Affordable housing, health, and climate resilience: Insights from residents and stakeholders in the Brazil’s Minha Casa, Minha Vida Program

Affordable housing, health, and climate resilience: Insights from residents and stakeholders in the Brazil’s Minha Casa, Minha Vida Program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Affordable housing, health, and climate resilience: Insights from residents and stakeholders in the Brazil’s Minha Casa, Minha Vida Program Ana Luiza Favarão Leão, Milena Franco Silva, Guilherme Stefano Goulardins, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8853378/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Climate change exacerbates social inequalities in urban areas, disproportionately increasing disadvantaged communities’ exposure to environmental hazards. Housing shapes exposure, vulnerability, and adaptive capacity to climate risks, making it a key determinant of health and climate resilience. In Brazil, Minha Casa, Minha Vida (MCMV) is the largest federal affordable housing program, yet evidence on its health and climate implications remains limited. This study explores how MCMV affects health and climate resilience from the perspectives of residents and institutional stakeholders. We conducted semi-structured interviews with 52 residents (61.5% women; 53.8% self-identified as Brown/Pardo; primarily aged 30–49) and 12 institutional stakeholders (50% working in Curitiba–PR; 66.7% women; 83.3% self-identified as White; ages primarily 30–59) across five Brazilian cities. Guided by the Enhanced Socioecological Model (E-SEM), qualitative content analysis examined barriers and opportunities across individual, social, neighborhood, policy, and planetary levels. Across cities, residents described psychological security and emotional relief associated with stable homeownership (e.g., reduced anxiety and improved sleep), alongside challenges linked to peripheral siting and uneven infrastructure (long commutes, limited services, inadequate sidewalks/drainage, sewage problems, and weak state presence). Residents also reported environmental and infrastructure, worsened by lack of shade and green spaces. Stakeholders emphasized upstream drivers aligning with these experiences, including land-market pressures, zoning and governance constraints, fragmented intersectoral coordination, and limited incorporation/enforcement of climate adaptation. Overall, MCMV improves basic living conditions but often reinforces spatial inequities and climate vulnerability; advancing health and resilience will require improvements in location, intersectoral coordination, climate-responsive design, and community engagement. affordable housing climate resilience health equity active living Brazil qualitative research Introduction Access to adequate, secure, and well-located housing is increasingly recognized as a key social determinant of health and a pillar of climate resilience (Dunn, 2014; Revi et al., 2014; WHO, 2018). Affordable housing can mitigate climate-related vulnerabilities by improving structural safety, thermal comfort, and energy efficiency while providing stability that supports mental health and social cohesion (WHO, 2018). When affordable housing is integrated into well-planned urban areas, it also enhances access to employment, education, public services, and opportunities for active living, factors consistently associated with healthier lifestyles and reduced health inequities (Barton & Grant, 2006; Diez Roux & Mair, 2010; Giles-Corti et al., 2016; UN-Habitat, 2022) . Conversely, poorly located or inadequately designed housing developments can exacerbate segregation, increase exposure to hazards, and reinforce cycles of poverty and illness (Diez Roux & Mair, 2010; UN-Habitat, 2022) . In Brazil, housing policy has long grappled with deep spatial inequalities, informal settlements, and uneven urban development (Maricato, 2000; Rolnik, 2021). In response, the federal government launched the Minha Casa, Minha Vida (MCMV) program in 2009 (Law 11.977, 2009), one of the world's largest social housing programs (Júnia Santa Rosa, 2015). Designed to reduce the national housing deficit, MCMV provides subsidized or fully financed housing units for low- and middle-income families (Cardoso, 2013). Between 2009 and 2020, the program built over six million housing units and generated more than 3.5 million jobs, representing a major investment in social infrastructure (CMAP, 2020). Although temporarily discontinued in 2020, the program was reinstated in 2023 (Ministério das Cidades, 2023a) and is planned to deliver two million additional units by 2026 (Ministério das Cidades, 2023b). The program’s scale and reach make it a crucial policy lever for addressing not only housing shortages but also broader social and environmental challenges (Reis et al., 2026). The home is both a refuge and a frontline of climate impacts, shaping individuals' and families' capacity to cope with environmental stressors and maintain well-being (Cutter et al., 2003; WHO, 2018). It is a primary site where climate impacts are directly experienced (Hernández, 2022), particularly as people increasingly rely on their residences for protection against extreme weather events such as storms, heat waves, floods, and droughts (U.S. Environmental Protection Agency, n.d.). In this sense, providing high-quality, affordable, well-located housing can mitigate the impacts of environmental hazards, particularly in low- and middle-income countries, where climate risks are concentrated among vulnerable urban communities living in informal settlements (Revi et al., 2014; WHO, 2018). Despite its magnitude and relevance, limited evidence exists on how MCMV influences residents’ health, well-being, and climate resilience across Brazil’s diverse urban contexts (Araujo & Villa, 2020; Menezes & Mourão, 2017) . Most evaluations have focused on economic outcomes or construction metrics, overlooking residents' everyday experiences and the perspectives of institutions involved in planning, financing, and managing the program (Silva et al., 2025). Yet, understanding how affordable housing shapes multiple dimensions of health, physical, mental, and social, and interacts with environmental risks is essential to inform equitable and sustainable housing policy. In fact, climate change is rapidly intensifying the frequency and severity of extreme events, resulting in significant impacts on urban environments and public health in multiple fronts (Agache et al., 2025; An et al., 2020; Bezgrebelna et al., 2021; Ebi et al., 2020; Jacobsen et al., 2022; Rosenthal et al., 2021; Thomson & Stanberry, 2022). Drawing on qualitative interviews conducted in five cities across Brazil’s major regions, this study explores how the MCMV program affects health and climate resilience from the perspectives of residents and key stakeholders. By capturing detailed perceptions across diverse regional contexts, it highlights residents’ lived experiences, perceived co-benefits of this type of formal housing, and persisting challenges and constraints related to location, mobility, infrastructure, security, and environmental exposure. Using the Enhanced Socioecological Model (E-SEM) (Reis, Leão, et al., 2025), the analysis considers these issues across interconnected levels: individual, interpersonal, community, neighborhood environment, and policy. These results aim to inform housing strategies that promote healthier, more equitable, and climate-resilient urban spaces. Methods This qualitative study examined how Brazil’s MCMV program influences residents’ health, well-being, and climate resilience, as reflected in the lived experiences of beneficiaries and the perspectives of institutional stakeholders. Semi-structured interviews were conducted with residents and key informants, and the data were analyzed using qualitative content analysis. The analytical process was informed by the E-SEM framework (Reis, Leão, et al., 2025), which integrates the Ecological Model of Active Living, the Social Determinants of Health framework, and the Planetary Health paradigm. The E-SEM informed the development of the interview instruments and served as