Peripheries Features

periferias 5 | public, environmental, and democratic health

illustration: Juliana Barbosa

IPAD Institute for Thought and Action in Defense of Democracy

IPAD interviews the Praxis collective, with work focused on mental health in Rio de Janeiro, and TETO, a collective dedicated to supporting the construction of affordable housing in Belo Horizonte

| Brasil |

translated by Stephanie Reist

The Institute for Thought and Action in Defense of Democracy (IPAD) is a program that arose within the Instituto Maria e João Aleixo, a think tank dedicated to training periphery specialists in order to spread the paradigm of peripheries’ potential. 

Formed by activists with a long history of work in Brazilian civil society, IPAD is a multifaceted center of political formation with a focus on Black people and people from peripheries. It engages in the construction of methodologies, concepts, propositions, and actions that widen the possibilities for reinventing how politics are done and building relationships with public agencies of Brazilian society from the standpoint of defending a democratic state of rights. To that end, it contributes to overcoming structural racism, institutional patrimonialism, patriarchy, as well as other analogous anti-democratic practices — particularly corruption — that continue to dominate political structures and public agencies. 

Through trainings and organizational action workshops, IPAD fosters a political environment that enables people and groups from the peripheries to broaden their conceptual, theoretical, and methodological capabilities, encouraging them to identify with democracy and, in this way, expand their capacity for political action. Participants engage in a high-level academic training that integrates the demands of civil society. 

IPAD is also dedicated to contributing to the construction of a political agenda that, through civil society, influences the platforms of political parties and organizations that support democracy. 

With a focus on creating political training cohorts in the metropolitan regions of Rio de Janeiro and Minas Gerais, we establish support and coordination links to participant youth groups and collectives. Currently, the participants in the political training course are involved in over 60 local collectives and groups in the peripheries of both cities. These groups and collectives act in different areas that impact people in peripheries. 

For this edition of the magazine, the executive committee of IPAD spoke with two participants in the IPAD-Be Democracy program who represent collectives that work on overcoming the challenge of defending democracy in the areas of: the defense of the basic right of access to mental health and environmental sustainability within the context of families’ rights to housing in peripheries. Our goal is to present the analyses and actions of groups that see the defense of democracy as a powerful path towards guaranteeing conditions necessary for a dignified life and collective well-being. 

Cleber Riberio: Ana, to begin our conversation, I would like you to describe your group, its objectives, where it operates, the people involved, and the people it works with. 

Ana Paula Pimentel: I am a psychologist, having graduated from the State University of Rio de Janeiro 11 years ago with a specialization in psychoanalysis and mental health, which have always been my areas of practice and research. I am the founder of Praxis and an IPAD student, part of the first cohort here in Rio de Janeiro. Praxis was officially founded in 2012. We decided to establish it as a civil society organization. It is a center of psychological study and practice that is located near the Madureira Market, in the North Zone of Rio de Janeiro.

Our objective is to offer mental health services, both for people who need to resolve psychological conflicts and for those who need career and family counseling. We offer a series of psychological services in this regard. We want to extend our services to people who are unable to afford this type of care because, unfortunately, it is a very exclusive type of care in this country in general. So we look to expand access to people in our peripheral territories. 

The people involved in Praxis are mostly psychologists, for both teaching and clinical staff. We have a team of eight coordinators, sixteen practicing psychologists in the clinic, and thirty-eight teacher-collaborators. So there are 62 people involved. We’ve been working in Madureira for eight years — with difficulty, though, because we don’t receive public subsidies. But we are organizing alternatives. Our services, for example, are based on a pay-scale… a popular or social pay-scale based on a person’s ability to pay. Since we’re in Madureira, we get people from the Baixada Fluminense, the North Zone, even from the South Zone of Rio de Janeiro. 

The places where it is more difficult to access psychological care are those that are farthest removed [from the center] due to inequality. Necropolitics is real. And mental suffering is a very real and intense reality there. It’s precisely this portion of society that finds itself barred from access. This is the first issue. 

Psychological care in general is inaccessible. When we think about public health, for example, frequently due to lack of availability, it is usually unable to meet demand. Especially when we are talking about outpatient psychological care, which is offered in just a few clinics for people who suffer from mental health problems. 

