HEALTH PROFILE SUMMARY WHO WE ARE The Municipality of Seixal is situated in the southern bank of the Tagus River, in Setúbal District and it is part of the Lisbon Metropolitan Area. According to an estimate of the Municipal Directive Plan it had, in 1997, around 140.000 inhabitants, and covered an area of 93.6 km2 Six Parishes form it: Aldeia de Paio Pires, Amora, Arrentela, Corroios, Fernão Ferro and Seixal. The demographic forecast indicates that by the year 2000 we shall be 145.028 inhabitants and 154.688 by 2005. The Municipality of Seixal presents the highest demographic growth in the Lisbon Metropolitan Area, with the highest rates of actual and natural growth and it is an important pole of demographic attraction. Of the foreign population living in the municipality (1.84% of the population in 1991), 64.9% are from African Portuguese speaking countries and 11.4% from EU countries. Assessing the dependence rates in 1991, 30.1% for the young and 9.7% for the old, we can see a certain ageing at the top and bottom of the age pyramid. Nevertheless the municipality birth rate, from 1991 to 1996, is slightly superior to the national and district rate, 12.6%, both in 1991 and 1996. Concerning the men / women balance rate there were in 1991, 103 women for each 100 men, having increased, in 1994 to around 104 women but maintaining a steadier balance than the national one, which had 107 women to 100 men. Of the 37.442 classic families in 1991, 0.9% are single male parent families, while 5.2% are single female parents. Out of the total of the isolated individuals in the municipality, 9% of the population, 34.5% are individuals of 65 years of age 1 or more. 2 The Municipal Parish of Seixal is the most ageing one with 44.2% of its population with an age of 55 years or over and 10.8% with 75 years or over. The Municipal Parishes of Aldeia de Paio Pires, Amora, Arrentela and Corroios have quite a young population. It is most remarking in the 10 – 19-year-olds' group where the four parishes attain the highest population percentage. Arrentela and Corroios are the most densely populated, respectively 2.274 and 2.097 inhabitants per km2, while Fernão Ferro, has the lowest density, with 187 inhabitants per km2. How we are From the employed population in 1991, the large majority - 83% - were wage- earners. From the employed population and activity sectors, 65% work in services while 34.6% work in the manufacturing industry. In 1994, the last with available data, the unemployment rate was 11.6%, with women doubling men's figures. The manufacturing industry offers the majority of jobs in the municipality - 58%, followed by retail trade, hotels and restaurants, with 17% and the private and public construction industry with 14%. In 1991, out of the population with 12 years of age or over, 53.2% lived on their work and 27.5% were looked after by their families, with the remainder receiving pensions (13.5%) or unemployment allowances (1.8%). Concerning the Minimal Guaranteed Income, in December 1997, 202 families, involving 629 people were covered and 721 other cases were being assessed. Of the total number of families receiving this allowance, the majority are single female parents, closely followed by nuclear families with children 3 The population's school attendance rate in 1991 was not very high, despite the fact of being higher than in Setúbal district as a whole. The illiteracy rate was 4.7%, women being the double of the illiterate. 48.6% of the population had attended Primary or Preparatory School, 32.3% Secondary School and only 6.8% College or University. In a comparative analysis of the school years, 1994 - 1998, we conclude that, seeming to accompany the evolution of the age pyramid, in the whole the municipality the number of pupils registered in official schools at the three initial levels of education (until the 9th form) has decreased. Our conditions Our drinking water is of good quality, with only 0.7% of the measurements, carried out in the second half of 1997, exceeding 0 faecal residues (microbiological quality) and in the 8 tests to the nitrates and fluoride parameters, none exceeded 50 mg / litre and 1.5 mg / litre, respectively (chemical quality), with around 100% of the population being served by tap water. The consumption of drinking water in 1995 was 142 litres / day / inhabitant. The air we breathe is equally of good quality, being the indexes calculated from the Sulphur Dioxide (SO2) values, measured (by the Air Management Committee of Seixal and Barreiro) between 1992 and 1996, equal to 0%. Besides this pollutant, the Total Particles in Suspension (PTS) are also measured in the Municipality of Seixal. Although these are the pollutant that presents the highest concentrations, it doesn’t exceed the maximum values foreseen in the legislation in force. As for sewage water drainage and treatment, in 1997, around 96% of the population had sewers, this meaning a very significant improvement in relation to the last decade, this being the result of the existence of four sewage water 4 treatment plants (ETARs1), which are part of the Municipality General Sanitation Plan. 1 T.N.: From the Portuguese Estação de Tratamento de Águas Residuais. 