an analytic scaffold, enabling the classification of emerging codes into socioecological levels (individual, interpersonal, community, neighborhood environment, and policy) and supporting the examination of linkages between housing, health, equity, and climate resilience. Study setting Interviews were conducted in five major Brazilian cities, each representing one of the country’s geographic regions, to capture contextual diversity in climate, urban form, and policy implementation. The selected cities were Manaus (Amazonas, North), João Pessoa (Paraíba, Northeast), Campo Grande (Mato Grosso do Sul, Center-West), São Paulo (São Paulo, Southeast), and Curitiba (Paraná, South). In each location, interviews were conducted within developments in the MCMV program’s Faixa 1 category, which serve households with the lowest income levels through fully subsidized housing units, ensuring access to homeownership for the most economically vulnerable populations. The study was approved by the Research Ethics Committee of the research institution (CAAE 87845925.6.0000.0020). All participants provided informed consent and were assured of confidentiality and the voluntary nature of participation. Audio recordings were stored securely and deleted after transcription. Identifying details were removed from transcripts, and findings were reported in aggregate form. Participants and recruitment Residents Recruitment followed a purposive sampling approach to capture a wide range of perspectives related to housing, health, and environmental experiences. Trained local interviewers conducted in-person recruitment in August 2025 in selected MCMV tier 1 developments in each city. Before fieldwork, interviewers participated in remote training sessions in July 2025, organized by the coordination team, which provided standardized guidance on eligibility screening, ethical procedures, and strategies to ensure sample heterogeneity. Interviewers were instructed to seek heterogeneity in gender and age group (including young adults, adults, and older adults), prioritizing overall balance across these criteria within the practical constraints of field access and residents’ availability. Local partners and community contacts (e.g., residents’ associations and community leaders, when present) assisted in identifying eligible participants and facilitating trust within communities. When appropriate, snowball sampling was employed by asking interviewed residents to recommend other eligible participants within the same housing development, particularly to reach residents who were less connected to formal community networks. This strategy ensured that the sample represented the variety of experiences and perceptions across different cities, housing developments, and household compositions. Stakeholders To contextualize the perspectives of residents, key informants were interviewed, representing diverse sectors directly or indirectly involved in housing and urban development. Participants included professionals from the public sector, academic institutions, non-governmental organizations, and private consulting firms with recognized expertise in housing policy, urban planning, sustainability, or health-related research. Stakeholder recruitment also followed a purposive sampling approach, initiated through recommendations from the project’s advisory committee, which identified relevant actors with direct experience in the MCMV program or related policy agendas. These initial contacts were invited by the research team and, when interviewed, were asked to recommend additional participants with complementary roles or perspectives. This snowball strategy enabled the inclusion of stakeholders across different governance levels and sectors, enriching the institutional analysis of MCMV implementation, constraints, and opportunities for strengthening equity and climate-resilient housing. Data collection Instruments Two semi-structured interview guides (Supplementary file S1) were developed and conducted in Brazilian Portuguese, the native language of interviewees, to capture complementary perspectives of residents and stakeholders. The resident interview guide focused on participants’ experiences of living in MCMV housing, including perceptions of safety, mobility patterns, access to services, community relationships, environmental conditions, and perceived health impacts. The stakeholder interview guide explored institutional viewpoints on the implementation of MCMV, highlighting barriers and opportunities for equity and sustainability, policy design processes, strategies for climate resilience, and contributions to community well-being. Both instruments were informed by the E-SEM framework and were pretested during interviewer training sessions with four Brazilian researchers—experts in urban planning and public health—for refinement, ensuring clarity and consistency. The guides consisted of open-ended questions accompanied by flexible probes designed to encourage narrative depth, reflection, and the inclusion of contextual details. Fieldwork procedures for resident interviews Resident interviews were conducted in person with an average duration of 45 to 60 minutes. The fieldwork followed standardized procedures detailed in a training manual developed to ensure methodological rigor, data reliability, ethical compliance, and the safety of both participants and interviewers. All field researchers participated in a remote training session prior to data collection, where the study’s objectives, ethical protocols, and the use of the semi-structured interview guide were thoroughly discussed. The training emphasized respectful engagement with participants, accurate application of the instrument, and strict adherence to the research protocol. Interviewers received a printed and digital manual outlining detailed guidance for participant approach, consent procedures, data recording, and fieldwork conduct. They were instructed to carry all necessary materials, including the consent form, interview guide, and a reliable recording device, and to maintain a professional, impartial, and empathetic posture throughout the process. At the beginning of each encounter, interviewers introduced themselves as members of the research team, explained the purpose and scope of the study in accessible language, and confirmed whether it was a convenient time for the participant. The consent form was then presented and read together when necessary, ensuring full understanding of the study’s objectives, confidentiality measures, and the voluntary nature of participation. Only after participants provided written consent did the interview proceed. Interviews followed the standardized guide in sequence but were conducted conversationally and flexibly, allowing participants to elaborate on their experiences and perceptions. Interviewers were trained to maintain neutrality, avoid suggestive or leading questions, and use non-directive prompts such as “Could you tell me more about that?” to encourage depth and clarity. Participants were reminded at the outset and again during the interview that their involvement was voluntary, they could decline to answer any question, and their responses would remain strictly confidential. With the participant’s permission, interviews were audio-recorded using mobile devices to ensure the accuracy of transcription. When participants declined recording, interviewers took detailed written notes in real time. Before each session, fieldworkers verified the functionality of the recording equipment, checked available storage capacity and battery charge, and set devices to silent mode to avoid interruptions. Each interview was assigned a unique identification code and securely uploaded to the coordination team for transcription and storage, in compliance with data protection standards. Efforts were made to ensure diversity among participants in each city, aiming for an approximate balance across gender (around five women and five men per city) and age groups (young adults aged 18–30, adults aged 31–59, and older adults aged 60+). While exact quotas were not mandatory, the aim was to capture a broad range of experiences reflecting