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Edit or s of Lat in Am er ican Jour nal of Nur sing of Ribeir ão Pr et o of t he Univer sit y of São Paulo at Ribeir ão Pr et o College of Nur sing - WHO Collabor at ing Cent r e for Nur sing Resear ch Developm ent : 1 Full Pr ofessor, e- m ail: m ar ziale@eer p.usp.br ; 2 Full Pr ofessor, e- m ail: iam endes@eer p.usp.br
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POVERTY AND HUMAN DEVELOPMENT: GLOBAL STRATEGI ES
Mar ia Helena Palucci Mar ziale1
I sabel Am élia Cost a Mendes2
T
he leader s of t he 189 Mem ber St at es of t he Unit ed Nat ions and int er nat ional or ganizat ions agr eed, in2000, t o suppor t t he global dev elopm ent st r at egy k now n as “ Millennium Dev elopm ent Goals” and pledged t o
com ply w it h a ser ies of dev elopm en t goals disposed ion t h e Millen n iu m Declar at ion . On e of t h e est ablish ed
goals is t o r educe t he populat ion w ho liv es in ex t r em e pover t y, ident ified in 1990, by half.
This goal w as originally defined in relat ion t o an int ernat ional povert y line of approxim at ely one Am erican
dollar ( US$ 1.00) per capit a/ per day, accor ding t o Am er ican pr ices in 1985, w hich w er e conv er t ed t o nat ional
cu r r en cies t h r ou gh pu r ch asin g pow er par it y ex ch an ge r at es.
Pov er t y is a social, econ om ic an d com p lex p h en om en on , w h ose d im en sion s an d d et er m in an t s ar e
num er ous. But it can be defined as a set of incom e deficiencies and it s r educt ion r equir es t he com binat ion of
econom ic gr ow t h and r educt ion of social inequalit y.
Th e r eg ion of Lat in Am er ica an d t h e Car ib b ean r eg ist er s t h e h ig h est social in eq u alit y lev el in t h e
w or ld . I n 1 9 9 9 , con sid er in g t h e in t er n at ion al ex t r em e p ov er t y lin e, in cid en ce lev els v ar ied f r om 0 . 2 % in
Ar gen t in a, Dom in ican Repu blic an d Ur u gu ay t o a lit t le m or e t h an 2 . 0 % in Ch ile, Cost a Rica an d Pan am a, u p
t o 1 8 % in Ecu ador an d El Salv ador. I n Hon du r as an d Boliv ia it is abov e 2 6 % . I n 1 9 9 9 , on ly Boliv ia, Ecu ador,
El Sa l v a d o r, Ho n d u r a s, Ni ca r a g u a a n d Per u h a d a n i n ci d en ce l ev el o f ex t r em e p ov er t y a b o v e 1 0 % . I n
Br a zi l , t h e si t u a t i o n r ev ea l s su r p r i si n g g r ea t g r o w t h d em a n d s g i v en t h e st a b l e i n eq u a l i t y. Th e co u n t r y
n eeds t o r edu ce it s ex t r em e pov er t y by t w o per cen t age poin t s, w h ich w ou ld t ak e an est im at ed 4 8 y ear s t o
ach i ev e( 1 ).
Sim u lat ion s b ased on each cou n t r y ’s p er f or m an ce ( 1 9 9 0 ’s) in d icat ed t h at on ly sev en f r om t h e 1 8
count r ies in t hese r egions w ould m anage t o r educe t he ex t r em e pov er t y by half unt il 2015: Ar gent ina, Chile,
Colom b ia, Dom in ican Rep u b lic, Hon d u r as, Pan am á an d Ur u g u ay. Accor d in g t o est im at es, t h e r em ain in g 1 1
count r ies fr om Lat in Am er ican and t he Car ibbean ar e not ex pect ed t o r each t his goal if t heir gr ow t h dy nam ics
and inequalit y fr om t he 1990’s ar e r epeat ed dur ing t he 2000 - 2015 per iod. These count r ies can be divided in
t w o su b g r ou p s. Th e f ir st su b g r ou p is com p osed b y t h ose cou n t r ies w h ose r ecen t p er f or m an ce h as led t o
incr eased pov er t y rat es. These count r ies ( Boliv ia, Ecuador, Paraguay, Per u and Venezuela) w ill nev er r each t he
goal unless t hey change t heir t r aj ect or y, w hich is a sour ce of gr eat concer n. The ot her six count r ies ar e t hose
in w hich t he r educt ion of inequit y as w ell as gr ow t h hav e been ex t r em ely low in or der t o r educe t he lev el of
p ov er t y b y h alf in t h e n ex t 1 5 y ear s. How ev er, t h ey can ev en t u ally ach iev e t h is g oal, p r ov id ed t h at t h eir
per for m ance fr om 1990 is k ept . This int er m ediar y gr oup com pr ises Brazil, Cost a Rica, El Salvador, Guat em ala,
Mex ico and Nicar agua( 1).
