Mortality, data and political urgency: PopRua at the centre of the debate at Fiocruz Brasília

It was an intense two days at Fiocruz Brasilia (22 and 23 October). Debates, experiences and voices that showed why caring is recognising. Here you'll find a series of exclusive articles on the International Seminar Homeless people: comprehensive care and rights now

One of the main tables at International Seminar on Homeless People: Comprehensive Care and Rights Now, The event, held at Fiocruz Brasília, brought together four exhibitions. From different perspectives, they converged in defence of the qualified production of information, the intersectoral guarantee of rights and the need for the active participation of social movements. With the theme We are not invisible: information for public policies, Aldaiza Sposati, Marco Natalino, Rinaldo Artes and Flávio Lino presented analytical inputs that reveal the structural dimensions of the issue and the urgency of integrated public policies.

Aldaiza Sposati, senior lecturer at PUC-SP and author of the 1997 São Paulo Municipal Law on the Rights of the Homeless Population, opened the debate by questioning the term “street situation” itself. She recalled that the term arose with the intention of reducing stigmas and overcoming typifying notions such as “street dweller”, but warned that today it can hide the core of the issue: rights. According to her, the term shifts the focus from the subjects and citizenship to a circumstantial condition which, if naturalised, risks becoming permanent. “The right must come before the debt,” she summarised, suggesting that access to services cannot be conditioned on constant proof of need.

Sposati also criticised the indiscriminate use of the categories “user” and “segment” in the social assistance system. For her, these names reinforce symbolic distancing and make it difficult to build bonds. On the other hand, she defended the centrality of the relationship as the organising axis of care, especially in territories where policies should dialogue with each other. The current scenario, she noted, reveals just the opposite: shelters, hostels and other services operate in isolation, without effective integration with health, care and education.

His reading shows that although national policy has advanced in terms of institutional instruments, a configuration marked by fragmentation and the absence of minimum standards of care still prevails. One of the effects of this lack of coordination is persistent administrative invisibility. This is because information systems are based on the notion of a fixed abode, a criterion that excludes precisely those who do not have a home. As a result, decisions based on data tend to ignore a significant contingent of the population. The result is a paradox: very high social visibility on the streets, low visibility in formal registers.

Based on recent data from the Single Registry, Sposati cited more than 337,000 registered people, 421,000,000 of them in the state of São Paulo. However, this inclusion does not ensure uniform coverage of benefits: membership of the Bolsa Família varies between approximately 68% and just over 80%. In addition to territorial inequalities, the researcher drew attention to discrepancies in infrastructure and the number of professionals per service, emphasising that the lack of national parameters makes it difficult to guarantee rights.

Next, Marco Natalino, a researcher at the Institute for Applied Economic Research (IPEA), presented the initial results of a study that integrates administrative databases of death registers and Single Registry, The study was conducted in partnership with teams from Ipea, foreign academic centres and international agencies. Its aim was to compare mortality rates of the homeless population with those of the general population and the low-income population, controlling for age and sex. According to the researcher, the demographic composition of this population - mostly male and concentrated in adult ages - makes it essential to use standardised rates to ensure valid comparisons.

The result is striking: a homeless person was 348% more likely to die than the general population in 2024. Even when compared only to the low-income population, they were still 223% more likely to die. The study estimated that of the more than 6,000 homeless people who died in 2024, at least 4,664 represent excess deaths - in other words, they wouldn't have occurred if they had the same average mortality pattern as the population. Natalino emphasised that these figures are underestimated, as there is underreporting and a lack of registry records for a significant part of this population.

He added that female deaths have a lower absolute volume, but have an even higher mortality ratio when compared to women living at home, indicating specific vulnerabilities. The researcher pointed out limitations of the study, such as the under-representation of children, adolescents and people in conflict with the law, but emphasised that even conservative cut-outs maintain the findings. The next steps involve deepening analyses by cause of death and integrating data from the official mortality system, with a special focus on external causes and homicides.

The third speaker, Rinaldo Artes, who holds a PhD in Statistics from IME/USP and is affiliated to INSPER, discussed the use of administrative data produced in São Paulo to understand the dynamics of the circulation of the homeless population in the reception network. Working with three systems (CadÚnico, SISA/acolhimento and SISRU/abordagem), his team followed cohorts of people over 10 years. A pattern was repeated: there is a sharp drop in permanence in the first few months, followed by stabilisation at around 10% to 15% after two years. The behaviour is similar between cohorts, even during the pandemic.

According to Artes, this pattern raises questions, not definitive answers. The drop could indicate leaving the streets, migration, alternating use of shelters, a change of municipality or simply an interruption in the use of services. An analysis by age group showed that older people stay longer, while young people use the services more briefly or sporadically.

Another analysis showed that 12% of people used the service for up to 10 days in two years, while another portion used it very intensively, for more than 600 days. This heterogeneity indicates different profiles and different needs, requiring specific policies. The researcher also drew attention to the phenomenon of “qualified exits” - when the person leaves the service due to finding a home, a job or returning to their family. Even in these cases, around 40% returned to the network at some point, suggesting that it is not enough to ensure exit; it is necessary to guarantee sustenance and continued protection. Finally, he pointed out that CadÚnico, SISA and SISRU do not describe the same population, which requires analytical caution.

Closing the panel, Flávio Lino, from the National Movement of Homeless People, presented an international overview of the issue, based on a survey carried out in 2023-2024 on the BRICS countries. According to him, these countries have more than 6.2 million homeless people. In the absence of binding global targets, the result is the continuous growth of the PopRua in all the contexts analysed. Lino pointed out that none of the 17 Sustainable Development Goals (SDGs) explicitly mention this population, which contributes to their marginalisation. He therefore advocated the creation of specific indicators and targets, emphasising that many people only need housing to achieve autonomy, while others need psychosocial support.

Lino suggested that the table produce a charter of commitments, forwarded to strategic agendas such as COP30, with the aim of institutionalising recommendations, intensifying cooperation between civil society, public bodies and international organisations, and pushing for an SDG dedicated to the issue.

The four speakers converged on a common diagnosis: without integrated data, without standards of care and without guidelines for ongoing protection, the violation of rights is perpetuated. The speakers at this panel reinforced the need to reposition the homeless population at the centre of public policy formulation, recognising their diversity, their trajectories and their citizenship.

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Coverage of 22 October 2025

Opening Table

• International round table: What kind of world is this? Realities and possibilities of transformation for the social protection of the homeless population
• Panel I : We are not invisible: information for public policies
• Panel II : Homeless women: comprehensive care, maternity and social protection from the perspective of gender and race equality
• Trails invites: Fr Julio Lancellotti
• Panel III: The right to social protection and health care in Brazil.

Coverage of 23 October 2025

• Panel IV : Experiences of care I
• Panel V: Experiences of care II
• Panel VI: The role of justice in dealing with homeless people
• Round table: The plan's challenges and potential Visible streets as a public policy strategy - CIAMP/RUA national

Photo caption: From left to right, Aldaiza Sposati, Marco Natalino, Flávio Lino and Carla Bronzo, João Pinheiro Foundation (mediator)