different life stages and household circumstances. All interviews were conducted within a single MCMV development per city, chosen for accessibility and representativeness, thereby ensuring contextual consistency and facilitating logistical coordination. To ensure quality control, the supervisory team reviewed all audio files and field notes for completeness, clarity, and adherence to the interview guide. Cases of incomplete data, technical failures, or significant deviations from the protocol were identified and excluded from analysis. Any form of data fabrication, editing, or manipulation was explicitly prohibited and monitored as part of the study's ethical oversight. Procedures for stakeholder interviews All interviews were conducted online via Zoom , according to each participant’s availability, and lasted 45-60 minutes. This remote format enabled the inclusion of national- and local-level actors from across Brazil, enhancing the representativeness of institutional viewpoints. Before each interview, participants received an information sheet describing the study, along with the informed consent form, and were reminded that participation was voluntary, confidential, and unrelated to any institutional assessment. The stakeholder interviews aimed to explore institutional perspectives on the implementation and outcomes of MCMV, including barriers and opportunities for promoting equity, sustainability, and climate resilience. These conversations also sought to capture insights into governance processes, intersectoral coordination, and potential strategies for improving the integration of housing and health agendas in Brazil. Data analysis Data were analyzed using qualitative content analysis, following the procedures outlined by Bardin, (2011) and Mozzato & Grzybovski (Mozzato & Grzybovski, 2021). The analytical process began with a phase of familiarization, during which transcripts were read multiple times to develop a holistic understanding of participants’ narratives. This was followed by initial coding, where meaningful units of text related to housing, health, environmental conditions, and social dynamics were identified. In the next step, codes were grouped into categories aligned with the study’s analytical axis, examining the impacts and possibilities of the MCMV program for promoting healthy lives in cities. These categories were then organized into socioecological levels: individual, interpersonal, neighborhood or built environment, policy or societal, and environmental. Finally, a synthesis stage integrated themes across participant groups and study sites, allowing the identification of recurring patterns, divergences, and contextual nuances. Coding was carried out by trained researchers through a collaborative and iterative process, and emerging themes were reviewed and validated by the full research team to ensure analytical rigor, coherence, and interpretive consistency. After inductive coding, categories were mapped onto E-SEM levels to examine how experiences and determinants were distributed across individual, social, environmental, and policy domains. Results Participant characteristics We analyzed 64 qualitative interviews: 52 residents living in Minha Casa, Minha Vida (MCMV) Faixa 1 developments across five Brazilian cities: João Pessoa (n=8; Northeast), Manaus (n=12; North), Campo Grande (n=10; Central-West), Curitiba (n=10; South), and São Paulo (n=12; Southeast); and 12 institutional stakeholders working in planning, financing, delivery, or oversight of the MCMV program. Descriptive statistics for participant characteristics are presented in Table 1. Among the 52 residents, women predominated (n=32, 61.5%) over men (n=20, 38.5%). Most participants' ethnic self-identification was pardo (n=28, 53.8%), followed by white (n=14, 26.9%) and black (n=10, 19.2%). Residents’ birth cohorts spanned the 1950s through the 2000s, with the 1990s (n=17, 32.7%) and 1980s (n=13, 25.0%) representing the largest groups, followed by the 1970s (n=12, 23.1%); smaller proportions were born in the 2000s (n=4, 7.7%), 1950s (n=3, 5.8%), and 1960s (n=2, 3.8%), and birth year was unclear for one participant (n=1, 1.9%). Education levels were concentrated in secondary schooling, complete or ongoing (n=25, 48.1%), with smaller numbers reporting incomplete or completed higher education (n=8, 15.4%) and a small subset reporting primary education (n=5, 9.6%). Household income clustered predominantly between 1–2 minimum wages per family (n=26, 50.0%) and >2–3 minimum wages (n=15, 28.8%), although a minority reported earnings below 1 minimum wage (n=2, 3.8%) or above 3–4 minimum wages (n=3, 5.8%). Time living in the current unit varied substantially: <1 year (n=5, 9.6%), 1–5 years (n=28, 53.8%), 6–10 years (n=9, 17.3%), and 11–15 years (n=10, 19.2%). Most residents were born in their current city (n=35, 67.3%), suggesting largely local migration trajectories. Employment arrangements included formal employees (n=15, 28.8%), informal employees (n=8, 15.4%), and self-employed workers (n=12, 23.1%), alongside homemakers (n=10, 19.2%), unemployed individuals (n=3, 5.8%), retirees (n=2, 3.8%), and one resident currently on medical leave (n=1, 1.9%). Among the 12 institutional stakeholders interviewed, birth years ranged from the 1950s through the 1990s, with most born in the 1970s (n=6, 50.0%), followed by the 1990s (n=2, 16.7%); one stakeholder each was born in the 1950s, 1960s, and 1980s (each n=1, 8.3%), and birth year was not reported for one participant (n=1, 8.3%). Women predominated (n=8; 66.7%), followed by men (n=2; 16.7%); gender was not reported for two participants (16.7%). Most stakeholders self-identified as white (n=10; 83.3%); race/color was not reported for two (16.7%). Stakeholders represented a range of governmental, academic, and civil society institutions. Work jurisdictions were concentrated in Curitiba–PR (n=6; 50.0%), followed by São Paulo–SP (n=2; 16.7%), Rio de Janeiro–RJ (n=1; 8.3%), Brasília–DF (n=1; 8.3%), and one currently in the USA (8.3%). Table 1. Participant characteristics (N = 64 qualitative interviews) Characteristic Residents (n=52) Institutional stakeholders (n=12) Gender Women 32 (61.5%) 10 (83.3%) Men 20 (38.5%) 2 (16.7%) Race/color (self-identified) Brown/Pardo 28 (53.8%) — White 14 (26.9%) 10 (83.3%) Black 10 (19.2%) — Not reported — 2 (16.7%) Age (birth-year band) 1950–1959 3 (5.8%) 1 (8.3%) 1960–1969 2 (3.8%) 1 (8.3%) 1970–1979 12 (23.1%) 6 (50.0%) 1980–1989 13 (25.0%) 1 (8.3%) 1990–1999 17 (32.7%) 2 (16.7%) 2000–2009 4 (7.7%) — Not reported 1 (1.9%) 1 (8.3%) Education Secondary (complete or ongoing) 25 (48.1%) — Higher education (incomplete or complete) 8 (15.4%) — Primary education 5 (9.6%) — Other / not specified 14 (26.9%) — Household income (minimum wages / family) 2–3 15 (28.8%) — >3–4 3 (5.8%) — Other / not reported 6 (11.5%) — Time living in current unit <1 year 5 (9.6%) — 1–5 years 28 (53.8%) — 6–10 years 9 (17.3%) — 11–15 years 10 (19.2%) — Born in current city Yes 35 (67.3%) — No / not reported 17 (32.7%) — Employment status Formal employee 15 (28.8%) — Informal employee 8 (15.4%) — Self-employed 12 (23.1%) — Homemaker 10 (19.2%) — Unemployed 3 (5.8%) — Retired 2 (3.8%) — Medical leave 1 (1.9%) — Content Analysis Findings This section presents the results of the qualitative content analysis based on semi-structured interviews with institutional stakeholders and, subsequently, with residents of MCMV Faixa 1 developments. Findings are organized into five thematic axes reflecting the program’s impacts and possibilities for promoting healthy, equitable, and climate-resilient lives in cities (Table 1) . How MCMV shapes equity and access to sustainable urban living Stakeholders emphasized that the equity and sustainability outcomes of MCMV are largely determined by municipal governance capacities, land regulation, and local political priorities. While the program is federally designed, its implementation varies markedly across regions due to differences in zoning powers, land availability, and institutional coordination. Reliance on low-cost peripheral land is viewed as a primary mechanism for reproducing spatial inequities, distancing