Abstract

Introduction

According to the World Health Organization (WHO) report, more than 1.6 million individuals lose their life to violence each year. In Brazil, accidents and violence are a large-scale problem for public health, impacting heavily on the mortality and morbidity of the Brazilian population. It is in the youth age group – corresponding to 15 to 24 years old, according to the WHO definition (OPAS, 1985), that the risk of lethal victimization is concentrated, and it is males who are more susceptible to victimization processes (Souza et al., 2003SOUZA, E. R. de et al. Análise temporal da mortalidade por causas externas no Brasil: década de 80 e 90. In: MINAYO, M. C. de S.; SOUZA, E. R. de (Org.). Violência sob o olhar da saúde: infrapolítica da contemporaneidade brasileira. Rio de Janeiro: Fiocruz, 2003. p. 83-107.).

In Brazil, in 2004, homicides accounted for 39.7% of deaths in the 15 to 24-year-old age group, whereas in the 0 to 14-year-olds and 25s and over, only 1.8% of deaths were from homicide, showing that juvenile victimization has reached very serious levels (Waiselfisz, 2006WAISELFISZ, J. J. Mapa da violência 2006: os jovens do Brasil. Brasília, DF: Organização dos Estados Ibero- Americanos para a Educação, a Ciência e a Cultura- OEI, 2006.).

The Map of Violence 2012 – children and adolescents in Brazil– showed that external causes of mortality in children and adolescents have been confirmed as the principal cause of death in this age group. In 1980, they accounted for 6.7% of total deaths in this age group. By 2010 this had increased, reaching 26.5% (Waiselfisz, 2012WAISELFISZ, J. J. Mapa da violência 2012: crianças e adolescentes do Brasil. Rio de Janeiro: Cebela: Flasco, 2012.). The rate grew by 346% between 1980 and 2010, with 176,044 children and adolescents falling victim (Waiselfisz, 2012WAISELFISZ, J. J. Mapa da violência 2012: crianças e adolescentes do Brasil. Rio de Janeiro: Cebela: Flasco, 2012.).

The analysis of the evolution in homicides in the decade between 2000 and 2010, shown in the Map of Violence 2012, shows that the already high numbers and rates of homicide among children and adolescents increased still further, from 8,132 – a rate of 11.9 in 2000, to 8,686 – a rate of 13.8 murders per 100 thousand children and adolescents (minors aged from 1 to 19 years old), in 2010 (Waiselfisz, 2012WAISELFISZ, J. J. Mapa da violência 2012: crianças e adolescentes do Brasil. Rio de Janeiro: Cebela: Flasco, 2012.). This rate places Brazil fourth in an international ranking of 99 countries in the WHO database, exceeded only by El Salvador, Venezuela and Trinidad and Tobago (Waiselfisz, 2012WAISELFISZ, J. J. Mapa da violência 2012: crianças e adolescentes do Brasil. Rio de Janeiro: Cebela: Flasco, 2012.).

Globally, and especially in Latin America, it can be seen that, in the epidemiological profile of mortality from homicide, young people, especially young men who are black or of ethnic descent, socio-economically disadvantaged and with low levels of education, predominate (Souza et al., 2012SOUZA, E. R. de et al. Estudo multicêntrico da mortalidade por homicídios em países da América Latina. Ciência & Saúde Coletiva, Rio de Janeiro, v. 17, n. 12, p. 3183-3193, 2012.).

In the municipality of São Paulo, homicide rates have been falling since 2001. According to Peres et al. (2011b)PERES, M. F. T. et al. Queda dos homicídios no município de São Paulo: uma análise exploratória de possíveis condicionantes. Revista Brasileira de Epidemiologia, São Paulo, v. 14, n. 4, p. 709-721, 2011b., the mortality rate from homicide fell by 74% between 2001 and 2008, the biggest decrease recorded in Brazil. In the 15 to 24 and 25 to 34 age groups in the Municipality of São Paulo, the decrease was greater than that found for the population as a whole, 78.0 and 74.0%, respectively” (Peres et al., 2011aPERES, M. F. T. et al. Queda dos homicídios em São Paulo, Brasil: uma análise descritiva. Revista Panamericana de Salud Publica, Washington, DC, v. 29, n. 1, p. 17-26, 2011a., p. 20). According to these authors, many hypotheses have been raised; thus, the need for studies to explain the current trend (Peres et al., 2011aPERES, M. F. T. et al. Queda dos homicídios em São Paulo, Brasil: uma análise descritiva. Revista Panamericana de Salud Publica, Washington, DC, v. 29, n. 1, p. 17-26, 2011a.).

