In a groundbreaking population-based survey recently published in the International Journal for Equity in Health, researchers have unveiled startling insights into the health realities faced by adults living in the slums of Rio de Janeiro, Brazil. This comprehensive study sheds light on the prevalence of chronic non-communicable diseases (NCDs) and the often overlooked phenomenon of multimorbidity—the coexistence of multiple chronic conditions—in one of the world’s most densely populated and socioeconomically disadvantaged urban environments. As slums continue to burgeon globally, the findings underscore the urgent need for targeted public health interventions and equitable healthcare policies that address these vulnerabilities.
The urban slums, often known locally as “favelas,” represent a unique challenge for public health professionals. Characterized by inadequate housing, poor sanitation, limited access to clean water, and constrained healthcare resources, these areas are breeding grounds for health disparities. What this study uniquely delivers is a nuanced epidemiological analysis that captures not just isolated disease prevalence but the interconnected web of chronic health burdens borne by slum residents. By adopting a population-based survey method, the research team was able to provide statistically robust data reflective of real-world conditions in Rio de Janeiro’s slum communities.
Non-communicable diseases, including diabetes, cardiovascular diseases, chronic respiratory conditions, and hypertension, have emerged worldwide as leading causes of morbidity and mortality. Yet, there remains a dearth of rigorous data on how these diseases manifest and coexist within underprivileged urban dwellings. The study’s authors meticulously gathered data from adults residing in slums to calculate not only the frequency of single NCDs but also the prevalence of individuals suffering simultaneously from multiple conditions, a state clinically defined as multimorbidity. This focus is instrumental because multimorbidity significantly complicates clinical management, increases healthcare costs, and worsens quality of life.
The methodology employed illustrates a sophisticated blend of epidemiological techniques and community engagement strategies. Trained field workers conducted structured interviews coupled with clinical assessments, including biometric measurements and diagnostic screenings, to confirm the presence of multiple chronic conditions. This approach ensured comprehensive health profiling of participants beyond self-reported data, which is often limited by recall bias and underdiagnosis, particularly in marginalized populations. The integrative survey design thus provides a more accurate snapshot of the health ecosystem in Rio’s slums.
Findings reveal an alarmingly high burden of chronic illnesses within this population. The prevalence of hypertension alone mirrors or exceeds national averages, despite restricted access to regular healthcare. More strikingly, multimorbidity was identified in a significant proportion of surveyed adults, signaling that many residents navigate the complexities of combined pathologies, which may synergistically exacerbate health outcomes. Such overlap challenges traditional health systems designed around single-disease frameworks and demands a paradigm shift towards integrated care delivery.
Environmental and social determinants of health emerge recurrently as potent drivers behind these epidemiological patterns. Factors such as persistent poverty, food insecurity, overcrowded living conditions, and chronic stress from socioeconomic instability appear intricately linked to the onset and progression of NCDs. Moreover, lifestyle risk factors including tobacco use, physical inactivity, and unhealthy diets were prevalent, highlighting the critical intersection of behavioral and environmental exposures in shaping disease trajectories within slum populations.
Another significant revelation from this study is the gender differential in disease burden and multimorbidity patterns. Women, particularly middle-aged and older, exhibited notably higher rates of coexisting conditions compared to their male counterparts. This gender disparity invites further inquiry into biological, behavioral, and social determinants that may predispose women to more complex health challenges in disadvantaged urban settings. Tailored gender-sensitive intervention programs may thus be necessary to address these inequities effectively.
The study also draws attention to the gaps in healthcare accessibility and utilization among slum residents. Despite the high disease burden, many individuals reported infrequent medical consultations, attributed to structural barriers such as cost, distance, and discrimination within the healthcare system. These systemic obstacles compound the difficulties faced by multimorbid patients requiring ongoing, multifaceted care regimens. The findings underscore the need to strengthen primary healthcare infrastructure with a particular emphasis on continuity and comprehensiveness to effectively manage chronic diseases within these communities.
In addition to clinical implications, the research provides critical insights for public health policy and urban planning. Slums, often neglected in official urban health agendas, demand focused resource allocation and innovative health promotion strategies. Policies must prioritize equitable healthcare provision, ensure affordable medication availability, and develop community-based programs that address not only medical needs but also the social determinants fueling the NCD epidemic. Collaborative efforts involving government, non-governmental organizations, and community stakeholders are essential to implement sustainable health improvements.
The concept of multimorbidity introduced by the research has far-reaching consequences for healthcare providers and systems globally, especially those serving low-income urban populations. Traditional disease-specific guidelines and treatment protocols may be insufficient or even counterproductive when confronted with the complexity of managing multiple, interacting diseases. This study accentuates the urgent necessity for integrated care models that holistically address patient needs, optimize therapeutic regimens, and minimize polypharmacy and adverse drug interactions.
The survey’s epidemiological rigor and comprehensive data also provide a vital baseline against which future interventions can be measured. Continuous monitoring and further research will be indispensable to evaluate the impact of health policies, track epidemiological trends, and adapt strategies to the evolving realities of urban slum environments. Cross-disciplinary research incorporating socio-economic, psychological, and environmental perspectives will enrich understanding and foster multidimensional solutions.
Technology and innovation hold promise in overcoming some of the healthcare barriers identified in the study. Mobile health platforms, telemedicine, community health workers equipped with digital tools, and data-driven patient management systems could extend reach and quality of care in slum settings. However, such technological interventions must be carefully designed to account for infrastructure limitations and ensure cultural acceptability among vulnerable populations.
The research conducted by Echeverría-Guevara, Luz, Pires, and colleagues compellingly illustrates that chronic non-communicable diseases and multimorbidity are pervasive in the favelas of Rio de Janeiro and represent a critical public health crisis with multifaceted determinants. These findings echo global patterns observed in informal settlements worldwide but emphasize the particular vulnerabilities of Brazil’s urban poor. Addressing this syndemic will require concerted action grounded in equity, social justice, and scientific ingenuity.
As urbanization accelerates across the developing world, the health landscapes of slums will become increasingly consequential to global health agendas. This study stands as a clarion call to researchers, policymakers, clinicians, and communities alike—to recognize and respond to the complex burdens of chronic illness faced by those living on society’s margins. Only through integrated, inclusive, and informed approaches can the stagnation and suffering borne by multimorbid slum populations be alleviated, paving the way for healthier, more equitable cities of the future.
Subject of Research: Prevalence of chronic non-communicable diseases and multimorbidity among adults living in urban slums.
Article Title: Prevalence of chronic non-communicable diseases and multimorbidity among adults living in slums in Rio de Janeiro, Brazil: a population-based survey.
Article References:
Echeverría-Guevara, A., Luz, P.M., Pires, D.C. et al. Prevalence of chronic non-communicable diseases and multimorbidity among adults living in slums in Rio de Janeiro, Brazil: a population-based survey. Int J Equity Health 24, 262 (2025). https://doi.org/10.1186/s12939-025-02599-9
Image Credits: AI Generated