families from work, services, and social networks. As one stakeholder explained, MCMV developments are often placed “in the most peripheral areas of the city, which usually have the most precarious urban infrastructure, the least and worst public transport, and fewer leisure and cultural spaces,” so that families are relocated “to places farther from where they previously lived, increasing the daily cost of working, studying, and simply reproducing their lives,” thereby reinforcing poverty rather than reducing it. Stakeholders also highlighted weak integration across policy sectors, housing, transportation, social assistance, and health, and noted the dominance of market logics over environmental, social, and equity considerations in development decisions. Residents’ narratives reflect these institutional dynamics through lived experience. Across cities, most beneficiaries reported limited autonomy in the housing allocation process, with units commonly assigned through lotteries or on the basis of urgent need. While some residents selected units based on proximity to transport or quieter blocks, choice was generally constrained by financial pressure and limited availability. Despite these restrictions, ownership was widely associated with dignity, safety, and emotional stability compared with prior housing conditions. Yet, residents also identified major limitations in their neighborhoods, including scarce public spaces, long distances to essential services, limited commercial infrastructure, and inadequate state presence. Desired transformations centered on mobility improvements, green areas, security, maintenance, and structured opportunities for participation. These perspectives show how MCMV simultaneously expands access to secure housing and reproduces disparities in urban opportunity. Equity gains at the household level often coexist with structural barriers at the neighborhood scale, reinforcing the importance of aligning affordable housing provision with sustainable, service-rich urban environments. Climate risks and adaptation, environmental comfort, and sustainable design Stakeholders consistently described climate adaptation as an underdeveloped dimension within MCMV. While federal directives mention sustainability and resilience on paper, interviewees reported limited translation into practice: “If we look at the manuals and documents linked to the program, there’s certainly a lot written about resilience and climate change. But in practice, at least what I know, they don’t apply these guidelines.” In their accounts, implementation continues to be shaped by land costs and construction budgets, which push projects toward peripheral, often environmentally fragile areas. Several highlighted weak enforcements of standards, fragmented institutional responsibilities, and resistance to new building technologies by contractors and financing agencies: “We’ve been thinking about more sustainable materials… people talk a lot about new construction models, but when you have to get them approved within Caixa [the major financing agency in Brazil], they’re still resistant to new construction formats; it still goes back to the traditional—cement and masonry.” Although there are notable municipal climate resilience interventions, such as the installation of solar panels, rainwater reuse facilities, and the Caximba redevelopment in Curitiba, which focuses on infrastructure improvements and solar panel installations on houses, these remain exceptions rather than the norm. Stakeholders also pointed out that current program structures favor standardized new construction and do not adequately support retrofitting, environmental improvements, or upgrades to existing developments. Residents’ experiences expose the health and well-being consequences of these structural gaps. Across all cities, participants described significant thermal discomfort in their homes, very hot in summer, cold in winter, linked to poor ventilation and building materials. Mold, dampness, leaks, and noise further affected daily comfort. Neighborhood-level environmental hazards were widely reported, including smoke from fires and land clearing, industrial noise, air pollution, stagnant water, mosquito infestations, and localized flooding. As one resident explained, “There is a lot of rubbish and debris on the streets, and pollution brings many dengue mosquitoes and stagnant water, which is harmful.” Many residents valued the emotional security of homeownership, yet stressed financial pressure, limited green spaces, and difficulties accessing timely healthcare. The absence of shaded public areas and tree cover was seen as exacerbating heat exposure and constraining outdoor socialization: “Because of the weather. Sometimes it is extremely hot, and if we had more green areas with trees and plants, it would be cooler. Summer here is very hot. If there were more green areas, it would be better.” These perspectives highlight the disconnection between the program’s stated environmental ambitions and the everyday lived experience within MCMV developments. Structural decisions related to siting, design, and construction compound environmental stressors and undermine climate resilience, particularly for households already facing socioeconomic vulnerability. Location, transportation mobility, and access to essential services Stakeholders consistently identified location as the central determinant shaping living conditions in MCMV developments. They emphasized that, especially in Faixa 1 , the siting of projects is largely driven by land price, resulting in concentrations of new housing in peripheral or peri-urban areas (“urban fringes”), where infrastructure networks are incomplete and social services scarce. This pattern reflects what they described as a tension between social goals and market logic: cheap land enables large-scale delivery, but systematically distances vulnerable populations from employment, education, healthcare, and transport networks. As one participant noted, construction companies “ always look for the cheapest plots, which are often the most environmentally fragile and most exposed to risk.” Another reflected that site selection “has a lot to do with land value,” and that instead of promoting urban densification and more compact cities, MCMV “has, to a large extent, contributed to urban sprawl, with direct impacts on mobility.” Several highlighted that decisions at the municipal and developer level, such as prioritizing low-cost land, enclosed condominium typologies, and weak environmental criteria, often undermine goals of equity and healthy living. Proposed solutions included transit-oriented development, mixed-use planning, smaller-scale projects, and intersectoral urban governance to align housing, transport, and service provision. Residents’ accounts illustrate the lived consequences of these structural conditions. Experiences varied across cities and household profiles, but a recurring pattern emerged: while some residents benefited from proximity to neighborhood-level services (schools, small markets, health posts), daily commuters faced significant mobility burdens. Long and costly trips were particularly prevalent in Manaus and João Pessoa, where insufficient public transport and peripheral location increased dependence on private vehicles or informal transport. In Campo Grande and Curitiba, mobility outcomes depended heavily on occupation and gender roles, with homemakers and caregivers reporting improved access to schools and shops. At the same time, formal workers cited worsening commute times. São Paulo residents reported some improvements compared with previous informal housing arrangements, yet they still highlighted infrequent bus service, road deterioration, and gaps in modal integration. Deficiencies in local infrastructure further constrained mobility and service access. Across multiple cities, residents reported broken sidewalks, poor drainage, recurring sewage problems, flooding, irregular waste collection, water shortages, lack of shaded public spaces, and insufficient plazas or recreation areas. As one resident summarize d, “Sewage is terrible here, sewage is terrible - this