Nery et al. (2012)NERY, M. B. et al. Regimes espaciais: dinâmica dos homicídios dolosos na cidade de São Paulo entre 2000 e 2008. Revista Panamericana de Salud Publica, Washington, DC, v. 32, n. 6, p. 405-412, 2012. conducted a spatial dynamic study of wilful homicides between 2000 and 2008 in the city of São Paulo and demonstrated that, despite the 73% drop in wilful homicide rates, from 55.7 to 14.9 per 100,000 inhabitants, analyzing the data by census tract showed that the decrease was neither homogeneous nor systematic. In Jardim São Luis and Jardim Ângela, peripheral districts in the south of the city of São Paulo, homicide rates were high in almost a third of census tracts (Nery et al., 2012NERY, M. B. et al. Regimes espaciais: dinâmica dos homicídios dolosos na cidade de São Paulo entre 2000 e 2008. Revista Panamericana de Salud Publica, Washington, DC, v. 32, n. 6, p. 405-412, 2012.).

Faced with the scale and impact of homicides in the young population, especially in the periphery of the city of São Paulo, this research was carried out starting from the premise that, in the field of health, Health Promoting and Monitoring Policies and Actions, based on social determination of the health-disease process, can potentially diminish violence and reduce its impacts and should be implemented in different territories within cities.

The main aim of promoting health is that individuals and collectives increase their control over the determinants of the health-disease process, in other words, empowering them in the struggle to improve their living and health conditions, with equality. The challenge lies in questioning the mechanisms of social production of health and quality of life in the context of globalization (Westphal, 2009WESTPHAL, M. F. Promoção da saúde e prevenção de doenças. In: CAMPOS, G. W. de S. et al. (Org.). Tratado de saúde coletiva. 2. ed. São Paulo: Hucitec; Rio de Janeiro: Fiocruz, 2009. p. 635-667.; Lico, 2009LICO, F. M. de C. Juventude, violência e ação coletiva. 2009. 331 f. Tese (Doutorado em Saúde Pública) - Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, 2009.).

The initial hypothesis of the study was that having and implementing equitable public policies, through improving living conditions and access to integrated collective action, with the participation of young people, has greater potential for decreasing mortality rates from homicide than individual or collective actions which are not integrative or participative.

The locations chosen for the study were the Administrative Districts (AD) of Grajaú and Jardim Ângela, peripheral and excluded regions of the city of São Paulo, where the coefficients for morbimortality from external causes are highest, although the local administrations had made use of different modes of changing the realities there to decrease violence, especially among young people living there.

The aim was to analyze and compare health promotion collective actions and experiences for young people, conducted by governmental and non-governmental organizations, dealing with and resisting violence, in the selected administrative districts. Although the WHO classifies adolescence as between 10 and 19 years old and youth as the period between ages 15 and 24 years old, for the purposes of the study we decided to focus on the 10 to 19-year-old age group, taking into account the characteristics of the young population indicated in the literature, and applying the term ‘youth’ to the interviewees from this age group (Pais, 2003PAIS, J. M. Culturas juvenis. Lisboa: Imprensa Nacional: Casa da Moeda, 2003. 352 p.).

Methodological proceedings

A case study (Lüdke and André, 1986LÜDKE, M.; ANDRÉ, M. E. D. A. de. Pesquisa em educação: abordagens qualitativas. São Paulo: EPU, 1986. 99 p. (Temas básicos de Educação e Ensino).), which included articulating quantitative data from secondary sources and qualitative data obtained through a variety of techniques, such as individual interviews supported by a form and self-reporting questionnaires and document analysis. For the analysis, we followed the explanatory guidelines for mixed method research, assuming that qualitative data help to explain the quantitative data which characterize the research problem (Creswell and Plano Clark, 2007CRESWELL, J. W.; PLANO CLARK, V. L. Designing and conducting mixed methods research. Thousand Oaks: Sage, 2007.).

The study took place in an area of great social vulnerability, as indicated by workers from the Subprefecture Coordination of Development and Welfare and the Health Technical Supervisors from the districts studied.

To meet the proposed objectives, we sought to obtain data on the region and on the different actors involved in the problem of violence against youths. The data collection took place in six stages.

Stage I was conducted in order to characterize the region studied and the inhabitants’ living conditions; stages II, III, IV and V were to discover the opportunities existing in the regions: the institutions, projects and actions on offer, the degree of integration between the projects and programs and young people’s access and participation in formulating and developing them. Stage VI aimed to discover the public policies being implemented in order to protect youths in the regions studied.

