Healthy and Sustainable Territories: health care strategies for rural black population in Caruaru/Pernambuco

Brito, Thaís Cecília dos Santos; Peixinho, Bianca Cardoso; Pirró, Juliana Camargo de Faria; Oliveira, Rosane Suellen de; Carvalho, Polyana Loureiro Ferreira de; Silva, Diogivânia Maria da; Santos, Mariana Olívia Santana dos

doi:10.1590/0103-1104202113106I

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ORIGINAL ARTICLE • Saúde debate 45 (131) • Oct-Dec 2021 • https://doi.org/10.1590/0103-1104202113106I copy

Healthy and Sustainable Territories: health care strategies for rural black population in Caruaru/Pernambuco

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The socio-historical process in Brazil is crossed by racism and the agrarian issues, as both are part of the same structural dimension. Thus, the understanding of racism is essential to apprehend the social determination process of racial inequalities in health. This action research had as general objective to analyze the interference of racism in the health-disease-care process of rural black families and, more specifically, to describe the children’s group intervention activities. Primary data were used: field diaries and other documents prepared by the Resident Team; and secondary data: the Participatory Rural Appraisal as a tool of systematization in territorialization. This shared action between professionals residents in Family Health Care and settlement dwellers, located in Caruaru (PE), was developed from the popular health education focusing on health promotion and facing racism as a transversal axis. In this sense, the Family Health team is a powerful tool for promoting Healthy and Sustainable Territories by confronting racism in its non-biocentered issues, with the use of low technology, transdisciplinary, strengthening black identities and building health as recommended in health policies and the Sustainable Development Goals.

KEYWORDS
Community health education; Rural health; Health of ethnic minorities; Sustainable development; Social Determinants of Health

Elements that promote the health and life

Elements that threaten the health and life

1. Tradition of productive activity, agriculture; 2. Matrix-centered family relationship;
3. Community social support network;
4. Existence of traditional health practices;
5. A large part of the families are beneficiaries of the Bolsa Família Program;
6. Settlement has a football field;
7. Use of septic tank;
8. The settlement has two community cisterns;
9. Community covered by the Family Health Unit;
10. Interest and involvement of families and children in participating in the activities;
11. Interaction with the community and its facilities;
12. Availability of a place from the community to carry out the activities;
13. Resident team in training focused on rural health;
14. Monitoring the coordination of the educational institution in the development of the project;

15. Difficulty in accessing social and health services in the city of residence;
16. Absence of public policies for family farming;
17. Precariousness and lack of stability at work;
18. Diseases and health problems of workers in the clothing industry;
19. Presence of people with Common Mental Disorders (CMD);
20. Problems arising from the use of alcohol and other drugs;
21. Indiscriminate/abusive use of controlled medications;
22. Fragile community organization and political mischaracterization of the territory;
23. Child labor;
24. Insufficient garbage collection;
25. River pollution arising from the clothing hub;
26. Absence of sewage and water network;
27. Insufficient public transport;
28. Lack of public lighting and infrastructure;
29. Insufficiency of leisure devices;
30. Presence of stray animals and dissemination of zoonosis;
31. Insufficient policies for living with the climate in the semi-arid region;
32. Absence of day care, school dropout rate high and illiteracy;
33. Violence;
34. Non-recognition of racial identity;
35. Institutional racism.