is the only place where the water flows over the sewage instead of inside the pipes.” Access to healthcare and education varied widely, and limited local formal employment opportunities reinforced the need for long-distance travel. Many residents expressed a pervasive sense of abandonment by public authorities: “ We need the services provided by the government to be quickly accessible. When someone is sick, they cannot be left waiting; there cannot be a long distance between home, where they are ill, and the place where they will be treated. That is my opinion.” These perspectives demonstrate that the location of MCMV developments profoundly influences mobility patterns, access to services, and everyday well-being. While formal housing offers stability, peripheral siting and uneven infrastructure provision create structural mobility disadvantages, especially for low-income, caregiving, and disabled residents, ultimately shaping both social participation and health outcomes. Community relations, collective life, and perceived safety Stakeholders highlighted community organization as fundamental for the long-term success and resilience of MCMV developments. They emphasized that mutual support networks, neighborhood-based trust, and opportunities for participation are essential to maintaining well-being and preventing social isolation, particularly among vulnerable groups reassigned from areas of risk. However, they also identified significant structural barriers. Large, high-density developments were seen as undermining social cohesion by fostering anonymity, increasing resident turnover, and weakening local identity. As one stakeholder noted, “In many situations, we have many people or families who arrive without any prior neighborhood ties. I believe that creating or rebuilding a sense of community is more difficult in these cases”. Interviewees stressed the lack of systematic post-occupancy social support, suggesting that municipal teams and social workers often disengage after the initial delivery phase. Some pointed to promising practices, such as intersectoral working groups and participatory forums like Fala Curitiba (Prefeitura de Curitiba, 2017) , as ways to strengthen voice, accountability, and collective engagement. Nonetheless, the overall perception was that MCMV remains primarily an individual housing solution, offering limited mechanisms for community building. Several stakeholders highlighted the central role of social workers: “I think the work of social workers is very important for creating these bonds, especially because many residents (...) come from situations of significant social vulnerability.” Resident narratives indicate that community relations are central to everyday life in MCMV developments, yet yet they often remain informal and weakly structured. As one resident explained, “It’s very peaceful here, because of the friendships we have inside; everyone looks out for each other—if the kids are playing, whoever is downstairs keeps an eye on them, and if someone’s mother isn’t around…” Across cities, interactions among neighbors were generally described as cordial but intermittent, marked by proximity rather than deep ties. Organized collective life and participation in formal community groups varied widely: some residents reported joining occasional initiatives (e.g., courses offered through local services or municipal programs). In contrast, others avoided community involvement altogether (“I don’t really like talking to neighbors”). Where it existed, it was often driven by volunteer initiatives rather than institutional coordination. Limited or poorly equipped public spaces, the absence of consistent community mediation, and few structured policies for social strengthening contributed to fragile and individualized bonds. Residents also described how long work hours and time away from the condominium constrained opportunities to interact (“My time is really tight… I don’t have time to participate ”). Despite this, residents frequently described spontaneous practices of solidarity: sharing childcare, borrowing food or tools, organizing voluntary cleaning, forming informal support networks in moments of illness or crisis. Perceptions of safety were highly context dependent. In several developments, residents associated community proximity with protection and tranquility. Conversely, in Manaus and parts of São Paulo, residents reported feelings of fear, episodes of violence, or criminal factions acting as informal regulators, simultaneously enforcing rules and exposing residents to power asymmetries. Regarding the presence of these groups, one resident noted: “Even though it’s controlled by a faction, we’re not very afraid to go out, because they monitor everything. There have been cases of people robbing here, and they handle them themselves. So it’s very rare to have robberies because of that. If you steal, you’re judged inside. It’s not about public safety, it’s their own ‘security.’ So we actually feel safer because of them.” This dual experience, calm within the condominium boundaries yet insecure in the surrounding territory, was recurrent. Collectively, these results reveal that while MCMV offers physical stability, the social fabric remains thin yet capable of mobilizing care and cooperation. The absence of sustained institutional presence, lack of shared public spaces, limited mechanisms for participation, and the burden of long working hours all constrain the consolidation of cohesive community life. Yet residents continuously improvise forms of collective resilience. Health, well-being, and environmental conditions Stakeholders emphasized that health outcomes in MCMV developments are deeply shaped by structural factors linked to the built and social environment. Poor insulation and ventilation, which lead to thermal discomfort, high humidity, and mold growth, were viewed as a major determinant of respiratory and emotional distress. Interviewees noted that peripheral siting of MCMV developments reinforces inequalities in access to healthcare, nutritious food, and recreational spaces, while also weakening existing social support networks for caregivers, older adults, and people with disabilities. They also highlighted mental-health burdens associated with abrupt relocations, loss of community ties, and daily stressors linked to economic precarity. Proposed solutions centered on intersectoral action: expanding community-based services, integrating social assistance into post-occupancy phases, enhancing local provision of public spaces and health-promotion infrastructure (parks, sports courts, open-air gyms), and improving environmental comfort and housing performance. They argued that MCMV has transformative potential, but that health benefits are contingent on location, design quality, and sustained municipal engagement. Residents confirmed a dual experience: psychological security derived from stable homeownership, alongside persistent environmental and infrastructural stressors. Across cities, many participants described emotional relief after leaving precarious rental or informal settlements, with reduced anxiety, improved sleep, and increased sense of safety. However, these gains were often offset by worsening physical discomfort and new everyday burdens. Health concerns raised by residents included: excessive indoor heat and cold, mold and dampness, smoke and airborne pollution from nearby fires or industrial sites, noise disturbances, and difficulties accessing specialized healthcare. Regarding air and noise pollution, one resident shared : “Because of the industries and the terminal, there’s a lot of noise and smoke. Nowadays it doesn’t bother me anymore; I’ve learned to live with it.” Regarding heat, another resident noted: “The heat affects the house because it isn’t well ventilated—you can’t stay inside for long during the summer.” Several participants linked mobility strain to exhaustion, stress, and reduced time for leisure or rest. Environmental conditions were repeatedly tied to well-being. The scarcity of shade, trees, and accessible green spaces was perceived as a barrier to relaxation, physical activity, and children’s