Stages of the Research

• Stage I: characterizing the region using secondary data – demographic, socio-economic, on health, education and living conditions collected by the Brazilian Institute of Geography and Statistics - Instituto Brasileiro de Geografia e Estatística (IBGE), The State System of Data Analysis Foundation - Fundação Sistema Estadual de Análise de Dados (FSEAD), and the Health and Education secretariats and the Subprefectures.

• Stage II: Survey of projects and actions conducted through interviews with leaders and bodies that protect and support young people in the two regions.

• Stage III: Household survey with youths who have left school and their parents – families most vulnerable to violence-, identified in the areas covered by Family Health Strategy Basic Health Units.

• Stage IV: Research with the health unit coordinators in the selected administrative districts.

• Stage V: School research: interviews (1) with the Pedagogical Coordinators of Directors of the Municipal Secondary schools (EMEFS) and State Secondary and High Schools and (2) with pupils from the two regions studied, in the 10 to 19-years-old age group identified in the schools in the areas covered by the family health strategy teams. Pupils were selected from the 5th to 7th grades in Secondary schools and the 1st and 2nd grades in the high schools.

• Stage VI: Research with administrators (1) interviews with subprefects and with managers from the Sou da Paz and Sociedade Santos Mártires NGOs and (2) the researchers’ participation in the Capela do Socorro Intersectoral Committee.

Table 1 shows the composition of the sample according to the stage of the research - Grajaú and Jardim Ângela AD.

The data from the different stages of research were analyzed differently according to the nature of the data collected (Minayo, 2004MINAYO, M. C. de S. O desafio do conhecimento: pesquisa qualitativa em saúde. 8. ed. São Paulo: Hucitec, 2004. 269 p. (Saúde em debate, 46).). Data on the territory were analyzed quantitatively and placed into tables and graphics. Data obtained through interviews were first analyzed qualitatively, using content analysis, and then quantitatively. To compare the data for the two districts and to analyze the content at the different stages of research, the Sphinx plus Version 4.0 software was used.

Tables and graphics were used to work with the quantitative data and analyses included univariate and bivariate analysis with absolute and percentage description, crossing variables and correspondence analysis (Pereira, 2001PEREIRA, J. C. R. Análise de dados qualitativos: estratégias metodológicas para as ciências da saúde, humanas e sociais. 3. ed. São Paulo: Edusp, 2001.). Chi square statistical tests were used because of contingency tables, in order to identify possible associations between the variables studied.

The categories of analysis in Stage II were based on the Innovatory Schools: successful experiences in public schools study - Escolas Inovadoras: experiências bem sucedidas em escolas públicas (Abramovay et al., 2003ABRAMOVAY, M. et al. Escolas inovadoras: experiências bem sucedidas em escolas públicas. Brasília, DF: Unesco, 2003.). Eight overall themes, those which recurred most often in the material collected, were identified in the projects offered to the young population. They were: education, culture, environment, health, sport and leisure, professionalization, psycho-social development and participation, communication and citizenship. The classification was based on the reading of the objectives and on the descriptions of the projects and actions developed by the entities, institutions and services in the regions. In order to classify the entities responsible for the projects developed for youths in the two regions studied, we used the Typology of Civil Society Actors (Lavalle et al., 2006LAVALLE, A. G.; CASTELLO, G.; BICHIR, R. M. Os bastidores da sociedade civil: protagonismos, redes e afinidades no seio das organizações civis. São Paulo: Cebrap, 2006.).

The study was approved by the Ethic Committee of the School of Public Health of the Universidade de São Paulo – COEP/FSP-USP, according to Resolution CNS 196/96, protocolo No 1,489, OF.COEP/276/06 and the Research Ethics Committee of the São Paulo Municipal Health Secretariat, research protocol CAAE – 00015/06, record No 0042/2006 – CEP – SMS. All participants signed an informed consent form.

Results and discussion

The Context

The study enabled it to be verified that the districts of Jardim Ângela and Grajaú, located in the south of the municipality of São Paulo and incorporated in the subprefectures of M’Boi Mirim and Capela do Socorro, respectively, since August 2002, have various aspects in common. Both districts lie in environmentally protected areas. The occupation process began in the 1960s, associated with the industrialization of the Santo Amaro region. This process gave rise to the breakup of former smallholdings and ranches in both areas, as well as to the creation of neighborhoods and housing characterized by irregular settlements lacking infrastructure, remaining thus, in many areas, until the present day.

