Mapeando as disparidades socioeconômicas de saúde urbana: um estudo comparativo entre seis capitais brasileiras / Mapping socioeconomic disparities in urban health: a comparative study of six Brazilian capitals / Mapeando las disparidades socioeconómicas de salud urbana: un estudio comparativo entre seis capitales brasileñas

Resumo A cidade é um modo de viver, pensar e sentir. O modo de vida urbano é capaz de produzir ideias, comportamentos, valores e conhecimentos, mas também pode acirrar disparidades socioeconômicas e de saúde da população que ali reside. Este artigo examina as disparidades em saúde urbana em seis capitais brasileiras: São Paulo, Rio de Janeiro, Salvador, Fortaleza, Belo Horizonte e Manaus. Para quantificar e mapear as disparidades intraurbanas nesses espaços, foram utilizados os dados do Censo Demográfico de 2010 para a aplicação do índice de saúde urbana (ISU), uma métrica que sintetiza oito diferentes variáveis socioeconômicas e de saneamento desagregadas por setores censitários. Os resultados são discutidos à luz de três vertentes teóricas: a diferenciação centro-periferia; abordagem econômica da saúde; e epidemiologia social. As descobertas desse estudo revelam que os setores censitários que abrangem populações com maior status socioeconômico e melhores condições de saneamento apresentaram índices de saúde urbana mais elevados do que os da periferia da cidade. Há indícios de melhores indicadores de saúde urbana para o Rio de Janeiro e São Paulo, em comparação com as demais capitais analisadas. No entanto, há importantes nuances em cada uma das seis cidades estudadas, especialmente quando se atribuem diferentes pesos às variáveis que compõem o ISU, apesar da marcada segregação espacial comum a todas elas. Considerar as distinções dentro do espaço urbano é uma estratégia fundamental para a compreensão desses aspectos sociais e econômicos e seus potenciais desdobramentos nas condições de saúde da população.

Abstract A city is a way of living, thinking, and feeling. The urban lifestyle can produce ideas, behaviors, values, and knowledge. Still, it can also intensify socioeconomic and health disparities in the population. This article examines urban health disparities in six Brazilian capitals: São Paulo, Rio de Janeiro, Salvador, Fortaleza, Belo Horizonte, and Manaus. To quantify and map intra-urban disparities in these spaces, data from the 2010 Demographic Census are used to apply the Urban Health Index, a metric that synthesizes eight different socio-economic and sanitation variables disaggregated by census tracts. The results are discussed in light of three theoretical perspectives: center-periphery differentiation, the economic approach to health, and social epidemiology. The findings of this study reveal that census tracts covering populations with higher socio-economic status and better sanitation conditions exhibited higher urban health index scores than those in the city's periphery. Results indicate better urban health indicators for Rio de Janeiro and São Paulo, compared to the other capitals analyzed. However, there are important nuances in each of the six cities, especially when assigning different weights to the variables that compose the Urban Health Index, despite the marked spatial segregation common to all. Considering distinctions within urban space is a fundamental strategy to understand these social and economic aspects and their potential implications for population health conditions.

Resumen La ciudad es una forma de vivir, pensar y sentir. El modo de vida urbano es capaz de producir ideas, comportamientos, valores y conocimientos, pero también lo es de intensificar las disparidades socioeconómicas y de salud de la población que reside en ella. Este artículo examina las disparidades en salud urbana en seis capitales brasileñas: São Paulo, Río de Janeiro, Salvador, Fortaleza, Belo Horizonte y Manaus. Para cuantificar y mapear las disparidades intraurbanas en estos espacios, se utilizan datos del censo demográfico de 2010 para aplicar el índice de salud urbana, una métrica que sintetiza ocho diferentes variables socioeconómicas y de saneamiento desagregadas por sectores censales. Los resultados se discuten a la luz de tres perspectivas teóricas: la diferenciación centro-periferia, el enfoque económico de la salud y la epidemiología social. Los hallazgos de este estudio revelan que los sectores censales que abarcan poblaciones con un mayor estatus socioeconómico y mejores condiciones de saneamiento presentaron puntajes más altos en el índice de salud urbana que los de la periferia de la ciudad. Hay indicios de mejores indicadores de salud urbana para Río de Janeiro y São Paulo, en comparación con las demás capitales analizadas. Sin embargo, se observan matices importantes en cada una de las seis ciudades analizadas, especialmente al asignar diferentes pesos a las variables que componen el pindice de salud urbana, a pesar de la marcada segregación espacial común a todas ellas. Considerar las distinciones dentro del espacio urbano es una estrategia fundamental para comprender estos aspectos sociales y económicos y sus posibles implicaciones en las condiciones de salud de la población.

