1
Undergraduat e St udent , schorlarship for scient ific init iat ion PI BI C/ CNPq/ UNI FESP 2005- 2007, e- m ail: flaviaslf@gm ail.com ; 2 Undergraduat e St udent , e-m ail: e-m iv eigaraizer @bol. coe-m . br ; 3 Adv isor, RN, Sanit ar ist , Adj unct Pr ofessor. Depar t m ent of Nur sing, São Paulo Feder al Univer sit y, Br azil, e- m ail acbr et as@denf.epm .br
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
OLD, POOR AND OUT ON THE STREETS: ON THE ROAD TO EXCLUSI ON
Fláv ia Sar aiv a Leão Fer nandes1
Milena Veiga Raizer2 Ana Cr ist ina Passar ella Br êt as3
Fernandes FSL, Raizer MV, Brêt as ACP. Old, poor and out on t he st reet s: on t he road t o exclusion. Rev Lat
ino-am En fer m agem 2 0 0 7 set em br o- ou t u br o; 1 5 ( n ú m er o especial) : 7 5 5 - 6 1 .
This ex plor at or y st udy aim ed t o inv est igat e and descr ibe t he hom eless elder ly populat ion user of a
shelt er specifically designed for t hem in Sao Paulo. A t ot al of 20 elderly part icipat ed in t he st udy. The dat a were g at h er ed t h r ou g h in t er v iew s an d f ield ob ser v at ion . Th e d at a an aly sis w as b ased on Collect iv e Healt h an d
Ger on t olog y r ef er en ces. Th e m ain r esu lt s r ev eal t h at t h e v u ln er ab ilit y of t h e eld er ly t o b ecom e h om eless occur s in a m acr o lev el, char act er ized by fr agile w or k and r esidence t ies. The m icr o lev el is char act er ized by
t he lack of fam iliar suppor t . I n conclusion, t his st udy led us t o r et hink t he hum an values r egar ding t he social inequalit ies as well t he t rivializat ion of social inj ust ice. We learned t o view t he hom eless elderly as subj ect and
not j ust passiv e obj ect of char it y and assist ance.
DESCRI PTORES: aged; hom eless; healt h; public healt h; pov er t y
POBRE, ANCI ANO Y EN LA CALLE: UNA TRAYECTORI A DE EXCLUSI ÓN
Est e est udio explor at or io t iene por obj et ivo invest igar y descr ibir la población anciana que vive en las
calles, u su ar ia d e u n ab r ig o ex clu siv o p ar a est e seg m en t o social en la ciu d ad d e Sao Pau lo. Los su j et os est udiados fueron veint e ancianos. Los dat os fueron recolect ados m ediant e t écnicas de ent revist a y observación
de cam po. Est as infor m aciones fuer on analizadas m ediant e r efer enciales de las ár eas de Ger ont ología y Salud Colect iv a. Los pr incipales r esult ados m uest r an que la v ulner abilidad del anciano en la calle ocur r e t ant o en el
niv el m acr o, car act er izado por lazos de cuest iones labor ales y habit acionales fr ágiles, com o en el niv el m icr o, car act er izado por la falt a de apoy o fam iliar . En conclusión, est e est udio llev ó a r epensar los v alor es hum anos
r espect o a desigualdades sociales y canalización de la inj ust icia social. Apr endim os a v er al anciano que v iv e
en la calle com o suj et o y no obj et o pasiv o de car idad y asist encialism o.
DESCRI PTORES: anciano; per sonas sin hogar ; salud; salud pública; pobr eza
POBRE, I DOSO E NA RUA: UMA TRAJETÓRI A DE EXCLUSÃO
Est e est udo explorat ório t eve por obj et ivo invest igar e descrever a população idosa em sit uação de rua, usuár ia de um abr igo exclusivo par a esse segm ent o, na cidade de São Paulo. Os suj eit os do est udo for am 20
idosos. Os dados foram colet ados por m eio das t écnicas da ent revist a e observação de cam po. Foram analisados à luz dos r efer en ciais das ár eas da Ger on t ologia e Saúde Colet iv a. Os pr incipais r esult ados m ost r am que a
vulnerabilidade do idoso às ruas se dá t ant o no nível m acro, caract erizado por laços t rabalhist as e habit acionais
fr ágeis, quant o no nív el m icr o, car act er izado pela falt a de apoio fam iliar . Concluindo, esse est udo pr opocia a reflexão sobre os valores hum anos no que diz respeit o às desigualdades sociais e banalização da inj ust iça social.
Aprende- se a ver o idoso de rua com o suj eit o e não um obj et o passivo de caridade e assist encialism o.
I NTRODUCTI ON
I
n Oct o b er 2 0 0 3 , t h e Pr esi d en t o f Br a zi l passed Law num ber 10741, which concerns t he ElderlySt at ut e and pr esent s ot her m easur es( 1). I t should be
em phasized t hat it t ook long years of procedures and
discussions in t he Nat ional Congr ess and r equir ed a
b r o a d m o b i l i z a t i o n o f e l d e r l y a n d t e c h n i c i a n s
com m it t ed t o t h e cau se of ag in g . Not on ly d oes it
con solidat e t h e r igh t s en su r ed in ot h er legislat ion s,
in clu din g t h e Nat ion al Elder ly Policy( 2 ), t h e Nat ion al
Elderly Healt h Policy( 3) and t he Single Healt h Syst em( 4),
but it also broadens, enhances and defines prot ect ion
m easur es for people aged 60 y ear s or m or e.
The Elderly St at ut e( 1) considers life and aging
as indiv idual and social r ight s. I t dem ands t he St at e
t o guarant ee elderly people wit h t he prot ect ion of life
and healt h t hrough t he im plem ent at ion of public social
p o l i ci e s t h a t e n su r e h e a l t h y a n d d i g n i f i e d a g i n g .