Both districts show elevated demographic growth, with populations of predominantly low income, migrants from other regions of Brazil. The population profiles for the two districts are similar, revealing a high proportion of young people and a high birth rate, according to the demographic census from 2000 (São Paulo, [2007SÃO PAULO (Município). Secretaria Municipal de Planejamento. Histórico demográfico do município de São Paulo, [2007]. Disponível em: <http://sempla.prefeitura.sp.gov.br/historico/tabelas.php>. Acesso em: 22 de jan. 2007.
http://sempla.prefeitura.sp.gov.br/histo... ]).

According to the same source, the distribution of households according to household income in minimum wage bands in Jardim Ângela and Grajaú, is mainly below three and between three and five minimum wages, these bands representing, respectively 60.3% and 58.8 % of all households, compared with 37.7% of the total for the municipality of São Paulo.

Comparing the population percentage classified as vulnerable according to the criteria of the Centro de Estudos da Metrópole (Brasil, 2007BRASIL. Ministério das Cidades. Secretaria Nacional da Habitação. Centro de Estudos da Metrópole. Assentamentos precários no Brasil urbano. Brasília, DF, 2007. Disponível em: <http://www.direito.mppr.mp.br/arquivos/File/relatorio-assentamentos-precatorios-no-brasil-urbano.pdf>. Acesso em: 6 jul. 2007.
http://www.direito.mppr.mp.br/arquivos/F... ), in Grajaú and Jardim Ângela, 35.57% and 37.59%, respectively, were classed as severely and very severely deprived, this figure being 11.15% for the municipality as a whole, meaning that, in the areas studied, this age group was associated with high social vulnerability.

Violence among causes of death in the youth population

The study shows that the epidemiological profile of mortality from homicide in the selected districts follows the global trend, and that of Latin America, with a predominance of young, male victims, as shown in the introduction to this article.

The main cause of death, in both the municipality and the districts on which we focused, is cardiovascular disease, responsible for around a third of deaths. Whereas in the municipality the second most common cause of death was from tumors, in the Grajaú and Jardim Ângela, this position was occupied by external causes, of which homicide among youths is responsible for the majority of these deaths (São Paulo, 2007SÃO PAULO (Município). Secretaria Municipal de Planejamento. Histórico demográfico do município de São Paulo, [2007]. Disponível em: <http://sempla.prefeitura.sp.gov.br/historico/tabelas.php>. Acesso em: 22 de jan. 2007.
http://sempla.prefeitura.sp.gov.br/histo... ).

Observing the 10 to 19-year-old population, the focus of this study, it was verified that, between 1996 and 2007, in the municipality of São Paulo the total number of homicides recorded was 9,416, corresponding to 17.4% of total deaths in the municipality for all age groups. In Grajaú this percentage was 6.1% of total deaths occurring in the municipality in the age group in question and, in Jardim Ângela, 4.9%. The populations in Grajaú and Jardim Ângela in this age group correspond to 4.5% and 3.0% of the municipal population in this age segment (São Paulo, 2007).

When the 15 to 19-year-old age group is focused on, the proportion of deaths corresponds to 94.0%, 92.3% and 93.8%, respectively, for São Paulo, Grajaú and Jardim Ângela, showing that juvenile victimization is high, accompanying the percentages of deaths for the City of São Paulo.

Regarding the mortality rate from attacks/homicides, characterized by the events classified in items X85 and Y09 in the International Classification of disease – ICD 10, 2006 had the lowest figures since 1996, reflecting the declining trend for the municipality of São Paulo (São Paulo, 2007).

This trend is also present in Jardim Ângela and Grajaú, indicating a decrease in violence represented by deaths from attacks/homicides, a fall which is more noticeable from 2003 onwards, in both districts (Figure 1). The secondary data enable us to affirm that, in the municipality of São Paulo and in Jardim Ângela and Grajaú, the number of deaths relative to the young, male population in the 15 to 19-year-old age group is still falling in all territories (Table 2).

The trend for homicides to decline, found in the regions studied, is in line with the movements verified in the state and city of São Paulo, as was pointed out in the introduction. In the municipality of São Paulo, the trend of decline verified from 2000 onwards, stands out because of its accentuated rhythm over a short space of time and it “imposes itself on researchers and public administrators as an ongoing issue” (Peres et al., 2011aPERES, M. F. T. et al. Queda dos homicídios em São Paulo, Brasil: uma análise descritiva. Revista Panamericana de Salud Publica, Washington, DC, v. 29, n. 1, p. 17-26, 2011a., p. 18). The authors emphasize that this singularity means the municipality is considered an exemplary case, although the determinants in the reduced rates of lethal violence are still unknown (Peres et al., 2011aPERES, M. F. T. et al. Queda dos homicídios em São Paulo, Brasil: uma análise descritiva. Revista Panamericana de Salud Publica, Washington, DC, v. 29, n. 1, p. 17-26, 2011a.).

