Influence of Environmental Conditions on the Prevalence of Systemic

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Influence of Environmental Conditions on the Prevalence of Systemic DOI: 10.1590/1413-81232018235.20362016 1425 Influência das condições socioambientais ARTICLE ARTIGO na prevalência de hipertensão arterial sistêmica em duas comunidades ribeirinhas da Amazônia, Brasil Influence of environmental conditions on the prevalence of systemic hypertension in two riverine communities in the Amazon, Brazil Duarcides Ferreira Mariosa 1 Renato Ribeiro Nogueira Ferraz 2 Edinaldo Nelson dos Santos-Silva 3 Abstract This article discusses the influence of Resumo Este artigo discute a influência das con- environmental conditions on the prevalence of dições socioambientais na prevalência da Hiper- systemic hypertension in two riverine commu- tensão Arterial Sistêmica em duas comunidades nities in the Sustainable Development Reserve ribeirinhas da (RDS) Reserva de Desenvolvimen- of Tupé, Manaus, Amazonas, Brazil, through an to Sustentável do Tupé, Manaus, Amazonas, me- ecological study of multiple groups and contextu- diante estudo ecológico de grupos múltiplos e de al analysis carried out with the local inhabitants. análise contextual realizados com os moradores. To identify the environmental etiology describing Para delinear a etiologia ambiental que descre- the risk of disease development, the study com- ve o risco de acometimento da doença, o estudo pares demographics, incidence rates and common compara dados demográficos, taxas de incidência daily practices in these communities, using data e as práticas diárias comuns nas coletividades, collected in the field, between 2012 and 2014, as levantados em pesquisa de campo, entre os anos well as values provided by IBGE, originally from de 2012 e 2014, com valores apresentados pelo National Health Survey, 2013. The results suggest IBGE na Pesquisa Nacional de Saúde de 2013. that social and environmental determinants, such Os resultados da análise sugerem que determi- as general living conditions, occupation and ac- nantes socioambientais, como a precariedade das cess to protective health care, in the investigated condições gerais de vida, trabalho e de acesso aos 1 Grupo de Pesquisa Biotupé, Instituto Nacional communities, are relevant factors in explaining mecanismos protetivos à saúde das comunidades de Pesquisas da Amazônia the observed variability in systemic arterial hy- investigadas são relevantes para explicar a varia- (INPA). Av. André Araújo pertension (SAH) incidence rates. The study con- bilidade das taxas de incidência de HAS. Finali- 2936, Aleixo. 69060-001 Manaus AM Brasil. cludes by pointing out the importance and need za-se alertando para a necessidade de considerar a [email protected] to consider socio-environmental vulnerability in vulnerabilidade socioambiental na elaboração de 2 Programa de the elaboration of public health policies and in the políticas públicas de saúde e na gestão de unidades Mestrado Profissional em Administração, management of environmentally protected areas. de conservação. Gestão em Sistemas Key words Society, Environment, Systemic ar- Palavras-chave Sociedade, Ambiente, Hiperten- de Saúde, Programa terial hypertension, Health vulnerability, Health são Arterial Sistêmica, Vulnerabilidade em saúde, de Pós-Graduação em Administração, management Gestão em saúde Universidade Nove de Julho. São Paulo SP Brasil. 3 Coordenação de Biodiversidade, INPA. Manaus AM Brasil. 1426 et al. Mariosa DF Mariosa Introdução vel às pessoas localizadas naquele espaço socioge- ográfico seja observado7. Da mesma forma que fatores ambientais como a Em se tratando de localidades com poucos poluição do ar, exposição a pesticidas, inseticidas, habitantes e reduzida infraestrutura de serviços, metais pesados e contaminantes químicos dos torna-se, todavia, um desafio garantir a equidade alimentos inserem-se na matriz de importantes e integralidade do acesso e da atenção à saúde. mecanismos moleculares que ocorrem no inte- Um Produto Interno Bruto (PIB) total ou per ca- rior do corpo humano e que, consequentemente, pita superior não é garantia que os indicadores aumentam o risco de acometimento de doenças de saúde também o sejam. Pois, se o volume da e, também, a possibilidade de sua transmissão às riqueza é precondição para a melhoria da qua- futuras gerações1, fatores socioeconômicos de- lidade de vida, “nem sempre há uma correlação vem ser levados em consideração ao se estudar constante entre os macro-indicadores de riqueza o perfil de adoecimento e morte de uma popu- e os indicadores de saúde”8. É preciso observar lação2-4. a interação complexa dos fatores intervenientes. A relação sociedade-natureza é um elemento Doenças Crônicas Não Transmissíveis explicativo importante para determinar como o (DCNT), como as doenças cardiovasculares, al- processo de industrialização