Who are they , what do they talk about and who listens to the poor ?

The right to a dignified life for all requires overcoming the challenges imposed on the most vulnerable groups, and poverty is one of the oldest and most devastating phenomena. Listening to them is essential to create remediating opportunities. This study aims to identify characteristics of this listening in the context of health promotion and the Sustainable Development Goals – SDGs, an international effort to support the fight against poverty, among others. In an integrative review of literature, conducted through the search terms of Poverty, Right to the City, Equity Policy and Identification of Poverty, 86 studies that listened to vulnerable groups, such as women, children, adolescents, adults, the elderly, families and drug users, all poor and low-skilled workers were analyzed. Each strategy shown was related to one or more SDGs. The recurrent strategies in the studies analyzed were increased social protection and spaces to listen to vulnerable groups, as well as public policies that enabled the fight against poverty. Equity must be thought of in the context of comprehensive and universalizing rights policies, overcoming fragmented and focal policies that fail to address the structural causes of poverty and human exploitation.


Introduction
According to the World Health Organization -WHO 1 , a long and healthy life for all requires solid investments in the future of societies, providing the freedom to experience lives that previous generations have not imagined.Designing and sustaining life dignity as the right of all and not as the privilege of the few requires overcoming challenges that threaten existence and impose themselves on the most vulnerable groups on the planet.
Eradicating poverty in all its forms and realms is now the greatest global challenge, a condition for sustainable development."Releasing the human race from the tyranny of poverty and misery and healing and protecting our planet" urgently requires realizing radical and comprehensive actions that will lead the world towards sustainability, resilience and inclusion 2 .
The poverty found in humanity admits diverse interpretations, emphasizing either economic aspects associated with the incapacity to work or to inequity and injustice 3 .The neoliberal policies of international institutions stem from this economistic understanding as a paradoxical alternative to the exclusion deriving from a shrinking State and the centralization of power in the mercantilist logic 4 .In the ethical-philosophical perspective based on wage labor, it is pointed out that poverty derives from an unfair distribution of society's riches, which is a form of vulnerability, since people lose dignity and the intrinsic value of human existence and, without any possibility of escaping from exploitation, can lose their lives.
The monetarist interpretation establishes income shortage as an indicator of poverty, a view that persists in the lack of other realms that are an alternative to monetary indicators 5 .
Soares 6 affirms that poverty as a lack of resources can be classified as (a) absolute poverty -used from the capacity of consumption in relation to income, with the UN parameter 7 of US$ 2.00 per day; (b) relative poverty, based on the average consumption of a local society, where the poor are below this standard; (c) administrative poverty, a parameter for access to government programs, such as the Bolsa Família (Family Grant) Program; (d) subjective poverty, coming from people themselves from their context and history 6,8 .
Giffin 9 criticizes the argument that reducing poverty in peripheral countries relies on birth control because, while international programs in 1990 prevented 412 million births, changes in the pattern of sexual distribution of labor did not allow women to overcome it.
In most societies, the current capitalist process of production and consumption of goods and services threatens life.Sustainability involves an articulation between health, environment and economy that requires a more solidary economic and social organization, a transformative agenda and mechanisms of governance capable of implementing this agenda at the local level 10 .
WHO 1 is concerned about growing international inequalities, disparities in opportunities, wealth and power; unemployment, especially among young people; ethnic, political and religious conflicts; extremism and terrorism and with the depletion of natural resources, environmental degradation, desertification and land degradation, freshwater shortage, loss of biodiversity, climate change and its impacts on countries and peoples.It concludes on the risk to the survival of many societies and the biological systems of the planet.
In this global context, UN member states waive their flags out to end hunger and misery, which is one of the 17 Sustainable Development Goals (SDGs) of the 2030 Agenda.
This work addresses the topic of poverty and seeks to identify the expression of people and social groups that live in this situation and to give visibility to this phenomenon.It asks what groups these are, what do they talk about, who speaks for them, what are their experiences, how they are expressed, where and how they occur, who listens to these groups and how.The objectives of this study are: I -General: To identify strategies adopted to allow the vocalization of different vulnerable groups in the context of health promotion and sustainable development.