I n a r ep or t , r ecen t ly d issem in at ed b y t h e Secr et ar y of Social Com m u n icat ion of t h e Pr esid en cy of
t h e Rep u b lic, it is r ev ealed t h at Br azil h as ach iev ed t h e p lan n ed g oal b y h alv in g t h e cou n t r y ’s ex t r em e
pov er t y t en y ear s befor e t he dat e est ablished by UN. I t m eans t hat 4. 7 m illion of Br azilians left t his condit ion
b et w een 1 9 9 0 an d 2 0 0 5 . Th e p er cen t ag e of t h e Br azi l i an p op u l at i on i n ex t r em e p ov er t y con d i t i on s w as
r educed fr om 9. 5% in 1992 t o 4. 2% in 2005. I n addit ion, t he incom e of t he poor est 10% incr eased 9. 2% p. a.
bet w een 2 0 0 1 and 2 0 0 5( 2). How ev er, t he st r at egies t o fight pov er t y need t o be cont inued, im plem ent ed and
en lar g ed in or d er t o su p p or t t h e lev els ob t ain ed an d t o im p r ov e t h e q u alit y of lif e of a lar g e n u m b er of
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According t o t he nat ional report of t he m illennium developm ent goals( 3) follow - up, t he r educed ext r em e
povert y in t he count ry is an effect of t he int er est r at e reduct ion, since 2004, of t he expansion of policies like t he
Fam ily St ipend and t he m inim um salar y incr ease, and t he incr eased Social Secur it y base salary and Cont inuous
Cash Benefit Pr ogram - incom e t ransfer t o poor disabled people and t he elder ly. The 1994 m onet ar y st abilizat ion
is also r elat ed t o pover t y r educt ion, t hough it did not suppor t it s decr easing t endency: aft er a decr ease for four
cont inued y ear s, pov er t y st ar t ed t o incr ease in 2001.
I n v iew of t he pr esent ed scenar io, of t he differ ent policies adopt ed by Lat in Am er ican and Car ibbean
count ries t o im prov e t he dist ribut ion of resources t o t he m ost needy, t he scient ific com m unit y, playing it s social
r ole, has m obilized in or der t o giv e it s cont r ibut ion.
Th u s, t h e Cou n cil of Scien t ific Edit or s h as or gan ized a j oin t pu blicat ion by 2 1 9 j ou r n als of differ en t
ar eas of k now ledge and r egions in t he w or ld t o sim ult aneously dissem inat e ar t icles and edit or ials on pov er t y
and hum an dev elopm ent t oday, Oct ober 22nd, in t he hope t he r esult s of such r esear ch can cont r ibut e t o t he
at t ainm ent of t he m illennium dev elopm ent goals.
The Lat in Am er ican Jour nal of Nur sing, engaged in t his m ovem ent , st im ulat ed r esear cher s t o elabor at e
an d p u b lish st u d ies r ep or t in g t h e con seq u en ces of p ov er t y f or lif e, f or t h e h ealt h - d isease p r ocess an d f or
hum an developm ent , and or ganized a special issue ( Rev Lat Am Enfer m agem . 2007.oct ,15, special v. ) , available
as f r om Oct ob er 2 2n d on t h e URL: w w w . scielo. b r, w h ich con t ain s t h e ed it or ial an d 2 3 ar t icles p u b lish ed in Por t u gu ese, Span ish an d En glish , aim in g t o su ppor t a r eflect ion on adopt ed h ealt h pr act ices, discer n in g t h e
im plem ent at ion of such r esult s t o dim inish pov er t y and pr om ot e hum an dev elopm ent .
Nex t , w e pr ov ide infor m at ion on t he ar t icles t hat com pose t his special issue.
The evaluat ion of nur sing pr act ices in collect ive healt h in t he cont ext of pover t y in t he Am azon r egion
is pr esen t ed by a Can adian n u r se, w h o descr ibes h er ex per ien ce w it h people w it h lepr osy an d sex w or k er s,
w ho liv e in unsafe condit ions in r iv er side com m unit ies.
