Living and Dying in São Paulo: Immigrants, Health, and the Built Environment in Brazil

“Living and Dying in São Paulo” examines the often-competing visions of wellbeing among immigrants and representatives of the state like health professionals and policymakers. The book analyzes how rigid social structures and misattributed understandings of cause (culture) and effect (disease) often lead to enduring health issues. It treats health and care (broadly defined) as windows into the connected systems of the built environment, public health laws and practices, and citizenship. This project demonstrates how federal, state, and municipal health and immigration legislation (from about 1850 to present) engender continuity by triangulating the history of Brazilian public health research, laws and policies, and globally dominant ideas about disease and other health issues. The diverse approaches, sources, and methods explore the interactions between health, immigration, and physical structures such as workplaces and living spaces. “Living and Dying in São Paulo” asks how health is created by state-built environments ranging from health clinics and hospitals to sidewalks and streets.

“Living and Dying in São Paulo” uses a multi-ethnic neighborhood to analyze how the state and its representatives often flatten cultural differences and why immigrants, despite different historical and cultural trajectories, often generate similar responses to policies. In addition to archival and literary research, the Lesser Research Collective has been constructing an interactive cartographic platform of Bom Retiro and conducting research in the Bom Retiro Basic Health Clinic to explore long-term continuities in the relationship between health professionals and the public

We have chosen the neighborhood-focused approach for many reasons. First, observation of the medical team allows access to buildings and inhabitants, including sweatshops, unregulated multi-family housing settlements, and formal and informal businesses. Bom Retiro also contains two important institutions related to public health and the public’s health. One is the Central Disenfectory, built in 1893 over Brazil’s first immigrant hostel (think Ellis Island), which is today operated by the São Paulo Secretary of Health as a museum/archive and as a medical warehouse. Across the street, the Public Health Clinic sits on a lot that has housed a leprosy treatment center, a pro-natalist education site for expectant mothers, and a sexual health inspectory.

“Living and Dying in São Paulo” has been funded by a Fulbright Senior Research Fellowship, the University of São Paulo’s Institute for Advanced Study, the São Paulo State Research Foundation (FAPESP), the Emory University Research Council, the Emory University Global Health Institute, the Emory College of Arts and Sciences Interdisciplinary Faculty Fellowship, the Andrew W. Mellon Foundation/Emory College Office of Faculty Digital Publishing in the Humanities Open Access Fund, and the Emory University Center for Faculty Development and Excellence Scholarly Writing and Publishing Fund.

Lesser Research Collective members Dr. Emily Pingel, Alexandra Llovet, Dr. Fernando Cosentino, and I published “Committing to Continuity: Primary Care Practices During COVID-19 in an Urban Brazilian Neighborhood” in Health Education & Behavior (a legally shareable, accepted version is here). Another article related to the project, that I co-authored with Dr. Uriel Kitron, is entitled “The Social Geography of Zika in Brazil” [in English in the NACLA Report on the Americas and in Portuguese in Estudos Avançados].

Other publications related to the project include:

Research Collective Academic Production

Almeida, Cintia Rodrigues de, Luanna Mendes do Nascimento, Monaliza Caetano dos Santos, and Vitória Martins Fontes. “As lacunas enquanto escolha: Uma abordagem panorâmica sobre as fichas da Assistência Médica Policial de São Paulo e as mulheres do Bom Retiro presentes nessa documentação.” Unpublished manuscript, 2020.

Cikopana, Doris. “A Case Study of a São Paulo Health Clinic: Accessibility to Health Services by Patients Who Do Not Speak Portuguese as a First Language.” BA honors thesis, Emory University, 2018.

Ferla, Luis, Karine Reis Ferreira, Fernando Atique, Andrew G. Britt, Karla Donato Fook, Jeffrey Lesser, Cristiane Miyasaka, Daniela Musa, Thomas D. Rogers, and Nandamudi Vijaykumar. “Pauliceia 2.0: Mapeamento colaborativo da história de São Paulo, 1870–1940.” História, Ciências, Saúde—Manguinhos 27, no. 4 (October–December 2020): 1207–23.

FERLA, Luis; ALMEIDA, Raony Augusto de; ALMEIDA, Cintia Rodrigues de; BARRETO, Giovana; BRITT, Andrew; CAMARGO, Tamires Pereira; CORDEIRO, Daniel; FOOK, Karla Donato; LESS-ER, Jeffrey; LUZ, Abner; MONTEIRO, Vítor Mendes; MUSA, Daniela; NASCIMENTO, Luanna Mendes do; OLIVEIRA, Rafaela Mendes Bastos; SANTOS, Monaliza Caetano dos; SILVA, Raphael Augusto de Oliveira; VIJAYKUMAR, Nandamudi. “História da numeração das casas em São Paulo e seu uso na construção de um geolocalizador de endereços do passado.” Anais do Museu Paulista: História e Cultura Material, São Paulo, v. 33, p. 1-34, 2025. https://revistas.usp.br/anaismp/article/view/228290

Ferreira, Karine R., Luis Ferla, Gilberto R. de Queiroz, Nandamudi L. Vijaykumar, Carlos A. Noronha, Rodrigo M. Mariano, Denis Taveira, Gabriel Sansigolo, Orlando Guarnieri, Thomas Rogers, Jeffrey Lesser, Michael Page, Fernando Atique, Daniela Musa, Janaina Y. Santos, Diego S. Morais, Cristiane R. Miyasaka, Cintia R. de Almeida, Luanna G. M. do Nascimento, Jaine A. Diniz, and Monaliza C. dos Santos. “A Platform for Collaborative Historical Research Based on Volunteered Geographical Information.” Journal of Information and Data Management 9, no. 3 (December 2018): 291–304. https://periodicos.ufmg.br/index.php/jidm/article /view/426.