Pharmaceutical Care in Primary Care: an Experience with Hypertensive Patients in the North of Brazil

Abstract Background: Uncontrolled blood pressure has been associated with poor adherence to drug treatment. Objectives: To assess blood pressure control in hypertensive patients attending primary health centers after implementation of a pharmaceutical follow-up program in a city of the north of Brazil. Methods: Observational, cross sectional, descriptive study with 163 hypertensive patients attending public primary health care centers - one located on the riverside and one in the urban area of the city of Santarem, western Pará, Brazil. Adherence to the anti-hypertensive treatment was assessed using the eight-item Morisky test. Pharmacotherapy follow-up (Dader method) of patients with uncontrolled hypertension and non-adherent to anti-hypertensive treatment was performed. Results of the normality test showed that the data did not follow a normal distribution. Continuous variables were then compared using the Wilcoxon signed-rank test, and categorical variables by the likelihood ratio and the McNemar tests. Statistical significance was set at 5%. Results: Of the total sample, 94.5% were not adherent to anti-hypertensive drug therapy and 77.2% had uncontrolled hypertension. Adherence rate was higher in men than women (p=0.006). Pharmacotherapy follow-up improved blood pressure levels, particularly systolic blood pressure (p<0.001). Conclusion: An individualized pharmacotherapeutic follow-up, considering regional and cultural specificities, can contribute to the treatment of hypertensin in the primary care.

Satisfacción y percepciones sobre aspectos de la ciudad que afectan la salud, por nivel socioeconómico, 2010-2019, en Lima Metropolitana / Satisfaction and perceptions about aspects of the city that affect health, by socioeconomic status, 2010-2019, in Lima

RESUMEN Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos¼ entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

ABSTRACT We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens.

Ходьба пешком и езда на велосипеде: последние данные в поддержку формирования политики и практики

Активные способы передвижения, в частности ходьба пешком и езда на велосипеде, сегодня широко признаются как полноценные альтернативы другим видам городского транспорта. Они включаются в программы планирования и учитываются наравне с остальными видами мобильности не только в наиболее развитых странах, но и по всему миру. Постоянно растущий объем научных данных подтверждает преимущества активных способов передвижения для общества с точки зрения транспортной системы, окружающей среды и здоровья населения. В рамках практики планирования накоплен богатый арсенал мер, которые могут быть взяты за основу, адаптированы либо непосредственно использованы в любом городе. В настоящей публикации приводится всесторонняя аргументация в поддержку стимулирования ходьбы пешком и езды на велосипеде, а также дается описание методов реализации подобных инициатив, основываясь на последних данных научных исследований и передовой практике планирования.

Zufußgehen und Radfahren: Neueste Erkenntnisse zur Unterstützung von Politikgestaltung und Praxis

Aktive Beförderungsarten, insbesondere Gehen und Radfahren, werden heute von vielen als gleichwertige Alternativen zu anderen Verkehrsmitteln in der Stadt anerkannt und in die etablierten Planungsrahmen integriert – nicht nur in den fortgeschrittensten Ländern, sondern weltweit. Es gibt immer mehr Belege dafür, dass die Gesellschaft von einer aktiven Mobilität sowohl in Bezug auf Verkehr also auch auf Gesundheit und Umwelt profitieren kann. Planungsbeispiele aus der Praxis bieten heute einen umfangreichen Katalog von Maßnahmen an, der jeder Stadt als Anregung zur Anpassung und eventuell Anwendung dienen kann. Diese Publikation argumentiert auf Grundlage neuester Erkenntnisse aus Forschung und Planung umfassend dafür, warum und wie Gehen und Radfahren gefördert werden sollten.