Pov er t y coping st r at egies and t heir int er face w it h healt h pr om ot ion, adopt ed by a com m unit y in t he
Nor t heast of Br azil, show an ex am ple of ov er com ing social ex clusion and pov er t y coping.
A st udy on w or k envir onm ent and healt h r isks t o gar bage collect or s in a r ecyclable gar bage cooper at ive
fr om t he Sout h of t he count r y is pr esent ed and show s t hat t his act ivit y has at t r act ed an incr easing num ber of
people ex cluded fr om t he for m al j ob m ar k et . Such act iv it y pr esent s healt h r isk s t o t hese people and peculiar
st andar ds of diseases and should, t her efor e, be included in public discussions and policies.
Pov er t y, as a p r ed isp osin g f act or t o illn ess t en d en cies in su g ar can e w or k er s, is p r esen t ed in an
ex plorat or y r esear ch st r uct ur ed on t he ecological social t heor y, w hich ident ifies pr edisposing indiv idual, social
and environm ent al fact ors t o illness t endencies of w orkers in one of t he m ain sect ors of t he Brazilian econom y,
t he agro indust ry. Fift y- five percent of sugar cane product ion is direct ed at alcohol product ion and t his fuel has
at t r act ed t he w or ld’s at t ent ion due t o issues r elat ed t o global w ar m ing.
The im pover ished elder ly populat ion w as appr oached in som e of t he st udies t hat analyzed t he sit uat ion
of t hose w ho live in ret irem ent inst it ut ions, shelt ers for t he hom eless, and also t he qualit y of care delivered t o
oct og en ar ian s in t h e p u b lic h ealt h n et w or k an d t h e ep id em iolog ical sit u at ion of t u b er cu losis in r elat ion t o
socioeconom ic char act er ist ics. The r esult s show t he v ulner abilit y of t hese old people due t o fr agile w or k and
r esidence bonds, lack of fam ily suppor t , inadequat e condit ions of life, healt h and car e deliv er ed t o t he elder ly
in differ ent Br azilian cit ies.
Wom an’s healt h was also analy zed in st udies t hat evaluat e t he st r uct ur e and pr ocess of deliv er y car e,
aim in g t o pr ov ide su ppor t t o t h e f or m u lat ion of pu blic policies dir ect ed at h u m an dev elopm en t . Th e r esu lt s
appoint problem s relat ed t o t he m at er nit ies’ st r uct ur e, t he non- ut ilizat ion of pr act ices useful for nor m al deliver y
and t he use of harm ful or inefficacious pract ices. I n order t o change t his sit uat ion, it is essent ial t o offer qualit y
car e t o w om en, w it h a consequent r educt ion of m at er nal and neonat al m or t alit y r at es, so t hat t he count r y can
r each t he m illennium goals est ablished for im pr ov ing hum an dev elopm ent .
Anot her st udy com par ed t he pr ofile of adolescent m ot her s of liv e bor n infant s at t ended in public and
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consult at ions, had a low er level of schooling, higher parit y, higher num ber of norm al delivery, w hile t here w ere
a h igh er n u m ber of pr en at al con su lt at ion s, h igh er lev el of sch oolin g an d pr im ipar it y, an d c- sect ion w as t h e
m ost fr equent t y pe of deliv er y in t he pr iv at e sy st em .
Cancer, pov er t y and hum an developm ent w er e consider ed challenges t o be over com e by nur sing car e
in on cology, con sider in g t h e dem ogr aph ic, epidem iological an d sociocu lt u r al dist r ibu t ion of can cer in Br azil,
sin ce ar t icu lat in g car e an d act ion s n ecessar y for pr ev en t ion , ear ly det ect ion , t r eat m en t an d r eh abilit at ion in
t hese sit uat ions r equir es k now ledge not r est r ict ed t o t r eat m ent only, but also including t he needs inher ent t o
socioecon om ic an d cu lt u r al fact or s.
The em ot ional r eact ions of a gr oup of w om en fr om popular lay er s t o br east cancer w er e also st udied.
Th e r esu lt s in dicat e t h at st oicism w as t h e m ost f r equ en t em ot ion al r espon se am on g t h e pat ien t s an aly zed.
Lit er at ur e show s t hat t his r eact ion can cont r ibut e t o a t em por ar y r educt ion of st r ess but t ends t o hinder psychosocial
adj ust m ent t o t he disease and t r eat m ent .