II -Specific:
-To identify the main databases that address the issue of poverty, as well as the international distribution of this production over time; -To point out the identified vulnerable groups; -To describe what the specific topics studied by the different authors deal with; -To identify how vocalization occurs in these groups: direct or indirect listening of the subjects; -To recognize who speaks for the vulnerable; -To identify the methodological tools used to facilitate expressions; -To identify which strategies addressing poverty are proposed and to which SDGs they align.

Material and methodology:
This is a literature review, carried out in successive stages, as established by integrative review scholars 11,12 , with the theme of different forms of listening to the voice of the vulnerable, from the perspective of the SDGs established by the UN, in order to contribute to human development and fight against poverty.
The sample was selected by searching the Virtual Health Library Brazil (BVS), with papers indexed by LILACS (Latin American and Caribbean Literature in Health Sciences), MEDLINE (Medical Literature Analysis and Retrieval System Online), VetIndex Express, SciVerse Scopus and the Index Psicologia database.
Papers published between 1985 and 2016 were included, a period defined as one year after the Ottawa Conference, an international milestone for Health Promotion; papers in Portuguese, English and Spanish and those with online public access.Books, theses, dissertations or monographs and online papers with paid access were excluded.
Search was carried out in January 2017, with terms "Poverty", "Right to the City", "Equity Policy" and "Identification of Poverty", combined with the Boolean expressions "or" and "and".
-The combination "Poverty" and "Right to the City" resulted in 31 studies and, after filtering, eight studies were obtained and established Group 1.
-The search sentence "Poverty" and "Equity Policy" resulted in 74 papers, of which 25 were selected, establishing Group 2.
-The sentence "Identification of Poverty" resulted in 134 studies, of which 53 were included, establishing Group 3.
It is noteworthy that prior to full-text paper reading, the variables to be collected for all groups were defined as follows: society and location analyzed, the paper's theme, the vulnerable group addressed, the type of listening used (whether direct or indirect) to give visibility to the vulnerable group, instruments used in the study (interviews, questionnaires and documentary analysis), recommended strategies for overcoming poverty and vulnerability of that group, as well as the final considerations.A spreadsheet with Microsoft Excel features was created to organize data.

Results
The 86 papers from the searches make up the Search Table (ST), Chart 1.

Profile of selected studies
The main database of articles were Lilacs, with 64 articles, followed by Medline with 18. PubMed, SciVerse Scopus, VetIndex Express and Index Psicologia returned 1 paper each.For the three groups, papers were found starting in 1996, with increasing quantity as of 2005, as shown in Table 1.
The Portuguese language predominated in 61% of the total works.
The journals that published the eight articles on "Poverty and the Right to the City" (G1)   Studies focused more on population groups, women and on poor families, as detailed in Chart 2.

Type of listening
Authors considered two types of listening.Direct listening refers to the vocalizations made by members of the groups themselves to researchers, both through quantitative and qualitative or qualitative-quantitative studies.On the other hand, indirect listening was considered as such when the visibility given to vulnerable groups was based on literature data, through review work or by free theoretical essays on the subject.The result of this classification showed the predominance of direct vocalization of vulnerable groups for the works of identification of poverty included in the third group (G3), while indirect listening prevailed for Groups 1 and 2, with the following frequency: Thirty-nine papers were found in direct listening, of which three for Group 1 (ST4; ST7; ST8); six for Group 2 (ST86; ST14; ST15; ST21; ST23; ST26) and thirty for Group 3 (ST30 to ST32; ST34 to ST36; ST38; ST 40; ST44; ST47; ST53; ST55 to ST58; ST60; ST61; ST63; ST65 to ST69; ST72; ST 75; ST77 to ST79; ST82; ST83).

Instruments used
In the three search groups, studies used documentary analysis, semi-structured and structured interviews, participant observation, focus groups and questionnaires.G2 also used selection of indicators, literature review and theoretical essays.
Understanding that the strategies for overcoming poverty shown in the 87 studies analyzed would be in line with the SDGs, these were identified and it was possible to relate them by search groups to one or more SDGs.Chart 3 shows the strategies proposed in the works of Group 1 and 2 and the respective relationships with the SDGs.
The proposed strategies for fighting against poverty and listening to vulnerable identified in G3 are listed in Chart 4.