Données récentes à l’appui de la pratique de la marche et du vélo et des politiques en la matière

Les modes de déplacement actifs, en particulier la marche et le vélo, sont à présent reconnus par de nombreuses personnes comme étant pleinement égaux à d’autres modes de transport urbain ; ils sont également intégrés dans les cadres utilisés en vue de la planification et adoptés comme une tendance générale – non seulement dans les pays pionniers, mais aussi dans le monde entier. Les gains que la société peut tirer des déplacements actifs en termes de transport, de santé et d’avantages environnementaux sont prouvés par un corpus de données scientifiques en croissance constante. La pratique urbanistique a permis de constituer un volumineux dossier de mesures prêtes à être étudiées, utilisées comme source d’inspiration, adaptées, voire appliquées dans chaque ville. La présente publication offre un argumentaire complet sur les raisons justifiant la promotion de la marche et du vélo et les manières de la mettre en oeuvre, en s’appuyant sur les dernières connaissances issues de la recherche scientifique et de l’aménagement urbain.

Walking and cycling: latest evidence to support policy-making and practice

Active travel modes, especially walking and cycling, are now recognized by many as modes that are fully equal to other urban transport modes, integrated in planning frameworks, and adopted as part of the mainstream – not just in trailblazer countries, but worldwide. An ever-growing body of science underpins the gains society can reap from active travel in terms of transport, health and environmental benefits. Planning practice has accumulated a rich portfolio of measures ready to be considered for inspiration, adaptation and possible application in every city. This publication presents a comprehensive case for why and how to promote walking and cycling, based on the latest evidence from scientific research and planning practice.

São Paulo urban health index: measuring and mapping health disparities / Índice de saúde urbana de São Paulo: medindo e mapeando disparidades em saúde

ABSTRACT: Objective: To calculate and map the health inequalities in the city of São Paulo using the Urban Health Index (UHI) methodology. Methods: Seven indicators were selected from the Brazilian census: (1) proportion of households with access to sewage systems, (2) proportion of households served by regular waste collection, (3) proportion of households with two or more toilets, (4) proportion of households receiving tap water, (5) average income per household, (6) percentage of white people, and (7) literacy rate. Based on the UHI methodology, all health indicators were standardized and aggregated into a single metric at the census tract level. The UHI scores were ranked and plotted. The disparity ratio and the graph slope were calculated. The correlation between indicators was tested. Results were geocoded to produce a map of health risks. Results: The distribution of index values showed a linear middle section and deviations at each end. The disparity ratio found was 2.95, while the slope was 0.30. All indicators were significantly correlated. The map displayed a typical pattern of health inequality between the downtown and the periphery. The tracts located in the city's downtown had higher UHI values than those on the outskirts. Conclusions: The results of this study presented a visual distribution of health disparities in the city of São Paulo, proving to be a valuable method for identifying areas that require public health attention.

Resumo: Objetivo: Calcular e mapear as desigualdades em saúde na cidade de São Paulo por meio da metodologia do índice de saúde urbana (UHI). Métodos: Sete indicadores foram selecionados do censo brasileiro: (1) proporção de domicílios com acesso a esgoto, (2) proporção de domicílios com coleta regular de lixo, (3) proporção de domicílios com dois ou mais banheiros, (4) proporção de domicílios que recebem água encanada, (5) renda média por domicílio, (6) porcentagem de pessoas brancas e (7) taxa de alfabetização. Usando a metodologia UHI, todos os indicadores de saúde foram padronizados e agregados em uma única métrica para o setor censitário. Os valores de UHI foram classificados e plotados. A razão de disparidade e a inclinação do gráfico foram calculadas. A correlação entre os indicadores foi testada. Os resultados foram geocodificados, produzindo um mapa de risco à saúde. Resultados: A distribuição dos valores do índice apresentou uma seção intermediária linear e desvios nas extremidades. A taxa de disparidade encontrada foi de 2,95, enquanto o coeficiente angular foi 0,30. Todos os indicadores apresentaram correlação significativa. O mapa exibiu um arranjo característico de desigualdade em saúde entre o centro e a periferia. Os setores localizados na região central da cidade apresentaram valores de UHI mais elevados do que os da periferia. Conclusão: Os resultados deste estudo apresentaram uma distribuição visual das disparidades de saúde na cidade de São Paulo, demonstrando ser um método valioso para a identificação de áreas que requerem atenção da saúde pública.