There’s the Structured Network of Psychological Care (RAPIS). But it is exclusively for people who suffer from severe and persistent mental health issues. And it is unable to meet demand; it’s too great. And why does this happen? It’s not just psychological specialists. But, generally speaking, our public health system, our Unified Health System (SUS), cannot handle [this demand] precisely because for many years it has been incrementally subjected to systematic divestment, undergoing true sabotage. It’s a logic of dismantling. Of suffering. It’s a logic that is so tangible to the reality of our country, resulting in difficulties to access. We see grave administrative problems. A suffocating public-private relationship, detrimental to public interests. We see grave problems in infrastructure. So, all of this chaos makes it difficult to access services and psychological services as well. 

When someone has a psychological problem, what are they going to do? If they can’t find a spot in the public system, they will look in the private system. And that’s when these services become infeasible for the majority of people. In the private system, for you to get an idea, there is a national table for psychologist fees available on the Federal Council of Psychology’s website. There’s a table with a list of psychological services with different values. And it charts out the minimum limit, the middle limit, the most commonly charged price, and the highest fees. A psychological consultation, for example, which is the most sought after service, has an average price of R$239 per visit. Taking into consideration that psychological care takes time, someone needs to go every week. They would have an average investment of approximately R$1000 reais per month. And that’s why I ask, who can pay one thousand reais exclusively for psychological care, without disrupting their family’s subsistence, without compromising their family’s income? 

For reference, Casa Fluminense has a map of inequality available on their website. There, we can see a series of interesting indicators for thinking about the issue of access, the issue of democracy, including in our region of Metropolitan Rio. This cost of R$1000 in reality appears on the map as the per capita income of the majority of the population. Ninety percent of Rio’s Metropolitan region does not even make R$1000 reais per capita. More or less, only 10% earn just a bit over this amount. So, we have approximately 13 million people in this region, an average of 90% of people that have no way of being able to afford psychological services within the reality of that chart. This price of R$239 is a reality for the wealthier regions. Here, in our periphery, in the communities, the population cannot pay that. So there [at Praxis] the consultation is about R$60-80. But even so, let’s say that’s an average of R$300 [per month]. Who can spend R$300 on psychological care living paycheck to paycheck? It’s also not a lot of people. 

If we went to my territory, which is Japeri, for example, there is, considering the map of inequality I mentioned, 14% of the population living on less than half of that R$300. Fourteen percent of the population of Japeri lives on an income of R$140. Which means that either someone gets psychological care, or they eat. 

This is a very grave situation. And it’s one that worries our collective. Our preoccupation is trying to expand access to this care knowing that the problem is so severe. Our contribution is very limited. We know it won’t fix everything. The issue is too big. But at least we are taking action. 

Another area we act in is offering complementary training in psychological care. We receive, to complement someone’s university education, psychologists or psychology students in their last semesters. They come to hone their practice. Of course we know that this is an exclusive, elite field. Psychologists need to always be training. Five years at university doesn’t make you a psychologist. It’s when you leave with your diploma that you come face to face with a very difficult reality in which you need to do very necessary specializations and trainings, the great majority of which are located in the South Zone of Rio and have incredibly high costs. What we also want to do is decrease this inequality in access. Many professionals from the North Zone and the Baixada Fluminense enroll. We do complementary training for psychological support. So professionals from other areas can also come and do the training and increase their psychological knowledge, their knowledge of mental health, for their practice. 

Cleber Ribeiro: How does your group interpret and put into practice the subjects of public health and democracy?

Ana Paula Pimentel: The first point that I’ll highlight is our understanding that health and democracy are practically synonymous ideas. So, when we try to understand and explain the idea of democracy, we end up explaining health, and vice-versa. For this idea to be clearer, before talking about the relationship, I want to talk about the idea of democracy and the idea of health. And then I’ll talk about the idea of the collective, about what we do, and about what we would like to be. 

I think it’s interesting for us to understand democracy together with its purpose, which is guaranteeing the dignity of life to all. 

