Slums, justice & health: From Neighbourhood to Nation

In Buenos Aires, Argentina, the government has established neighborhood "justice centers" where residents of the city's poorest areas can get legal assistance to gain access to government services, including health care, housing and other life-supporting programs. The model is similar to what the Asian Development Bank is supporting in Bangledesh, where a network of community health centres that provide comprehensive and integrated services, from legal and land rights to ambulatory care, for the urban poor. Improving unjust living conditions is at the heart of both these programs: “Poor living conditions leave the urban poor, especially women and children, more exposed to health problems than the general population,” said M. Teresa Kho, Country Director of the Bangladesh Resident Mission.
Brazil remains one of the world's leaders in linking neighborhood-based, integrated and comprehensive services to health equity for the urban poor.  Brazil's Family Health Program (PSF) and related clinics, staffed by clinicians, nurses, lay outreach workers, social workers and others, is increasingly seen as a one of the most significant reasons behind the health gains being experienced by the urban poor in Brazil, as discussed in this recent Lancet series. What is important to note about the factors of success in Brazil (and granted they still have much progress to make) is that public health officials are acknowledging that reductions in morbidity and mortality for the least well off are the result of an integrated set of economic, social, and place-based policies, along with national leadership but local (municipal and neighborhood-scale) priority setting and implementation.  As a government worker in the slums of Buenos Aires noted in the below referenced article, there is no one-size-fits-all or single intervention that will change entrenched inequalities that contribute to health inequities. Rather, what is needed are integrated strategies with the power of the national government but with the accountability of neighborhood organizations: “There are economic, social, cultural and geographic barriers standing in the way of everyone having access to the same rights. For that reason, rather than sporadic interventions, what we are seeking at the centre is to provide a stable state presence.”