Território da saúde: espaços da vulnerabilidade e lugares (des)iguais de produção de doença

Abstract

This work aimed at analyzing the process of construction of the territory of Fortaleza, Ceará State, Brazil and its relationship with the health of the city population. Therefore, it was necessary to describe the evolution of its occupation based on the variation of population density and socio-occupational characteristics of the neighborhoods in the period 1970-2010 and the movements (waves) of territorial occupation and its relation to the socioeconomic profile in 2010, characterizing socioeconomic profile and mortality by sex of the population of Fortaleza in 2010 and identifying the relationships between socioeconomic profiles and mortality with social determinants of the population of Fortaleza by sex in 2010. This was an ecological study, using secondary data collection, from the Mortality Information System (SIM) of Fortaleza, in 2010, investigating the ten leading causes of mortality for men and women and also from the 2010 database of the Brazilian Institute of Geography and Statistics (IBGE). The program STATA 10.0 was used for organizing the database structured by the following socioeconomic indicators: population density, index of living conditions, GINI, ratio of average income of the 10% richer and 40% poorer, illiteracy rate, poverty rate and average income. Thematic maps were produced for all socioeconomic indicators and of mortality by Fortaleza neighborhood for the year 2010, using the 10.1 ArcGIS applicative. The results show that urban space in Fortaleza was constituted in a differentiated manner, which is reflected in the spatial distribution of living conditions of the city population. For some causes, the relationship was directly proportional to life conditions, that is, the worst were these conditions, higher were the rates of mortality by specific cause. Noteworthy is Aggression by means of another firearm shooting or by unspecified weapon (AGRES), which percentage represents the highest basic cause of death for men in Fortaleza, with 35.6% of the total number of deaths in 2010 and presenting a direct relationship with all socioeconomic indicators; the worst were living conditions found, higher the death rates by AGRES. Unspecified stroke and Dependence Syndrome were also basic death causes in which the relationship established was of the worst the indicators, higher were 12 the mortality rates. For other diseases such as Early-onset Alzheimer Disease, Breast malignant neoplasm and Bronchi or lungs malignant neoplasm, the relationship was much better were socioeconomic indicators, higher were mortality rates. Considering the results found in the study, we conclude that the most needy and historically segregated population is that which is subject to the worst living conditions and consequently, the most vulnerable.