Ciência & Saúde Coletiva ISSN: 1413-8123 [email protected] Associação Brasileira de Pós-Graduação em Saúde Coletiva Brasil Ramos de Souza, Edinilsa; Carvalho de Lima, Maria Luiza The panorama of urban violence in Brazil and its capitals Ciência & Saúde Coletiva, vol. 11, núm. 2, abril-junho, 2006, p. 0 Associação Brasileira de Pós-Graduação em Saúde Coletiva Rio de Janeiro, Brasil Available in: http://www.redalyc.org/articulo.oa?id=63011214 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative 363 The panorama of urban violence ARTICLE ARTIGO in Brazil and its capitals Panorama da violência urbana no Brasil e suas capitais Edinilsa Ramos de Souza 1 Maria Luiza Carvalho de Lima 2 Abstract This article presents a descriptive epi- Resumo Faz-se uma análise epidemiológica des- demiological analysis of accidents and violence in critiva da morbidade e da mortalidade por aci- Brazil and in the Brazilian capitals in recent dentes e violência no Brasil e suas capitais, em years. The data used were made available by sev- anos mais recentes para os quais as informações eral sources: the Mortality Information System estão disponíveis. Usam-se dados dos Sistemas de and the Hospital Information System of the Min- Informações sobre Mortalidade e de Internações istry of Health; the National Safety Department Hospitalares, do Ministério da Saúde; da Secre- of the Ministry of Justice and the National De- taria Nacional de Segurança, do Ministério da partment of Transit of the Ministry of the Cities. Justiça; e do Departamento Nacional de Trânsito, The population data for the years 2002 and 2003 do Ministério das Cidades. Os dados populacio- were made available by the DATASUS of the nais de 2002 e 2003 são os disponibilizados pelo Ministry of Health. The authors emphasize some Datasus/MS. Destacam-se algumas situações que already known aspects: the high homicide rates persistem no Brasil: elevadas taxas de homicídios and high death rates due to traffic accidents, the e de mortes por acidentes de trânsito, concen- concentration of these events in the population of tração dos eventos na população jovem, negra e young black males and the complexity and multi- do sexo masculino e a complexidade e multide- plicity of determinants of these phenomena. The terminação desses fenômenos. Como novo, apon- text points to a new scenery involving the spread- ta-se um processo de disseminação de homicídios ing of homicides to neighbor communities of met- para outros municípios das regiões metropolita- ropolitan areas and to the inner regions of the nas e do interior dos Estados. Destaca-se a mag- 1 Centro Latino States. They further verify higher morbidity than nitude da morbidade em relação à mortalidade. Americano de Estudos mortality rates. It calls attention to Porto Velho, Destacam-se Porto Velho, Macapá, Vitória, Rio de Violência e Saúde Jorge Macapá, Vitória, Rio de Janeiro and Cuiabá with de Janeiro e Cuiabá, com os maiores indicadores Careli, Departamento de Epidemiologia e Métodos the highest indicators for intentional violence – de violência intencional – elevadas taxas de ho- Quantitativos em Saúde, high rates of homicides and injuries – and to Pal- micídios e de lesões corporais e Palmas, onde ocor- ENSP, Fiocruz. mas, with high death rates from traffic accidents rem altas taxas de mortalidade por acidentes de Av. Brasil 4036, sala 700, Manguinhos, 21040-361, and non-fatal victims per 10 thousand vehicles. transporte e de vítimas não fatais por 10 mil veí- Rio de Janeiro RJ. Key words External causes, Homicides, Traffic culos. [email protected] accidents, Violence and Health Palavras-chave Causas externas, Homicídios, 2 Departamento de Medicina Social Centro de Acidentes de transporte, Violência e Saúde Ciências da Saúde, UFPE. 364 Introduction The mortality data refer to deaths of resi- dents from external causes (V01-Y98 of the In- The unprecedented magnitude and intensity of ternational Classification of Diseses/ICD10) Souza, E. R. & Lima, M. L. C. social violence in Brazil, expressed in the epi- occurred in 2003, and were extracted from the demiological and criminal indicators based on Mortality Information System (SIM) available lethal and nonlethal events, is even greater than at the DATASUS. The coverage and quality of in countries in state of war. the data of the SIM varies. They are more reli- The death rates from violence in the main able in the States in the South and Southeast of urban centers in Brazil show a continuously in- the country, where more than 80% of munici- creasing trend since the 80s1 and rank today palities count on regular death registries, while among the highest in the American continent. in the municipalities of the regions North, According to data from the Ministry of Health, Northeast and Center-West this percentage, al- Brazil passed from 59.0 deaths from external though gradually improving, is only of about causes (accidents and violence) per 100 thou- 60%10. In