title: The involvement of community leaders in healthcare, the environment and sanitation in áreas of social vulnerability.
abstract: The main purpose of this article is to identify access to: social assistance inclusion programs; assistance from health agents; public water supply services; and water saving practices, in areas of irregular occupation in Brazil. A stratified random sampling technique by clusters was adopted with a simple sampling strategy. In the universe of 14,079 households, 68 community leaders were identified, representing 6,800 households on average, in a normalized distribution (mean zero, standard deviation 1), deemed to include situations covering 96% of the cases with a margin of error of + or - 1% of the average. The theoretical approach proposes a reflection and verification through questionnaires on the mechanisms of exclusion. Poverty perpetuates the vicious circle of inequality, risks to health and the environment, and it is necessary that these should be considered in the policies and procedures for urban expansion. As a conclusion, various challenges were identified for serving areas of social-environmental vulnerability - the needs to: improve the low quality of health and water services in subnormal agglomerations; modify the behavior of the population accessing the networks in a clandestine manner; and to put inclusive governance mechanisms in place.
authors.affiliation: Companhia de Saneamento Básico do Estado de São Paulo, São Paulo, SP, Brasil, feche.guimarães@gmail.com.
authors.forename: Ester Feche Guimarães de Arruda
authors.initials: EF
authors.lastname: Juliano
authors.affiliation: Escola de Engenharia de São Carlos, Universidade de São Paulo, São Carlos, SP, Brasil.
authors.forename: Tadeu Fabrício
authors.initials: TF
authors.lastname: Malheiros
authors.affiliation: Instituto Superior Técnico de Lisboa, Lisboa, Portugal.
authors.forename: Rui Cunha
authors.initials: RC
authors.lastname: Marques
mesh_terms: D001938:Brazil; D003695:Delivery of Health Care; D004777:Environment; D006801:Humans; D007857:Leadership; D012499:Sanitation; D035862:Vulnerable Populations; D014881:Water Supply