Among possible explanations for the decrease in homicides, studies highlight actions and investments in field of public health and disarmament actions (Peres et al., 2012PERES, M. F. T. et al. Evolução dos homicídios e indicadores de segurança pública no município de São Paulo entre 1996 a 2008: um estudo ecológico de séries temporais. Ciência & Saúde Coletiva, Rio de Janeiro, v. 17, n. 12, p. 3249-3257, 2012.; Waiselfisz, 2011WAISELFISZ, J. J. Mapa da violência 2011: os jovens no Brasil. São Paulo: Instituto Sangari; Brasília, DF: Ministério da Justiça, 2011.).

The trend verified in the state capitals and large metropolitan conglomerations has also been explained by the phenomenon of homicidal violence moving to the interior, related to the process of economic de-concentration, with the appearance of growth hubs in the interior of the states (Waiselfisz, 2011WAISELFISZ, J. J. Mapa da violência 2011: os jovens no Brasil. São Paulo: Instituto Sangari; Brasília, DF: Ministério da Justiça, 2011.).

A study conducted by Peres et al. (2011b)PERES, M. F. T. et al. Queda dos homicídios no município de São Paulo: uma análise exploratória de possíveis condicionantes. Revista Brasileira de Epidemiologia, São Paulo, v. 14, n. 4, p. 709-721, 2011b. shows that demographic alterations, acceleration of the economy, and, in particular, the drop in unemployment, investment in social policies and changes in public safety policies may act in synergy to reduce homicide mortality rates in the city of São Paulo, although it is necessary to develop complex analysis models incorporating the joint action of different factors with explanatory potential (Peres et al., 2011bPERES, M. F. T. et al. Queda dos homicídios no município de São Paulo: uma análise exploratória de possíveis condicionantes. Revista Brasileira de Epidemiologia, São Paulo, v. 14, n. 4, p. 709-721, 2011b.).

In the regions studied, various factors may explain the reduction, among them, greater investment in Public Safety, as well as the existence of Projects developed by non-governmental organizations together with the Subprefectures, in addition to projects and programs developed by social bodies, schools and Health Units in the regions.

Although a declining trend in homicides was found, when homicides between 1996 and 2007, particularly those affecting the young, male population, are analyzed, we verified that these regions are still considered violent, without significant difference between them. This evidence was obtained comparing data on mortality from external causes in the Municipality of São Paulo – 9.13%, with those of the regions studied – Grajaú 15.56 % and Jardim Ângela 16.53 %, in 2007 (São Paulo, 2007SÃO PAULO (Município). Secretaria Municipal de Planejamento. Histórico demográfico do município de São Paulo, [2007]. Disponível em: <http://sempla.prefeitura.sp.gov.br/historico/tabelas.php>. Acesso em: 22 de jan. 2007.
http://sempla.prefeitura.sp.gov.br/histo... ).

Regional differences in homicide rates, whether between different countries or in the interior of the same country, show the role of social inequality, as well as differences in gender and race, suggesting more attention on urban environments associated with violence and structural understanding of the phenomenon (Nery et al., 2012NERY, M. B. et al. Regimes espaciais: dinâmica dos homicídios dolosos na cidade de São Paulo entre 2000 e 2008. Revista Panamericana de Salud Publica, Washington, DC, v. 32, n. 6, p. 405-412, 2012.; Peres et al., 2012PERES, M. F. T. et al. Evolução dos homicídios e indicadores de segurança pública no município de São Paulo entre 1996 a 2008: um estudo ecológico de séries temporais. Ciência & Saúde Coletiva, Rio de Janeiro, v. 17, n. 12, p. 3249-3257, 2012.).

Health Promotion Projects, Collective Actions and Public Policies in the Districts of Grajaú and Jardim Ângela

Analysis of the projects and actions developed by leaders and entities (Care Providers, Neighborhood Associations, Community Associations, Non-Governmental Organizations and Civil Society Public Interest Organizations) verified that, in both districts, the majority of projects and actions aimed at youths in the 10 to 19-year-old age group were developed in the area of participation, communication and citizenship (58.4%). These were followed by projects in the area of education (44.4%), this percentage being higher in Grajaú (60.6%) than in Jardim Ângela (19%).In the area of psycho-social development, the percentage was higher in Jardim Ângela (47.6%) than in Grajaú (27.3%). There were no significant differences between the regions with regards projects developed by the Leadership/Entities studied in the areas of: culture (27.8%), professionalization (18.5%), sport (18.5%), environment (16.7%), health (14.8%) and care (13%). With regards the distribution of the social entities which promoted these projects, according to the typology adopted in the study, it was observed that Neighborhood Associations predominated in Grajaú (33.3%), followed by Care Providers (21.2%) and NGOs/OSCIPs (15.2%), whereas in Jardim Ângela, Care Providers (61.9%) stood out, followed by Neighborhood Associations (14.2%) and Community Associations (9.5%).