Re ce n t st u d i e s h a v e e m p h a si ze d t h e n e e d t o d e t a i l t h e i m p a ct o f sp e ci f i c d i m e n si o n s o f t h e
socioeconom ic cont ex t w hich can w or k as r isk fact or s r egar ding t he use of dr ugs. Anot her par t of t his special
issue is a st udy t hat v er ified t he pot ent ial r elat ionship bet w een t he use of psy choact iv e dr ugs in adolescence
an d socioecon om ic lev el. Th e r esu lt s sh ow t h at , as op p osed t o com m on sen se ex p ect at ion s, ad olescen t s
fr om m iddle/ upper m iddle classes pr esent ed a significant higher usage per cent age of alcohol, t obacco, cannabis
and solv ent s, w hen com par ed t o t heir peer s fr om low / infer ior low classes. These dat a suggest t he im por t ance
of st u d ies t h at seek t o clar if y p ot en t ial in f lu en ces of socioecon om ic st at u s on t h e con su m p t ion of d r u g s
am on g ad olescen t s.
Ch ild an d adolescen t h ealt h w as t h e t h em e of ar t icles t h at appr oach ed h ealt h car e in sit u at ion s of
dom est ic violence, childcare and in t he nut rit ional cont ext in t he rural area. St udies w it h dist inct populat ions of
in div idu als w it h diabet es, lepr osy, sex u ally t r an sm it t ed diseases, AI DS an d deficien cies ar e also par t of t h is
issue and bring im port ant cont ribut ions for nursing car e dir ect ed t o people w it h a low socioeconom ic profile and
w ho face disabilit ies t hat can negat iv ely affect t heir qualit y of life.
One of t he ar t icles focused on a bioet hical r eflect ion on t he concept ion of pover t y as a r est r ict ing and
vulnerable condit ion or circum st ance. Healt h and environm ent al right s in t im es of social exclusion are present ed
t hr ough a t heor et ical r eflect ion t hat denounces t he com plex pr oblem s associat ed t o social and env ir onm ent al
in j u st ice in Br azil, w h ich ar e m at er ialized in t h e f or m of social ex clu sion an d en v ir on m en t al d eg r ad at ion ,
com pr om ising t hese r ight s and t he possibilit y of a societ y ’s collect iv e achiev em ent . I t can pr ov ide a r elev ant
cont r ibut ion in or der t o r ev er t t his sit uat ion.
I t has been obser ved t hat t he st udies published in t he Lat in Am er ican Jour nal of Nur sing cont r ibut e t o
t he est ablishm ent of st r at egies t hat , coupled w it h polit ical and econom ic act ions adopt ed by poor count r ies, can
help in t he reduct ion of inequalit ies. The w ealt h of Brazilian and Lat in Am erican nursing is also highlight ed in it s
const ant sear ch t o assur e of access t o qualit y healt h car e( 4)
We en d t h is t ex t b y appoin t in g t h at , alt h ou gh Brazil h as m an aged t o r edu ce ex t r em e pov er t y, t h er e
ar e st ill u r g en t p r ob lem s t o b e f ou g h t in or d er t o m ov e t ow ar d s t h e ot h er g oals est ab lish ed b y t h e eig h t
m i l l en n i u m d ev el o p m en t g o a l s ( er a d i ca t i o n o f h u n g er, p r o m o t i o n o f g en d er eq u a l i t y, r ed u ct i o n o f ch i l d
m or t alit y, com bat in g AI DS an d m alar ia, ach iev in g u n iv er sal pr im ar y edu cat ion an d en su r in g env ir on m en t al
su st ai n ab i l i t y ) .
REFERENCES
1 . Pr og r am a d as Nações Un id as p ar a o Desen v olv im en t o ( PNUD) , Com issão Econ ôm ica p ar a a Am ér ica Lat in a e o Car ib e ( CEPAL) , I n st it u t o de Pesqu isa Econ ôm ica Aplicada ( I PEA) . Ru m o ao obj et iv o do Milên io de r edu zir a pobr eza n a Am ér ica Lat in a e o Car ibe. San t iago. Ch ile. 2 0 0 3
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Rev Latino-am Enfermagem 2007 setembro-outubro; 15(número especial): 713- 6 w w w . eer p. usp. br / r lae
3 . Br asil. Pr esidên cia da Repu blica. Obj et iv os de desen v olv im en t o do m ilên io: r elat ór io de acom pan h am en t o. Coor den ação: I n s t i t u t o d e Pe s q u i s a Ec o n ô m i c a A p l i c a d a e S e c r e t a r i a d e Pl a n e j a m e n t o e I n v e s t i m e n t o s Es t r a t é g i c o s . B r a s íl i a : I p ea, SPI , set em b r o 2 0 0 7 . 1 5 2 p .
