Salud ambiental urbana: Aproximaciones antropológicas y epidemiológicas sobre la evaluación de un programa de alcantarillado en un contexto de grandes desigualdades sociales

Abstract

[spa] El acceso al saneamiento básico es un problema que afecta actualmente a la mayoría de países de América Latina. Mientras que en Europa el desarrollo del saneamiento básico se produjo entre los siglos XIX y comienzos del siglo XX como un conjunto de medidas políticas a favor de la salud pública, los países en vías de desarrollo tuvieron que esperar básicamente hasta mediados del siglo XX para comenzar a resolver los problemas de insalubridad en la mayoría de sus ciudades. En estas dos últimas décadas diversas agencias internacionales promovieron políticas de derecho de acceso al agua y al alcantarillado, las cuales influyeron positivamente en el desarrollo de intervenciones de saneamiento básico en varios países, entre ellos Brasil. Este país alcanzó mejoras significativas en este campo, sobre todo en las zonas urbanas. El esfuerzo económico que Brasil había realizado en las dos últimas décadas para construir el sistema de alcantarillado no había alcanzado el mismo nivel de éxito que el acceso al agua potable.

[eng] The aim of this paper is to analyze how the social inequalities influence the environmental urban health inside a context of development of basic sanitation. The principal challenge of this text is to apply theoretically this analysis from the joint of two fields of knowing differentiated, the medical anthropology and the social epidemiology, which common spaces of investigation share to obtain a major comprehension of the problems that nowadays concern the public health. To theoretical level it splits of the thesis of which the local development of the basic sanitation depends on the globalization of political measures that influence the design, evolution, implementation and management of programs and services. The historical frame in the one that limits itself this development, which in case of the Brazil is characterized by its great inequality, explains the continuities, variations and solutions of the problems of sanitation in a temporary and spatial specific context. It is necessary to define what they understand the epidemiology and the anthropology for “context” and “social inequalities” to observe how these concepts have operated to methodological level in the investigation that both disciplines have carried out to evaluate the epidemiological impact of the program of sanitation “Bahia Azul” in Salvador of Bahia. The empirical material used for the accomplishment of this paper comes from an interdisciplinary investigation (1997-2004) in which they informed the epidemiology and the anthropology, among other disciplines, before and after the implementation of this program. The hypothesis of is that the social inequalities continue explaining the intra-urban differences in health, in spite of relying on the installation of an infrastructure of sewage system that it offers a wide coverage to the population of the whole city. Whereas to level macro the improvements in health come from the intervention in sewage system, the social inequalities to level mike have been reinforced because the benefits in environmental health continue being unequal. Nowadays, the principal problem that illustrates the social inequalities is linked by the management and the subsistence of the infrastructure. It is necessary to compare between the epidemiological variables that measured the social inequality, before and later, and to define what understands itself for this concept, as well as to show from the fieldwork the development of these inequalities and to define how they operate in a social specific context. Finally, the offer to reach a model of analysis who overcomes the methodological quantitative-qualitative dichotomy is approached as frame of theoretical discussion for the study of the social inequalities in environmental health.