Much has been written about the utmost importance of tackling the security problem in Brazil’s favelas, as well as the troubled relations between favela residents and the police. In this post, Erika Robb Larkins complicates this picture by proposing that, in fact, a more pressing urgency is the limited policy attention to healthcare in these communities. She argues that improving accessibility to healthcare services and addressing preventable health problems would require longterm investment and planning, resulting in favelas’ greater buy-in of government policies

Larkins, Erika Robb

LSE Research Online

Communicating bottom-up social developmentA different kind of security: The need forappropriate healthcare policies in Rio deJaneiro’s favelasMuch has been written about the utmost importance of tackling thesecurity problem in Brazil’s favelas, as well as the troubled relationsbetween favela residents and the police. In this post, Erika Robb Larkinscomplicates this picture by proposing that, in fact, a more pressingurgency is the limited policy attention to healthcare in thesecommunities. She argues that improving accessibility to healthcareservices and addressing preventable health problems would require long-term investment and planning, resulting in favelas’ greater buy-in ofgovernment policies.I have been doing research in the Rio de Janeiro community of Rocinhafor almost a decade. Living in the favela intermittently over that time, Ihave heard gunfire fly outside my window, interviewed traffickers, andbeen searched by police more times that I can count. I have written aboutviolence and security as problems that deeply affect social and culturallife. As time has gone by, however, I have noticed that the majority ofpeople that I know in the favela don’t die from bullets, from offendinggun-toting traffickers, or even from police violence. They die from stupid,silly things that make me want to cry: from chronic uncared diabetes andpoor diet, from the inability to access emergency medical services in thecase of stroke or heart attack or from infectious diseases that simplyshouldn’t be — like tuberculosis or leptospirosis (caused by contact withrat urine).Home About Book Blog posts Links Resources This site is supportedbyThe Favelas at LSEproject has come to anend, and we will nolonger be publishingnew posts on this site.However, you can stillexplore our blog posts,download a free copy ofour book UndergroundSociabilities, andexplore our toolkit.If you want to seehow socialpsychologists workon socialdevelopment, visit© Rafaela Cardoso Fotografia.Though I have attempted to avoid addressing medicine and humansuffering in my academic work, I have come to see the shortcomings inthe public healthcare system as vital elements of the security problem inplaces like Rocinha. While at first blush addressing the crippled publichealthcare system vis-à-vis the lives of favela residents might seemdistant from security, I would argue otherwise.The central favela-based policy currently in effect, “pacificação”, or“peacemaking”, seeks to reclaim territory from the drug traffickers whohave long governed local life[i]. It promises increased security andreduced inequality, expanded social projects, and the integration of thefavela and its residents into the larger fabric of the city. In Rocinha,however, evidence indicates that pacificação has produced neithersecurity, nor opportunity. As we see in the failures of Iraq andAfghanistan, insecurity and violence cannot be solved with armed force,or with the simple addition of more guns and more “security”. Pacificaçãois right in that it recognises that security changes can only come as aresult of the transformation of the state/favela relationship. But it iswrong in assuming that attempts to reconfigure favela security are themost vital.Indeed, security, prior togovernment intervention atleast, was not a top priorityfor Rocinha residents. Inmy conversations withpeople over the years,residents identify threebasic things that wouldmost improve their lives:healthcare, educationand basic sanitation.They believe that they havea right to these services ascitizens and that theyshould be provided by thestate. Instead, what theyget from the state aresubstandard services,accompanied by a punitivepolitics of policing (before and after pacificação, albeit in different forms).Dear friends, our project has now come to an end, but resources on our blog and toolkit will remain available. Thanks.blogs.lse.ac.uk/toolkitsocialdFavelas at LSE @FavelasatLSEExpandStudying #development and #arts ? Don't miss this free toolkit from @FavelasatLSE blogs.lse.ac.uk/toolkitsociald pic.twitter.com/zopUlkXQzfRetweeted by Favelas atLSELSE @LSEnewsExpand23 Jul22 JulTweets FollowTweet to @FavelasatLSEThe focus is always on security to the exclusion of other core issues.Different tactics are urgently needed.Brazil’s constitution guarantees healthcare for all citizens. This alone is amajor accomplishment. But the public system (Sistema Único de Saúde orSUS) is underfunded and understaffed, especially in urban areas. It failsto adequately care for the country’s poorest residents, who alreadyexperience what Vargas and Alves (2010: 613) describe as a highlyracialized “relational citizenship” or “non-citizenship”.Addressing basic healthcare would go much further in winning residentallegiance than increasing police patrols. This would entail redirectingfunds that are being invested in strengthening security and