Pediatrician Daniel Becker Reflects on Children’s Health in Favelas and the ‘Asphalt’ [INTERVIEW]

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Prominent pediatrician and community health expert Daniel Becker received his medical degree from the Federal University of Rio de Janeiro (UFRJ) and a Master’s Degree in Public Health from the National School of Public Health (ENSP) at Fiocruz, Brazil’s national institute of health. As well as attending to and treating children for years in his private practice, he is also an Ashoka Fellow, an international organization that recognizes and supports social entrepreneurs. He was selected for the Ashoka Fellowship for his role in CEDAPS (Center for the Promotion of Health), an NGO founded in 1993 which partners with local representatives to promote healthcare in hundreds of Rio favelas. His Facebook page, Pediatra Integral (Whole Pediatrics), currently has more than 76,000 likes. He also has a YouTube channel called Canal Criar e Crescer (Raise and Grow Channel). Becker has appeared on the national talk show Roda Viva to speak about childhood in Brazil today. RioOnWatch interviewed Becker about his path and his thoughts on the current situation facing youth both in the favelas and the ‘asphalt’ (as the ‘formal city’ is known in Rio).

RioOnWatch: Can you tell us briefly about your career path as a pediatrician? When and where did it begin, and in what capacities have you worked in low-income and high-income communities?

Becker: I began my life as a pediatrician thirty years ago, and I did my residency in pediatrics at UFRJ. Not long after that I went overseas. I trained in France for two years in clinical pediatrics, adolescent medicine, and social pediatrics, and then I spent nearly a year with Doctors Without Borders in Thailand, working with Cambodian refugees. When I returned home, I joined the NGO CEDAPS, which was working in a favela called Vila Canoas, and we started a little health center there. I began as a pediatrician, but later became the coordinator of the project, which was supported by the Dreyfus Health Foundation from the US. We realized we were just doing more of the same—we were replicating what already existed in the local health centers and, at the time, we weren’t making much of a difference in the lives of that population.

So we decided to change our approach and create a model that would foster a connection with the community based on a responsible relationship, an exchange. We studied our options a little and looked at Cuban and English models. We decided to initiate a community health representative role, which was already being successfully implemented in the Brazilian state of Ceará. And then we launched the first Family Health team in Rio. We were therefore pioneers in the Family Health Program in Rio, and along with other entities in São Paulo, Rio Grande do Sul, Minas Gerais, Ceará, and Niterói, we brought this idea to the Ministry of Health, which adopted and expanded the program, making it the principal health policy in Brazil, a source of pride for us in the international community.

So this is something I’m very proud of. I was one of the pioneers of this model, which is the most appropriate model for serving working-class communities. You’ve got the healthcare team together with the community, working where the community is located, where people live. We can get a better understanding of what people’s needs are when we see where they’re living. And then we started working with this idea of promoting health, which is the idea that you don’t achieve health through medical care. Health is achieved through development, through care, through good nutrition, through good housing, through recreation, culture, education, peace and security. Rights, right?! Fundamental rights.

The work began to strengthen the communities, empowering community leaders to further promote health in their areas. This went on for 20, almost 25 years. But then the foundation that was funding us closed its doors.

From that time on I’ve dedicated myself more to my private practice which has turned out really well. Today I’m part of CEDAPS’ advisory board.

So my experience with communities is not only about pediatrics—it’s about the life, the day-to-day of the children, and their families in general. In my private practice I work with middle- and upper-class families and children who can afford to pay a pediatrician who doesn’t take insurance. But in my broader practice, I’ve continued to be concerned with society as a whole. I don’t restrict myself to the world of the family. I always try to understand and help others reflect on the social, environmental, and cultural context that surrounds us. So I began to join discussions, to talk, to give lectures, and to write in my blog about what it’s like to be a father and mother nowadays, in the 21st century, taking into account the conditions we live in in Brazil and the characteristics of our society, and I try to help people understand that social factors are very influential in our family lives and in the way we raise our children.

RioOnWatch: Was it in this period that you did the TEDx Talk?

Becker: The TEDx Talk was during that time, in 2015. The talk was in fact a synthesis of various issues, which I summarized in this idea of “seven sins.” I’m currently writing a book about this, too, for [publisher] Editora Objetiva.