How ever, elder ly oft en live in a sit uat ion of ex t r em e
pov ert y, deprived of such prot ect ion t hat would ensure
t h e m ain t en an ce of t h eir b asic h ealt h n ecessit ies.
Mor eov er, it is con st an t ly ob ser v ed t h at t h e Pu b lic
Pow er and societ y lack preparat ion t o m eet t he legal
p r ecep t s.
This st udy is based on t he belief t hat public
policies, in t he social dom ain, are inst rum ent s capable
n o t o n l y o f a ssessi n g p o v er t y, b u t , a b o v e a l l , o f
r edef in in g access t o oppor t u n it y. I n t h is sen se, t h e
aut hors present t he issue of aging on t he st reet s, wit h
a view t o accent uat ing t he difference bet ween charit y
and j ust ice in com ply ing w it h legislat ion.
I n Sao Pau lo, t h e Cit y Cou n cil p assed Law
num ber 1232/ 97, which det erm ines on care t o people
on t he st r eet s. Despit e being assist ent ialist , it aim s,
insofar as possible, t o ensure const it ut ional right s t hat
seek t o guarant ee equalit y am ong Brazilians. The Law
det erm ines services and program s for t his populat ion,
aim in g t o pr ov ide t h em at least w it h car e f or t h eir
absolut e pov er t y sit uat ion.
I n 2003, t he Fundação I nst it ut o de Pesquisas
Eco n ô m i ca s ( FI PE) [ Eco n o m i c Re se a r ch I n st i t u t e
Fo u n d a t i o n ] , b y r e q u e s t o f t h e S e c r e t a r i a d e
Assist ên cia Social ( SAS) [ Social Car e Secr et ar iat ] ,
carried out a census of people living on t he st reet s in
Sao Paulo, regist ering 10,394 people - 6,186 of whom
were locat ed in t he st reet s and 4,208 in shelt ers( 5).
Agin g is a n at u r al ph en om en on . Hen ce, all
being get old, since t heir bodies ar e finit e. The idea
of finit ude in life is giv en by t he v icissit udes of t he
body and should be part of hum an exist ence. However,
not ev er y one not ices and/ or accept s aging.
The aging process includes, but is not lim it ed
t o, t he old age phase. Life and aging qualit ies r elat e
wit h t he individual’s view of t he world and societ y he
or she lives in. Therefore, aging is not only a biological
p h en o m en o n , b u t , a b o v e a l l , t h e co n v er g en ce o f
socially const r uct ed fact or s, w hich assign a differ ent
st at u s t o agin g people( 6 ). This asser t ion is essent ial
w hen w orking w it h elderly living on t he st reet .
I n t his discussion, t he aut hor s int r oduce t he
pr ecept t hat t her e ar e differ ent for m s of aging and,
t h u s, old age. Th e place in div idu als h old in societ y
affect s t he way t hey obt ain condit ions t o m anage t heir
per sonal car e. This fact suggest s t hat social inj ust ice
affect s t his car e r elat ionship, and, t her efor e, cannot
be disregarded when analyzing t he obj ect of t his st udy.
Th e cu r r en t social con j ect u r e h as poin t s in
com m on w it h a w ar sit u at ion . How ev er, it does n ot
refer t o an arm ed conflict , but t o an “ econom ic war ”.
I t s set t ing is t he j ob m arket and world, in which people
w h o ar e n ot r eady for com bat ar e h ar m ed becau se
t h e y a r e n o t a b l e t o a c h i e v e t h e p r o d u c t i v i t y,
availabilit y, discipline, and abnegat ion im posed by t he
e co n o m i c sy st e m . Pe o p l e e x cl u d e d f r o m t h e j o b
m ar k et com pr ise t he r eser v e ar m y - elder ly w ho do
n ot h av e t h e ag ilit y of y ou n g er in d iv id u als, y ou n g
indiv iduals w ho do not hav e t he ex per ience of older
on es, an d t h ose w it h ou t access t o in f or m at ion an d
educat ion( 7). From t his perspect ive, t he aut hors include
in t h e discu ssion elder ly liv in g on t h e st r eet s, w h o
are doubly excluded since t hey are bot h old and poor.
Therefore, t he purpose of t his st udy is t o invest igat e
a n d d escr i b e t h e el d er l y p o p u l a t i o n l i v i n g o n t h e
st reet s, at a shelt er exclusive for elderly in Sao Paulo.
METHOD
Th i s i s an ex p l o r at o r y st u d y, si n ce i t w as
dev eloped t o pr ov ide m or e fam iliar it y w it h t he st udy
obj ect( 8 ), offer ing an ov er all v iew r egar ding old age
o n t h e st r eet s. Th i s ch o i ce w as m ad e d u e t o t h e
scar cit y of st udies on t his t hem e. I t aim s t o deepen
k n ow led g e ab ou t ag in g on t h e st r eet s in or d er t o
support ot her st udies at t he Cent er for Healt h St udies
and Resear ch, Public Policies and Social Mov em ent s
at Sao Paulo Feder al Univ er sit y ( Unifesp) . The st udy
w a s a p p r o v e d b y t h e U n i f e s p r e v i e w b o a r d
St udy subj ect s were elderly m en and wom en,
aged 60 years or m ore, users of t he shelt er, conscious
and apt t o m aint ain a dialogue. Twent y elderly ( eight
m e n a n d 1 2 w o m e n ) t o o k p a r t i n t h i s st u d y. Al l
s u b j e c t s m e t t h e r e q u i r e m e n t s a n d a g r e e d t o
part icipat e in t he research aft er being inform ed about
t he obj ect , obj ect ives, m et hod and for m of diffusion.