Themes	Activities conducted	Main goals	Date of the activity	Nº of participants
1. Healthy eating	1.1. Dynamics of myth or truth about foods and their characteristics; ultra-processed food vs. real food; healthy snack.	1.2. Discuss the importance of food choices and the balance of different nutrients in the diet, considering the context of socioeconomic vulnerability and regional availability of food.	06/15/2017	10
2. Racism and its interfaces	2.1. Storytelling ‘Beautiful girl in the ribbon bow’ associated with painting.	2.2. Promote a reflective debate on the different forms of racism and its implications for children's health.	07/19/2017	12
3. Oral health	3.1. Dynamics of teeth and oral health-friendly foods; Assessment of children's oral health status; distribution of oral kit with orientation for use and painting of drawings on the theme.	3.2. Discuss the importance of diet and oral hygiene habits in maintaining health; guide children's brushing; offer the oral kit to children.	07/19/2017	20
4. Affection and Emotional Aspects	4.1. Dynamics of the affection tree.	4.2. Discuss affection and its forms of resistance in the context of socioeconomic vulnerability.	08/22/2017	10
5. Arboviruses and social determination	5.1. Puppet theater (Mosquivaldo), painting of drawings related to the theme and question and answer game.	5.2. Discuss illness caused by arboviruses and the process of social determination and environmental racism.	09/13/2017	15
6. Motor aspects	6.1. Plasticine workshop, painting workshop, stick game.	6.2. Stimulate the development of motor aspects (laterality, global and fine coordination, manual refinement) and a leisure activity.	10/18/2017	13
7. Cognitive aspects	7.1. Puzzle games, stick games, storytelling.	7.2. Stimulate the development of cognitive aspects (logical reasoning, memory, attention and concentration).	11/21/2017	15
8. Expression of affections	8.1. Giant board game with gifts aimed at affection and massage wheel.	8.2. Stimulate the exchange of affection, sensory exchanges, social interaction and global motor coordination.	12/13/2017	12
9. Evaluation meeting of the Group of children with the participation of the guardians	9.1. Conversation circle with guardians at the health unit and with children in the territory.	9.2. Provide a space for evaluating the group, its organization and objectives in a feedback focused on its improvement.	01/18/2018	7
10. Senses	10.1. Senses box	10.2. Stimulate the senses through play, such as the stereognosis box.	02/12/2018	12
11. Social aspects	11.1. Storytelling	11.2. Assist in the development of social aspects (respect for rules, respect for others); social interaction.	03/15/2018	14
12. Body perception/body image	12.1. Self-drawing on cardboard and a conversation wheel about self-perception.	12.2. Encourage children's perception of the construction of their identity and respect for different phenotypes and other bodily characteristics.	04/11/2018	15
13. Verminosis	13.1. Setting up the table of hygiene habits and health care for the prevention of helminths.	13.2. Guide children in the care and prevention of helminths, in a contextualized way.	04/26/2018	20
14. Traditional and Cooperative Games	14.1. Rhythmic gymnastics workshop and materials construction.	14.2. Educate for free body expression and body awareness; in addition to stimulating cooperation, creativity and communication among children.	05/16/2018	13
15. São João Festival	15.1. Junes festival square dance and banquet.	15.2. Strengthen community ties and regional culture.	06/13/2018	25
16. Organic garden	16.1. Construction of an organic garden using low cost/recyclable materials.	16.2. Encourage healthy eating, the relationship with the land and belonging to the countryside.	08/15/2018	10
17. Environment and Sustainability	17.1. Toy workshop made with recyclable materials (empty toilet paper rolls, caps and pet bottles, barbecue sticks and used paper).	17.2. Discuss the role of the community in promoting a healthier environment and in reducing the accumulation of solid waste from its reuse through recycling.	09/17/2018	16
18. Children’s day	18.1. Treasure hunt, snack and gift delivery; Angola capoeira circle.	18.2. Provide a leisure and mental health environment for children and their families through games that encourage collectiveness and teamwork; rescue of black ancestry through the discussion of capoeira and its relationship with the history of black people.	10/11/2018	26
19. Black Awareness month	19.1. Painting workshop with African tribal inspiration; Turban and mooring workshop.	19.2. Discuss the formation history of our slave society and value the culture and resistance of the black people, highlighting aesthetic, musical, dance and struggle aspects.	11/14/2018	12
20. Collective reading	20.1. Storytelling with diverse themes.	20.2. Develop the habit of reading as a way to expand the worldview, vocabulary and critical interpretive capacity.	12/13/2017	12
21. Vacation and leisure	21.1. Workshop for Bowling made with pet bottles and cans.	21.2. Addressing the right to leisure, playing and vacations, bringing contextualized play alternatives.	01/07/19	15
22. Carnival’s ‘Health Block’	22.1. Mask workshop and carnival march. Banner exhibition.	22.2. Promote the strengthening of community ties and regional culture.	02/04/2019	17
23. Closing meeting	23.1. Exhibition of the group's activities on a mural. Closing party with games and group evaluation.	23.2. To fraternize and rescue the activities developed every month between residents and children.	02/23/2019	25

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[1] Collaborators

Brito TCS (0000-0002-6486-0769)^* * Orcid (Open Researcher and Contributor ID). , Peixinho BC (0000-0002-7516-534X)^* * Orcid (Open Researcher and Contributor ID). , Pirró JCF (0000-0002-4464-2975)^* * Orcid (Open Researcher and Contributor ID). , Oliveira RS (0000-0003-4600-4982)^* * Orcid (Open Researcher and Contributor ID). , Carvalho PLF (0000-0001-5370-6902)^* * Orcid (Open Researcher and Contributor ID). , Silva DM (0000-0002-5917-6831)^* * Orcid (Open Researcher and Contributor ID). and Santos MOS (0000-0002-2129-2335)^* * Orcid (Open Researcher and Contributor ID). contributed equally to the elaboration of the manuscript.