HEALTH PROFILE

SUMMARY

WHO WE ARE

The Municipality of is situated in the southern bank of the Tagus River, in Setúbal District and it is part of the . 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, , , , 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.

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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

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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.

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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.

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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 , 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. That is why the Programme to Control Diabetes and High Blood Pressure / Cardiovascular Diseases and the More Movement, More Capacity Programme are there, they monitor data relating to these diseases. The National Programme Mellitus Diabetes is integrated in the European Programme DiabCare.

Morbidity due to malignant tumours in the municipality of Seixal, from 1989 to 1997, according to the Regional Oncology Registration, is due in the first place to breast cancer followed by colon and rectum tumours, thirdly by lung and bronchial cancer and fourthly by stomach malignant tumour. Still important are malignant tumours in skin, mouth, pharynx, prostate and female genital system. We equally

9 notice that while in women the most frequent is breast cancer, lung and bronchial cancers are the most frequent in men. Colon and rectum malignant tumours come next for both genders.

Concerning accidents, in Portugal in 1991 there was a rate of 706 people injured in road accidents per 100.000 inhabitants. Home and leisure accidents, in 1993 were 7.500 per 100.000 inhabitants and they were responsible for 10% of the total number of people needing to go to hospital emergency wards.

As for work accidents there was in Portugal, in 1993, a rate of 2.544 per 100.000 inhabitants.

The communicable diseases of compulsory declaration, more frequent during 1993 and 1996, were tuberculosis and hepatitis. Tuberculosis had a very high rate of 54.3 per 100.000 inhabitants in 1996, when the national rate was 46.9 for the same year. Between 1988 and 1996 there was an increase in the incidence and prevalence rates in the municipality of Seixal. The largest number of cases was registered in the 15 to 34 year-olds. Also in B and C Hepatitis, the highest figures are found the younger groups, a fact which some studies tend to relate with the existence of drug addiction.

Concerning AIDS, the number of new cases detected at national level has gradually been increasing. Of the total number of cases registered from 1983 to September 1997, 84% were males and 69% between 20 and 39 years of age. In terms of transmission factors, 42% were drug-addicts.

How healthy we live

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More than 1/3 of the live births in the municipality of Seixal - 37.2% - in 1996, were born from mothers between 25 and 29 years of age. Still for 1996, 6.5% of births in the municipality were from mothers with 19 years of age or less. In 1993, the average age of women giving birth for the first time was 25.5 years.

A low birth weight (< 2.500 g) was registered in 5.3% of births in 1997 (according to a sample survey) representing a rate of 5.300 per 100.000 live births.

Concerning mistreatment to children and adolescents, a national survey was carried out in 1996, in which 3.465 health professionals were interviewed. Of those, 53% said that in their professional lives they had come across cases of ill- treated, neglected, psychologically / sexually abused and abandoned children or children at high psycho-social risk, at least 11% mentioned a case of sexual abuse.

In 1994 the Children’s Protection Committee was created in the Municipality of Seixal, and it is constituted by representatives of the municipal authority, education, the court, social security, health centres, private institutions of social solidarity, police and parents’ associations. In 1997 85 processes concerning 135 children were installed. Of these 17,6% were related to mistreatments and / or sexual abuse, 18,8% to cases of abandonment or school absenteeism, and around 15% due to negligence and / or abandonment.

In 1995 a survey was carried out to the health, hygiene and safety conditions in schools of the municipality of Seixal. There we found a large percentage of problems related with traffic and safety issues in school buildings and their precincts, and hygiene in general.

Also in relation to the youngsters in the municipality, a sample survey was carried out in 1988, trying to find out the youngsters' habits and life-styles.

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In that study it is worth underlining the high percentage of youngsters who consider themselves healthy (89.6%), those who declare that they have a good or a very good communication with their parents (84.7%), those that declare that they are satisfied with the information available on sexuality (75.5%), although only 25% of those who have sexual intercourse (23.8%), always use contraceptives.

Concerning the ethnic minorities' neighbourhoods, namely Santa Marta de Corroios neighbourhood, different health activities have been organised, particularly vaccination campaigns, like hepatitis B and the detection of parasites in the neighbourhood children.