Discussion
The complex poverty phenomenon requires that multiple aspects underlying the production of life, such as access to land, health services, water, decent work, inclusive education, overcoming social inequities, gender, ethnic minorities and religious groups be considered.
It is imperative that these social groups that experience processes of exclusion vocalize their life experiences, express their needs and mobilize segments of society through strategies to face and overcome their vulnerable and degrading conditions.
Authors' concerns are revealed in the several dozens of papers surveyed.They are from different regions of Brazil and the world and address general and unique themes that bring us back to the realities of diverse populations carrying the common mark of poverty.
One of the concerns identified is environment.It was recognized that these urban settings became unhealthy through pollution, violence and poverty, affecting mainly the poorest.At a time when, in the world, discussions turn to the right to the city, the critical look at exploration and environmental depletion and its sustainability is justified by the challenge of transforming it to fulfill the historical function of embracing the various social groups that have a right to it, over-coming social exclusion and promoting equity.
Ethnic and racial minorities face situations of poverty, exclusion, marginalization, discrimination and vulnerability, ratified by their current morbimortality coefficients that are among the highest, with hunger and malnutrition and systematic occupational risks and social violence.There will be no equity without confronting and overcoming these conditions.
Regarding gender, the feminization of poverty and the economic model stand out in the logic of exclusion.While there was a hard fought battle for the right not to give birth, the analysis of highly differentiated concrete conditions for motherhood among social groups was relegated in the background 9 .Thus, the fallacy of arguments that reduced poverty in peripheral countries was linked to birth control, against the millions of births avoided without the reduction of poverty falls apart 9 .
There is also a critical view on the so-called urban disposable, the "human waste" to be removed as common urban waste, rescuing the complexity of the existence of a homeless population and the challenges to health policies and other social policies.
Also inevitable is the recognition of a growing poverty and the accelerated concentration of income in the hands of the few.According to ECLAC 13 , the number of poor has increased by 50%, from 136 million in 1980 to 200 million in 1990.The proportion of the poor in the population also increased from 40.5% to 48% 14 .The concentration has reached levels of the end of the 19 th century, since the wealth of 1% of the world's population surpassed that of the remaining 99%, and that only 62 individuals concentrate as much income as 3.6 billion people.In 2010, there were 388, which confirms the increasing financial concentration 15 .
While the World Bank recommends health systems equity policies, developments of the macroeconomic policy with external debt financing and public indebtedness compromise resources for health, reducing broad and universal policies to targeted programs and extension projects of coverage 16 .
Thus, agreeing with scholars in this area, there is an understanding that equity must be thought within the policies governed by the principle of universality.Taken in isolation, it can impose the "replacement of solidarity and equal opportunities values with radical utilitarian individualism values" 17apud18 .Thus, even the implementation of the Bolsa Família (Family Grant) Program has It requires policies to cope with the systematic social exclusion to which they are subjected.
X X X X X X X ST27.Set public policies that address equity with universality.X X X ST28.Define public policies that include and strengthen income transfer programs that can allow the beneficiaries to leave the poverty condition and find employment, besides the opportunity to study and to qualify professionally.
X X X X ST29.Establish equitable policies that prioritize actions for the social determinants of oral health: increasing coverage of basic sanitation and fluoridated water for supply with reduction of poverty and regional inequities.Recommending the green economy as opposed to the brown economy, which has increased the impact that the human being produces in the use of planet's resources, giving emphasis to the social determinants of health.Construction of an agenda to intervene in SDH with implementation of SDGs and governance mechanisms that can implement them, especially at the local level.
X X X X X X X ST86.Broaden listening to social groups facing inequities, considering the meanings that people attribute to their experiences and how they understand the world in which they live.
X X X X X X X X X Source: own elaboration.
Chart 3. continuation questioned the potency of its conditionalities to actually strengthen families' autonomy 19 .
The theme of differentiated access to health services, which can be defined by their availability, accessibility, economic feasibility and acceptability, which is marked by conceptual differences between access and use, but in common identify that the poor use less effective interventions 20 .
In this setting, the role of international conferences 21 is highlighted, since WHO policies have been consolidated in these spaces.The best known are those of Alma Ata 22 , due to the emphasis placed on Primary Health Care, and Ottawa 23 , which gave great visibility to health promotion.Brazil participated in the first event, but not in Ottawa, which counted more on developed countries and with few peripheral countries, unlike Alma Ata.Peripheral countries also met in Jakarta, Port-of-Spain (Caribbean) and Bogotá (Colombia) in 1992, and were signatories in the latter.
In Alma Ata, the concept of health was "the most complete state of physical, psychic and social well-being" 22 , idealized and not so operational, which used the programmatic actions to curb differences in the health status of the population.According to the WHO 24 , health ceases to be a "state" and becomes a "project" 25 , one for each nation or social group, according to its economic, technical, political and cultural possibility 24 .
At the Bogota Conference, a concept of equity was discussed and was related to the elimination of unnecessary, avoidable and unfair differences that restrict opportunities to achieve the right to well-being 24 .
Almeida 18 points out an imprecision between equality and equity and a distinction between difference and diversity, which are the most critical conceptual issues.For health promotion, the WHO incorporates the two concepts.The first one is related to the political change of health determination's general aspects 26 .The second is geared to unhealthy behavioral and lifestyle changes, which is one of the fields of public health formulated by Lalonde 27 .
While the different Health Promotion Conferences may admit conceptual inaccuracies, they all have the highest principle of overcoming poverty and social inequalities, and that all citizens of the world must be embraced, protected and assisted in their main right, which is life.This was the case from the first to the most recent event, which took place in Shanghai in November 2016 and reaffirmed the 2030 Agenda for Sustainable Development.
The famous motto of Alma Ata 22 "Health for all in the year 2000" is now reiterated in Shanghai 28 by the slogan "Health for all and all for Health", demanding the involvement and commitment of managers, professionals and citizens Chart 4. Proposed strategies and related SDGs in the studies of Group 3. Ribeirão Preto, 2017.ST78.The high prevalence of giardiasis in children living in the settlement of landless people, even after treatment (64.3%), reinforces the need to identify the forms of contamination so that the treatment does not only work as a palliative measure.