interfere na preva- guns tipos de câncer, diabetes e doenças respi- lência de doenças infectocontagiosas, quando o ratórias crônicas, são responsáveis por gerar um perfil societário é de baixo desenvolvimento, e elevado número de mortes prematuras, perda de de doenças crônico-degenerativas, para o caso qualidade de vida, e suscitar impactos negativos de sociedades mais industrializadas5. Em países à vida econômica das pessoas, seus familiares e a como o Brasil, em que a transição para o perfil sociedade de um modo geral9. Enfermidades crô- de sociedade industrialmente desenvolvida ainda nicas como o diabetes e a hipertensão geram, de não se completou totalmente, algumas regiões, maneira crescente e preocupante, enormes per- por suas características intrínsecas (perfil demo- das para os sistemas de saúde, sendo considera- gráfico e estilo de vida) e extrínsecas (localização das doenças de importância em saúde pública em geográfica, acesso aos serviços de saúde e a influ- todo o mundo10. Um recente levantamento iden- ência de centros urbanos mais dinâmicos), estão tificou que as DCNT são responsáveis por cerca sujeitas a uma substituição gradativa, porém não de 70% da mortalidade no Brasil, atingindo, pre- completa, das doenças infecto-contagiosas pelas valentemente, a população mais pobre em razão doenças cardiovasculares, tumores e “causas ex- de sua maior exposição aos fatores de risco e ao ternas” ou mortes violentas, constituindo-se essa menor acesso aos serviços de saúde11. São con- condição de risco ou de vulnerabilidade socio- siderados como fatores de risco para as DCNT ambiental um desafio para as políticas públicas hábitos e comportamentos, em geral, associados de saúde6. ao estilo de vida moderno, efeito da globalização Ao se falar de risco e de vulnerabilidade, en- e da rápida urbanização, como o sedentarismo, o tende-se que a distribuição da saúde e da doença consumo de alimentos com alto teor de gordu- se apresenta social e espacialmente estratificada. ras e açúcares, o tabagismo, a ingestão excessiva O padrão da riqueza material produzida, seu de álcool, o sobrepeso e obesidade, níveis altera- volume, diversidade e forma de distribuição al- dos de pressão arterial e hiperglicemia12. Fatores cançam grupos de indivíduos promovendo sua como gênero, etnia e nível de escolaridade, além diferenciação econômica e social. Essa caracterís- do local e situação de residência, exercem consi- tica pode ser observada nas sociedades mediante derável influência sobre o padrão de distribuição a análise de certos atributos que os integrantes de das DCNT13. um grupo de status possuem em comum, como Hipertensão arterial sistêmica (HAS) é de- gênero, renda, faixa etária, escolaridade, ocupa- finida pela Sociedade Brasileira de Cardiologia, ção e local de moradia. Para cada uma dessas em sua “VI Diretrizes Brasileiras de Hipertensão”, faixas ou divisões coletivas, forças sociais em sua como uma condição clínica multifatorial, que se ação concorrem para que formas, estruturas e caracteriza por níveis elevados e sustentados de processos materializem em seus respectivos espa- pressão arterial (PA)14. Considera-se hipertenso o ços os equipamentos, bens e serviços colocados à paciente adulto (acima de 18 anos) cuja medida disposição das coletividades, nem sempre de ma- da pressão arterial mantém-se acima de 140/90 neira igualitária, apropriada ou suficiente, mas mm/Hg. Todavia, a mortalidade por doença que sustentam condições favoráveis para que um cardiovascular aumenta proporcionalmente à determinado perfil de morbimortalidade aplicá- elevação da PA, já a partir de 115/75 mm/Hg, de 1427 Ciência & Saúde Coletiva, 23(5):1425-1436, 2018 23(5):1425-1436, Coletiva, & Saúde Ciência “forma linear, contínua e independente”14. Entre desenvolvimento17. A vulnerabilidade é anterior os fatores de risco apontados estão a relação di- ao risco, pois inclui fatores não apenas de origem reta com a idade, aumentando linearmente sua biológica, mas também geográficos, políticos, incidência a partir dos 40 anos, um pouco maior culturais e sociais, de natureza socioambiental, entre homens até os 50 anos, mas invertendo a portanto18,19. proporção em favor das mulheres acima dos 50 anos. Entre os não brancos é duas vezes mais pre- valente; e o excesso de peso e obesidade, mesmo Objetivos em indivíduos ativos, alarga o risco de desen- volver a hipertensão. Hábitos alimentares que Na perspectiva de contribuir para os processos de incluem a ingestão excessiva de sal e o uso pro- gestão e no melhor aproveitamento dos recursos longado de álcool associam-se com a ocorrência aplicados à saúde coletiva, o presente estudo tem de HAS, no Brasil, independente das condições como objetivo discutir a influência das condições demográficas. Quanto ao sedentarismo, fatores socioambientais na incidência e variabilidade das socioeconômicos
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