Fatores associados ao conhecimento de locais públicos de esporte e lazer nas capitais brasileiras / Factors associated with knowledge of public places of sport and leisure in Brazilian capitals

O objetivo foi avaliar o conhecimento sobre locais públicos de esporte e lazer nas capitais brasileiras e sua relação com fatores sociodemográficos e do ambiente urbano.Estudo com dados da Pesquisa Nacional de Saúde, edição no ano de 2013, inquérito de base domiciliar, representativo da população adulta residente em todas as capitais do Brasil. A variável de desfecho foi conhecimento sobre locais públicos de esporte e lazer. As variáveis de exposição foram sexo, faixa etária, escolaridade e Índice de Bem-Estar Urbano (IBEU), que avalia as condições coletivas de vida na cidade por meio dos dados do Censo Demográfico de 2010. Realizou-se análise bivariada através do teste Qui-quadrado e cor-relação de Pearson. Dos 27.017 entrevistados, 56,6% (IC95%: 55,1 - 58,1) relataram conhecer locais públicos de esporte e lazer, sendo maior entre homens (58,2% vs 55,3%) e mais escolarizados (45,5% de 0 a 4; 49,2% de 5 a 8; 55,2% de 9 a 11; 68,2% de 12 anos ou mais). Não foi observada diferença entre as faixas etárias. Foi observada correlação positiva entre proporção de conhecimento e IBEU (r = 0,709; p < 0,05). As capitais com melhores indicadores de conhecimento e do ambiente urbano foram Vitória, Brasília, Goiânia e Curitiba. Diante disso, a melhoria e criação de espaços públicos de lazer deve considerar as desigualdadesna sua distribuição em relação ao ambiente e as características sociodemográficas da população,para contribuir para a promoção da atividade física e, consequente-mente, para melhorar a saúde e equidade social

The objective was to evaluate the knowledge about public places of sport and leisure in the Brazilian capitals and their relationship with sociodemographic factors and the urban environment. Study with data from the National Health Survey, edition in the year 2013, a household-based survey, representative of the adult population residing in all capitals of Brazil. The outcome variable was knowledge about public places of sport and leisure. The exposure variables were sex, age group, education and Urban Well-Being Index (IBEU), which assesses the collective living conditions in the city troughthout data from the 2010 demographic cen-sus. A bivariate analysis was performed using the chi-square test and Pearson's correlation. Of the 27,017 interviewees, 56.6% (95% CI: 55.1 - 58.1) reported knowing public places of sport and leisure, being higher among men (58.2% vs 55.3%) and more educated (45.5% from 0 to 4; 49.2% from 5 to 8; 55.2% from 9 to 11; 68.2% from 12 years or older). There was no difference between the age groups. A positive correlation was observed between the proportion of knowledge and IBEU (r = 0.709; p < 0.05). The capitals with the best knowledge and urban environment indicators were Vitória, Brasília, Goiânia and Curitiba. Therefore, the improvement and creation of public leisure spaces must take account into the inequalities distribution in relation to the environment and the sociodemographic characteristics of the population, to contribute to the promotion of physical activity and, consequently, to improve health and social equity

Sufrimiento de mujeres en una ocupación urbana de São Paulo, Brasil: un desafío para el trabajo en atención primaria de la salud / The suffering of women living in an informal settlement in São Paulo, Brazil: a challenge to the work of Primary Health Care