In Jardim Ângela, the importance of the Catholic Church stands out, in the form of the Sociedade Santos Mártires - Society of Holy Martyrs, which was created in 1988 and since then has developed projects and actions aiming to intervene and change the situation in the region, as can be verified in analyzing the network protecting against violence mentioned in this article.

Analysis of projects and actions to tackle violence developed by EMEFS and by the selected State Elementary and High schools in the districts studied, shows the existence of projects concerning participation, communication and citizenship (60.0%), followed by educational (50.0%), cultural (48.6%), environmental (42.9%), health (37.1%), psycho-social development (18.6%) and sports and leisure (12.9%) projects. Significant differences between the districts were verified in the cultural projects, with 58.7% in Grajaú and 29.2% in Jardim Ângela, as well as for the projects in the area of the environment, with 52.2% in Grajaú and 25.0% in Jardim Ângela. The results show greater participation on the part of schools in the District of Grajaú in developing cultural and environmental projects in the region.

The main objectives of the projects, classified according to the described criteria, were: raising environmental awareness (37,1%), community/school integration (30.0%), promoting culture and beliefs (27.1%), developing self-esteem (17.1%), literacy (12.9%), leisure and culture activities (12.9%), preserving school property (12.9%), preventing AIDS and STDs (11.4%), developing reading and writing skills (10.0%), preventing alcohol and drug use (10.0%). None of them had the explicit objective of promoting peace rather than violence.

The Health Units reported developing projects and actions that were predominantly in the area of health (93.6%). Of the actions developed by health care professionals, the following stood out: pregnancy and post natal care (33.3%), sexual education (33.3%) were those most reported in Grajaú (46.2%) and actions aimed at contraception (23.1% in Grajaú and 30.3% in Jardim Ângela). No mention was made of aiming to promote peace rather than violence, although the positive actions developed lead to this.

In the study, it was observed that the projects and actions in both districts are aimed at leisure and culture activities, showing that, in the context of socio-cultural transformation, new places seem to appear in the world of the juveniles, almost always linked with culture (Dayrell, 2003DAYRELL, J. T. O jovem como sujeito social. Revista Brasileira de Educação, São Paulo, n. 24, p. 40-52, set./dez. 2003.). According to this author, the world of culture appears more democratic and enables spaces, times and experiences to occur, allowing the youths to construct themselves as subjects; however, in Brazil, cultural modernization has a strong influence on the lives of young people, but is not accompanied by social modernization. Thus, “if culture is presented as a more open space, it is because other social spaces are closed to them. We cannot fall into the ingenuous trap pf overvaluing the world of culture as a panacea for all of the problems and challenges young people face” (Dayrell, 2003DAYRELL, J. T. O jovem como sujeito social. Revista Brasileira de Educação, São Paulo, n. 24, p. 40-52, set./dez. 2003., p. 51). As the author says, in the context in which poor youths live, any institution – school, work or those linked with culture -, in and of themselves “can do very little if unaccompanied by a wider support network, with public policies guaranteeing space and time for young people to find themselves as subjects and citizens and fully experience youth” (Dayrell, 2003DAYRELL, J. T. O jovem como sujeito social. Revista Brasileira de Educação, São Paulo, n. 24, p. 40-52, set./dez. 2003., p. 51). We consider that the conditions the author sets in order for exposure to cultural projects to result in citizenship do not exist in the two regions studied, as we will see an analyzing the youths’ participation.

On the topic of participation, the leaders reported that the youths participated in the projects and actions developed by the entities (83.3%), with no differences between the two districts. Regarding the type of participation, 42.2% of the youths made suggestions for developing the projects, but did not participate in decision making. A greater percentage of responses was found in Jardim Ângela (60%). The most frequently found form of participation was through specific meetings (20%).

Those interviewed from education reported youth participation in the projects in schools (71.4%), with 30% conducted in the classrooms with the teachers. Participation also occurred through suggestions (26%), projects mediated by educators (16%), in Class Councils (20%) and in Student Unions (10%), with no significant differences between the districts.

The health care professionals reported that 63.6% of the youths participated in actions and projects developed by the Health Units, in organized groups (52.4%), in meetings and talks (28.6%), during care and consultations (14.3%) and in the welcoming processes conducted by community health agents (4.8%).

