Saúde urbana, direito à cidade e as comunidades de Manguinhos no Rio de Janeiro / Urban health, the right to the city, and the communities of Manguinhos in Rio de Janeiro

Resumo O artigo propõe uma leitura crítica do contexto histórico urbanístico e social das comunidades de Manguinhos considerando a fundamentação teórico-metodológica do campo da saúde urbana, apoiada no paradigma da determinação social da saúde e do direito à cidade. O recorte de análise para a identificação dos processos críticos de determinação social da saúde considerou a relevância da superação das necessidades habitacionais como condição indispensável para o direito à cidade e à saúde. A constatação da permanência dos processos mencionados, mesmo após os vultosos investimentos em urbanização realizados em Manguinhos, aponta para a necessidade de revisão das políticas públicas relacionadas e a inserção efetiva e emancipatória da população nessas políticas.

Abstract This article proposes a critical reading of the urbanistic and social historical context of the communities of Manguinhos, considering the field of urban health as a theoretical and methodological foundation based on the paradigm of the social commitment to health and the right to the city. Our demarcation of this analysis to identify the critical processes in the social commitment to health considered the relevance of overcoming housing needs as an indispensable condition for the right to the city and to health. The fact that these processes persist, even after the vast investments made in Manguinhos, indicates the need to review related public policies and their effective implementation to improve conditions for this population.

Desastre socioambiental: condições de saúde dos atingidos na perspectiva dos profissionais de saúde e gestores* / Desastre socioambiental: condiciones de salud de los afectados desde la perspectiva de los profesionales y gestores sanitarios / Socio-environmental disaster: the health conditions of those affected from the perspective of healthcare professionals and managers

Objetivo: analisar as condições de saúde da população atingida pelo rompimento da barragem de mineração na perspectiva dos profissionais de saúde e gestores. Método: estudo de caso qualitativo, realizado por meio de documentos de domínio público e entrevistas com profissionais de saúde e gestores, entre os meses de março a maio de 2022, totalizando 14 participantes. Os dados foram analisados segundo a estratégia de proposições teóricas à luz da Determinação Social da Saúde. Resultados: considera-se como piora nas condições de saúde em relação aos problemas respiratórios, gastroenterites, obesidade, arboviroses, intensificação do uso de álcool e drogas, e doenças mentais. Destaca-se a perda do trabalho, da casa, e do pertencimento comunitário dos atingidos. Conclusão: o desastre socioambiental foi condicionante para mudanças nas condições de saúde dos atingidos, expondo-os a novos cenários e sobreposição de riscos capazes de modificar a qualidade de vida e agravar as condições de saúde biopsicossociais.

Objective: to analyze the health conditions of the population affected by the mining dam collapse from the perspective of healthcare professionals and managers. Method: this is a qualitative case study, conducted using public domain documents and interviews with healthcare professionals and managers, from March to May 2022, totaling 14 participants. The data were analyzed according to the theoretical propositions strategy based on the Social Determinants of Health. Results: the health conditions of this population have worsened in terms of respiratory problems, gastroenteritis, obesity, arboviruses, increased use of alcohol and drugs, and mental illnesses. The loss of employment, home, and community belonging of those affected is highlighted. Conclusion: the socio-environmental disaster was a conditioning factor for changes in the health conditions of those affected, exposing them to new scenarios and overlapping risks capable of modifying their quality of life and aggravating their biopsychosocial health conditions.

Objetivo: analizar las condiciones de salud de la población afectada por el colapso de la presa minera desde la perspectiva de los profesionales y gestores sanitarios. Método: estudio de caso cualitativo, realizado por medio de documentos de dominio público y entrevistas a profesionales y gestores de salud, entre marzo y mayo de 2022, con un total de 14 participantes. Los datos fueron analizados según la estrategia de proposiciones teóricas a la luz de la Determinación Social de la Salud. Resultados: se considera el empeoramiento de las condiciones de salud en relación con los problemas respiratorios, la gastroenteritis, la obesidad, los arbovirus, la intensificación del consumo de alcohol y drogas, y las enfermedades mentales. Se destacan la pérdida del trabajo, del hogar, y de la pertenencia a la comunidad de los afectados. Conclusión: el desastre socioambiental fue un factor condicionante de alteraciones en las condiciones de salud de los afectados, exponiéndolos a nuevos escenarios y riesgos superpuestos capaces de modificar la calidad de vida y empeorar las condiciones de salud biopsicosocial.