Strategies proposed by studies
X X X ST79.Defined inclusion criteria led to the establishment of a group that showed a diagnosis of malnutrition and nutritional risk in 42% of children and adolescents.This finding is relevant as it allows the prioritization of actions for the highest risk group.
X X X ST80.Adopt the IPVS application for a detailed view of the living conditions of the resident population in all the municipalities of São Paulo, identifying segments vulnerable to poverty.
X X X X ST81.To train primary care professionals about the aspects of bioethics so that they can identify and face the ethical problems that emerge in the work context.X X ST82.Faced with the higher prevalence of iron deficiency anemia in schoolchildren in the poorest strata, (class D with 43%, C with 30%, E with 22% and B with 5%, suggests more effective intervention strategies that put the nutritional issue as a fundamental component of health promotion.
X X X ST83.In traditional Pakistani society, there is a culture of silence around sexuality, lacking control over their future and reproductive health.Discussion groups and other innovative initiatives based on understanding the needs of young people are required.Increasing self-identity and integrating women into decision-making, first with their parents and later with their husbands, should be promoted to every society.

X
Source: own elaboration.
Chart 4. continuation in this technical, ethical and political construction.In the world, and especially in Brazil, this challenge is monumental, with successive losses of financial resources for social areas, with Constitutional Amendment 95/17, and the degradation of the poorest strata of the population due to the loss of labor and pensions rights, labor insecurity and progress toward the logic of the interests of the international market.These policies clash head-on with the essential interests and rights necessary for the social production of health, since systematic, unnecessary and unfair differences increase.

Final considerations
In this complex setting that affects the most diverse social groups in the most different regions of the world, focal and disarticulated policies can hinder the achievement of SDGs.International agencies' concerns about poverty are of great relevance, considering the right of access to land, basic sanitation, water, food, exploitation-free labor, access to health services and, above all, people's conscious and leading participation in their self-determination and in the control of the social determinants of health.Many of these challenges have been addressed through fragmented and sectoral policies that lose the ability to provide concrete responses to vulnerable social groups around the world as they fail to address the structural causes of poverty and human exploitation, thus perpetuating this condition.

Collaborations
MA Freitas, ATR Mattos, WZ Gomes and MCGG Caccia-Bava also participated in all stages of the article's elaboration.This overcoming involves establishing complex global priorities that are broken down into ethical and political decisions, such as eradicating world hunger and implementing peace policies, versus keeping global hegemony through military power and extermination policies.
Countries affiliated to the international movements and each citizen should above all support the movements for peace, prosperity, social and economic development and the self-sufficiency of developing countries, as well as the pathways of sustainable development to transform life for the better in the whole planet.