Fook, Karla Donato, Daniela Leal Musa, Nandamudi Vijaykumar, Rodrigo M. Mariano, Gabriel dos Reis Morais, Raphael Augusto O. Silva, Gabriel Sansigolo, Luciana Rebelo, Luís Antônio Coelho Ferla, Cintia Almeida, Luanna Nascimento, Vitória Martins Fontes da Silva, Monaliza Caetano dos Santos, Aracele Torres, Ângela Pereira, Fernando Atique, Jeffrey Lesser, Thomas D. Roger, Andrew G. Britt, Rafael Laguardia, Ana Maria Alves Barbour, Orlando Guarnier Farias, Ariana Marco, Caróu Dickinson, and Tamires P. Camargo. “Collaborative Historical Platform for Historians: Extended Functionalities in Pauliceia 2.0.” In Proceedings of the 17th International Conference on Web Information Systems and Technologies, 460–66. scitepress—Science and Technology Publications, Setúbal, Portugal, 2021. https://www.scitepress.org/Papers/2021/107134/107134.pdf

Gonzalez, Daniella. “Defining Family Planning in a São Paulo Clinic: Healthcare Providers and Patients’ Varied Conceptualizations of ‘Planned’ and ‘Unplanned’ Pregnancies.” BA honors thesis,Emory University, 2018.

Jin, Sabrina. “New Perspectives on Race and Racism among Brazilians of Asian Descent.” BA honors thesis, Emory University, 2022.

Kauko, Sara. “Criollo Entrepreneurialism: Transforming Racial and Class Identities and Social Mobility among Mixed-Race Argentines.” PhD diss., Emory University, 2020.

LaCroix, Delphine, Juliana Casagrande, and Jeffrey Lesser. “A Sacred Space of Health.” Paper presented at the 25th International Congress of History of Science and Technology. Rio de Janeiro, July 27, 2017.

Llovet, Alexandra. “Stigma Continuity of Leprosy in Brazil, 1924–2018.” BA honors thesis, Emory University, 2018.

Miller, Savannah. “A Qualitative Assessment of Water, Sanitation, and Hygiene in an Urban Working-Class Neighborhood of São Paulo, Brazil.” Master’s thesis, Emory University, 2022.

Pingel, Emily Sweetnam. “Immigrants, Migrants, and Paulistanos: Racialized Geographies of Labor and Health in São Paulo, Brazil.” ssm-Qualitative Research in Health 2 (December 2022): 1–8. https://doi.org/10.1016/j.ssmqr.2022.100074.

Pingel, Emily Sweetnam. “Primary Care and the Reproduction of Health Inequity in a Central São Paulo Neighborhood.” PhD diss., Emory University, 2021.

Pingel, Emily Sweetnam. “Seeing Inside: How Stigma and Recognition Shape Community Health Worker Home Visits in São Paulo, Brazil.” Community Health Equity Research and Policy 44, no. 3 (2024): 303–13. https://doi.org /10 .1177 /2752535X221137384.

Pingel, Emily Sweetnam, Alexandra Caridad Llovet, Fernando Cosentino, and Jeffrey Lesser. “Committing to Continuity: Primary Care Practices during covid-19 in an Urban Brazilian Neighborhood.” Health, Education and Behavior 48, no. 1 (2021): 29–33. https://doi.org/10.1177/1090198120979609.

Santos, Fabio Alexandre dos, Fernando Atique, Janes Jorge, Luis Ferla, Diego de Souza Morais, Janaina Yamamoto, Maíra Rosin, Ana Carolina Nunes Rocha, Nathalia Burato Nascimento, Orlando Guamier Cardin Farias, Wesley Alves de Moura, Thássia Andrade Moro, and Amanda de Lima Moraes. “A enchente de 1929 na cidade de São Paulo: Memória, história e novas abordagens de pesquisa.” Revista do Arquivo Geral da Cidade do Rio de Janeiro 8 (2014): 149–66. http://www.rio.rj.gov.br/dlstatic/10112/4204432/4133801/revista_agcrj_oito.pdf.

Shrivastava, Surbhi. “Stratified Surgical Births: Disparities in Cesarean Section Births in São Paulo, Brazil.” Paper presented at the Population Association of America (paa) Annual Meeting, Atlanta, GA, April 9, 2022.

Shrivastava, Surbhi, and Heeju Sohn. “Extricating Individual and Contextual Sources of Racial/Ethnic Disparities in C-Sections in Brazil: A Decomposition Analysis of Live Births from 2019.” Poster presented at the Academy Health Annual Research Meeting, Seattle, WA, June 26, 2023.

The S. Daniel Abraham Center for International and Regional Studies, Tel Aviv University (January 2019)