This purpose can be gleaned principally from the federal constitution. I would like to highlight two articles that I think are important for this reflection. The third and the fifth. The third article, for example, lists four fundamental objectives for the State to be able to establish democracy. Paraphrasing, it says: to establish democracy, it is necessary to construct a free, just, and solidary society. The second objective is to guarantee national development. Third, to eradicate poverty and marginalization and to reduce social and regional inequalities. And the fourth objective is to promote the well-being of all without discriminating on the basis of place of origin, race, sex, color, age or any other form of discrimination. The fifth [article] lists a series of fundamental rights in order to achieve the dignity of life. It’s an enormous article, but I wanted to highlight just the opening lines, which already put forth this idea and five rights that are interesting for our reflections. The opening lines of article 5 say: “all persons are equal before the law, without any distinction whatsoever, Brazilians and foreigners residing in the country being ensured of the inviolability of the right to life, to liberty, to equality, to security and to property”. 

Highlighting these two articles, then, we see that the idea of democracy is linked to the idea of the dignity of life. And the dignity of life can be understood here, just in these two little snippets, as understanding that someone is able to lead a decent life, a just life, and equitable life, a free human life whose humanity and difference is recognized. Not just individual difference, but also collective. The constitution brings this up quite a bit. It’s important to recognize the difference between people, between cultures, between regions. It’s an access to freedom that needs to be guaranteed for all. Independent of social class, religion, or gender. 

Looking at these attributes of a dignified life, we see that, in truth, we do not live in a democracy. Especially when we look at the reality of Black people from the periphery. 

What we see is the establishment of an excessively minimal State. And as a result, inequalities increase. Misery increases. We see the State acting in such a way in order to ignore the basic necessities of periphery territories. People, then, have their very humanity ignored or, sometimes perversely invisibilized. We see a reality of violence that is naturalized, that is quotidian. When we look at these features, present in our territories, what we see is this group of fundamental rights blocked. When we think about the fifth article, for example. When it talks about the right to security, which should be inviolable. Security is one of the most violated rights in our territories. What’s more, it has a huge impact on people’s health. 

So here we can speak a bit about health. Health is another right; it’s fundamental to guarantee the dignity of life. When we think about democracy as the dignity of life, health should also be thought of as the dignity of life. That’s why I say that democracy and health should be thought of as synonyms. Our Unified Health System exists for that very reason, to guarantee our constitutional right. 

Health should not be thought of as just another right. It is democracy itself. Sérgio Arouca, a medical doctor, affirmed this at the 8th National Health Conference in 2008. What he wanted to assert is that, in truth, health is having rights. But to what? It’s the right to housing. It’s you having the right to a dignified job, with a just salary. It’s having the right to running water in your house. It’s eating properly. It’s the right to leisure. The right to education. So health is you having a set of rights that are fundamental. Without any given one of them, there is no way to talk about a dignified life. To explain this a bit better, Arouca takes up a very interesting concept, that of the economic cycle of illness, saying that life conditions are directly related to how possible it is for you to have health and, therefore, have a dignified life. 

With difficult life conditions, people are too weak to even fight for their rights and to break the cycle. On the other hand, when the population has access to this set of rights, which uphold the dignity of life, it gains strength together with its subjects. The struggle for rights gains strength, and, in this way, people can fight and are able to break the cycle. And so the powerful path for breaking the cycle is access to health. 

A guiding principle in this discussion is health as a path for social transformation. To this end, we try to do what we can. To see how far we are able to go. We understand that it’s important to unite struggles in order to be able to gain this right within the State. That’s what most attracted me to the IPAD course: its capacity to integrate the different struggles for rights of people who live in peripheries. 

It’s a characteristic of psychology to stick to clinical issues. It’s necessary and important, but we’re very restricted to this universe. When things open up, we make these link, we see how much the issues of life go beyond health. 

It’s necessary to get out of our comfort zones, that of looking strictly at health, and to expand this perspective. 

We need to unite struggles. Because starting from this expanded idea of what health is, we thought about how to strengthen democracy throughout the IPAD course. One path is to join health to this struggle. This interests all of us. All human beings, without exception.

Maria Evaristo: Valter, tell us about the TETO Collective [Roof Collective]. 

Valter Manuel Gomes Neto: I work with TETO, a social organization that works towards the goal of ending poverty. We believe that ending poverty and the struggle for equality can come about through the undertaking of community projects. These projects need to involve the residents of favelas and precarious areas where we operate — regions where basic rights are denied, like [the right] to sanitation, infrastructure, and dignified housing. 