Par t icipant s pr ov ided w r it t en consent .
D a t a w a s c o l l e c t e d u s i n g i n t e r v i e w a n d
o b s e r v a t i o n t e c h n i q u e s , b y a d m i n i s t r a t i n g a n
inst rum ent and keeping a field diary. Sim ple frequency
d i st r i b u t i o n a n a l y si s w a s u se d a n d t h e d a t a w a s
analyzed by m eans of int erpret at ive reading( 8), in t he
light of select ed t heor et ical- concept ual r efer ences in
Ger on t ology an d Collect iv e Healt h .
RESULTS AND DI SCUSSI ON
Th e scar ci t y o f so ci o d em o g r ap h i c st u d i es,
published ov er t he last decades, capable of out lining
a set t in g ab ou t t h e p r of ile of t h e Sao Pau lo st r eet
populat ion im pedes t he cor r elat ion w it h t his st udy ’s
f in d in g s. How ev er, su b j ect iv e d at a, b ased on f ield
o b ser v a t i o n a n d co n v er sa t i o n s w i t h p r o f essi o n a l s
w o r k i n g w i t h t h i s p o p u l a t i o n , s u g g e s t t h a t t h i s
segm ent has gr ow n older.
A c c o r d i n g t o a s t u d y p e r f o r m e d b y t h e
Municipal Secret ariat for Social Developm ent( 9) in 621
s h e l t e r s , t h e r e i s a t e n d e n c y t o w a r d s s h e l t e r
popu lat ion agin g: in t h e y ear 2 0 0 0 , 1 2 . 7 % of t h at
p op u lat ion w er e ag ed 5 5 y ear s or m or e; in 2 0 0 3 ,
19. 9% ; and t he pr esent st udy, car r ied out in 2006,
o b se r v e d t h a t t h e e l d e r l y p o p u l a t i o n r e p r e se n t s
23.1% . While t he av er age shelt er ed adult s’ age w as
41.2 years in t he year 2000, t oday it is 44.7 years.
The ov er all Br azilian populat ion’s aging, lik e
in t he rest of t he w orld, has deserved m any sort s of
analy ses and j ust ificat ions for it s pr ocess. How ev er,
as m ent ioned befor e, due t o t he few st udies in t his
ar ea, it is difficult t o ex plain t his phenom enon for a
st r eet p op u lat ion . I t is n ot k n ow n w h y t h e st r eet
populat ion has aged, neit her what happens wit h t hem
af t er w ar d .
The increase in t he num ber of elderly on t he
s t r e e t s h a s b e e n t h e r e s e a r c h g o a l o f a s t u d y
perform ed in San Francisco, USA, which analyzed t he
local st r eet popu lat ion ’s t en den cy t o agin g. I n t h at
region, t he average age of people living on t he st reet
increased from 37 t o 46 years over a 14- year period,
bet w een 1990 and 2004. A sim ilar fact w as found in
ot her fiv e Nor t h Am er ican cit ies.
Th i s a g i n g p h en o m en o n o n t h e st r eet s i s
r e p e a t e d i n Sa o Pa u l o , w h i ch su g g e st s t h a t t h e
increase in t he st reet people’s average age has risen
in ov erall capit alist societ ies. Adult s ar e now elder ly,
and t heir chances of social r einser t ion ar e gr adually
r ed u ced .
Lit t le is k now n about w hat happens w it h t he
st r eet populat ion aft er t hey age. I n spit e of t he shelt er
- t he place of r esear ch - being for people aged ov er
60 y ear s, t he aut hor s did not find any elder ly aged
o v e r 7 0 . Th e r e i s n o e x p l a n a t i o n f o r t h i s f a c t .
Ho w e v e r, h y p o t h e se s m a y b e r a i se d . I n d i v i d u a l s
m i g h t b e w i l l i n g t o l i v e o n t h e st r e e t . Mo st a r e
w ander er s, sear ching for food, shelt er and pr ot ect ion.
Once t hey lose t heir phy sical abilit y t o m ov e ar ound
t h e cit y, su r v iv al st r at eg ies ar e ar m ed . Hen ce t h e
st udy ’s quest ion: do t hey die, or ar e t hey w elcom ed
by any ent it y, som e k ind of long- st ay inst it ut ion for
in st an ce?
Regarding origin, t he SMADS det ect ed t hat a
sm all par t of shelt er ed adult s ar e act ually fr om t he
capit al; m ost are from t he Nort heast and Sout heast( 9).
I n t he st udied shelt er, it was verified t hat nine elders
are from t he Nort heast , t en from t he Sout heast , and
only t w o w ere born in Sao Paulo.
Six t een elder ly hav e liv ed in t his cit y for ov er
2 0 y e a r s . Th i s s u g g e s t s t h a t t h e y w o u l d h a v e
est ab lish ed af f ect iv e at t ach m en t s or som e k in d of
social suppor t net w or k in t he cit y. How ever, t he only
t y pe of social suppor t ident ified w as inst it ut ional: t he
shelt er. Thr oughout t he lives of t he st r eet populat ion,
t her e is a r upt ur e w it h fam ily t ies, an abandonm ent
of r oles t h at inv olv e r espon sibilit ies an d af f ect iv it y.
This is r eflect ed in t he infir m it y of t he affect iv e t ies
t hey est ablish on t he st r eet s. When fam ily br eak age/
r u p t u r e e x i s t s , i n s t i t u t i o n a l d e p e n d e n c e i s
ev idenced( 11). That dependence, char act er ized by t he
u s e o f s u p p o r t s e r v i c e s , c o u l d e n c o u r a g e t h i s
populat ion t o r em ain on t he st r eet s. These pr oj ect s
ar e essen t i al f o r t h e st r eet p o p u l at i o n ’ s su r v i v al .
