The recognition of the human right to water and sanitation (HRtWS) by the United Nations General Assembly and Human Rights Council in 2010 constituted a significant political measure whose direct consequences are still being assessed. Previous to this date, the HRtWS and its link to a healthy life and adequate standard of living had been recognised in diverse legal and judicial spheres worldwide, in some cases under the pressure of the initiatives of strong social movements. However, while the HRtWS is recognised by the UN State Members, it constitutes a concept in construction that has not been approached and interpreted in consensual ways by all concerned stakeholders. The present article presents a formal definition of this right with a base in human rights regulation. It attempts to dialogue with the different existing perspectives regarding the impact of its international recognition as a human right. It then elucidates the progressive development of the HRtWS in law and jurisprudence. Finally, it considers the urgency and challenge of monitoring the HRtWS and discusses important implications for public policies.

Is waste collection associated with hepatitis B infection? A meta-analysis

This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.

O direito humano à água e ao esgotamento sanitário como instrumento para promoção da saúde de populações vulneráveis

The concept of health promotion, which is based on social determinants, is aligned with principles of human rights such as social participation, accountability, transparency and non-discrimination. The Human Right to Water and Sanitation (HRWS) was approved in 2010 by the United Nations General Assembly and the Human Rights Council and it aims to ensure access to water and sanitation, without discrimination, for all. This article aims to analyze how the human rights framework, and more specifically the HRWS, can be used to strengthen the health promotion of vulnerable groups. The article begins by presenting the relationship between health and human rights. It then demonstrates how the concept of social vulnerability is based on human rights and, finally, it shows the relationship between the HRWS and the promotion of the health of vulnerable groups.

Planos municipais de saneamento básico: avaliação de 18 casos.

Since 2007, Brazilian municipalities have faced the new challenge posed by Law 11,445, which brought a new organization to the sector management, assuming it as not only services provision but also planning, regulation, supervision and social control. In this paper, 18 environmental sanitation municipal plans were assessed, aiming at understanding difficulties and potentialities for the planning process. Five geographical regions of the country and 14 states were included in the sample. The assessment was guided by the principles of universality, equity, integrality, cross-sectoral relations, quality, policy implementation, management capacity and sustainability. In most cases, weaknesses in policy implementation were identified, as well as the incorporation of the principles in the plans took place only incidentally, although some of them have stood out due to greater adherence to the principles considered (Alagoinhas, BA; Morada Nova, CE; Ariquemes, RO, e Ouro Branco, MG).

Planos municipais de saneamento básico: avaliação de 18 casos brasileiros*

Since 2007, Brazilian municipalities have faced the new challenge posed by Law 11,445, which brought a new organization to the sector management, assuming it as not only services provision but also planning, regulation, supervision and social control. In this paper, 18 environmental sanitation municipal plans were assessed, aiming at understanding difficulties and potentialities for the planning process. Five geographical regions of the country and 14 states were included in the sample. The assessment was guided by the principles of universality, equity, integrality, cross-sectoral relations, quality, policy implementation, management capacity and sustainability. In most cases, weaknesses in policy implementation were identified, as well as the incorporation of the principles in the plans took place only incidentally, although some of them have stood out due to greater adherence to the principles considered (Alagoinhas, BA; Morada Nova, CE; Ariquemes, RO, e Ouro Branco, MG).

A crise no abastecimento de água: como se mostraria diferente se observada através da lente do direito humano à água?

. The combination of these concepts results in citizens’ entitlement to these rights (including the right to claim them through the legal system) and obligations on the part of national states and service providers.Achieving this human right to water and sanitation (RtWS) means ensuring water with availability, accessibility, quality, safety, and af-fordability, meeting the requirements of accept-ability, dignity, and privacy.As Brazil now faces a dramatic crisis in wa-ter supply, severely affecting its most populated, urbanized, and industrialized region, the RtWS framework can serve as an invaluable perspec-tive for assessing the situation.First, assessing the roots of the current cri-sis, if water providers had respected RtWS principles, the current climatic oscillation would not have turned into a water scarcity for hu-man consumption. Key RtWS principles include “maximum available resources” and the need for appropriate planning to ensure access to water. In addition, retrogression in access vio-lates the right to water. We can safely state that, if adequate planning for the water supply in the affected localities, amphasizing water security, had been properly adopted, the problem would not exist in its current intensity. When simulating future scenarios, appropriate strategic planning must take into account climatic situations with low probability of occurrence, among other vari-ables

Urban Waste Collectors in Belo Horizonte, Brazil: Their Perceptions of Occupational Health Risk

Frequent contact with hazardous materials makes waste collection a potentially unhealthy activity. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Brazil. Six focus groups were performed between June 2014 and August 2015. The aims of this study were to apprehend different aspects of the participants’ health, workers’ experiences of work-related accidents and perception of risks. Cuts and puncture injuries were reported most frequently in the line of work and were often considered as irrelevant. Immunization against hepatitis B was not common among all workers, which increases the risk of infection for those individuals. Finally, it is considered urgent to consolidate an inclusive space in which workers can have discussions on their health.