5 Concerning the collection of urban solid waste (RSU), in 1997 54.847,28 tons of household waste – 80,49% of the total RSU collected – were collected in containers. We also register the volunteer selective collection of: 430 tons of glass; 195 tons of paper / card-board; 0,65m3 of batteries; 8980,73 tons of dead stock; 0,70 tons of tyres; 2174,75 tons of debris; 1222,86 tons of boughs and leaves; 0,42 tons of radiographs and 293,7 tons of ferrous materials collected in the Sanitary Landfill by a scrap-yard owner. The total household waste collected is deposited at the Sanitary Landfill. 100% of the dead stock, tyres, debris and boughs and leaves were also deposited at the Sanitary Landfill. The total recyclable waste (glass, paper / card-board) collected were also recycled. Medical waste from public services and from some private services is collected separately and taken for incineration at the Garcia d'Orta Hospital. In 1992 the green area in the Municipality totals 4.334 ha., meaning 46.6% of the municipality total area. There are 250.000 m2 of green spots with free public access, thus averaging 2.1 m2 per inhabitant. In what refers to public transport, particularly road transport, we are offered, on weekdays, 1.428 seats for 1.000 inhabitants; river ferryboats offer a daily average of 255 seats per 1.000 inhabitants. In 1991, 3.1% of the population lived in dwellings which did not meet the minimum comfort and hygienic criteria (no bathroom and / or tap water). The average of rooms per inhabitant was 1.4 rooms / inhabitant. According to the Municipal Housing Division, there were in 1993 in the municipality 444 shacks in which 635 families lived. Of these, 60 (9.4%) have already solved 6 their housing situation through the Special Re-housing Programme - PER2 families. 2 T.N.: From the Portuguese Programa Especial de Realojamento - Famílias. 7 Concerning the Community Intervention Projects and PER there are surveys carried out in run-down neighbourhoods with ethnic minorities populations: Vale de Chícharos, Santa Marta de Corroios and Quinta do Cabral. Our Health What we die of In Portugal, in 1996, life expectancy at birth was 71 years for men and 78 for women. Mortality rates for 1.000 live births, namely infantile, neo-natal and peri-natal suffered a clear decrease in the last three decades in Portugal, a trend which occurred in the whole country and also in Seixal, where the infantile death rate (5.5% in 1996) reached low levels sooner than in Setúbal District and in the rest of the country and it still presents figures below the national ones. Maternal mortality also decreased strongly nationally (in 1993, 6.1 for 100.000 live births) this indicator being related with improved monitoring during pregnancy and better assistance on delivery: 99.9% of childbirths are medically assisted. The general mortality rate due to all causes was in 1996, in the municipality of Seixal, 663.6 / 100.000 inhabitants, higher in men (780.29) than in women (551.72). The rates of the main death causes, diseases of the circulatory system and malignant tumours, have increased particularly between 1989 and 1996 in male mortality due to malignant tumours and in female mortality due to blood- vessels diseases, which in 1996 overcame the male rate, particularly in vascular 8 cerebral diseases. As for HIV / AIDS mortality, from 1983 to September 1997, in Setúbal District, 563 AIDS cases were registered, with 64% of deaths. In assessing death by age groups in the Municipality of Seixal, in 1996, we see that 84.1% occurred in individuals of 50 years of age or over. Accidents are the main cause of death until the age of 24. Besides accidents, suicides, malignant tumours and digestive system diseases are the main cause for the highest average number of years of life lost in the municipality of Seixal, for they are the cause fo death of younger people. WHAT WE SUFFER FROM Cardiovascular diseases have a high morbidity in Portugal and in the Municipality of Seixal. One major concern is to identify individuals wit high blood pressure and other risk factors, on the one hand and the monitoring of individuals who have already suffered brainstrokes.