Saúde quilombola: percepções em saúde em um quilombo do agreste de Pernambuco/Brasil / Quilombola's Health: health perceptions in a quilombo in the agreste of Pernambuco/Brazil

Resumo Este estudo analisa a percepção de saúde dos quilombolas de uma comunidade no agreste de Pernambuco à luz da determinação social da saúde. A comunidade apresenta uma população de aproximadamente 250 famílias, sendo a agricultura e o trabalho na casa de farinha suas principais fontes de subsistência. Trata-se de uma pesquisa-ação, de caráter analítico, baseada na abordagem qualitativa na coleta e análise dos dados, a partir de entrevistas em profundidade, círculo de cultura e observação participante. Os dados foram analisados pela técnica do discurso do sujeito coletivo. Destaca-se, nos resultados, que a compreensão da saúde se insere num contexto de complexidade integrando a qualidade da alimentação, o trabalho desenvolvido e a relação com a terra. O olhar por meio da perspectiva sistêmica proporcionada pela determinação social da saúde, contribuiu para a compreensão da saúde em sua totalidade, onde o território aparece como elemento central na reprodução dos modos de vida e de saúde da população quilombola, estando esta, em constante luta pela demarcação e titulação de suas terras, condição fundamental para o viver saudável na comunidade quilombola.

Abstract This study analyzes health perception within a quilombola community in the agreste region (scrubland) of Pernambuco based on the social determinants of health. The community comprises approximately 250 families, with agriculture and work in the flour mill as their main sources of subsistence. This action-analytic research was conducted with data collected and analyzed by means of qualitative approaches, through in-depth interviews, culture circle, and participant observation. Data were analyzed using the collective subject discourse technique. The results indicate that a complex context underlies the perception of health within this environment, including diet quality, the work developed, and the relationship with the land. The systemic perspective offered by the social determinants enabled us to understand health in its entirety, whereby territory appears as a central element in the reproduction of the quilombola population's health and way of life. This is especially relevant when we consider that these groups are in constant struggle for the demarcation and titling of their lands - a fundamental condition for a healthy living in the community.

La determinación social de la salud: la comprensión de la complejidad de la vida / The social determinants of health: understanding the complexity of life

Hacer un monográfico sobre la determinación social de la salud es un aporte importante para ampliar las discusiones en salud colectiva, y es fundamental reconocer que en el sistema mundial actual se requiere de ejercicios sistemáticos que interpelen la hegemonía en salud que en los últimos 50 años ha profundizado las desigualdades en los modos de vida. El enfoque de la salud colectiva considera que el estado individual de la salud, equilibrio/desequilibrio, es una construcción compleja y multidimensional, determinada por tres escalas o dominios de la realidad: 'la realidad general' (que comprende los contextos históricos- territoriales), 'la realidad particular' (definida por los modos de vida de las comunidades) y 'la realidad singular' (que se puede describir por los 'estilos de vida'). Estos tres dominios operan en una suerte de relación dialéctica de "interafección" e "interinfluencia"

A monograph on the social determination of health is an important contribution to broaden discussions on collective health, and it is fundamental to recognize that in the current global system, systematic exercises are required to question the hegemony in health that has deepened inequalities in lifestyles over the last 50 years. The collective health approach considers that the individual state of health, balance/imbalance, is a complex and multidimensional construction, determined by three scales or domains of reality: 'the general reality' (which includes historical-territorial contexts), 'the particular reality' (defined by the lifestyles of communities) and 'the singular reality' (which can be described by 'lifestyles'). These three domains operate in a sort of dialectical relationship of "inter-affection" and "inter-influence".