Although the professionals connected to the projects reported that the youths participated in the activities, this information does not coincide with the statements of the young people interviewed. The majority of young students said that they did not participate in community groups (93.7%), indicating their negligible involvement in the actions and projects existing in the regions. Those who did mention participating in activities referred to church groups, 15.4% in Jardim Ângela and 6,3% in Grajaú.

Of those who were no longer studying, 97.4% said that they did not participate in any type of group, with no significant difference between the districts.

The public policies identified and evaluated by the interviewed administrators and leaders as successful in tackling violence and improving living conditions in Jardim Ângela, were 22.00 closing time for bars and the establishment of Community Police bases. There was no mention of actions concerning improving neighborhood infrastructure, encouraging participation in the projects or even forming networks between the projects.

Regarding collective actions, the Forum for Defending Life by Overcoming Violence played an internal and external role in the region in dealing with violence and improving health conditions and quality of life. This forum was created by the first Walk for Peace in Jardim Ângela, organized by Catholic Church leaders, which took place on 02 November 1996.

According to the interviewees in Jardim Ângela, the forms of dealing with violence in the region have been improved by the integration of public authorities and civil society and the formation of a network for developing projects and actions, with falling rates.

Another important collective action also identified in Jardim Ângela was the creation of the Civil Tribunal, with the aim of making the authorities deal with the population’s demands. Two public civil actions were brought, one in 2002 in the area of health and safety and another in October 2008, in the leisure and culture area. The results of the latter civil action were deemed unsatisfactory. According to the interviewee, [...] we have had two tribunals, now we are promoting public civil actions, six months have gone by and they have done nothing, not in culture or in health, so we are going to bring a public civil action (L).

In the subprefecture of Capela do Socorro, a partnership was established with the Instituto Sou da Paz, the Local plan for Preventing Violence and Promoting Coexistence, drawn up in participation. It was committed to promoting peaceful coexistence and safety in Grajaú, to decreasing adolescent and youth involvement in violence and to reducing the crimes that were most common or had the highest impact in the district. The Instituto Sou da Paz articulated actions between the subprefecture, the entities and the population in the region.

The interviewees’ statements showed the difficulties in consolidating the Plan, wue to the lack of dialogue between the subprefecture and local entities. According to the interviewee, [...] for us at this time, it is very difficult to invest in the local authorities to consolidate these actions [...] so we are going to invest in the community, to consolidate the program’s sustainability (E. 2).

In the interviewees’ opinions, there are various initiatives dealing with violence in Grajaú, but the collective actions are specific and unconnected.

According to the administrators, effort is made to involve the entities and communities, but there are difficulties. Many entities are centralized around two or three people, the group is not representative of those with interest in the community’s problems.

In contrast to Grajaú, in Jardim Ângela there was, initially, an intense mobilization of the civil community, outraged by the high levels of violence in the region, in which the Catholic Church played a significant part, although this was not an integrated action. The Catholic Church, represented by the Sociedade Santos Mártires, played an essential role in linking and establishing a network to protect from and tackle violence in the region.

The history of dealing with violence in Grajaú is more recent and it is the NGOs which act to coordinate actions and mediate conflicts in the region. One of the main challenges is to promote cooperation between entities from civil society, from local youth, public institutions and the subprefecture in order to take responsibility for and consolidate the Peaceful Coexistence plan in the district.

Violence Protection Network in the Districts

The protection network in the regions is composed of individuals, institutions, governmental and non-governmental organizations, with coordinated initiatives for the support and development of young people. Analysis of these networks shows that the interventions are principally aimed at reducing the risk of violence (33.3%), with 42.1% in Jardim Ângela and 24.1% in Grajaú. Regarding the integration of projects and entities, the Correspondence Analysis (CA) indicated 259 associations between them, 125 in Grajaú and 134 in Jardim Ângela, corresponding to, on average, 2.3 associations per entity interviewed, with the relationship of articulation more significant in Jardim Ângela than in Grajaú.

Figure 2 – CA in Grajaú – shows that the schools in this region play a centralizing role, acting together with diverse programs and actions. The other entities, including neighborhood, community and care associations, concentrate mainly on assistentialism, especially concerning distributing milk and providing crèche and nurseries. Other actors are active in the territories, playing similar roles without, however, these being well defined in the integrated action against violence.

Figure 3 – CA Jardim Ângela – shows a situation that is a little different. Although the school plays a relevant role, this is shared with health care entities with intense participation in administering programs directed at young people.

In both districts, (Figure 2 and 3), there is evidence that the associative entities are principally involved in assistentialism, this perhaps being one of the motives why young people do not participate in them. An important function performed by these entities is teaching literacy to young people and adults.