How ev er, t h ey cou ld also h av e a n egat iv e in flu en ce
on t h e social ( r e) in ser t ion p r ocess, con t r ib u t in g t o
t h e lack of en cou r ag em en t f or t h em t o sear ch f or
au t o n o m y. Hen ce, i n st ead o f p r ep ar i n g t h em an d
g iv in g t h em t h e t ools t o r ecov er t h eir cit izen sh ip ,
t h ey ar e i m p ed ed f r o m d ev el o p i n g t h e au t o n o m y
n eed ed t o b r eak d ep en d en ce t i es an d g et of f t h e
Co n s i d e r i n g t h a t f a m i l i e s a r e p r i m a r y
socializat ion agent s and ser v e as a suppor t net w or k
d u r i n g cr i se s, t h e i r a b se n ce co u l d i m p l y se r i o u s
con seq u en ces. Fam ily su p p or t is in ex ist en t f or t h e
m a j o r i t y o f t h e st r e e t p o p u l a t i o n( 1 3 ). Th e r e f o r e ,
breaking w it h fam ily t ies in addit ion t o breaking w it h
work t ies is considered “ point zero” in t he process for
becom ing a st r eet per son. This is especially t r ue for
t h e Br azi l i an so ci et y, i n w h i ch f am i l y u n i t y i s t h e
support for t he poor working- class social relat ionships,
so, it s absen ce can be a det er m in in g f act or in t h is
pr ocess( 1 1 ). Th is fact can be obser v ed sin ce, in t h is
st udy, it w as found t hat 12 part icipant s had relat ives
in Sao Paulo, but only t hree kept in t ouch wit h t hem
f r eq u en t ly. Elev en p ar t icip an t s h ad r elat iv es ou t of
t ow n , an d on ly on e k ept in t ou ch . Fiv e par t icipan t s
report ed t hat fam ily breakage was t he reason for t heir
m oving ont o t he st reet s. I n addit ion, despit e t he ot her
par t icipant s not consider ing lack of fam ily suppor t a
lim it ing fact or t o m ove ont o t he st reet s, it was present
in ot her st at em ent s.
Tw o g r o u p s o f f a c t o r s i n t e r a c t w h e n
consider ing t he r easons for w hich people m ov e ont o
t h e st r eet s. Fi r st , t h er e ar e t h e b r o ad , st r u ct u r al
t en d en cies at m acr o lev el; an d , secon d , t h er e ar e
biographical fact ors, i.e., at individual level( 13). For t he
st udy populat ion, t he indiv idual fact or w as ident ified
as t he lack of fam ily suppor t , as m ent ioned befor e.
Regarding t he m acro level, it was not possible
t o e s t a b l i s h a d i r e c t r e l a t i o n s h i p b e t w e e n
u n em ploy m en t , f r agilit y of w or k t ies, an d liv in g on
t h e st r eet s. How ev er, u n em ploy m en t is r epor t ed in
m any life hist ory st at em ent s as t he reason for m oving
ont o t he st reet s( 11,13). From t his perspect ive, people’s
vulnerabilit y in t he face of t he work m arket becom es
evident , since eight part icipant s m oved ont o t he st reet s
due t o financial pr oblem s, including unem ploy m ent .
The vulnerabilit y of work t ies, before m oving
int o t he st reet s, is also evident . I t is charact erized by
hav ing low or no specific qualificat ion. This im poses
f r a g i l e o ccu p a t i o n a l i d e n t i t i e s o n t h e p o p u l a t i o n ,
ch ar act er ized b y act iv it ies w it h a h ig h p ot en t ial of
replacem ent and wit h a borderline incom e for survival
lev els( 11).
Such vulnerabilit y was ident ified in t he present
st udy w hen it w as found t hat m ost par t icipant s, 1 8
elder ly, h ad w or k ed in m or e t h an on e r em u n er at ed
act ivit y t hat did not require any specific qualificat ion;
m ost in t he com m er cial and ser v ice sect or, such as
h ou sek eepin g an d elect r ician s.
The sam e st andard was observed in act ivit ies
cu r r en t ly per for m ed by t h e st r eet popu lat ion , w h en
t h ey d o w o r k . Am o n g t h e cu r r en t l y a n d f o r m er l y
w or k in g ad u lt s an d eld er ly, 9 6 % d o n ot h av e an y
for m al w or k r egist er( 9 ). I n t h e st u dy, fiv e of t h e 2 0
par t icipant s w or k ed in t he infor m al m ar k et , w it h no
form al regist er. However, 14 part icipant s report ed t he
need and desir e t o w or k . Besides pr ov iding phy sical
su b sist en ce, w or k in g assig n s p r of ession al id en t it y,
which is part of one’s personal ident it y. I n t he current
societ y, in t he capit alist sy st em , pr ofessional ident it y
is ov er est im at ed. I ndiv iduals ar e r ecognized by t heir
p r of ession . Th er ef or e, lack in g su ch a p r of ession or
an y ot h er d r aw b ack t o t h e in d iv id u al’s in ser t ion in
t h e w or k m ar k et poses st igm at izat ion s an d feelin gs
of g u ilt , w h ich is q u it e com m on am on g t h e st r eet
populat ion( 15).