play. In every city, residents described how the physical apartment, the immediate surroundings, and the wider neighborhood combined to influence comfort, mental health, and daily functioning. Overall, resident narratives demonstrate that health improvements are neither automatic nor evenly distributed, but mediated by climate exposure, housing performance, proximity to services, and social life within the developments. Integrated Synthesis Stakeholder and resident perspectives converge around structural challenges that shape everyday life in MCMV developments, especially peripheral siting, fragmented intersectoral coordination, and limited attention to climate resilience and social cohesion. Stakeholders describe these issues at the level of governance, land markets, and policy design, while residents articulate how they are experienced in practice: long commutes, heat stress, exposure to environmental hazards, insecurity, and weak community ties, alongside improved residential stability and dignity. Guided by the Enhanced Socioecological Model (E-SEM), this analysis demonstrates how institutional decisions and environmental conditions cascade across individual, interpersonal, community, and neighborhood levels to influence health and well-being. By doing so, it showcases how the same upstream program decisions are expressed across nested levels of influence, and how resident experiences “translate” structural choices into daily exposures, Four leverage points emerged as especially critical for transforming housing impacts: (1) location and connectivity, (2) environmental and thermal performance, (3) access to services and green infrastructure, and (4) social support networks. Strengthening these dimensions is essential for repositioning MCMV from a housing delivery mechanism to a platform that promotes healthier, more equitable, and climate-resilient urban living. In the integrated interpretation, stakeholder and resident accounts are examined at each E-SEM level, specifying key barriers, corresponding opportunities, and how mechanisms cascade across levels. For example, policy/structural decisions (e.g., governance fragmentation and market-driven land allocation) shape neighborhood environments (e.g., peripheral siting, weak infrastructure, and limited services), which in turn influence community conditions (e.g., thin social cohesion, perceived insecurity, and limited participation) and ultimately interpersonal and individual outcomes (e.g., time poverty, chronic stress, thermal discomfort, and constrained well-being). Table 2 provides an integrated interpretation that synthesizes stakeholder and resident accounts at each E-SEM level, highlighting key barriers and opportunities and indicating how upstream mechanisms cascade into downstream outcomes. Table 2. Integrated thematic synthesis mapped to E-SEM levels. E-SEM Level Stakeholder themes Resident themes Mechanism linking levels Integrated interpretation Policy / Structural MCMV, equity & sustainability Residential trajectories; access to housing; perceptions & desires for territorial transformation Governance, equity, autonomy in access to housing Barrier: structural governance fragmentation & market-driven land allocation. Opportunity: more participatory, equity-oriented governance & integrated housing policy. Neighborhood environment Location, infrastructure & access to services Mobility, infrastructure & access to services Spatial integration, transport, public services Barrier: spatial isolation produces time poverty & inequitable access—opportunity: transit-oriented location, service clustering & mixed-use strategies. Neighborhood environment Climate risk management & sustainable strategies Health, climate & green spaces Environmental comfort, climate resilience, green infrastructure Barrier: environmental vulnerability built into design & siting. Opportunity: integrate climate adaptation, green infrastructure & environmental comfort standards. Community Community & social relations Community relations & shared spaces; perception of safety Social cohesion, trust, safety, participation Barrier: fragile social fabric & institutional absence. Opportunity: community hubs, social work & participatory structures. Individual + Interpersonal (downstream outcomes) Health & well-being Health, climate & green spaces Physical & mental health determinants Barrier: cumulative strain across environment, mobility & isolation. Opportunity: integrated territorial health strategy & improved environmental design. Discussion This study qualitatively demonstrates that while MCMV has generated substantial gains in residential stability and formal housing access, its ability to promote health, equity, and climate resilience remains uneven across cities. Stakeholders highlighted structural and governance gaps, whereas residents emphasized daily challenges related to location, mobility, safety, and environmental comfort. While stakeholders spoke in abstract systemic terms (i.e., land market dynamics, policy fragmentation, governance failures), residents expressed these same forces through direct, embodied experience (i.e., indoor temperature, hours spent commuting, financial strain, or fear of violence and crime in the neighborhood). Climatic and environmental discomfort was reported more frequently by residents than by stakeholders, illustrating how daily living and climate vulnerabilities remain largely invisible in institutional discourse. Our results align with international evidence demonstrating that housing is a powerful socio-environmental determinant of health (Bentley et al., 2025), particularly for low-income populations in rapidly urbanizing regions (Mehdipanah, 2023). Studies have shown that poorly located or inadequately serviced housing developments can reinforce socio-spatial inequality (Leite et al., 2022), increase exposure to environmental risks (Chakraborty Jayajit and Koul, 2024; de Sousa & Braga, 2020), and hinder access to health-promoting infrastructure (Leite et al., 2022; Linke et al., 2016). The patterns observed in MCMV communities mirror well-documented dynamics in other large-scale social housing programs, especially in Latin America (Martínez et al., 2018; Zunino & Hidalgo, 2009), where peripheral siting (Souza & Sugai, 2018) and infrastructural fragility undermine health and mobility outcomes (Teixeira et al., 2023). At the same time, our findings extend this literature by illustrating how these mechanisms operate across diverse Brazilian urban contexts and climatic regions. Importantly, residents’ narratives highlight how physical, social, and environmental drivers compound in everyday life, amplifying vulnerability. The study also reveals the dual nature of MCMV’s impacts, as residents gain stability, legal tenure, and distance from unsafe or precarious former housing, significant trade-offs often accompany these benefits. Peripheral siting increases commuting time and financial strain; limited transport options constrain employment and education opportunities; and environmental challenges, from heat stress to poor ventilation, affect health and comfort. Social fragmentation and restricted community life further limit the transformative potential of relocation. These findings echo broader debates in Latin America about the tension between rapid housing delivery and integrated urban development (Habitat III Secretariat, 2017), underscoring the need to balance quantity with the quality of location, infrastructure, and community support (Gabriel et al., 2024). Importantly, they also reinforce the relevance of the program’s 2023 reframing, which explicitly positions MCMV not only as a housing provision but also as a policy intended to promote the right to the city alongside the right to housing (Ministério das Cidades, 2023a). This shift strengthens the argument that program success should be evaluated not only by the number of units delivered but also by their integration into urban systems, access to services and opportunities, and the everyday conditions that enable health, well-being, and climate resilience. Climate and environmental concerns were especially prominent among residents, who frequently