Urban equity and urban health: using existing data to understand inequalities in health and environment in Accra, Ghana and Sao Paulo, Brazil.

PIP: This paper presents the research methodology that applied existing data to the study of environmental and health inequalities in Accra, Ghana, and Sao Paulo, Brazil. After an introductory section, the paper considers why more research in this area is necessary and the reasons why information on cities in the South is lacking. The third section describes the aims and methods of the study by 1) looking at the development of the methodology, a form of descriptive epidemiology that uses existing data on morbidity and mortality rates to explore and describe the intra-urban distribution of health and environmental conditions in each location; 2) discussing the creation of an index of socioenvironmental deprivation based on judgements about the validity and quality of data on various socioeconomic and environmental indicators made by working groups in each location; and 3) reviewing data collection techniques and problems with data quality. Section 4 summarizes the results of the study by first noting that the study proved that existing data can be used to identify the extent of intra-urban differentials in environmental and health conditions and then presenting the results of the data analysis that exposed the myth of urban benefits by revealing the unequal distribution of socioeconomic conditions and exposed the myth of urban health by revealing the inequalities in life chances between groups in each setting. The concluding section explores the relevance of these results in environmental and health terms. A main achievement of the study was to introduce a method that allowed planners and policy-makers to work together to devise complex definitions of deprivation using existing data and to use the resulting information for actual decision-making to reduce inequalities.^ieng

[Environment and health: an analysis of intra-urban differentials in the city of São Paulo, Brazil]. / Saúde e meio ambiente: análise de diferenciais intra-urbanos, Município de São Paulo, Brasil.

A field study undertaken in the city of S. Paulo is presented as part of the project Environment and Health in Developing Countries: An Analysis of Intra-Urban Differentials Using Existing Data financed by the Ministry of Foreign Affairs of the United Kingdom with academic support from the London School of Hygiene and Tropical Medicine (LSHTM). The research aim was to fill in the gaps in the information needed to establish associations between mortality, urbanization and the environment. Statistics were produced by means of existing data collected by city departments, research carried out by universities and census data. Data quality was assessed taking into consideration data coverage, accuracy, and sensibility to pinpoint deprived areas in the city of S. Paulo. Socioeconomic data were used to create a composite index for districts and subdistrict in order to form four socioeconomic zones. Mortality differentials between the zones by five broad age groups (0-4, 5-14, 15-44, 45-64 e 65+) and four ICD chapters (circulatory, respiratory, infectious and parasitic and external causes) are presented. The zoning used showed that 43.8% of S. Paulo residents live in areas under the worst socioeconomic conditions. Health data demonstrated that people living in this areas had higher rates of mortality then those living in the areas with the best conditions. Finally, excess mortality data are analyzed and suggested as a good method for allocating health resources.

Health and environment in São Paulo, Brazil: methods of data linkage and questions of policy.

This article addresses the development of data linkage methods for the analysis of urban environmental health problems and the development of appropriate policies and discusses, based on existing experience of data linkage in São Paulo (Brazil), the potential for routine environmental health monitoring and management in a major developing country industrial centre. The article looks briefly at two major environmental health problems in São Paulo: first, air pollution which has potential impacts on health of the whole population; and second, environmental differentials in conditions between groups within cities, which have substantial health effects on the economically deprived. The article argues that the health impact of environmental differentials in São Paulo is large, but unmonitored as a serious environmental health threat. In contrast, air pollution is monitored routinely, although its health effects are relatively small at present. The paper concludes with a discussion of policy implications of environmental health monitoring--which potentially require a substantial shift in attitudes of the urban wealthy.

[Health and environment: an analysis of intra-urban differences focusing on the city of São Paulo, Brazil]. / Saúde e meio ambiente: uma análise de diferenciais intra-urbanos enfocando o Município de São Paulo, Brasil.

A project concerned with the study of intra-urban health differentials in S. Paulo city, Brazil, is described. A brief outline of urban problems in the city is presented, followed by a review of the locally published literature on the subject of geographical differentials (stratification by socioeconomic status and environment). Two topics are introduced: geographical subdivision of the area studied and the methods used to choose the socio-environmental indicators for the construction of a deprivation index with to stratify the city. Suggestions are made as to possible applications of results achieved by the project.