The capit alist cult ur e is also obser ved in t he
st a t em en t s o f st r eet p o p u l a t i o n i n v o l v ed i n w o r k
f o u n d ed o n so l i d ar y eco n o m y. Co o p er at i v i sm w as
difficult t o im plem ent and not w ell accept ed am ong
t h e s t r e e t p o p u l a t i o n o f a n o n - g o v e r n m e n t a l
o r g a n i za t i o n ( NGO) i n Sa o Pa u l o . St r e e t p e o p l e
p e r c e i v e w o r k a n d i n c o m e g e n e r a t i o n t h r o u g h
cooper at iv e as t em por ar y act iv it ies, fr om w hich t hey
w ou ld m ov e aw ay as soon as t h ey g ot a j ob . Th e
p er sp ect i v e of b ei n g em p l oy ed , sel l i n g t h ei r w or k
pow er, was gr eat er t han gener at ing incom e t hr ough
t h e c o o p e r a t i v e . Th i s s h o w s t h e r e c o g n i t i o n o f
em ploy m ent as t he only desir ed for m of w or k( 12).
I n t h i s s t u d y, t h e s t u d i e d p o p u l a t i o n i s
e x t r e m e l y v u l n e r a b l e f i n a n ci a l l y a n d d e p e n d s o n
g o v e r n m e n t a l su p p o r t . So ci a l se cu r i t y / p r o m o t i o n
su ppor t is t h e in com e sou r ce for eigh t par t icipan t s,
o t h e r e i g h t d o n o t h a v e a n y i n co m e , a n d co u n t
ex cl u si v el y o n t h e sh el t er f o r t h ei r p h y si o l o g i ca l ,
w elcom ing and pr ot ect ion needs.
I n addit ion t o t he difficult y of insert ion in t he
w or k m ar k et , t her e is t he housing v ulner abilit y t hat
a f f e c t s s o c i e t y a s a w h o l e , p a r t i c u l a r l y p o o r e r
Br azilians. This pr oblem is aggr av at ed in t he case of
u n der qu alified popu lat ion s w it h fr agile t ies w it h t h e
work m arket , increasing t he possibilit y of m oving ont o
t he st reet s. I n t his perspect ive, t his st udy found five
elder ly w ho r epor t ed ev ict ion as t he cause for t heir
m ov ing ont o t he st r eet s.
Ear ly in ser t ion in t h e w or k m ar k et an d low
educat ion level are fact ors t hat influence vulnerabilit y
in t er m s w or k and/ or housing t ies( 14). Regar ding t he
e i g h t h a d c o m p l e t e p r i m a r y e d u c a t i o n , s i x h a d
incom plet e prim ary educat ion, and t w o had com plet e
secon dar y edu cat ion .
Moreov er, it was surprising t hat , in t he st udied
popu lat ion , t h er e w as on e law y er an d on e t each er.
This led t o a reflect ion about t he relat ionship bet ween
edu cat ion al lev el an d social v u ln erabilit y. Edu cat ion
i s a n i n d i v i d u a l a s s e t . H o w e v e r, i t c a n n o t b e
consider ed a guarant ee of social secur it y. Since t he
st u d y f ou n d p r of ession als w it h su p er ior ed u cat ion
l i v i n g i n sh el t er s an d o n t h e st r eet s, t h e au t h o r s
r econsider t he v alue of a univ er sit y diplom a.
Dip lom as m ay f acilit at e st ab le an d f or m al
w or k r elat ionships, but w ould it m aint ain indiv iduals
i n t h i s c o n d i t i o n a n d p r e v e n t t h e r i s k o f
u n em ploy m en t , f in an cial dif f icu lt ies, an d of m ov in g
on t o t h e st r eet s i n t h i s con t em p or an eou s con t ex t
of st r uct ur al unem ploy m ent ? I n t his sense, it is safe
t o af f ir m t h at t h e in div idu al’s v u ln er abilit y of bein g
ex posed t o t he st r eet s r esult s fr om t he int er fer ence
o f a g r o u p o f i n d i v i d u a l , c o l l e c t i v e , s o c i a l a n d
co n t e x t u a l f a ct o r s, r a t h e r t h a n f r o m o n e si n g l e
fact or. How ev er, it should be inv est igat ed if t his fact
is r ecent or not , since st udies hav e show n t hat t he
e d u ca t i o n a l l e v e l a m o n g sh e l t e r e d i n d i v i d u a l s i s
h i g h e r a m o n g y o u n g e r a d u l t s ( u n d e r 3 0 y e a r s i f
a g e ) . O f t h e s e , 3 3 % h a d s t a r t e d s e c o n d a r y
ed u cat ion( 9 ).
I t w as obser v ed t h at elder ly w it h less t im e
in t he shelt er ar e m or e cr it ical about t heir sit uat ion.
The aut hor s believ e t hat t her e is a dir ect r elat ionship
b et w een t h e sat isf act ion t h at in d iv id u als assig n t o
t h ei r l i f e co n d i t i o n a n d t h ei r ex p ect a t i o n s i n t h i s
r espect . I n ot her w or ds, t he closer one get s t o his or
h e r e x p e c t a t i o n s , t h e m o r e s a t i s f i e d o n e g e t s .
Know ledge incr eases and m ult iplies people’s desir es,
and t he less t hey desir e, t he easier it is t o hav e t heir
n eed s f u lf illed .
As far as healt h is concer ned, t he shelt er is
part of t he Com m unit y St reet Healt h Agent s Program
a t t h e S a o Pa u l o Mu n i c i p a l H e a l t h S e c r e t a r i a t .
Therefore, elderly living at t he shelt er have access t o
Basi c Heal t h Un i t s ( BHU) , w i t h o u t an y t r o u b l e t o
sch ed u le ap p oin t m en t s. Six p ar t icip an t s h av e h ig h
blood pr essur e and t hr ee hav e diabet es m ellit us, all
of w hom ar e per iodically follow ed- up at t he BHU.
