Social conditions and urban health inequities: realities, challenges and opportunities to transform the urban landscape through research and action.

The process of urbanization entails social improvements with the consequential better quality-of-life for urban residents. However, in many low-income and some middle-income countries, urbanization conveys inequality and exclusion, creating cities and dwellings characterized by poverty, overcrowded conditions, poor housing, severe pollution, and absence of basic services such as water and sanitation. Slums in large cities often have an absence of schools, transportation, health centers, recreational facilities, and other such amenities. Additionally, the persistence of certain conditions, such as poverty, ethnic heterogeneity, and high population turnover, contributes to a lowered ability of individuals and communities to control crime, vandalism, and violence. The social vulnerability in health is not a "natural" or predefined condition but occurs because of the unequal social context that surrounds the daily life of the disadvantaged, and often, socially excluded groups. Social exclusion of individuals and groups is a major threat to development, whether to the community social cohesion and economic prosperity or to the individual self-realization through lack of recognition and acceptance, powerlessness, economic vulnerability, ill health, diminished life experiences, and limited life prospects. In contrast, social inclusion is seen to be vital to the material, psychosocial, and political aspects of empowerment that underpin social well-being and equitable health. Successful experiences of cooperation and networking between slum-based organizations, grassroots groups, local and international NGOs, and city government are important mechanisms that can be replicated in urban settings of different low- and middle-income countries. With increasing urbanization, it is imperative to design health programs for the urban poor that take full advantage of the social resources and resourcefulness of their own communities.

Contributions for repositioning a regional strategy for Healthy Municipalities, Cities and Communities (HM&C): results of a pan-American survey.

This article presents the results of the 1st Regional Survey of Healthy Municipalities, Cities and Communities (HM&C) carried out in 2008 by the Pan American Health Organization (PAHO) and ISALUD University of Argentina. It discusses the responses obtained from 12 countries in the Americas Region. Key informants in Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Paraguay, Peru, and Uruguay were selected and encouraged to answer the survey, while informants from Canada and Honduras answered voluntarily and were included in this analysis. The discussion of the results of the Survey provides insight into the current status of HM&C in the Region and suggests key topics for repositioning the Regional strategy relative to: (1) the conceptual identity and tools for HM&C; (2) challenging areas in the implementation process (scale, legal framework, and development of capacities); (3) related strategies and participatory processes such as the ways citizen empowerment in governance is supported; (4) the need to monitor and assess the impact of the HM&C strategy on the health and quality of life of the populations involved; and (5) the need for developing a strategic research and training agenda. The analysis and discussion of these results aims to provide useful input for repositioning the strategy in the Region and contributing to the emergence of a second generation of concepts and tools capable of meeting the developing priorities and needs currently faced by the HM&C strategy.

Pessoas com deficiência: pesquisa sobre sexualidade e vulnerabilidade / Disabled people: research about sexuality and vulnerability

As autoras, inicialmente, tecem considerações sobre o desenvolvimento da sexualidade humana, que tem início ao nascimento e se constitui em alicerce básico do desenvolvimento global de todos. Relatam dificuldades encontradas pelas pessoas com deficiência para que possam exercer esse direito como seres sexuados e a importância do papel da família e dos profissionais da área das deficiências. Abordam o conceito de vulnerabilidade ligado à saúde e à área dos direitos humanos, mostrando como o processo de inclusão social dessas pessoas e a falta de informações adequadas na área da sexualidade contribuem para o aumento da vulnerabilidade em relação às DST/aids. A seguir, colocam a pesquisa-ação que realizaram na cidade de São Paulo, pelo Amankay Instituto de Estudos e Pesquisas, contratado pelo Programa Municipal de DST/aids. Esta foi de natureza qualitativa, de caráter exploratório e preliminar, visando identificar as condições de vulnerabilidade ao HIV/Aids entre pessoas com deficiência visual, auditiva e física, maiores de 18 anos e residentes na cidade. Utilizando a metodologia de trabalho com pares, a equipe realizou: a formação de quatro Agentes de Pesquisa com deficiência, o levantamento das condições de acessibilidade dos Serviços Especializados em DST/aids da cidade, seis Grupos Focais de Intervenção e cinco Entrevistas em Profundidade com representantes dos vários tipos de deficiência. Este trabalho testou metodologias, produziu instrumentos e levantou dados e constatações que poderão subsidiar políticas públicas voltadas a essa população, que vem sendo atendida de forma insuficiente pelas campanhas de prevenção às DST/aids e pelos serviços de atendimento.