RESUMEN Entre los efectos sociales de la pandemia de COVID-19, el aumento de la pobreza, el desempleo y la desigualdad social en el país agravaron los problemas de salud, principalmente, de la población más pobre. Esta investigación buscó discutir potencialidades y limitaciones del proceso de trabajo en atención primaria de la salud, basado en la Estrategia de Salud Familiar. Para ello, entre enero y febrero de 2020, se realizaron entrevistas semiestructuradas a cuatro mujeres residentes de una ocupación urbana del interior del estado de São Paulo, Brasil. Se encontró que presentan sufrimiento relacionado con la precariedad de las viviendas, la provisoriedad, el aislamiento social y el silenciamiento. El modo en que se organiza la atención primaria de la salud y el proceso de trabajo de las y los profesionales dificulta tanto el acceso de una parte de la población a los servicios de salud, como la percepción de las y los profesionales sobre el sufrimiento de la población. Los resultados de la investigación indican la necesidad de una nueva evaluación y perfeccionamiento de la Estrategia de Salud Familiar.

ABSTRACT Among the social effects of the COVID-19 pandemic, increased poverty, unemployment, and social inequality in Brazil have led to worsening health problems, especially in the poorest citizens. The purpose of this research was to discuss the potentialities and limitations of the work process in primary health care based on the Family Health Strategy. In order to do so, we conducted semi-structured interviews with four women living in an informal settlement in the interior of the state of São Paulo, Brazil, between January and February 2020. We found that the women experienced suffering in relation to issues such as housing precariousness, transience, social isolation, and silencing. The way in which primary health care is organized and professionals' work processes make it difficult for this population to access health services and for professionals to perceive their suffering. The findings of this research point to the need to reevaluate and improve the Family Health Strategy.

Благоприятные условия для жизни людей старшего возраста в Европе: индикаторы, мониторинг и оценка

Процесс развития мер политики, нацеленных на создание более благоприятных условий для жизни людей старшего возраста, приобретает все больший масштаб в Европе и по всему миру. Участие в нем принимают все больше городов и сообществ, местных и региональных органов власти. В настоящей публикации рассматривается роль информационных систем, индикаторов, мониторинга и оценки в обеспечении эффективности и устойчивости инициатив по формированию политики в сфере создания благоприятной среды для людей старшего возраста. В ней приводятся источники, воспользовавшись которыми можно получить всеобъемлющую картину положения пожилых людей и качества их жизни, а также узнать способы эффективного информирования об этих факторах. Настоящая публикация подготовлена с учетом опыта существующих инициатив по созданию благоприятных условий для жизни людей старшего возраста в Европе и механизмов их поддержки – в частности, инструментов мониторинга, оценки и целенаправленной коммуникации, таких как профили здорового старения и местные информационные системы. В число этих механизмов входят партисипативные подходы к проведению оценки ситуации с участием пожилых людей и инициируемые на местном уровне проекты, предусматривающие сбор и распространение информации, помогающей пожилым людям оставаться активными, участвовать в жизни сообщества и продолжать заниматься тем, что они считают для себя важным.

Благоприятные условия для жизни людей старшего возраста в Европе: Пособие с описанием стратегических областей действий

Процесс развития мер политики, нацеленных на создание более благоприятных условий для жизни пожилых людей в Европе,становится все более масштабным, и в нем принимает участие все большее число городов и сообществ, местных и региональных органов власти. Настоящая публикация предназначена для лиц, ответственных за планирование и формирование политики на местном уровне; она представляет собой пособие по восьми областям стратегических действий, которые охватывают как физическую, так и социальную среду, а также общественные услуги. Пособие разработано на основе модели ВОЗ, предусматривающей восемь областей действий для создания в городах и сообществах благоприятных условий для людей старшего возраста, которая активно применяется местными органами власти в странах Европы в качестве отправной точки для дальнейшей работы. В основу данного пособия легли уроки, извлеченные в ходе реализации существующих инициатив по созданию благоприятных условий для людей старшего возраста в Европе. Соответственно, оно отражает все многообразие имеющихся в нашем распоряжении инструментов, разработанных на местном и региональном уровнях, а также новейшие исследовательские данные. В настоящей публикации действия по созданию благоприятных условий для людей старшего возраста рассматриваются в контексте более широких мер политики в области охраны здоровья и социальной защиты стареющего населения стран Европы. Основное внимание уделяется вопросам взаимосвязи и синергии между выделенными областями, а также реализации их совместного потенциала для достижения общих целей, таких как укрепление социальной инклюзии, содействие физической активности и обеспечение поддержки людей, живущих с деменцией. Министерство здравоохранения Российской Федерации оплатило перевод и печать этой публикации на русском языке.