We work on housing and infrastructure projects. We have an emergency housing project, where we build housing for families in communities. But we also have other infrastructure projects, like undertaking community works, composting toilets, staircases, bridges. There are various projects, all of which consider families’ abilities and their surroundings. 

I came to Minas Gerais ten years ago to work at the organization. During this time, I’ve learned a bit more about Minas Gerais. We operate in four cities: Terra Nossa in the Taquaril region in Belo Horizontes, Tomás Balduíno in Betim, Guarani-Kaiowá in the Contagem, and in Aldea Naô Xohã in São Joaquim di Bicas. In addition, we’ve done a few one-off projects in Pátria Livre, which are two MST [Landless Workers’ Movement] occupations also in São Joaquim de Bicas. 

Since the pandemic started, we are putting all of our effort into infrastructure projects connected to health. We’ve carried out projects building composting toilets, community bathrooms, community gardens, and dining halls. 


Mariana Evaristo: Based on TETO’s debates and actions, how do you understand the current relationship between sustainability and democracy?

Valter Manuel Gomes Neto: My answer is in line with what we’ve been discussing in IPAD about what democracy is. We understand that democracy is when everyone has the possibility to give their opinion and participate in the things they are embedded in — to participate in processes related to each person, to have their rights and their duties within that society. It very much includes this question of participation. And, in favelas, that’s something denied to people. It’s very common for us to arrive in a community and find places that don’t have basic sanitation, that don’t have a sewer system, that don’t have a place for trash collection. There’s no way to have potable water to use, to take a bath, to drink. And that’s how we see these nuances of how sustainability is denied within these spaces. How these people lose the right to lead a sustainable life because they are embedded in that context. 

An example. We arrived in a community that has a giant crater, over there in Tomás Balduino. And people there used to throw trash, throw debris in that crater. This crater got bigger and bigger, big enough to engulf a house. Residents began to get worried. During the rainy season, things got worse, making the crater even bigger. And so the residents’ first hurdle was understanding what needed to be done to shrink the crater. 

We talked about how the garbage that was being thrown there also contributed to increasing the size of the hole. We invited a geologist to speak with the residents. They explained exactly what was happening. 

I think, then, that sustainability has a strong connection to democracy. Within democracy, people need to have the right to be able to live a sustainable life, to have sanitation. How society is structured today denies this right to some groups. So we end up always thinking about democracy, in relation to citizenship and elections, but we end up forgetting that there is a range of things, like the right to the city, sustainability, the right to have a place to throw your trash away, to have quality sanitation. So I think that democracy should guarantee rights to these people. 


Mariana Evaristo: We saw this in the city of Belo Horizonte, during the rainy season at the beginning of this year, 2020. When rains impact neighborhoods in the periphery, media and policymakers tend to put the blame it on residents by saying that they don’t know how to throw their trash away, by questioning why they built their homes in high risk areas. But, when the floods reached the wealthy neighborhoods, it was a different conversation. They changed the discourse to keep validating that differentiation. 

Valter Mauenl Gomes Neto: The regions in southern and central Belo Horizonte were quickly renovated. Everything is already back to normal. While in the favelas where we work, there are residents who still don’t have a place to live, who were removed from where they lived, from the only home they had. And no initiatives were undertaken for them to be rehoused in a safer place. 

In one of the communities where we work, Terra Nossa, an occupation of residents in the periphery located in Taquaril, they’ve started a community garden. They cook dinner using food grown close to home. They are doing very cool work there.


IPAD - Institute for Thought and Action in Defense of Democracy | Brazil |


@IPAD-Seja-Democracia-105524541062291/ @ipadsejademocracia

Valter Manuel Gomes Neto | Brasil |

Valter Manuel Gomes Neto works for TETO in the metropolitan region of Belo Horizonte. TETO is an organization that seeks to overcome the poverty of the millions of people that live in precarious communities through community participation and through the mobilization of young volunteers.

@TETObra @tetobra

Ana Paula Pimentel | Brazil |

Ana Paula Pimentel is one of several psychologists that founded the NGO Praxis, an institution located in Madureira, a neighborhood with one of the highest concentrations of Black people in Rio de Janeiro. Her goal is to offer mental health care to people who are unable to receive care from the public health system and who cannot afford private health services. 



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