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

Residents of Jardim Paraná, in São Paulo, Brazil.

"There are some families that still don't have access to treated water so we’re trying to get the water company to extend the network," says Calisto, who serves as president of the residents’ association.

"The conditions there [in Jardim Paraná] are far from perfect, but at the beginning the situation was so dire that I was surprised not to find typhus in the region," says Thelma Nery, a pediatrician and founder of the nongovernmental National Health Organization, which has helped the Jardim Paraná community organize itself and fight for environmental improvements using a strategy known as Primary Environmental Care, promoted by PAHO.

The successful community organizing has led to "green" environmental initiatives as well. Jardim Paraná borders an Atlantic forest preservation area known as Serra da Cantareira, and some 45,000 square meters of the land purchased by the community lies within the forest’s boundaries. The community is seeking partnerships with private organizations to protect and manage the forest and preserve it for their children’s future.

Jardim Paraná’s organizing has had other benefits, too. It has attracted the attention of the Rotary Club, which plans to build a community center focusing on small business development as a way to create jobs.

Health and environmental initiatives must be developed alongside programs that create income and redistribute wealth in poor regions, says Marcia Westphal, head researcher at CEPEDOC, a University of São Paulo research center on "healthy cities."

"You have to think of biomaps and include in the planning not only health and environment but also housing and the economy," she says. "If the houses are substandard and people in the region don’t have a job, then you don’t produce social health, you produce social illness. You have to coordinate activities in different sectors."

Using the healthy cities concept as a basis, Westphal develops strategies to empower local communities. The process starts with rallying community members around a cause and teaching them to diagnose their problems and define priorities. Once the local communities are aware of the problems they can start working with local governments and private entities to improve basic services.

Katia Edmundo, of CEDAPS, has seen this process in the Rio de Janeiro district of Vila Paciencia, where her organization has a health promotion and community empowerment program. There, community members determined that the main source of a common skin disease in children was their direct contact with pigs that wandered freely in the neighborhood feeding on rubbish. Eventually the pigs were confined, and the skin problems began to diminish.

"The health of children is by far the main motivator for community organization," says Edmundo. "Once the diagnosis is made, people can start to take action."

That assumes one important additional detail: that communities are somehow "legalized." In many poor neighborhoods, residents lack property titles because they "invaded" the land or it was sold to them illegally, or in some cases because they cannot pay for the necessary paperwork. In the absence of official documents, government agencies find it difficult to arrange to provide basic services.

Jardim Paraná is a case of a community that mobilized, legalized and began to construct a better future for its children.

Meanwhile, in Vale do Anhangabaú, Jonathan dos Santos continues to build mud castles 200 meters from City Hall while his 50-year-old grandmother looks on. When a visitor asks her who owns the land, she answers: "I’ve been here for 15 years and am still trying to get the property rights in court."

Alexandre Spatuzza is a Brazilian freelance journalist living in São Paulo.

Additional Information:
Diagnosing health and the environment
Ecoclubs for the environment

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