The “seven sins” being committed against children today, according to Dr. Daniel Becker:

1. Deprivation of natural birth and breastfeeding
2. The outsourcing of childhood
3. The intoxication of childhood
4. Confinement and perpetual distraction
5. The commercialization of childhood and childhood consumerism
6. Premature adulthood and the eroticization of children
7. The placement of children on a pedestal and the overprotection of childhood

RioOnWatch: What do you see as the major differences between children raised in the favela and those raised on the ‘asphalt’?

Becker: It’s really a difference in access to rights. Children in the favela, generally speaking, have poorer housing. Often they don’t have adequate sanitation. Often they live next to open sewers. They don’t have good quality education or health services. Having the Family Clinic nearby is very helpful, but if the child needs a specialist or a more complex exam, for example, that’s harder to come by.

That said, Rio de Janeiro has made substantial improvements in terms of access to medical care. What we have today is much more organized. This was a great improvement brought about by the previous administration, one of the only things that can really be appreciated about the administration of former Mayor Eduardo Paes: improvements to the organization of the health system. He had a good health team.

And, certainly, access and the right to freedom—the right to play and move around freely—are seriously threatened by the presence of violence, from both the police and organized crime. It’s terrible, and the violence impedes the implementation of other rights. So children [in this situation] can’t play in the street, and don’t have access to nature. They can’t even necessarily get to the beach because sometimes they don’t have money for the bus. It’s very tragic.

People were happy when the Pacifying Police Units (UPPs) were working well. But then they started to deteriorate, and now things are worse than before. Now you’ve got police violence and the violence of organized crime, such that oppression is coming from all sides, with terrible consequences for the physical and emotional well-being of all the residents. There’s also the problem of food. Children on the periphery of the city have little access to natural food, which is more expensive than mass-produced food. In the little food shops in the neighborhood, you can’t find fruits or vegetables, only low-quality food—salty snacks, sodas, cookies. That food has more sugar, more salt, more fat, and more chemical substances. So the children tend to be malnourished or overweight, even obese. So the right to healthy food is also a serious problem for these children.

On top of that, low-income families who have to work a lot don’t see much of their children. They work more, they work farther away. These are communities on the periphery of the city. So it takes the mother and father longer to get to work. The percentage of families run by women, where the father isn’t around, is very high—that’s why it’s very important to work on fatherhood.

Another thing I always point out is that a child has to have access to fresh air and nature to develop well. A natural space—with trees, rocks, soil, animals—is so important to a child’s development. Some favelas do have green spaces, but the children don’t go there because of the drug traffickers.

On the ‘asphalt’ there are many privileges, but there are also many problems. You have children today who have good housing, who have adequate homes, who have sanitation and food and nannies. But these children don’t see much of their fathers, either. Their fathers are absent most of the time. You also have the issue of mass-produced food, because people don’t have time to cook, and they watch television or videos on the Internet and are influenced by the commercials. Often, these are children who aren’t allowed to go outside. It’s interesting to note that in the favela, kids do play more in the street—despite the much higher risk of violence [in favelas with drug trafficking]. The perception of risk is different. A neighbor is watching them. Children stay out of the house a lot more, which can be very good for their [development]. Families from the ‘asphalt’ are much more fearful. The children can’t go out because [parents are afraid that] there will be a shooting, they’ll be run over. You wind up playing outside of the house or in the park less. You stay in the house spending a lot of time on your tablet, or watching TV, and that’s very bad for a child’s development.

RioOnWatch: What are the advantages of being raised in the favela?

Becker: Often you have a network of affection, a loving network that’s more present in the favela. It’s common to have your grandmother, aunt, neighbor, everybody, in the same space—a more present social network. So children are more immersed in these affectionate networks, with caretakers who know them and who care for them in a more loving way. And that’s good for them, for the children’s development. They are more free to play, because a lot of times there’s a little yard there, there are trees nearby, and often they aren’t too afraid to go out in the street. Those are the main advantages. Mostly they have disadvantages, but there are advantages too. There may be less overprotection [in favelas]. In the upper-middle class, there’s a strong tendency to fail to set limits, to raise children with a minimum of positive discipline. That overprotection is really toxic.

RioOnWatch: Can you say a little more about that?

