A Comparison of Social and Spatial Determinants of Health Between Formal and Informal Settlements in a Large Metropolitan Setting in Brazil

Abstract

Urban informal settlements are often under-recognized in national and regional surveys. A lack of quality intra-urban data frequently contributes to a one-size-fits-all public health intervention and clinical strategies that rarely address the variegated socioeconomic disparities across and within different informal settlements in a city. The 2010 Brazilian census gathered detailed population and place-based data across the country's informal settlements. Here, we examined key socio-demographic and infrastructure characteristics that are associated with health outcomes in Rio de Janeiro with the census tract as the unit of analysis. Many of the city's residents (1.39 million people, 22 % of the population) live in informal settlements. Residents of census tracts in Rio de Janeiro's urban informal areas are younger, (median age of 26 versus 35 years in formal settlements), and have less access to adequate water (96 versus 99 % of informal households), sanitation (86 versus 96 %), and electricity (67 versus 92 %). Average per household income in informal settlement census tracts is less than one third that of non-informal tracts (US\$708 versus US\$2362). Even among informal settlements in different planning areas in the same city, there is marked variation in these characteristics. Public health interventions, clinical management, and urban planning policies aiming to improve the living conditions of the people residing in informal settlements, including government strategies currently underway, must consider the differences that exist between and within informal settlements that shape place-based physical and social determinants of health.

Hypertension in a Brazilian Urban Slum Population

“…This is especially true in informal communities such as slums where the terrain, population, municipal services, and other important demographic and infrastructure characteristics vary dramatically. 37 Our study found that any elementary education compared to none at all was enough to reduce blood pressure. This indicates that even within this slum community characterized by high levels of absolute poverty, differences in educational status influence blood pressure.…”

“…In our study, 70 % of subjects were between 18 and 39 years of age, reflecting the younger age demographic of slums. 37 A summary of 18 studies of the disease conducted in Brazil found a prevalence that ranged from 21 to 29 %. 24 However, the majority of these studies came from non-slum populations in the more heavily industrialized southeast.…”

Tuberculosis DALY-Gap: Spatial and Quantitative Comparison of Disease Burden Across Urban Slum and Non-slum Census Tracts

“…11 TB remains a leading cause globally of DALYs among young adult males aged 15-39 years of age, 4 the largest age group in the slums of Rio de Janeiro. 12 Here, we quantitatively compared TB DALYs between formal and informal neighborhoods of Rio de Janeiro to assess differences in the burden of this disease. We propose a new metric called BDALY-gap^as a way to quantitate disease burden between two communities in the same city.…”

Situating the Scientist: Creating Inclusive Science Communication Through Equity Framing and Environmental Justice

“…And it also encompasses EJ insights regarding unequal access to environmental privileges, e.g., parks, green space, community services, etc. that have been shaped by longstanding racial and economic segregation (Pulido, 2000;Park and Pellow, 2011;Snyder et al, 2014;Corbin, 2018).…”