A Qualitative Assessment of Water, Sanitation, and Hygiene in an Urban Working-Class Neighborhood of São Paulo, Brazil Público

Abstract

Accessible and equitable water, sanitation, and hygiene (WASH) fundamentals are needed to slow the spread of WASH-related viruses, bacteria, and protozoa. Rapid urbanization poses challenges to the provision of adequate WASH services due to increased risk for contact with and exposure to diseases and infected individuals. This is especially noticeable in the highly urbanized Brazilian state of São Paulo, where 96.56% of the state’s total population of over 44 million lives in urban areas. WASH-related diseases, including malaria, dengue, Zika, cholera, tuberculosis, and other diarrheal illnesses, have been a persistent problem in Brazil. Brazil’s water and sanitation industries utilize quantitative quality indicators in assessing overall performance to achieve universal access to water and sanitation. While these measures are often embraced by policymakers as an evidence-based tool for policy decision-making, they do not always reflect needs on the ground, such as enhanced equitable access to safe water and specialized health programs addressing WASH issues for vulnerable populations. The goal of this study was to use qualitative research methods, especially thematic analysis of community ethnography field notes, to illustrate the reality of daily-life for those living in an urban-working class neighborhood of São Paulo city. By analyzing historical and contemporary WASH policies in Brazil, this research provides better understandings of inconsistencies between public policy and the reality of daily life in the context of WASH. The study has two primary questions 1) “How has the prioritization of sanitation by policymakers, both historical and contemporary, shaped the health of the urban working-class in Brazil?” 2) “How do living and working conditions among the urban working class relate to the creation and/or implementation of water, sanitation, and hygiene (WASH) services?” Findings from this study suggest that local authorities should employ a bottom-up, equity-centered lens emphasizing distributive justice when creating and implementing WASH-related public policies to ensure inequities are not overlooked.

Table of Contents

1.0 Introduction...........................................................................................................1

2.0 Background............................................................................................................3

2.1 Universal Healthcare and the Sistema Único de Saúde (SUS)......................................3

2.2 Immigration to Brazil and to São Paulo....................................................................6

2.3 WASH in São Paulo.................................................................................................8

3.0 Methods................................................................................................................16

3.1 Review of Policies...................................................................................................16

3.2 Qualitative Data Collection.....................................................................................16

3.3 Qualitative Data Analysis........................................................................................17

4.0 Results...................................................................................................................19

4.1 Historical and Contemporary Laws and Policies........................................................19

4.2 Narrative Case Study of Bom Retiro..........................................................................22

4.2.1 Introduction.........................................................................................................22

4.2.2 Bom Retiro and Structure of Local Primary Care Clinic............................................23

4.2.3 WASH-Related CHW groups..................................................................................25

4.2.4 Oficinas...............................................................................................................27

4.2.5 Homelessness and Other Informal Housing............................................................29

4.2.6 Water Crises........................................................................................................31

4.2.7 Spaces of Health..................................................................................................33

4.2.8 Racialization.......................................................................................................36

5.0 Discussion.............................................................................................................40

6.0 Conclusion............................................................................................................48

7.0 References.............................................................................................................51

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Latin American Studies Environmental Sciences
Palavra-chave	public health Brazil hygiene WASH sanitation
Committee Chair / Thesis Advisor	Donghai Liang, Emory University
Committee Members	Jeffrey Lesser, Emory University Emily Pingel, Emory University

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