Mortalidade por homicídios em áreas vulneráveis de Belo Horizonte, objeto de intervenções urbanas e sociais do projeto vila viva: uma análise comparativa

Abstract

Introduction: The theoretical reference of social determinants relates to living conditions, work and opportunities for access to goods and services beyond individual factors. Thus, the path of falling ill and dying has political, economic, cultural, and historical determinations. The theoretical reference of Urban Health arises with the growth of cities and urban population, and presents the city as an opportunity generator, but also of social disparities and multiple aggravations resulting from its uneven development. Urban redevelopment projects, especially in less favored areas, modify health indicators, including homicides, one of the most sensitive indicators of exclusionary urbanization. Objective: To analyze the impact of interventions carried out in the scope of the Vila Viva Program on the homicide mortality of populations living in vulnerable areas of Belo Horizonte, the subject of the interventions. Methods: This thesis is part of a larger project called "BH-Viva", a two-phase quasi-experimental study of quantitative and qualitative methods, using secondary data and primary health, census and other public policy data. The project is a first step in the evaluation of the Vila Viva Program of Belo Horizonte, which works to redevelop towns and slums in the city in order to expand the opportunities for its residents and improve the quality of life in these areas. The study scenario was then the municipality of Belo Horizonte, and from 2002 to 2012 the homicides and their relation with the interventions were analyzed. The homicide data were obtained through the Mortality Information System of the Ministry of Health, georeferenced by the victim's place of residence. The units of analysis were chosen for the study according to similar social and demographic characteristics, having five villages with program intervention and five comparison villages, without intervention. For the descriptive study, the formal city was also

elected. The data of the interventions were collected through the Urbanization and Housing Company of Belo Horizonte to identify the typology, the schedule of interventions and the time of beginning, execution and completion of the works, which gave rise to variables of analysis. Based on the literature review, a conceptual model for the occurrence of homicides in the cities was constructed, in addition to a descriptive analysis of the homicides in the units participating in the study. By means of a non-concurrent quasi-experimental design, the homicide rates were analyzed comparing five favelas with intervention (S1-S5) and five favelas without intervention, grouped in S0. The Poisson regression model estimated the effect of observation time in the study period and the effect of exposure time (in years) on the completion of interventions. The risk ratio for the variables was calculated in this model. Results: the conceptual model pointed out that homicides found in cities their most expressive determinants linked to inequality and exclusion, together with values of a culture of force and prejudices. Homicides had high rates in the formal city, from three to six times as many in the favelas. More blacks died, young men, men of low schooling, on public roads and in vulnerable territories. Using the observation time variable in years, homicide rates decreased in the years of the period, especially when considering the cumulative time of exposure to the conclusion of the intervention from S1 to S4, but not to S5. The risk of dying from homicides in the villages with and without intervention were not different, except in the village with the longest exposure to completion (S1). Conclusion: Homicides constitute a synthesis of urban disadvantages, especially in vulnerable territories. In this study, this reality was compatible with that observed in Brazil, denouncing inequality present in Belo Horizonte. Although the results of the effect of interventions on homicide rates have not been repeated in all favelas, there has been a downward trend in homicide rates related to interventions. New approaches are needed to verify the nexus between favela renovation projects and the reduction of homicide rates.