policing toprojects that address the acute healthcare crisis, as well as investing inpreventive medicine.Policy change should address a citywide deficit in resources andavailability of public healthcare, particularly emergency services. As Ilearned during my fieldwork, if you call an ambulance in Rocinha, like inmany other parts of the city, it simply will not come. The emergency roomin the nearest public hospital is grossly overcrowded. The walls areliterally crumbling, and it is common to see sick people lying on the floor,enduring long waits for treatment. I can recount some of the horrors Ihave seen first-hand, or those I have heard from others: the pregnantwoman covered in blood who was told they didn’t have an obstetrician onduty and that she should find another hospital; the man with gangreneovertaking his legs who came daily to wait in line for a month as theinfection spread; the patient who showed me a scar from a supposedappendix removal, which was inexplicably on the wrong side of his body!Even the traffickers I knew had their own private doctor and team ofemergency surgeons to avoid potential arrest at the hospital and becausethey considered the public hospitals to be death-traps.How are people to take seriously state claims to their inclusion intosociety as citizens, when they are left to die in such places? Instead ofstate-of-the-art policing, Rocinha’s 150,000+ residents need a state-of-the-art hospital. Rocinha did receive an urgent care center, Unidade dePronto Atendimento or UPA, as part of recent PAC (Growth AccelerationProgramme) upgrades; however, it lacks adequate supplies and doctors.One resident told me on the day she visited they had run out ofpainkillers. “I couldn’t even get an aspirin”, she lamented, jokingly playingon the acronym and referring to it as the UPA — the Unidade de PéssimoAtendimento (Unit for Terrible Treatment).Policy should also entail longer-term solutions, such as addressing dietand the prevalence of lifestyle-related diabetes in the favela. Preventablehealthcare issues, which are often themselves linked to poverty and theinability to access affordable nutritious food, could also be developed.This would mean designing new programs and educational initiatives andinvesting in favela youth for the long haul. It would mean enactingchange over generations, not just during electoral cycles. It would meaninvesting in and expanding community-based healthcare, in culturallyappropriate and innovative ways (see, for example, the health-relatedvisual activism of NGO Viramundo).Though less spectacular than arrests of drug traffickers, intervention inpublic health is much more likely to produce feelings of state legitimacy.Further, overhauling health-related matters in the favela would supportclaims to the benefit of government intervention, challenging andcomplicating images of state violence that currently haunt the favelawithout a credible counter narrative.[i] On pacification, see this excellent two volume collection of essays fromUFRJ/NECVU: http://www.dilemas.ifcs.ufrj.br/page_65.html andhttp://www.dilemas.ifcs.ufrj.br/page_64.htmlFeatured image credit: © Rafaela Cardoso Fotografia.About the AuthorErika Robb Larkins is Assistant Professor in the Department ofInternational and Area studies at the University of Oklahoma. Ananthropologist by training, her work focuses broadly on the study ofviolence and inequality in urban Brazil. Her book, The Spectacular Favela,explores the connections between the production of spectacular violencein Rio de Janeiro and its commodification and consumption. She iscurrently working on an ethnography of the private security industry inRio.The views expressed on this post belong solely to the author and shouldnot be taken as the opinion of the Favelas@LSE Blog nor of the LSE. Please read our comments policy before commenting.April 8th, 2015 | Brazil, English, Featured | 1 CommentOne Comment Previous postShare this:Facebook 137 Twitter 23 Email LinkedIn GoogleRedditNext post Flavio Wittlin  April 8, 2015 at 9:34 pm - Edit - ReplyErika did provide an excellent view about the uneasy daily lifeexperienced by Rocinha residents.Indeed, her insights can be expanded to other favelas in Rio de Janeirowhere I live and take actions through Viramundo (access the Englishversion of our website herehttp://www.viramundo.org/viramundo/Viramundo_%28English%29.html)I only would add – with her permission- one more assertion: part of theappaling healthcare state policies is due to the influence of healthinsurance corporations (native and recently US ones).They are omnipresent and are eager to sell insurance plans to peoplewho live in the favelas, of course with very low coverage.In our efforts to promote health and environmental participatory    RelatedRepresenting Brazil'sfavelas through thelenses of communityphotographersTypes of favela mediaactivismFavela pacificationand mega-events inRio: Shifting thenature of ‘narcopolitics’July 3, 2014In "Art"September 18, 2014In "Brazil"July 9, 2015In "Brazil"Leave A Commenteducation we often include the denouncement of the above mentionedfact.Because for us our unified health system, the SUS, should get by and beimproved in quality and access to become a real advance for all citizens.Logged in as Blog editor. 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A different kind of security: The need for appropriate healthcare policies in Rio de Janeiro’s favelas

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