Por que morreu VMS? Sentinelas do des-envolvimento sob o enfoque socioambiental crítico da determinação social da saúde / Why did VMS die? Sentinels of the de-velopment under the critical social environmental approach of the social determination of health

RESUMO Partiu-se do óbito de trabalhador em empresa transnacional por hepatopatia causada por agrotóxicos, para debater limites do paradigma biomédico que orienta as ações do Sistema Único de Saúde. Com base no enfoque socioambiental crítico e transformador, busca-se alargar a compreensão desta e de outras mortes de trabalhadores, 'incluídos' por meio do emprego precarizado e desigualmente protegidos pelas políticas públicas. Caracteriza-se, então, um processo de vulnerabilização mediado pelo Estado neoliberal e tensionam-se as bases teórico-metodológicas da saúde coletiva para avançar em uma perspectiva crítica e emancipatória, em diálogo com os saberes de outros sujeitos epistêmicos e políticos.

ABSTRACT We start from a transnational company worker who died of liver disease caused by pesticides, to discuss limits of the biomedical paradigm that guides the actions of the Unified Health System. Based on the critical and transformative social environmental approach, we seek to expand the understanding of this and other deaths of workers 'included' through precarious jobs and unequally protected by public policies. It features a vulnerability process mediated by the neo-liberal state and its extrativist policies of development, and enhance the theoretical-methodological bases of public health to advance critical and emancipatory perspective, in dialogue with the knowledges of other epistemic and political subjects.

Trends of chronic health effects associated to pesticide use in fruit farming regions in the state of Ceara, Brazil / Tendencias de agravos cronicos a saude associados a agrotoxicos em regiao de fruticultura no Ceara, Brasil

The lower valley of Jaguaribe has registered, since the XXI century, the arrival of transnational and regional companies, which led to deep transformations in this region. The increased use of the pesticides is one of the most important ones, being able to cause alterations in human procreation and leading to congenital deformations, besides premature birth and low weight newborns. This article is an ecological study related to the period from 2000 to 2010 in the population of some cities in the state of Ceará, and it was divided in two parts: the first one, a draft of historical series of morbidity and mortality databases and trend verification performed by a simple linear regression; the second one comprehends the calculation of the ratio of rates between cities that are highly exposed to pestiides and the cities selected for comparison, with history of little use of these substances. There was statistically considerable growth tendency (p = 0.026) in the number of hospitalized people with neoplasms. Analyzing the ratios of the rates in these same indicators, it is observed that the rates of hospitalized people with neoplasms were 1.76 times higher in the studied cities than in control cities (p < 0.0010). With regard to to fetal deaths, a statistically considerable increase was observed (p < 0.05) as to the mortality rates in the studied cities. Results suggest there was higher morbidity and mortality caused by neoplasms in the cities with broader use of pesticides, which could be influenced by production, environmental and social transformations associated to the process of deterritorialization induced by the expansion of the agricultural modernization over the morbidity and mortality profile of the population of lower Jaguaribe. This process is a reflex of the production chemical-dependent model adopted by the agribusiness companies, expanding the vulnerability of the country side population.

O Baixo vale do Jaguaribe registra, a partir do século XXI, a chegada de empresas transnacionais e regionais, induzindo profundas transformações nos territórios, sendo a ampliação do uso de agrotóxicos uma das mais importantes, podendo provocar alterações na reprodução humana, malformações congênitas, além de partos prematuros e recém-nascidos de baixo peso. O presente artigo trata-se de um estudo ecológico, referente ao período de 2000 a 2010, conduzido em alguns municípios do Estado do Ceará, que foi dividido em duas fases: a primeira consiste na construção de séries históricas de indicadores de morbimortalidade e verificação da tendência realizada por meio de regressão linear simples; a segunda compreende o cálculo das razões das taxas entre municípios com alta exposição aos agrotóxicos e municípios de comparação com histórico de pouco uso dessas substâncias. Houve tendência de aumento estatisticamente significante (p = 0,026) das taxas de internações por neoplasias. Ao se analisar as razões de taxas desses mesmos indicadores percebe-se que a taxa de internações por neoplasias foi 1,76 vezes maior nos municípios de estudo em relação aos municípios controle (p < 0,001). Em relação aos óbitos fetais, observou-se uma tendência crescente (p < 0,05) da taxa de mortalidade nos municípios estudados. Os resultados sugerem que houve uma maior morbimortalidade por neoplasias nos municípios com maior consumo de agrotóxicos, podendo ser influenciados pelas transformações produtivas, ambientais e sociais associadas ao processo de desterritorialização induzido pela expansão da modernização agrícola sobre o perfil de morbimortalidade da população do baixo Jaguaribe. Esse processo é reflexo do modelo produtivo químico-dependente incorporado pelas empresas do agronegócio, ampliando a vulnerabilidade da população rural.

Trends of chronic health effects associated to pesticide use in fruit farming regions in the state of Ceará, Brazil.

The lower valley of Jaguaribe has registered, since the XXI century, the arrival of transnational and regional companies, which led to deep transformations in this region. The increased use of the pesticides is one of the most important ones, being able to cause alterations in human procreation and leading to congenital deformations, besides premature birth and low weight newborns. This article is an ecological study related to the period from 2000 to 2010 in the population of some cities in the state of Ceará, and it was divided in two parts: the first one, a draft of historical series of morbidity and mortality databases and trend verification performed by a simple linear regression; the second one comprehends the calculation of the ratio of rates between cities that are highly exposed to pestiides and the cities selected for comparison, with history of little use of these substances. There was statistically considerable growth tendency (p = 0.026) in the number of hospitalized people with neoplasms. Analyzing the ratios of the rates in these same indicators, it is observed that the rates of hospitalized people with neoplasms were 1.76 times higher in the studied cities than in control cities (p < 0.0010). With regard to to fetal deaths, a statistically considerable increase was observed (p < 0.05) as to the mortality rates in the studied cities. Results suggest there was higher morbidity and mortality caused by neoplasms in the cities with broader use of pesticides, which could be influenced by production, environmental and social transformations associated to the process of deterritorialization induced by the expansion of the agricultural modernization over the morbidity and mortality profile of the population of lower Jaguaribe. This process is a reflex of the production chemical-dependent model adopted by the agribusiness companies, expanding the vulnerability of the country side population.