Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Volume 8, Number 1, 2003

Dangers all around

Young residents of Glicério clown for a reporter's camera.

The lack of play space, formal leisure activities and often even access to schooling exposes poor children to another set of environmental risks. Accidents such as falls, traffic accidents, electrocution and suffocation kill an estimated 100,000 children annually in Brazil alone, according to the Brazilian church group Pastoral da Criança. Poverty also increases children’s exposure to violence, including stray bullets, domestic abuse and homicide.

These problems can be particularly acute in cities. "Children mostly play in the streets, because they have nowhere else to go," says Katia Edmundo of the Center for Health Promotion (CEDAPS), a nongovernmental organization based in Rio de Janeiro. "There are also cases of children being locked in their houses all day because the parents are afraid of the violence on the streets but have to go to work and can’t afford day care."

There are signs that the situation has improved in some ways in the last decade. Sanitation coverage in the region rose from 66 percent of the population in 1990 to 79 percent in 2000, while potable water coverage rose from 80 percent to 85 percent during the same period, according to the Pan American Center for Sanitary Engineering and Environmental Sciences (CEPIS), a technical center of the Pan American Health Organization (PAHO). These improvements have contributed to declines in both infant (under age 1) mortality and child (under age 5) mortality throughout the region in the last decade.

Brazil is one of the countries that have seen the biggest reductions. Its child mortality rate dropped from 64 per 1,000 live births in 1994 to 45.2 per 1,000 in 1999. (By comparison, Colombia reached a relatively low rate of 34 deaths per 1,000 in 1999 but started with 42 per 1,000 in 1994.) One of the main reasons for the improvements in Brazil has been increased access to clean drinking water, along with health promotion initiatives first introduced in 1991 and significantly stepped up in the last seven years. An increase in school enrollment also has helped.

But there is still a long way to go. "About 20 percent of the urban population has 21st-century living standards, but the rest are heavily impacted by the environment they live in," says Ivan Estribi, a PAHO consultant in Brazil and expert on environmental health.

"In cities, people have easier access to drinking water, which goes a long way in reducing deaths from preventable diseases. But they live in unhealthy houses, exposed to dangers such as factories and pollution, and at risk from landslides because of the areas they live in."

In rural Brazil, an estimated 20 million people, or about 12 percent of the population, are considered out of reach of government programs.

"There is no official information about how these people live, where they get their water from," says Estribi.

In the past, large-scale government programs were viewed widely as the only way to address such problems. But these have gone only so far in getting children out of danger zones. Chronic financial woes have made it difficult for federal, state and local governments to detect communities’ problems, let alone solve them.

Tito Nery, a pneumologist in the São Paulo Mayor’s Office, offers the following analysis: According to the city government, about 2 million people live in shacks or substandard housing in the city’s favelas, or shantytowns. At last count, there were more than 2,000 favelas. If the local government were to begin diagnosing problems and implementing solutions at the rate of one community per month it would take more than 150 years to reach the whole city. For Nery, further improvements can be reached only through community mobilization.

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