As for alimentation, at the end of the 1996 / 97 school year, a questionnaire was directed at the children attending Primary School in order to find out about the nutritional habits in this age group. Its results will soon be published. Concerning the hygiene and salubrity conditions, in the context of the programme for hygiene in food-trade and industry, in 1995, 163 shops were visited and 85% had excellent or good conditions.

The coverage of companies by health at work services is clearly insufficient, for only 3.8% of 475 enterprises have a company doctor. Concerning professional diseases the largest share comes from conjunctivitis, deafness and tendinitis, underlining the need to verify the workers' working and protection conditions.

There were 141 presumed lawbreakers related with drugs traffic and / or consumption, in 1996 in the municipality of Sexual, of which 52.5% were presumed consumers, 34.7% dealers / consumers and 12.8% presumed dealers. Here we see a big difference in relation to the rest of the country, where 24.8% of the presumed lawbreakers, in 1996, were presumed dealers.

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OUR HEALTHCARE SERVICES

The population coverage by the National Health Service in the municipality of Seixal was carried out, until January 1998 by two health centres (Amora and Seixal) and their respective extensions. From that date on Corroios health centre has been open. The hospital unit is Garcia d’ Orta Hospital in . Our municipality is part of Setúbal Health Sub-Region. In 1996 there were 144.430 people registered at both health centres, with Amora Health Centre covering 64.6% of those. More than half of those registered, 52.1%, are women. Almost 1/3(30.9%) are 24 years old or less and 13.8% are 65 or older. Concerning the ratio of health professionals, there is one family doctor for 1.651 patients at Seixal Health Centre and 1/2454 at the Amora Health Centre. There is 1 nurse for 1,706 patients at Seixal Health Centre and 1/2521 at Amora Health Centre. These figures are revealing of the existing shortage.

The coverage of birth control for women at fertile age (15 to 49) registered at the health centres is situated around 32.4%. Concerning the maternal health medical consultation, the number of consultations in the first three months of pregnancy increased (55.7% in 1996 and only 13.5% in the last three months). Sessions for child delivery preparation cover 31.3% of the municipality.

As for infantile health consultation, 92.5% of the first medical consultations take place during the child's two first months, but they are down to 61.6% in the first 15 days of life.

In relation to the National Vaccination Plan (PNV3), in 1996 there was a coverage rate of 94.9% in children up to 12 months and a rate of 94.8% in children up to 24 months.

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In terms of health at school and for the area covered by Seixal Health Centre, 91% of the 6 year-old children attained a rate of 91% in relation to the PNV.

In terms of health at school there are also activities connected with oral health.

Seixal Health Centre has a specific space for adolescents once a week. The average age of these users is 17. In 1996, 308 youngsters were attended.

Analysing the number of medical consultation for the elderly at the health centres, we notice that they account for 28% of the consultations. This difference between the number of consultations and the percentage of those registering shows that this population uses the health services extensively.

3 T.N.: From the Portuguese Plano Nacional de Vacinação.

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The Health Centre of Seixal classified a sample of 382 elderly people by risk groups, revealing that the greatest significance falls upon chronic patients, 71.2%, following those lying in bed / dependent: 13.9% of the elderly. This analysis shows the need of an integrated home healthcare service. In 1998 there will be presented applications to a Local Promotion Project – Home Healthcare Service – and to a Central Promotion Project – Telealarm Service, both comprised in the Integrated Home Healthcare Programme to Elderly People (PAII), at national level. Also in 1998 a collaboration Protocol will be established among several entities to materialise, at local level, the Continued Healthcare Project of the Health Region of Lisbon and Tagus Valley.

WHAT WE HAVE

There is a data base containing all the institutions, in education, culture, sports, childhood, youth, old age, the handicapped, ethnic minorities, community centres and clubs, which is permanently updated. On the other hand, and through different equipment charters (school, investor's, sport equipment, health, ...) already completed or being implemented, the planning of equipment is carried out. There are also other tools for the strategic planning, namely: the Municipal Directive Plan, the Plan for Road Circulation and Transport, the Plan for an Integrated System of Solid Waste, the General Sanitation Plan, the Plan for the Improvement of Seixal Natural Bay, theGreenPlan of the Municipality, the Sports Development Plan, the Annual Social Plans for Schools. The surveys on the impacts upon health are taken into account in the Health Profile of the Municipality, undergoing permanent updating.

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