Urbanização, modos de vida e produção da saúde na cidade / Urbanization, lifestyles and health production in the city

As desigualdades em saúde constituem o centro da relação entre condições de vida e situação de saúde, sobretudo, em contextos urbanos, espaço que concentra maior parte da população mundial. Este artigo objetiva discutir sobre urbanização, modos de vida e produção da saúde na cidade, assinalando os desiguais impactos do processo de urbanização e as iniquidades em saúde no Brasil. À luz do paradigma da Determinação Social da Saúde, destaca os mecanismos e dinâmicas das desigualdades sociais e como estão dispostos nos territórios, relacionando-se com conjunturas específicas das cidades e grupos populacionais. Por fim, indica os embates em processo contra o modelo de urbanização hegemônico e as mobilizações pela garantia do direito à moradia, por uma mobilidade sustentável, de luta contra o racismo ambiental, em prol da ocupação dos espaços públicos, do resgate da memória dos lugares e do fortalecimento das resistências interseccionais no espaço urbano. (AU)

Inequalities in health are at the heart of the relationship between living conditions and health status, especially in urban settings, where most of the world's population is concentrated. This article aims to discuss urbanization, lifestyles and health production in the city, pointing out the unequal impacts of the urbanization process and the inequities in health in Brazil. In light of the paradigm of Social Determination of Health, it highlights the mechanisms and dynamics of social inequalities and how they are arranged in the territories, relating to specific conjunctures of cities and population groups. Finally, it indicates the clashes in process against the hegemonic urbanization model and the mobilizations for the guarantee of the right to housing, for a sustainable mobility, of fight against environmental racism, in favor of the occupation of the public spaces, the rescue of the memory of the places and the strengthening of the intersectional resistances in the urban space.(AU)

Determinação social do uso de álcool e outras drogas na visão dos adolescentes / Social determination of the use of alcohol and other drugs in the view of adolescents

The use of Psychoactive Substances (PAS) is a reality among Brazilian adolescents, who may use alcohol or other illicit drugs as a form of social adaptation or even to be able to live in a fluid and hedonistic society. PASs can be considered commodities in postmodernity, being freely traded, as in the case of alcohol, or sold clandestinely, generating profits for the few. When studying the consumption of these psychoactive substances, generalizations or just blaming the individual for their use should be avoided. The phenomenon must be observed from the perspective of social determination, considering the general, particular and singular dimensions. The aim of this research was to understand the social determination of psychoactive substance use by adolescents enrolled in the 9th grade of Elementary School in Divinópolis, Minas Gerais. For this purpose, we used the sequential transformative mixed method, which was conducted with 9th grade adolescents from public and private elementary schools. In the quantitative axis (n = 303), the modules of general information, use of alcohol and illicit drugs of the 2015 National School Health Survey (PeNSE) were applied. The qualitative axis was preponderant and followed the quantitative, in which semi-structured interviews were conducted with 18 adolescents who had participated in the quantitative axis. As for the analyzes, a descriptive and multivariate analysis was performed for all quantitative variables. In the qualitative axis, the discourses based on dialectical hermeneutics were analyzed and the results of both axes were integrated in the discussion of the results, as recommended by the sequential transformative method. In the analysis of quantitative variables, there was an association in the multivariate analysis between making use of alcohol and intending to study only until high school or technical (p = 0.007), continuing to study and work (p = 0.003), not living with parents (p = 0.010) and have friends who use alcohol (p = 0.009). The quantitative results discuss, complement and agree with the discourses of adolescents on the qualitative axis, demonstrating the importance of a mixed approach on the subject. The use of PASs by adolescents is related to the social imaginary about the phenomenon, in which media, policies and market dictate norms of conduct, as noted in the lack of supervision of the sale of beverages for adolescents, in the relationship between having a job that generates income and have friends who use alcohol. All these factors are related, so that the social space of this adolescent, the place occupied socially by him and his social class will largely dictate the consequences of using PAS. It is concluded that adolescents relate all dimensions of the phenomenon to the choice of whether or not to use PAS, but the overall dimension stands out, mainly due to the economic factor that guides the others, influencing the media, products considered desirable and places. of individuals. By recognizing the main points of social obstacle and risk determinants, the community can debate and propose actions aimed at changes in both the physical space and the psychological field. In the latter case, in the field of subjectivity, actions can be developed that empower young people of their rights and duties to cover improvements of rulers and initiate changes at a singular level, with transformations in their interpersonal relationships. These steps are simultaneous and require time to be realized, because any change occurs with changes in both the behavioral level and the social imaginary. Such changes will awaken opposing forces, mainly at the political and economic levels, however, only through the clash of ideas and paradigms that new forms of organization can emerge.