the capitals, on the other hand, prac- sand inhabitants in the 80s to 75.2 in 2002. tically all deaths are recorded. West-European countries show rates lower than The morbidity rates were collected from 3 premeditated deaths per 100 thousand in- three sources: The Hospital Information Sys- habitants and the United Sates show rates be- tem of the Ministry of Health, the National De- tween 5 and 6 premeditated deaths per 100 partment of Transit of the Ministry of Cities thousand inhabitants2. and the National Safety Department linked to Different studies carried out in the country the Ministry of Justice. The data refer to recent showed that violence does not affect the popu- years, for which information was available. lation uniformly, the risk varies according to The information regarding hospital admis- gender, race, color, age and social space3, 4, 5.The sions due to injuries and some other conse- death rates from violence however, even taking quences of external causes (S00-T98 of the under-recording into consideration, show only ICD10) were collected from the AIH/SUS, in the tip of an enormous iceberg, in fact represent- charge of processing the Hospital Admission ing a much higher number of violent deaths. Authorization forms (AIH). This system how- Although being clearly more intense in ur- ever shows some limitations: it does not con- ban areas with high population density where sider acute health problems with quick evolu- about 75% of the total of deaths from external tion and requiring less than 48 h of inpatient causes are concentrated1, 6, recent studies re- care. There is also no control as refers to multi- vealed another process, a dynamic some authors ple admissions, a fact capable of compromising call the “interiorization of violence”, in the the information by generating more than one sense of violence being taken to the inner re- admission registry for the same patient. Final- gions of the country7. In part this is due to the ly, the data produced by this system only in- route illegal drugs trade is taking through the clude admissions in hospitals belonging to the inner regions of different Brazilian States, where network of the Unified Health System or facili- some municipalities participate as producers ties linked to this system through agreements and others serving as corridors for the trans- and the reliability of the data depends on the port of drugs8, 9. nature of the data processing system11, 12, 13, 14, 15. This article presents a picture of urban vio- We also analyzed the information regard- lence in Brazil, analyzing mortality and mor- ing traffic accidents for the year 2002, pub- bidity rates from external causes focusing on lished by the National Department of Transit traffic and transportation accidents and homi- in its Annual Statistics of Traffic Accidents16.In cides according to differences in relation to sex, spite of the sub-recording due to under-notifi- age and capitals. cation from some State Departments of Tran- sit, this system provides indicators allowing for evaluating and establishing the dimension of Methods morbidity and the seriousness of traffic acci- dents in the greater part of Brazilian States and This study represents a descriptive epidemio- capitals. Finally, the data about injuries were logical analysis of morbimortality due to acci- collected from the statistics of the National De- dents and violence in Brazilian capitals in re- partment of Transit, based on the number of cent years. occurrences registered in the National System 365 Ciência & Saúde Coletiva,Ciência 11(2):363-373, 2006 of Public Safety and Criminal Justice Statistics external causes (Table 1), turning them into a for the year 200317. A possible limitation of this priority with respect to interventions and justi- system is under-registration as a result of un- fying the special attention given to them in this der-notification from some police departments. article. The variations in the number of occurrences In 2003, the mortality rate from external were also due to the different procedures and causes varied from 53.8 to 120.1 per 100 thou- systems adopted for the collection and record- sand inhabitants among the Brazilian capitals ing of criminal information by each of the 27 (Table 2). Seven of the 27 capitals showed death civil police forces of the country. The under- rates from external causes higher than 90 per registration of occurrences by the public safety 100 thousand inhabitants (Porto Velho, Boa authorities varies in intensity among the dif- Vista, Macapá, Recife, Vitória, Rio de Janeiro ferent capitals studied in this paper. and Cuiabá); eight capitals (Manaus, Belém, The population data for the years 2002 and São Luís, Teresina, Natal, João Pessoa, Floria- 2003 were based on estimations drawn from the nópolis and Porto Alegre) showed lower rates 2002 census, made available by the DATASUS/ (between 50 and 69 per 100 thousand inhabi- Ministry of Health18.