From the correspondence analysis and its results, we can conclude that there are relationships between the existing institutions acting in the two districts, constituting prototypes of networks, albeit with fragile links, as the majority implement their programs without integration. In Figures 2 and 3, it can be seen that the links in the networks that group together the institutions in the two districts are still inconsistent, making them ineffective for protecting the young people living in the regions studied. The multiple programs act practically in isolation, providing care but not encouraging the development of personal skills or the adoption of participation or empowerment strategies for the young people, enabling them to deal with situations of violence and its causality (Gomes et al., 2010GOMES, R. et al. Êxitos na prevenção da violência. Rio de Janeiro: Fiocruz, Ensp, Claves; Hucitec, 2010.).

Thus, we can conclude that the young people in these districts are not protagonists in public policies, taking little part in the collective actions underway and those who no longer attend school are excluded from public policy and the projects of the entities, essential for their integrated development. This becomes even more serious when we consider the fact that the study was conducted in family health strategy areas, regions considered to be most socially vulnerable.

São Paulo, a megacity in which socio-economic development is growing, still has few special projects for children and young people in its peripheral regions, increasing the probability that social vulnerability in these areas will continue and even increase, as in the case of the districts of Grajaú and Jardim Ângela.

Urban violence is a significant health problem and directly and indirectly affects the entire population of the city, although risk of mortality from homicide varies considerably between the different regions of the city. Those who live in the areas that are most socially vulnerable are at higher risk than those who live in areas with better social conditions. Subordinate to this macro-structural determination, differences in exposure between age, gender and racial groups stand out.

Thinking about the relationships between violence and the situation of children and young people through the prism of public health is a challenging and complex task. “The real complexity of experience of the phenomenon of violence requires overcoming meanings and opening up to the integration of efforts from various disciplines, sectors, organizations and community” (Minayo, 2002MINAYO, M. C. S. O significado social e para a saúde da violência contra crianças e adolescentes. In: WESTPHAL, M. F. (Org.). Violência e criança. São Paulo: Edusp, 2002. p. 95-114., p. 112).

In the context in which poor, young Brazilians live, public policies, projects to prevent violence and collective actions should exist, adopting the complexity of the phenomenon of violence, its macro-structural roots, its forms of expression and the cultural and interpersonal issues involved in the conceptual framework.

The young people of the two districts are excluded from the policies which could affect such macro-structural conditions: housing, sanitation, quality education, vocational training with the possibility of employment, better salaries, access to culture, leisure etc., conditions essential for driving social change and health and violence indicators (Buss and Pellegrini, 2007BUSS, P. M.; PELLEGRINI, F. A. A saúde e seus determinantes sociais. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 17, n. 1, p. 77-93, 2007.).

According to Spósito (2003)SPÓSITO, M. P. Trajetórias na constituição de políticas públicas de juventude no Brasil. In: FREITAS, M. V. de; PAPA F. de C. (Org.). Políticas públicas: juventude em pauta. São Paulo: Cortez, 2003. p. 57-75., there is a consensus concerning the need to implement public policies aimed at young people in Brazilian society; therefore, analysis of existing initiatives in the districts studied may contribute to constructing a new paradigm around this issue.

Final considerations

The findings show that, in the two districts studied, public authorities – the subprefectures were concerned with the high violence and homicide rates. Interventions of projects, programs and actions developed in the regions of the study are mainly aimed at education, culture, sport and leisure and socio-educative development, aiming to reduce the risk of violence. The young people, however, are not protagonists in the projects of the entities and in public policies to improve living and employment conditions in the region.

In both Districts, the networks protecting young people are diffuse, the schools play a dominant role and the entities carry out more care practices. The fall in the mortality from homicide rate was greater in Jardim Ângela than in Grajaú from 2003 onwards, in line with the trend noticed in the city of São Paulo and Brazil as a whole. Although a fall in incidences of violence was recorded, the rates are still high in these two districts, compared with the rest of the municipality.

The initial hypothesis of this study was partially confirmed. We emphasize the difficulty in stating that the reduction in violence is actually attributable to the projects developed, bearing in mind their fragility and the low level of coordination between them, especially in the district of Grajaú.

This study may contribute to the inter-sectorial experiences, projects and actions developed in these regions, when valued and publicized, encouraging decision makers to think of an outline of broad, universal policies including equality and the rights of children and young people to quality of life. New policies aimed at dealing with violence and its determinants, especially social inequality, should assume that the young people are social subjects with autonomy and are active interlocutors in formulating, executing and evaluating the policies.

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