Considerations for an urban health perspective in Chile from the "Quiero Mi Barrio" program

ABSTRACT OBJECTIVES To explore the perceptions of residents regarding their health and well-being in areas of personal and collective life, in relation to the experience of urban transformation originated by the Program for the Recovery of Neighborhoods in Chile "Quiero mi Barrio" (PQMB). METHODS Qualitative study conducted in eight neighborhoods, which were subject to interventions between 2012-2015, located in seven communes of Chile: Arica, Renca, Padre Las Casas, Villarrica, Castro, Ancud. Eighteen focus groups and 27 interviews were conducted between 2018 and 2019. A content analysis was carried out following the social determinants of health approach. RESULTS Material conditions of neighborhood infrastructure and psychosocial determinants were the main emerging and predominant categories in the residents' narratives. The new or improved infrastructure enhances sports and playing practices, as well as contributes to the feeling of safety and to the improvement of walkable spaces, support networks, socialization and dynamization of social organization. However, neglected aspects were visualized. The program had limitations of structural character that operate locally, such as aging, individual lifestyles that limit participation, and contexts of insecurity, especially in neighborhoods victims of drug trafficking. CONCLUSIONS The urban changes originated by the PQMB included improvements in neighborhood infrastructure and in the psychosocial environment, which are perceived by residents as beneficial aspects and promoters of collective wellbeing. However, global phenomena, and those related to the program, limit its scope and have repercussions on the perception of overall wellbeing of the residents in the neighborhoods. To go deeper into how this or other state neighborhood programs may or may not favor equitable access of different social groups, or which works may be better used by the groups, is an aspect that enhances the integral action with other sectors and local actors in the territories.

Unidade de contexto e observação social sistemática em saúde: conceitos e métodos / Context unit and systematic social observation: a review of concepts and methods

Assumimos que "onde você mora é importante para sua saúde, para além de quem você é". Entendemos que o impacto do local de moradia ou unidade de contexto (UC) na saúde das populações se deve à heterogeneidade dos atributos do entorno físico e social da UC, para além das características individuais ou agregadas daqueles ali aninhados. Estes atributos, embora dependentes dos indivíduos, são tipicamente externos a eles e potencialmente modificáveis. As UC são compreendidas como unidades ecológicas inseridas em conjuntos sucessivamente mais amplos e interdependentes. Quando relevante para a hipótese do estudo, unidades geográficas administrativas podem ser utilizadas como aproximações da UC. Outra alternativa é a que utiliza a percepção de seus moradores, a "vizinhança percebida". O ressurgimento do interesse com relação à determinação dos efeitos da UC sobre a saúde correlaciona com novas tendências na área da saúde coletiva: incorporação de novos níveis hierárquicos de exposição, as iniqüidades e seus determinantes, a urbanização e seus efeitos e a avaliação de intervenções multi-setoriais. Nosso objetivo central é rever opções para a escolha da UC a ser investigada além de estratégias para a aferição de seus atributos físicos e sociais, utilizando a observação social sistemática (OSS). A combinação de dados originárias de dados administrativos, da vizinhança percebida, dos inquéritos populacionais e da OSS ainda necessita de maiores elaborações conceitual, metodológica e analítica. Entretanto, a compreensão da distribuição dos atributos físicos e sociais da UC permite compor níveis hierárquicos de complexidade relevantes para o entendimento da ocorrência dos eventos relacionados à saúde nas populações.

We understand that "where one lives makes a difference to health in addition to who you are", and that the effects of the place of residence or context unit (CU) on public health are due to the heterogeneity of the physical and social environment characteristics, in addition to the individual and aggregate attributes of the population nested in the CU. Those attributes, although intrinsically dependent on the individuals, are typically external to them and susceptible to intervention. Also, the UC's are understood as ecological units nested within successively larger communities. Depending on the study hypothesis, census-defined areas may be used as proxy for the CU. Alternatively, the CU may be defined by the individual's perception of his/her neighborhood. The renewed interest on the health effects of the CU are associated with new trends in public health, namely: new hierarchical levels of exposure beyond individual level characteristics, inequalities and social determinants of health, urbanization and the need to evaluate interventions not traditionally associated to public health. Our objective was, first, to review options while choosing the relevant CU and second, to review strategies to determine and quantify the characteristics of the CU using social systematic observation (SSO). The combination of census-defined data, information on the neighborhood defined by the local population, surveys and SSO still needs conceptual, methodological and analytical development. However, the distribution of the physical and social attributes of the CU will permit to incorporate other hierarchical level of complexity to better understand the incidence and prevalence of health related events in populations.