Avrupa’da yaș dostu çevreler olușturmak: Politika yapıcılar ve planlamacılar için bir araç

Daha iyi Yaş dostu çevrelerin oluşturulmasına dönük politikalar, giderek artan sayıda kentlerin ve toplumların, yerel mercilerin ve bölgesel hükümetlerin katılım gösterdiği Avrupa’da ve dünyada güçlü bir hareket haline gelmiştir. Bu politikalar, çevre, ulaşım, konutla ilgili fiziksel ortamı geliştirmek ve saygı, sosyal içerme ve topluma katılımı artırmak ile kamu hizmetlerine yatırım yapmak arasındaki sinerjileri araştırmaktadır. Bu yayında, yerel politika yapıcılara ve planlamacılara, insanların aktif ve sağlıklı yaşlanmasına, böylelikle kendileri için önemli olan şeyleri yapmalarına ve içinde yaşadıkları topluma katkıda bulunmalarına destek olacak olan yaş dostu politikalar ve müdahaleler geliştirmek, uygulamak ve değerlendirmek konusunda rehberlik sağlayacak bir araç verilmektedir. Bu yayında Avrupa’da halihazırda mevcut olan yaş dostu inisiyatiflerden öğrenilen dersler ışığında politika sürecinin dört safhası olan dahil etme, planlama, uygulama ve değerlendirme aşamaları içerisinde başarılı inisiyatifler oluşturmak ve sürdürmek için gerekli kilit faktörler özetlenmektedir. Birçok örnek sayesinde yerel hükümetlerin yaş dostu eylem ilkelerini nasıl hayata geçirdikleri gösterilmektedir.

Avrupa’da yaş dostu ortamlar: Politika eylem alanları el kitabı

Daha iyi yaş dostu ortamların oluşturulmasına dönük politikalar, giderek artan sayıda kentlerin ve toplulukların, yerel mercilerin ve bölgesel hükümetlerin katılım gösterdiği Avrupa’da ve dünyada güçlü bir hareket haline gelmiştir. Bu yayın, yerel politika yapıcılar ve planlamacılar için sekiz politika eylemi alanında kılavuz niteliğine sahiptir. Bu alanlar, hem fiziksel hem de sosyal ortamı ve ayrıca topluluk hizmetlerini de içermektedir. Avrupa’daki yerel hükümetlerce referans noktası olarak sıklıkla kullanılan yaş dostu kentler ve topluluklara yönelik sekiz alanlı bir DSÖ modelinin üzerine bina edilmiştir.Bu kılavuz, Avrupa’da halihazırda mevcut olan yaş dostu girişimlerden öğrenilen dersleri temel almıştır. Dolayısıyla bu alanda şu an mevcut olan yerel ve bölgesel olarak geliştirilmiş araçların zenginliğinin ve son araştırmalardan elde edilen kanıtların üzerine inşa edilmiştir. Bu yayın yaş dostu ortamlar oluşturma eylemlerini, daha geniş bir kavram olan Avrupa’da yaşlanan nüfuslara yönelik sağlık politikaları ve sosyal politikalar bağlamı ile ilişkilendirmektedir. Odak noktalardan biri de söz konusu sekiz alanın birbiriyle bağlantılı ve karşılıklı sinerji içerisinde olması ve bu alanların sosyal içerme, fiziksel aktivitenin teşvik edilmesi ya da demanslı kişilerin desteklenmesi gibi ortak hedefler doğrultusunda nasıl beraber çalışabilecekleri konusudur.