Safety’s Impact on Physical Activity in Brazil

Yaphet Getachew and Jennifer Mandelbaum,

2015 GHLI Fellows

We often hear parents complain that their kids spend too much time on the internet or they are too lazy to play outside. But, in Brazil, it’s not lack of desire among kids to be active, there is a far more serious reason why physical activity is a challenge – safety.  

As part of our GHLI fellowship this summer, we spend time in Brazil observing the Agita São Paulo program – designed to prevent childhood obesity through physical activity. During our first week in Brazil, we visited the island of Ilhabela to learn about efforts in both elementary and middle schools to help kids be more active. 

We met with representatives from the Secretary of Education and learned about the very real barriers to physical activity facing children on the island. For example, even though they’re surrounded by water, the majority of children and their parents on the island do not know how to swim. Parents worry about violent crime, causing them to keep their children indoors most hours that they are not in school. And, so the only real safe space students have to exercise is within the schools. This leads many children to spend their free time playing video games or watching television and being sedentary instead of playing sports outside with their peers. Students are typically only in school for half of the day, leaving many hours of unscheduled time, which is why the development of active after-school programs is crucial.

Given these barriers to physical activity, Ilhabela has made strides to provide outlets for physical activity in schools. For instance, the schools we visited had recently built an athletic facility, which included a basketball court and a pool. Our visit to the schools gave us a much clearer picture of the physical activity environment theses kids can access and helped us develop recommendations for Agita’s future programs. Maybe more importantly, we observed how a community bands together to tackle a major problem for its children.

Addressing Violence in Early Childhood to Improve Global Health

Mike Skonieczny, GHLI Executive Director

From left to right: GHLI Executive Director Mike Skonieczny,
First Lady Ana Estela Haddad,
and James Leckman, MD of the Child Study Center

Childhood violence and global health – two seemingly disparate issues that may be more closely related than one might think. As part of the Yale Global Health Leadership Institute Forums for Change program, we worked with colleagues at the Yale Child Study Center and in Brazil to discuss early childhood development (ECD) issues, including the effect of violence on children. 

Comprised of academics, clinicians, policymakers and advocates, our Brazilian delegation recently visited Yale with the goal of continuing to develop effective ECD programs for the children of São Paulo. The group discussed how the welfare of children and families is about more than just physical health, and why emotional and mental well-being are also critical components. But what does violence have to do with global health? 

Research by the World Bank has proven that children who participate in well-conceived ECD programs tend to be more successful in school and are more competent socially and emotionally. The early years are also critical in the formation of cultural norms, identities and prejudices in terms of a child’s behavior towards others.

In 1996, the World Health Assembly declared violence a major public health issue. This signaled an urgent need to reduce the toll of day-to-day violence and finding effective ways of preventing larger conflict. Peace-building efforts have generally involved top-down approaches, but peace is more than just the absence of physical conflict – it is a multi-dimensional process of investing in social, economic and political structures and policies that minimize violence in all of its forms.

Given this wider scope, early childhood development issues have gained unique significance. ECD programs present an untapped opportunity for empowering young children with the values, attitudes and skills that contribute to the reduction of violence in their communities. There is an enormous opportunity for ECD programs to build safer and healthier families, communities and, potentially, nations.

Helping the Smallest in One of the Biggest Countries in the World

Carolina Rivera, 2014 GHLI Fellow

The fifth most populous country in the world, and fourth largest economy with burgeoning growth, Brazil still faces serious struggles involving wealth disparity, poverty and violence. There also exists a wealth of knowledge, passion and solidarity that have helped the country achieve universal health care and allowed it to make substantial strides in the field of early childhood development.

I’m currently in Brazil working as part of the GHLI Forums for Change. Compared to the 11 million São Paulo city residents, 43 million São Paulo state residents and more than 200 million residents of Brazil, our delegation of 10 leaders may appear minuscule, but is large in spirit. 