reported heat discomfort, poor thermal performance (de Carvalho et al., 2021), pollution, a lack of shaded public space, and low unit layout adaptation (Araujo & Villa, 2020). These findings reinforce emerging evidence linking climate vulnerability to housing design (Gabriel et al., 2024), neighborhood environmental quality, and access to green and blue infrastructure (Carneiro et al., 2021). As extreme heat, flooding, and air pollution intensify, the resilience of social housing will increasingly depend on integrating climate-aware design and maintenance standards, strengthening not only building performance but also essential infrastructure such as sanitation systems (Nishimura, 2020). The MCMV experience illustrates how climate exposure intersects with poverty, location, and infrastructural deficits, signaling the urgency of embedding adaptation strategies into affordable housing policy. The findings from this study underscore that housing impacts on health and climate resilience operate simultaneously across the individual, household, community, and policy levels. Applying the E-SEM framework (Reis, Favarão Leão, et al., 2025) enabled the interpretation of how thermal discomfort, mobility barriers, social fragmentation, and governance gaps are connected rather than isolated challenges. By linking household-level experiences to community infrastructure and to broader institutional and environmental conditions, E-SEM highlights how decisions regarding land use, construction standards, transport planning, and climate adaptation cascade into daily living conditions. This multi-level perspective reinforces that improving health and resilience in MCMV requires coordinated action across sectors, including housing, mobility, social protection, and environmental planning, rather than isolated upgrades within residences. Findings point to pressing implications for both research and policy. From a research standpoint, longitudinal studies are needed to understand how health and climate-related outcomes evolve as families transition from informal settlements to formal MCMV housing. Robust causal research designs are needed to isolate the effects of MCMV from broader urban or socioeconomic trends. In this context, the evolution of the program itself offers a valuable natural experiment: the earlier phase of MCMV (2009–2020), widely associated with peripheralization and uneven urban insertion, can be contrasted with the post-2023 reforms that place greater emphasis on location, infrastructure, and sustainability standards (Reis et al., 2026). There is also an urgent need for improved data collection on and measurement of thermal performance, environmental exposure, mobility access, and social cohesion. Intersectional analyses are also necessary to capture differentiated impacts across residents of varying gender, race, disability, and age. Future work should additionally investigate how housing conditions shape daily health-related behaviors, including physical activity, caregiving, and social participation. From a policy perspective, the results indicate several strategic priorities for strengthening MCMV and advancing healthier, more equitable, and climate-resilient housing in Brazil. First, improving location and connectivity is essential and must prioritize access to employment, healthcare, education, and public transport, supported by integrated mobility planning and Transit-Oriented Development strategies. Second, to strengthen environmental and thermal performance, climate adaptation must be embedded into design and retrofitting standards, not as optional innovations, through improved ventilation, better insulation, shaded public spaces, expanded tree cover, water reuse systems, and flood-safe locations. Third, expanding access to services and green infrastructure requires coordinated investments in neighborhood-level public space, recreation facilities, and basic commercial services, as well as upgrades to surrounding infrastructure networks. Fourth, social support networks must be intentionally cultivated through participatory governance structures, ongoing social assistance, and mechanisms for resident input across planning, allocation, delivery, and post-occupancy phases. Finally, overcoming fragmentation will require strengthened intersectoral coordination across housing, transport, social services, health, and environmental management, supported by aligned financing instruments and shared monitoring systems that track social and climate outcomes over time. Strengths and Limitations This study has several strengths, and, to our knowledge, this is the first qualitative study to examine MCMV through a climate resilience and health lens across five Brazilian regions. First, it draws on data collected across five Brazilian regions, encompassing diverse sociocultural, economic, and climatic contexts, thereby enhancing the findings' variability and transferability. Second, it integrates perspectives from both residents and institutional stakeholders, allowing for a multi-level understanding of the MCMV program and its impacts. Third, the analysis was guided by the E-SEM framework, which supported a structured and comprehensive interpretation of the connections between housing, health, and climate resilience. Fourth, the study addresses a major national social housing initiative for which empirical evidence on health and climate outcomes remains limited. Finally, given the program's recent reinstatement (2023), the findings provide timely insights relevant to current policy reforms and implementation debates. Nonetheless, important limitations should be acknowledged. As a qualitative and exploratory study, the results are not statistically generalizable to all MCMV residents. While the sample included 52 residents, this number remains modest relative to the program's national scale. Recruitment relied on purposive and snowball sampling, which may introduce selection bias and limit representativeness. Variation in interview documentation formats (audio-transcribed vs interviewer-annotated) may have influenced the richness and depth of accounts. Additionally, the research captures a single moment in time, and residents’ experiences, particularly in rapidly changing urban environments, are likely to evolve. Conclusion This study demonstrates that while MCMV has expanded access to stable housing for low-income families, spatial, environmental, and governance constraints continue to limit its capacity to promote health equity and climate resilience. By foregrounding residents’ lived experiences alongside institutional perspectives, the findings show how peripheral siting, environmental discomfort, and weak service integration translate into daily burdens that undermine well-being, despite gains in safety and tenure security. To our knowledge, this is the first qualitative study to examine MCMV across five Brazilian regions through a health and climate resilience lens. 