The role of the socioenvironmental context in the infant and postneonatal mortality of the population living in the precarious settlements of the Municipality of São Paulo

Author(s)

Mirela Barros Serafim

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Filosofia, Letras e Ciências Humanas (FFLCH/SBD)
• Defense date: 2023-10-31

Examining board members

Ligia Vizeu Barrozo; Francisco Chiaravalloti Neto; Marina Jorge de Miranda; Carlos Leite de Souza

• Advisor: Ligia Vizeu Barrozo

Abstract

Monitoring slum health can be a useful strategy for reducing inequality within a city, since the neighborhood effects are more intense in these areas. Socioenvironmental vulnerability indexes are important tools to monitor and understand health inequalities. In Brazil, the Municipal Human Development Index (MHDI) has been the most applied composite measure to characterize the intraurban socioeconomic context. However, the adequacy of the MHDI for health studies is limited due to the mathematical redundancy produced by its longevity dimension in regression models. Furthermore, the MHDI does not incorporate housing conditions and the physical characteristics of its surrounding environment. Infant mortality data represent society\'s ability to provide minimum conditions for the development of children under one-year-old. The segmentation of infant mortality into the postneonatal period helps to identify the effects of the place of residence, by eliminating deaths that occurred in the neonatal period, which are usually related to the quality of the delivery care services. In this sense, the present study aimed to understand the association between the socioenvironmental context and the spatial patterns of health outcomes in the Municipality of São Paulo, especially the spatial patterns of the relative risks of infant and postneonatal mortalities, with a focus on its precarious settlements. Based on theoretical health references, the Socioenvironmental Index (ISA) was developed, considering two subindexes, the Socioeconomic Index (ISOC, composed of \"income\", \"poverty\", \"education\", \"wealth\", \"mobility\" and \"segregation\" dimensions) and the Environmental Index (IAMB, composed of \"housing\" and \"infrastructure of urban services and environment\" dimensions). The indexes were developed using Principal Component Analysis for the 1,593 Human Development Units of the Municipality of São Paulo. The relative risks of infant and postneonatal mortalities were obtained using a spatial scanning technique, considering the covariable sex. To analyze the indexes\' applicability for slum health research, a mean rank comparison was performed between the urban settlement typologies (favelas, irregular allotments, urbanized cores, tenement houses, and formal city). The indexes\' potential in explaining the relative risks of infant and postneonatal mortalities was assessed using the Ordinary Least Square (OLS), Geographically Weighted Regression (GWR) and, Multiscale Geographically Weighted Regression (MGWR) models. Additionally, to evaluate the applicability of the indexes for health studies in small areas, the same methods were performed using each index as a single predictor and the ageing rate as the explained variable. ISOC and IAMB were internally consistent (Cronbach\'s Alpha of approximately 0.7 for both indexes). Significative differences in socioenvironmental conditions and health results were observed for the group of urban settlement typologies. However, the post hoc tests indicated that the three indexes did not identify significant differences between the tenement houses and the formal city, nor between the irregular allotments and urbanized cores. Results from the post hoc tests also showed that the relative risks of infant and postneonatal mortalities significantly differed between the formal city and the irregular allotments. In the case of the relative risk of infant mortality, results also significantly differed between the formal city and the favelas. Different techniques applied in this study pointed to the need of including variables related to housing and its surrounding environment in indexes developed to explain health outcomes. The comparison of the GWR and MGWR results, between the models that incorporated the variables retained in the ISOC and the models that included the variables retained in the IAMB as predictors, showed that the second explained an additional amount between 33.6% and 37.8% of the variance for the relative risks of infant and postneonatal mortalities. Finally, the proposed indexes are useful for identifying the mechanisms shaping health inequalities and can contribute to the allocation of resources to the most vulnerable communities (AU)

• FAPESP's process: 18/05633-5 - VULNERABILITY OF POPULATIONS LIVING IN PRECARIOUS SETTLEMENTS OF THE MUNICIPALITY OF SÃO PAULO
• Grantee: Mirela Barros Serafim
• Support Opportunities: Scholarships in Brazil - Doctorate