During my time in this beautiful country, I already met the Minister of Health, Arthur Chioro, who is in charge of administration and oversight of the “Unified Health Care System” for all of Brazil. The Minister signed into action the allocation of millions of dollars to public hospitals in São Paulo for the healthcare of expectant mothers and children.

Through multiple site visits to work places, universities and hospitals, I help identify critical points of contact and opportunities for meaningful collaboration. Despite their different backgrounds, from government officials to academics and the third sector, all acknowledge the importance of communication and partnership in moving forward with efforts to improve early childhood development in São Paulo and Brazil.

As I continue my work here, I’m excited to establish and solidify more ways that our Brazilian delegates can work together, share information, and expand both our group and potential impact. Great, complex and ever-growing, São Paulo, Brazil is fortunate to have these visionary leaders working to improve early childhood development opportunities for all.

Integrating Interventions for Early Childhood Development in Brazil: GHLI Forum for Change

Bacy Fleitlich-Bilyk, PhD 

I am a child psychiatrist, and when I leave home to see my patients, my son Tiago understands that I have to go and help them feel better. But my trip to Yale University was a little more difficult to explain; the focus was much broader: “Integrating Interventions for Early Childhood Development (ECD) in Brazil.”

ECD is a global health challenge that requires multi-disciplinary collaborations. Our delegation is composed of professionals from the public sector, academia, and NGOs.  At the beginning of our visit we set two main goals: learn how to bridge policy and practice in ECD; and how to work together in public and private partnerships. After just the first day of sessions, I left with a greater understanding about these issues. And hearing about the great work done at Yale inspired me to continue my work back home!

Then we spent time with Minding the Baby Training Institute staff to learn how they help needy families to improve parenting, parent-child and family relationships, and child development. The training program presented us with new concepts such as mentalization theory and reflective functioning – tools that we can take home to help us build our own parenting program. The challenge, however, will be to adapt this tool in a city with 860,000 children under 3 years old and an average of 175,000 births per year.

Over the course of the week, invaluable bonds were formed. Maybe GHLI was the spark that we needed to spur collaboration, or maybe we all needed to benefit from learning and practicing the reflective functioning approach, but we all returned home with a renewed energy to continue to work towards improved ECD in São Paulo.

Um Sonho Brasileiro (A Brazilian Dream)

Mary Weng, 2013 GHLI Fellow

Back in New Haven after nine weeks in Brazil, I realize how lucky I was  to participate in an internship that offered me the chance to help  with improving early child development (ECD).  To be involved with ECD outcomes in São Paulo city at many different levels – working with  state and municipal government leaders, university researchers, advocates, and community health workers, was truly a unique experience.

As my plane took off and I watched the beautiful Brazilian nightscape disappear into the clouds, I couldn’t help but feel overwhelmed by how my work this summer was just the first drop in the ocean of this long-term project. I am proud of the progress that has been made so far. Even in my last week, my schedule was full of site visits to various neighborhoods to assess ECD needs and the feasibility of starting a pilot intervention.  And, soon after my departure, the city of São Paulo launched a Municipal Policy for Early Child Development, defining principles and guidelines for actions related to ECD. It is very encouraging to see a commitment from the government in putting early childhood as a priority. However, the true challenge will be in how the mayor goes about carrying out his new policy, and my hope is that he will seek input from people working on the ground in the various neighborhoods.

This experience has been formative in solidifying my interest in global health. I learned just how challenging and rewarding it is to map the landscape of an issue, and to facilitate collaboration between professionals from many different sectors. I came back to New Haven equipped with my most valuable souvenir: the notebook full of my scribbles from everything I witnessed this summer, each page a glimpse into my beautiful Brazilian dream.

Exploring Brazil’s ECD landscape

Mary Weng, 2013 GHLI Fellow

With a population of more than 11 million, São Paulo city could be classified as a small country. Working with public health on such a large scale is certainly daunting, but I am reminded that while there are great challenges, the potential benefits and gains are also great.