Becker: It’s what they call ‘helicopter parenting.’ When parents who work a lot are with their children, they feel guilty because they’ve barely seen their children all week. So on the weekend you take the children to the shopping mall. If they want a toy, you give them a toy. If they want a present, you give them more presents. You take them to the play area and don’t let them hurt themselves. You stay on top of them the whole time: ‘You can’t do this, can’t do that, don’t do this, don’t do that, you’re going to hurt yourself, you’re going to fall.’ The children live with no chance of taking a little bit of risk in their lives. And what is the risk? The risk of falling and scraping your knee, for example: it’s very important because the child will learn courage, to evaluate risks, and to understand that problems come and go, and that wounds heal, and to consider life an adventure. An overprotected child will believe that they run the family, and this will make them more narcissistic—spoiled. The chance to feel pain, and to feel frustration, and to know that ‘you can’t do that now’ is very important for the child’s development. Perhaps in the favela where there is more poverty, children wind up having to face this more often, and they have more chores, they have to help around the house. In the end, they turn out better prepared, with better manners and social skills. Overprotection can be very harmful for a child. It’s very common in the upper-middle class.

RioOnWatch: Over your years of work in this field, what’s been the biggest change you’ve seen in terms of the development of youth in favelas?

Becker: In the days when the UPPs were beginning to work, there was more economic activity. There was a general improvement in the quality of life in the communities. Social activities—there was more freedom for them. Again, violence is very oppressive to children, especially police violence against black youth.

RioOnWatch: Could you please elaborate on the impact of social stigma on children in the favela?

Becker: I find the question of stigma very important. More than that, there’s the widening gulf of inequality in Brazil, especially with the recent government, which will keep making inequality worse. Inequality in healthcare is recognized as one of the most harmful things. There are scientific studies in public health, economics, and social sciences that show that inequality harms everyone, the whole society. The extreme separation of two sides of society creates this notion that the ‘other’ is my enemy. The ‘other’ is the poor, it’s someone I look down on, who is my enemy, who I’m afraid of, who I’d rather not see, or I’d even try to get rid of. The life of ‘the other‘ winds up not having the same value. So poor black youth enter into a terrible process of stigmatization where they represent crime, threat, the ‘other.’ And the rich white population begins to look down on and hate these people. In a society with such a deformed moral framework—where lives don’t have the same value—everything is devoid of morals. And from there we get corruption, and the tolerance of corruption. The rich don’t care about the quality of public transportation because they don’t use it, so we all get stuck in traffic. The rich don’t care about the quality of the public schools because their children are in private schools, but that means that the poor get a low-quality education and are easily manipulated by corrupt or fascist politicians. And on it goes, in a spiral that leaves everyone worse off.

RioOnWatch: How does this impact the child’s social and emotional development?

Becker: A poor black teenager from the favela doesn’t even have the right to walk through the streets of the South Zone. He’s seen as an enemy. If someone thinks he stole something, he’ll be beaten up. Not long ago there was a police operation prohibiting black children with no money from going to the beach. The beach is a free public space, one of very few. I find this very cruel to the psyches of children and teenagers, this feeling of being less than, of not having rights, of being stigmatized as a criminal. It makes their lives more difficult, with less purpose and less meaning. It’s really difficult.

RioOnWatch: What can the parents of children who are growing up in formal neighborhoods learn from the parents of children in favelas, and what can favela parents learn from parents from the ‘asphalt’?

Becker: For favela parents, I would say that they should be aware that they can use the city’s cultural and recreational spaces. When you go to the beach or to Parque Lage, which are free spaces, you don’t see many working-class people. There are people in Alemão who have never been to the beach—just 20 kilometers away. You go to the Banco do Brasil Cultural Center, which has incredible shows and exhibitions, everything free of charge. Nearby you have the France-Brazil House, the Correios Cultural Center, the Federal Justice Cultural Center—all in the same vicinity—and you don’t have to pay anything. But a lot of people don’t know they can go to these places. In general, there are only white people in these spaces. There are no black people, no poor people. And you have Vidigal, Rocinha, Mangueira, it’s a bus ride away as well. Some of them could even go on foot. From Rocinha you could walk to the Botanical Gardens. So I would tell favela parents that they should use these cultural and natural spaces in the city because these are their spaces, too. They are not only meant for the rich, but it is only the rich who take advantage of them.

For the rich, I would say the same thing: that they should continue to use these spaces, and allow their children to meet children from the favela and play with children from the favela. The less segregation we have, the more chances we have to meet and to care about one another. Meeting each other will create empathy, understanding. It will end up reducing stigma, which is very important for this city. For us to understand that we all need a fairer, more egalitarian, more sustainable city—and that this is only possible when we put pressure on our leaders, demanding more transparency and a government focused on the real interests of the population, and not on the interest groups that hang around the politicians. This is what I call participatory government. For that, we need to get together and talk.