At the Skoll Foundation, we have seen time and again the importance of the deep connection and inspiration social entrepreneurs get from working with and staying close to people and communities they love.
This is the case for Saúde Criança, which supports children who have been hospitalized and are living below the poverty line, by fostering the economic and social self-sufficiency of their families. Given the organization’s long history of impacting the lives of poor communities in Rio de Janeiro, I spoke with the founder and president of Saúde Criança, Vera Cordeiro, and its CEO, Cristiana Velloso, about what the Olympics has meant for them personally and for their ongoing work to achieve systems change in Brazil.
With the Olympic games taking place this summer in Rio, a lot of international attention has focused on inequality in Brazil, specifically Rio. What makes this problem so unique?
Vera: What makes Rio unique from other parts of the world is that the rich and poor live very close to one another. Everywhere you go in the city, even the beaches, the poor, middle class, and rich come together.
I haven’t seen that kind of a mix between different social classes of people anywhere else, even [elsewhere] in Brazil! In Rio, it’s impossible to forget about poverty because we are all in the same place.
How does that influence public policy?
Vera: Many political movements start in Rio because everyone is very aware of the problems. We may not know the solutions yet, but there is a kind of respect for each other and we share the same values.
I’m not saying we don’t have problems [in working together]—we have a lot of problems. We know that there is a long history of inequality, but in Rio, at least we cannot hide this mess away from our eyes. Nobody can deny it.
Cristiana: Unfortunately, I think what makes it difficult for policymakers is that sometimes the interests of middle class and rich people are different from the interests of the very poor, and some things that would be very important for the poor, like mass transportation, better clinics, and schools closer to their houses, are not on the agenda of the middle class and rich that have other alternatives.
Additionally, some politicians don’t really value the needs of the very poor and try to help the middle class and rich, which isn’t good for the city—or even for the wealthy—because inequality will grow. Until we offer good services to the poor, we won’t be able to decrease inequality in our city.
Prejudice here is prejudice against poverty and lack of education, rather than against skin color.
How does Saúde Criança’s work influence systems change?
Cristiana: Vera started Saúde Criança 25 years ago, and back then, people thought about health as disease control and prevention. The focus was on medical care and treatment, and they didn’t see the whole picture of why someone was getting ill and not getting better.
Saúde Criança is trying to change this system so that governments and the health sector can understand that you won’t be able to be healthy if you don’t have the social and psychological areas covered also.
Vera: For instance, pneumonia is just the tip of the iceberg. The real causes behind pneumonia are how people live—it might be raining inside the house or the father may be jobless. Really, pneumonia is just one way to describe poverty.
We were one of the pioneering institutions to say to the world that it’s about the social determinants of health. Poverty is a multidimensional problem, and we have to work in a multidisciplinary way if you want to change a system.
The government of the third largest city in Brazil, Belo Horizonte, started to use our social methodology as public policy. More and more, our work is bringing awareness to people and governments that there is a holistic dimension to health.
This is exactly the systems change we are seeing, starting with Belo Horizonte, and we are also helping other social entrepreneurs adopt the DNA of our methodology across 30 countries. For instance in Portugal, one of our former staff members went to Lisbon and is starting to work with families there, implementing Saúde Criança’s methodology.
How does this actually work?
Cristiana: Families come to us after being referred by public health units, which are public hospitals where the very poor are treated, since the health system is open to all in Brazil. When they see that the family is not able to deal with the disease and the child keeps coming back to the hospital, not necessarily because of the disease but because of social conditions, they are referred to Saúde Criança.
We work in five areas—health, education, housing, citizenship, and income generation—and make a two-year plan with the family that they must achieve to graduate from Saúde Criança. Our goal is that after two years, the family is self-sustaining and able to deal with adversity and the problems they face.
Vera: Research shows that three to five years after a family leaves the Saúde Criança program, the re-hospitalization rate decreases by 90 percent and income generation almost doubles. It’s about moving families from misery to dignity forever.
What gives you hope for the future?
Cristiana: The younger generation now is very aware of inequality and that lots of things need to be done if we want a country with less violence and fewer problems. We need younger volunteers and young people starting in the social area to join our efforts.
That’s why this year we’re launching a center of excellence in social inclusion here in Rio, to have discussions with other organizations and entities who work with social inclusion and social determinants of health, poverty, and inequality. Jointly our forces can do more and really make a difference in systems change.
Vera: In Rio, we like to understand other people’s cultures. For example, the other day, I went to go see one of the Olympic games, and there was a lot of good energy in the air. It is our nature as carioca, people who were born here in Rio, like me and Cristiana—we like to be near other cultures and other people. Even though people are saying bad things about the Olympic games and about our challenges, during the Olympics, there is great joy among us.