Initially the authors make some considerations about human sexuality development that begins when the child is born and is considered the basic foundation of human being global development. They report the difficulties that disabled people have to put in practice their sexual rights and the important role that families and professionals play in this matter. They also present the concept of vulnerability as seen by health and human rights areas, making clear that the process of social inclusion of these persons and the lack of appropriate information about sexual issues improves their vulnerability to STD/aids. Subsequently they tell about their research in São Paulo, performed by Amankay Instituto de Estudos e Pesquisas, under engagement of the Municipal Program of STD/aids. This research had a qualitative nature and a preliminary and exploratory character, trying to identify the vulnerability conditions of citizens over 18, with visual, hearing and physical impairment, living in the city. They made use of the methodology of peer groups by training Research Agents with disabilities, developed a survey about the accessibility of STD/aids Specialized Services in town, six meetings with Interventional Focal Groups and five Individual interviews with representatives of these groups. This work had the opportunity of testing methodologies, produced instruments and updated data and considerations that will help public policies in behave of these people, who have not been cared enough by the prevention campaigns to STD/aids and by the Specialized Services.

Pessoas com deficiência: pesquisa sobre sexualidade e vulnerabilidade / Disabled people: research about sexuality and vulnerability

As autoras, inicialmente, tecem considerações sobre o desenvolvimento da sexualidade humana, que tem início ao nascimento e se constitui em alicerce básico do desenvolvimento global de todos. Relatam dificuldades encontradas pelas pessoas com deficiência para que possam exercer esse direito como seres sexuados e a importância do papel da família e dos profissionais da área das deficiências. Abordam o conceito de vulnerabilidade ligado à saúde e à área dos direitos humanos, mostrando como o processo de inclusão social dessas pessoas e a falta de informações adequadas na área da sexualidade contribuem para o aumento da vulnerabilidade em relação às DST/aids. A seguir, colocam a pesquisa-ação que realizaram na cidade de São Paulo, pelo Amankay Instituto de Estudos e Pesquisas, contratado pelo Programa Municipal de DST/aids. Esta foi de natureza qualitativa, de caráter exploratório e preliminar, visando identificar as condições de vulnerabilidade ao HIV/Aids entre pessoas com deficiência visual, auditiva e física, maiores de 18 anos e residentes na cidade. Utilizando a metodologia de trabalho com pares, a equipe realizou: a formação de quatro Agentes de Pesquisa com deficiência, o levantamento das condições de acessibilidade dos Serviços Especializados em DST/aids da cidade, seis Grupos Focais de Intervenção e cinco Entrevistas em Profundidade com representantes dos vários tipos de deficiência. Este trabalho testou metodologias, produziu instrumentos e levantou dados e constatações que poderão subsidiar políticas públicas voltadas a essa população, que vem sendo atendida de forma insuficiente pelas campanhas de prevenção às DST/aids e pelos serviços de atendimento.(AU)

Initially the authors make some considerations about human sexuality development that begins when the child is born and is considered the basic foundation of human being global development. They report the difficulties that disabled people have to put in practice their sexual rights and the important role that families and professionals play in this matter. They also present the concept of vulnerability as seen by health and human rights areas, making clear that the process of social inclusion of these persons and the lack of appropriate information about sexual issues improves their vulnerability to STD/aids. Subsequently they tell about their research in São Paulo, performed by Amankay Instituto de Estudos e Pesquisas, under engagement of the Municipal Program of STD/aids. This research had a qualitative nature and a preliminary and exploratory character, trying to identify the vulnerability conditions of citizens over 18, with visual, hearing and physical impairment, living in the city. They made use of the methodology of peer groups by training Research Agents with disabilities, developed a survey about the accessibility of STD/aids Specialized Services in town, six meetings with Interventional Focal Groups and five Individual interviews with representatives of these groups. This work had the opportunity of testing methodologies, produced instruments and updated data and considerations that will help public policies in behave of these people, who have not been cared enough by the prevention campaigns to STD/aids and by the Specialized Services.(AU)

Schools for health, education and development: a call for action.

In 2007, the World Health Organization, together with United Nations and international organization as well as experts, met to draw upon existing evidence and practical experience from regions, countries and individual schools in promoting health through schools. The goal of the meeting was to identify current and emerging global factors affecting schools, and to help them respond more effectively to health, education and development opportunities. At the meeting, a Statement was developed describing effective approaches and strategies that can be adopted by schools to promote health, education and development. Five key challenges were identified. These described the need to continue building evidence and capturing practical experience in school health; the importance of improving implementation processes to ensure optimal transfer of evidence into practice; the need to alleviating social and economic disadvantage in access to and successful completion of school education; the opportunity to harness media influences for positive benefit, and the continuing challenge to improve partnerships among different sectors and organizations. The participants also identified a range of actions needed to respond to these challenges, highlighting the need for action by local school communities, governments and international organizations to invest in quality education, and to increase participation of children and young people in school education. This paper describes the rationale for and process of the meeting and the development of the Statement and outlines some of the most immediate efforts made to implement the actions identified in the Statement. It also suggests further joint actions required for the implementation of the Statement.