Wh en ask ed ab o u t h eal t h p r o b l em s, n o n e
o f t h e p a r t i ci p a n t s r e p o r t e d h a v i n g a n y ch r o n i c
d i s e a s e . S o m e a c u t e f a c t o r s w e r e r e p o r t e d ,
i n c l u d i n g f l u , h e a d a c h e ; p n e u m o n i a , a n d o t h e r
h ealt h pr oblem s, su ch as t w o cases of r u n - ov er. I t
w as obser v ed t hat , for par t icipant s, healt h pr oblem s
r ef er t o so m et h i n g t h at m ak es t h em i m m ed i at el y
seek h ealt h ser v ices - Em er gen cy Room an d/ or t h e
BHU. Th i s su g g est s t h a t ch r o n i c d i sea ses d o n o t
m ak e p ar t icip an t s f eel ill.
Considering t hat being healt hy and becom ing
ill ar e ex clu siv e, in d iv id u al ex p er ien ces, as w ell as
f or m s of lif e ex p r ession s( 1 6 ), i t b ecom es easi er t o
u n d er st an d t h e an sw er s o b t ai n ed . Th ese an sw er s
cannot be analyzed by m eans of t he WHO definit ion
-com plet e biopsy ch osocial w ellbein g - sin ce it w ou ld
be not iced t hat no one is healt hy; it would becom e an
u t op ia. I f h ealt h w er e n ot con sid er ed as t h e m er e
absence of illness, nor as com plet e wellbeing or t ot al
n or m alit y, b u t as a m od er at e am ou n t of su f f er in g ,
wit h prevalence of wellbeing feeling, it would becom e
an ideal, but also a realit y( 17).
Disease is not t he m er e disappear ance of a
physiologic funct ion, but t he appearance of a new vit al
or d er. Healt h is a st at e of f u n ct ion al h ar m ony an d
balance, bot h phy sical and psy chological, consider ing
on e’s n at u r al an d social en v ir on m en t . Th is balan ce
an d h ar m on y ar e capable of adapt in g t h e or gan ism
w h en su b m it t ed t o n ew en v ir on m en t al con d it ion s,
eit her nat ur al or social( 18).
Co n si d er i n g t h at t h e o r g an i sm h as n o r m s
t h at per m it s it t o adapt t o t h e en v ir on m en t , bein g
healt hy is not only being nor m al in a cer t ain sit uat ion,
but in v ar ious. On t he ot her hand, disease cannot be
consider ed as t he absence of a nor m . Act ually, it is
a l i f e n o r m t h a t i s n o t ca p a b l e o f a d a p t i n g t h e
or ganism t o t he env ir onm ent al condit ions w hich it is
in ser t ed in( 1 8 ). Hu m an bein gs do n ot f eel w ellbein g
b e ca u se i t i s t h e co n sci e n ce o f l i v i n g , i t i s t h e
i m p e d i m e n t t o s p e n d t h e l i f e t h a t i s f e l t a n d
r ecogn ized. Hy per t en siv e an d diabet ic st r eet people
d o n o t co n si d e r t h e m se l v e s i l l , si n ce t h e y h a v e
adapt ed t o t h e n ew n or m im posed by t h eir bodies,
and do not feel t heir w ellbeing.
Anot her cat egor y t hat em er ged dur ing dat a
an aly sis con cer n s t h e t im e liv in g on t h e st r eet s. I n
t h i s r esp ect , t h e r ef er en ced u sed w as a t y p o l o g y
f o u n d ed o n st r eet p eo p l e, ap p r o ach i n g cat eg o r i es
su ch a s t h e “ n e w l y - d i sl o ca t e d ”, ch a r a ct e r i ze d b y
people w ho ar e afraid of st r eet com pany, do not k now
w h o t o t r u st an d i f t h ey w i l l su r v i v e. Th e n ew l y
-dislocat ed usually t ur n t o car e inst it ut ions w her e t hey
r eceiv e food and shelt er. They r ecall t heir m em or ies
for m er condit ion. I n addit ion t o t heir plans of leav ing,
t h eir beh av ior s ar e r at ion ally dir ect ed t ow ar ds t h at
goal; t hey ar e t he ones w ho m ost look for j obs. They
d e n y t h e so ci a l i d e n t i t y o f a st r e e t p e r so n a n d
e m p h a s i z e t h a t t h e y a r e n o t l i k e t h e i r s t r e e t
fr ien ds( 1 3 ).
Based on t he st udy populat ion’s st at em ent s,
t hey can be consider ed new ly - dislocat ed, since t hey
hav e not ex per ienced liv ing on t he st r eet s; t hey ar e
all shelt ered wit h lit t le or no t im e on t he st reet s. The
shelt er was t he fir st inst it ut ion for eight elder ly, and
seven had been in only one shelt er before. Sevent een
part icipant s report ed t hat , less t han t hree years ago,
t hey had a house t o live in, which illust rat ed t he short
per iod in t hat sit uat ion. Many st ill plan t o leav e t he
shelt er, and st ill look for a j ob.
Th e s t r e e t p o p u l a t i o n i s d e f i n e d a s t h e
segm en t of ex t r em ely low in com e t h at , t em por ar ily
or perm anent ly, spends night s on t he cit y st reet s, and
in pu blic or social en t it y sh elt er s( 1 9 ). Th is def in it ion
b r i n g s a b o u t a r e f l e c t i o n a b o u t t h e a p p a r e n t
h om og en izat ion of t h is p op u lat ion , sin ce it p laces
in div idu als liv in g on t h e st r eet s an d t h ose liv in g in
shelt ers in t he sam e segm ent . I n t he case of t he st udy
populat ion, it is not known if it can be considered as
p eo p l e l i v i n g o n t h e st r eet s, si n ce t h ey h av e n o t
ex act ly liv ed t his specific ex per ience.