When I first started work on a strategy for early child development (ECD), I strived to seek out the perfect plan that would address the issue. My experience this summer has taught me that there is no “silver bullet” to address ECD in Brazil. During various site visits, I witnessed extremes in the range of quality and delivery of care. I visited the Dante Pazzanese Cardiology Institute, one of the premier pediatric cardiology centers in Latin America, and in contrast, then visited an Unidade Básica de Saúde (primary care unit) in a under resourced area of the city, where doctors sometimes see up to four patients an hour.

In a city as large as São Paulo, the vulnerabilities that children face are diverse. No single program or plan can address all of the issues; a set of strategies would be more adequate. At the same time, I have learned that the implementation process is just as important as the plan itself, and that the people working with the children must be equipped with the ability to handle the vulnerabilities they encounter.

I’ve met with NGO activists, child psychiatrists, nurses pioneering parenting programs, public health officials from the city of Sao Paulo – and I am inspired by the way everyone I have met does his or her job with such passion. The children of São Paulo have some great advocates on their side! As a result of my meetings thus far, I have been able to better map existing ECD programs and policies, and identify possible gaps that need to be addressed. With just a few weeks left in the country, I am picking up the pace to make sure I observe and contribute as much as I can before I leave.

Bom Dia, Brasil!

Mary Weng, 2013 GHLI Fellow

I arrived in São Paulo amidst the wave of protests where hundreds of thousands of people took to the streets of Brazil each night. The protests started out as a small movement against transportation fare hikes, but have spiraled into a nation coming together to fight for better health, education, and public services. The energy among the people is contagious, and I have no doubt that I am witnessing the making of Brazilian history.

My work here focuses on improving the vast inequity of access to early child development programs, and I think this issue is especially meaningful in light of all the people demanding a better quality of life. Support in early childhood has been associated with higher school attainment, lower crime rates, and higher incomes. The delegation I am working with consists of key players from many different sectors: academia, municipal and state governments, and the NGO sector. One of my most interesting roles in this project is to serve as the middle person to improve coordination between the different sectors. I am grateful to have the opportunity, early in my public health career, to learn about the widespread challenge of translating health policy and research into effective delivery of services.

I have to mention all the FUN I’ve been having as well! I arrived in time to attend a “Festa Junina” (June Festival), a celebration with great food and “quadrilha” (square dancing). Last weekend, I spent time in the beautiful city of Campos de Jordão. While I was there, I was fortunate to catch an amazing concert by the São Paulo Symphony Orchestra, conducted by Marin Alsop (Yale ’77).  I’m so excited to see where this project goes, and plan on making the most of the precious weeks I have left. Tchau!

Visiting Brazil to Discuss Early Childhood Development

Shirin Ahmed,

Project Coordinator, GHLI

Some of the GHLI team recently made a trip to Brazil to finalize delegates who will attend our GHLI Conference in June. The trip served as a great opportunity to strengthen relationships with colleagues in Brazil, whose work involves research and programs related to Early Childhood Development (ECD).

During our trip, GHLI met with psychiatrists at the University of Sao Paulo and Universidade Federal de São Paulo, as well as policymakers and NGO representatives who are actively developing strategies to improve early childhood experiences and services in Brazil. Our team gained a better understanding of existing policies related to ECD in Brazil and began to lay the foundation for future collaborations in research and programming between Yale University and Brazil. A visit to a local community offered insight to the country’s primary care system in practice and also helped us understand operations of the local health system and the need to address mental health in these communities. 

In June, our Brazilian colleagues will participate in the GHLI Conference on Yale’s campus and will work with other attending country delegates to develop interventions to improve the mental and physical health of children in the city of Sao Paulo. Brazilian faculty are also exploring a collaboration between Brazil and the ACEV Foundation, a non-profit that has implemented successful parent training programs in Turkey, with potential applications in Brazil.  

One major challenge is the gap between academic research and the implementation of these findings through the public health system. Strategies that the Brazilian delegation will tackle at the GHLI Conference will focus on bridging this gap and integrating research-based, proven approaches to ECD programming into the delivery of public health care in Sao Paulo. We look forward to assisting our colleagues in Brazil with this important phase in improving their health care system.