Urban Health Access: An Intersectional and Complexity-Based Comparative Analysis of Formal and Informal Settlements in Belo Horizonte, Brazil.
1
School of Medicine - Department of Preventive and Social Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
rapid and unplanned urbanization in Brazil created deep socio-spatial segregation, where the "formal city" and informal settlements represent distinct realities of citizenship and rights. ¹ while health services may be physically available, "invisible walls" often prevent marginalized populations from effectively utilizing them. ² this study addresses the need to understand how the urban environment and structural inequalities modulate health-seeking behavior. the objective is to analyze health access and utilization disparities in Belo Horizonte (BH) by comparing formal and informal settlements.
METHODS:
this research uses data from the BH-viva project, a quasi-experimental survey (n=4048) conducted in 2017-2018. ³ the framework integrates Andersen’s behavioral model, ⁴ intersectionality theory, ⁵ and complexity science. ⁶ a composite variable will be used to stratify the population into eight intersectional categories, following established methodological approaches for urban informal settlements. ⁷ binary logistic regression with a hierarchical approach will compare determinants across territories.
RESULTS:
as a work in progress, the study expects to demonstrate that access is structurally constrained by socio-spatial segregation. ⁸ it is hypothesized that black women in informal settlements face significantly higher barriers compared to residents of the formal city, even with similar clinical needs. factors like housing quality, neighborhood perception, and income are likely central determinants. by identifying non-linear feedback loops within the urban system, the results will provide a "face" to the data, showing how multiple axes of oppression interact to produce distinct strata of vulnerability.
CONCLUSIONS:
integrating complexity and intersectionality challenges the notion of universal access by revealing persistent hierarchies of citizenship. these findings will provide strategic evidence for health governance in Brazil, supporting equity-based policies that move beyond population averages. this research reaffirms that the right to health is inseparable from the right to the city, offering a model to reduce injustices linked to urban locations. ⁹
rapid and unplanned urbanization in Brazil created deep socio-spatial segregation, where the "formal city" and informal settlements represent distinct realities of citizenship and rights. ¹ while health services may be physically available, "invisible walls" often prevent marginalized populations from effectively utilizing them. ² this study addresses the need to understand how the urban environment and structural inequalities modulate health-seeking behavior. the objective is to analyze health access and utilization disparities in Belo Horizonte (BH) by comparing formal and informal settlements.
METHODS:
this research uses data from the BH-viva project, a quasi-experimental survey (n=4048) conducted in 2017-2018. ³ the framework integrates Andersen’s behavioral model, ⁴ intersectionality theory, ⁵ and complexity science. ⁶ a composite variable will be used to stratify the population into eight intersectional categories, following established methodological approaches for urban informal settlements. ⁷ binary logistic regression with a hierarchical approach will compare determinants across territories.
RESULTS:
as a work in progress, the study expects to demonstrate that access is structurally constrained by socio-spatial segregation. ⁸ it is hypothesized that black women in informal settlements face significantly higher barriers compared to residents of the formal city, even with similar clinical needs. factors like housing quality, neighborhood perception, and income are likely central determinants. by identifying non-linear feedback loops within the urban system, the results will provide a "face" to the data, showing how multiple axes of oppression interact to produce distinct strata of vulnerability.
CONCLUSIONS:
integrating complexity and intersectionality challenges the notion of universal access by revealing persistent hierarchies of citizenship. these findings will provide strategic evidence for health governance in Brazil, supporting equity-based policies that move beyond population averages. this research reaffirms that the right to health is inseparable from the right to the city, offering a model to reduce injustices linked to urban locations. ⁹
| eISSN: | 2654-1459 |
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