Th e a u t h o r s b e l i e v e t h a t t h i s a f f e ct s t h e
const it ut ion of a social ident it y, as w ell as t he
self-car e condit ions and hav ing a per spect iv e t o get out
of t h is sit u at ion . Mov in g on t o t h e st r eet s m ean s t o
d ev el o p a com p en sat or y p r ocess r eg ar d i n g l osses
and using ot her sur v iv al r esour ces, w hich had been
ignor ed unt il t his m om ent , and assim ilat e new for m s
of or ganizat ion t hat per m it fulfilling t heir needs and
ov er com in g ob st acles im p osed b y t h e cit y( 2 0 ). Th is
“ st r eet cult ur e” was not obser ved in t he elder ly.
Ju st lik e t h e au t h or s, p ar t icip an t s d id n ot
recognize t hem selves as st reet people. I n t his sense,
t his st udy is being broadened t o analyze t he exist ence
o f d i f f e r e n c e s b e t w e e n r e a l s t r e e t p e o p l e a n d
sh elt er ed people. Based on t h e pr esu pposit ion t h at
individual healt h is direct ly relat ed wit h hum an beings’
l i v i n g co n d i t i o n s, a n d i s i n f l u en ced b y so ci a l a n d
econom ic policies( 21), int er vent ions, in t he healt h and
social ar ea, sh ou ld n ot h av e t h e sam e em ph asis in
d i f f er en t g r o u p s. Si n ce sh el t er ed i n d i v i d u al s h av e
securit y, shelt er and hygiene condit ions, t hose on t he
st r eet h av e t o f in d st r at egic u n con v en t ion al m ean s
for t heir sur v iv al.
FI NAL CONSI DERATI ONS
Due t o t he ex plorat or y nat ur e of t his st udy,
no br oad generalizat ions ar e possible. How ev er, t he
st udy findings lead t o r eflect ions, t hough indiv idual,
about t he sit uat ion of aging on t he st reet s.
Th e b r eak ag e an d d ecom p osit ion of f am ily
and social t ies are present in t he life hist ories of t he
st u died st r eet popu lat ion . I t w as obser v ed t h at t h e
f r ag ilit y r eg ar d in g h ou sin g an d af f ect iv e d om ain s,
exposure t o discrim inat ion and violence are associat ed
w it h t he pr ev ious v ulner abilit ies of t his populat ion.
I n t erm s of t he fam ilies, t he st udied subj ect s
pr esen t a det ach m en t an d/ or at t en u at ion of f am ily
t ies, w h ich m ay be a r efer en ce fr om a dist an ce. I n
t he Brazilian cont ext , in which t he fam ily is considered
an indispensable belonging unit , not hav ing a place
m eans loosing fam ily t ies.
Con cer n in g t h e Eld er ly St at u t e, t h e social
p r o t e c t i o n f o r t h e s t u d i e d s t r e e t p o p u l a t i o n i s
g u a r a n t e e d , si n ce t h e y a r e su p p o r t e d b y so ci a l
se cu r i t y a n d / o r i n st i t u t i o n a l ca r e . Th i s d o e s n o t
guarant ee any im provem ent in qualit y of life, since it
is d ir ect ly r elat ed w it h ex p ect at ion s an d m ean in g s
each per son at t r ibut es under t he influence of his/ her
ow n beliefs and v alues, const r uct ed t hr oughout his/
h er ex ist en ce.
Th i s st u d y m a d e t h e a u t h o r s r e t h i n k t h e
h u m a n v a l u e s r e g a r d i n g i n e q u a l i t i e s a n d t h e
v u lg ar izat ion of social in j u st ice. As sch olar s in t h e
healt h ar ea, t he aut hor s lear ned t o see elder ly living
o n t h e s t r e e t s a s s u b j e c t s w i t h i n d i v i d u a l
char act er ist ics and not as passiv e obj ect s of char it y
an d assi st en t i al i sm . By r ev eal i n g t h i s o b j ect , t h e
aut hor s hope t o cont r ibut e t o incr easing int oler ance
t ow ar d social inj ust ice, w hich r equir es polit ical act ion
rat her t han char it y.
Th e au t h or s con t in u e t h is st u d y w it h n ew
v iew s on t h e q u alit at iv e p er sp ect iv e t o u n d er st an d
t he relat ionship bet ween current t hought s in different
social segm ent s about t he different m eanings of being
a st r eet per son. As r esear cher s com m it t ed w it h t he
S i n g l e H e a l t h S y s t e m , b y u n d e r s t a n d i n g t h e s e
d i f f e r e n ce s, t h e a u t h o r s se e k t o su p p o r t h e a l t h
pr ogr am s for t his segm ent .
The aut hor s believ e t hat t his st udy can add
v alue t o k now ledge pr oduct ion in nur sing, especially
b y i n t r o d u ci n g n e w i n d i ca t o r s a n d v i e w s i n t h e
sy st em ized car e of f er ed t o t h e st r eet popu lat ion at
REFERERNCES
1 . Lei n º 1 0 . 7 4 1 , d e 0 1 d e ou t u b r o d e 2 0 0 3 ( BR) . Disp õe sobr e Est at ut o do I doso e dá out r as pr ov idências. Br asília; [ A c e s s o e m 2 0 0 7 a g o s t o 2 5 ] . D i s p o n ív e l e m h t t p : / / w w w . p lan alt o. g ov. b r / cciv il/ LEI S/ 2 0 0 3 / L1 0 . 7 4 1 . h t m 2. Lei nº 8.842, de 04 de j aneiro de 1994 ( BR) . Dispõe sobre a Polít ica Nacion al d o I d oso, cr ia o Con selh o Nacion al d o I doso e dá ou t r as pr ov idên cias. Br asília; [ Acesso em 2 0 0 7 agost o 25] . Disponív el em ht t p: / / w w w. planalt o. gov. br / cciv il/ LEI S/ L8 8 4 2 . h t m
3 . Minist ér io da Saúde ( BR) . Polít ica Nacional de Saúde do I doso. Por t ar ia 1395/ GM. Br asília ( DF) : Minist ér io da Saúde; 1 9 9 9 .
4 . Lei n º 8 . 0 8 0 , de 1 9 de set em br o de 1 9 9 0 ( BR) . Dispõe sobre as condições para a prom oção, prot eção e recuperação d a saú d e, a or g an ização e o f u n cion am en t o d os ser v iços cor r espondent es e dá out r as pr ov idências. Br asília; [ Acesso e m 2 0 0 7 a g o s t o 2 5 ] . D i s p o n ív e l e m h t t p : / / w w w . p lan alt o. g ov. b r / cciv il/ LEI S/ L8 0 8 0 . h t m
5 . Fu n dação I n st it u t o de Pesqu isas Econ ôm icas. Cen so dos m oradores de rua na cidade de São Paulo. Relat ório Execut ivo. São Pau lo ( SP) : FI PE; 2 0 0 3 .
6 . B e a u v o i r S . A v e l h i c e : o m a i s i m p o r t a n t e e n s a i o cont em por âneo sobr e as condições de v ida dos idosos. Rio de Janeir o ( RJ) : Nov a Fr ont eir a; 1990. p.711.
7. Dej ours C. A banalização da inj ust iça social. 3ª ed. Rio de Janeir o ( RJ) : FGV; 2 0 0 0 .
8 . Gil AC. Com o elabor ar pr oj et os de pesqu isa. 4 ª ed. São Pau lo ( SP) : At las; 2 0 0 6
9 . Secr et ar ia Mu n icip al d e Assist ên cia e Desen v olv im en t o S o c i a l . Fu n d a ç ã o I n s t i t u t o d e Pe s q u i s a s Ec o n ô m i c a s . Est u d o s d o s u su á r i o s d o s a l b er g u es co n v en i a d o s co m a pr efeit ur a. São Paulo ( SP) : SMADS/ FI PE; 2 0 0 3 .
1 0 . Hahn JA, Kushel MB, Bangsber g DR, Riley E, Moss AR. The aging of t he hom eless populat ion: four t een- y ear t r ends in San Fr ancisco. J Gen I nt er n Med 2 0 0 6 ; 2 1 : 7 7 5 - 8 . 1 1 . Escor el S. Vidas ao léu : t r aj et ór ias de ex clu são social. Rio de Jan eir o ( RJ) : FI OCRUZ; 1 9 9 9 .
12. Ghirardi MG, Lopes SR, Barros DD, Galvani D. Vida na rua e co o p er at i v i sm o : t r an si t an d o p el a p r o d u ção d e v al o r es. I n t er f ace 2 0 0 5 set em b r o- d ezem b r o; 9 ( 1 8 ) : 6 0 1 - 1 0 . 13. Snow D, Anderson L. Desafort unados: um est udo sobre o pov o da r ua. Pet r ópolis ( RJ) : Vozes; 1998.
1 4 . Mat t os RM, Fer r eir a RF. O id oso em sit u ação d e r u a: Sísifo r ev isit ado. Est udos de Psicologia 2005 j aneir o- m ar ço; 2 2 ( 1 ) : 2 3 - 3 2 .
15. Mat t os RM, Fer r eira RF. Quem vocês pensam que ( elas) são? - Rep r esen t ações sob r e as p essoas em si t u ação d e r u a. Psicol Soc 2 0 0 4 m aio- ag ost o; 1 6 ( 2 ) : 4 7 - 5 8 .
1 6 . Czer esn ia D. O con ceit o de saú de e a dif er en ça en t r e p r e v e n ç ã o e p r o m o ç ã o . I n : Cz e r e s n i a D , Fr e i t a s CM , o r g a n i za d o r es. Pr o m o çã o d a sa ú d e: co n cei t o s, r ef l ex o s, t endências. Rio de Janeir o ( RJ) : Fiocr uz; 2003. p. 39- 53.
17. Coelho MTAD, Alm eida N. Análise do conceit o de saúde a p a r t i r d a e p i st e m o l o g i a d e Ca n g u i l h e m e Fo ca u l t . I n : Goldenber g P, Mar siglia RMG, Gom es MHA, or ganizadoras. O Clássico e o Noco: t en d ên cias, ob j et os e ab or d ag en s em ciências sociais e saúde. Rio de Janeir o ( RJ) : Fiocr uz; 2003. p . 1 0 1 - 1 3 .
1 8 . Canguilhem G. O nor m al e o pat ológico. 4 ª ed. Rio de Jan eir o ( RJ) : For en se Un iv er sit ár ia; 1 9 9 5 .
1 9 . Fu n dação I n st it u t o de Pesqu isa Econ ôm icas. Cen so de m oradores de rua na cidade de São Paulo. Relat ório Execut ivo. São Pau lo ( SP) : FI PE; 2 0 0 0 .
20. Varanda W, Adorno RCF. Descart áveis urbanos: discut indo a com plexidade da população de rua e o desafio para polít icas de saúde. Saúde & Soci 2004 j aneir o- abr il; 13( 1) : 59- 9. 2 1 . Ro sa AS, Ca v i cch i o l i MGS, Br ê t a s ACP. O p r o ce sso saú d e- d oen ça- cu id ad o e a p op u lação em sit u ação d e r u a. Rev Lat in o am En fer m agem 2 0 0 5 j u lh o agost o; 1 3 ( 4 ) : 5 7 6 -8 2 .