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Louis","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Wang","suffix":""},{"id":614388486,"identity":"ea065f19-8288-47a3-98d3-09737e34a26e","order_by":5,"name":"Diane Boda","email":"","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Diane","middleName":"","lastName":"Boda","suffix":""},{"id":614388487,"identity":"90d4f2ad-9c00-474d-99fc-861cf5f884ac","order_by":6,"name":"Marilia Velardi","email":"","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Marilia","middleName":"","lastName":"Velardi","suffix":""},{"id":614388488,"identity":"2c803592-4d34-4af9-b206-d5be43f8a25b","order_by":7,"name":"Maryse Rios-Hernandez","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"prefix":"","firstName":"Maryse","middleName":"","lastName":"Rios-Hernandez","suffix":""},{"id":614388489,"identity":"ba13dce3-3bea-4a6b-9739-fee5466bb169","order_by":8,"name":"Paulo Nascimento Neto","email":"","orcid":"","institution":"Pontifícia Universidade Católica do Paraná","correspondingAuthor":false,"prefix":"","firstName":"Paulo","middleName":"Nascimento","lastName":"Neto","suffix":""},{"id":614388490,"identity":"6017519b-d188-4eec-b184-2c901be5e6df","order_by":9,"name":"Alex Antônio Florindo","email":"","orcid":"","institution":"Universidade de São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Alex","middleName":"Antônio","lastName":"Florindo","suffix":""},{"id":614388491,"identity":"33eca32d-42d8-4f69-8f8e-1559cc48b30f","order_by":10,"name":"Rodrigo Siqueira Reis","email":"","orcid":"","institution":"Washington University in St. Louis","correspondingAuthor":false,"prefix":"","firstName":"Rodrigo","middleName":"Siqueira","lastName":"Reis","suffix":""}],"badges":[],"createdAt":"2026-02-11 15:24:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8853378/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8853378/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106094864,"identity":"be12e6cb-3585-4dd6-ad4c-39a5cd13387d","added_by":"auto","created_at":"2026-04-03 11:43:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":995287,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8853378/v1/e9a77e0a-a3b1-488a-bf41-7f1a422775a9.pdf"},{"id":106027298,"identity":"c536d0bf-088f-425d-938e-db8375a184af","added_by":"auto","created_at":"2026-04-02 14:51:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":57241,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFileS1.SemiStructuredInterviewGuideforResidentsandStakeholdersNGOsGovernmentInstitutionsandPolicymakers.docx","url":"https://assets-eu.researchsquare.com/files/rs-8853378/v1/c14f01058d1bfd47af7c4caa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAffordable housing, health, and climate resilience: Insights from residents and stakeholders in the Brazil’s Minha Casa, Minha Vida Program\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAccess to adequate, secure, and well-located housing is increasingly recognized as a key social determinant of health and a pillar of climate resilience (Dunn, 2014; Revi et al., 2014; WHO, 2018). \u0026nbsp; Affordable housing can mitigate climate-related vulnerabilities by improving structural safety, thermal comfort, and energy efficiency while providing stability that supports mental health and social cohesion (WHO, 2018). When affordable housing is integrated into well-planned urban areas, it also enhances access to employment, education, public services, and opportunities for active living, factors consistently associated with healthier lifestyles and reduced health inequities \u003cspan lang=\"PT-BR\"\u003e(Barton \u0026amp; Grant, 2006; Diez Roux \u0026amp; Mair, 2010; Giles-Corti et al., 2016; UN-Habitat, 2022)\u003c/span\u003e. Conversely, poorly located or inadequately designed housing developments can exacerbate segregation, increase exposure to hazards, and reinforce cycles of poverty and illness \u003cspan lang=\"PT-BR\"\u003e(Diez Roux \u0026amp; Mair, 2010; UN-Habitat, 2022)\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eIn Brazil, housing policy has long grappled with deep spatial inequalities, informal settlements, and uneven urban development (Maricato, 2000; Rolnik, 2021). In response, the federal government launched the Minha Casa, Minha Vida (MCMV) program in 2009 (Law 11.977, 2009), one of the world\u0026apos;s largest social housing programs (J\u0026uacute;nia Santa Rosa, 2015). Designed to reduce the national housing deficit, MCMV provides subsidized or fully financed housing units for low- and middle-income families (Cardoso, 2013). Between 2009 and 2020, the program built over six million housing units and generated more than 3.5 million jobs, representing a major investment in social infrastructure (CMAP, 2020). Although temporarily discontinued in 2020, the program was reinstated in 2023 (Minist\u0026eacute;rio das Cidades, 2023a) and is planned to deliver two million additional units by 2026 (Minist\u0026eacute;rio das Cidades, 2023b). The program\u0026rsquo;s scale and reach make it a crucial policy lever for addressing not only housing shortages but also broader social and environmental challenges (Reis et al., 2026).\u003c/p\u003e\n\u003cp\u003eThe home is both a refuge and a frontline of climate impacts, shaping individuals\u0026apos; and families\u0026apos; capacity to cope with environmental stressors and maintain well-being (Cutter et al., 2003; WHO, 2018). It is a primary site where climate impacts are directly experienced (Hern\u0026aacute;ndez, 2022), particularly as people increasingly rely on their residences for protection against extreme weather events such as storms, heat waves, floods, and droughts (U.S. Environmental Protection Agency, n.d.). In this sense, providing high-quality, affordable, well-located housing can mitigate the impacts of environmental hazards, particularly in low- and middle-income countries, where climate risks are concentrated among vulnerable urban communities living in informal settlements (Revi et al., 2014; WHO, 2018).\u003c/p\u003e\n\u003cp\u003eDespite its magnitude and relevance, limited evidence exists on how MCMV influences residents\u0026rsquo; health, well-being, and climate resilience across Brazil\u0026rsquo;s diverse urban contexts \u003cspan lang=\"PT-BR\"\u003e(Araujo \u0026amp; Villa, 2020; Menezes \u0026amp; Mour\u0026atilde;o, 2017)\u003c/span\u003e. Most evaluations have focused on economic outcomes or construction metrics, overlooking residents\u0026apos; everyday experiences and the perspectives of institutions involved in planning, financing, and managing the program (Silva et al., 2025). Yet, understanding how affordable housing shapes multiple dimensions of health, physical, mental, and social, and interacts with environmental risks is essential to inform equitable and sustainable housing policy. In fact, climate change is rapidly intensifying the frequency and severity of extreme events, resulting in significant impacts on urban environments and public health in multiple fronts (Agache et al., 2025; An et al., 2020; Bezgrebelna et al., 2021; Ebi et al., 2020; Jacobsen et al., 2022; Rosenthal et al., 2021; Thomson \u0026amp; Stanberry, 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDrawing on qualitative interviews conducted in five cities across Brazil\u0026rsquo;s major regions, this study explores how the MCMV program affects health and climate resilience from the perspectives of residents and key stakeholders. By capturing detailed perceptions across diverse regional contexts, it highlights residents\u0026rsquo; lived experiences, perceived co-benefits of this type of formal housing, and persisting challenges and constraints related to location, mobility, infrastructure, security, and environmental exposure. Using the Enhanced Socioecological Model (E-SEM) (Reis, Le\u0026atilde;o, et al., 2025), the analysis considers these issues across interconnected levels: individual, interpersonal, community, neighborhood environment, and policy. These results aim to inform housing strategies that promote healthier, more equitable, and climate-resilient urban spaces.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis qualitative study examined how Brazil\u0026rsquo;s MCMV program influences residents\u0026rsquo; health, well-being, and climate resilience, as reflected in the lived experiences of beneficiaries and the perspectives of institutional stakeholders. Semi-structured interviews were conducted with residents and key informants, and the data were analyzed using qualitative content analysis. The analytical process was informed by the E-SEM framework (Reis, Le\u0026atilde;o, et al., 2025), which integrates the Ecological Model of Active Living, the Social Determinants of Health framework, and the Planetary Health paradigm. The E-SEM informed the development of the interview instruments and served as an analytic scaffold, enabling the classification of emerging codes into socioecological levels (individual, interpersonal, community, neighborhood environment, and policy) and supporting the examination of linkages between housing, health, equity, and climate resilience.\u003c/p\u003e\n\u003ch4\u003eStudy setting\u003c/h4\u003e\n\u003cp\u003eInterviews were conducted in five major Brazilian cities, each representing one of the country\u0026rsquo;s geographic regions, to capture contextual diversity in climate, urban form, and policy implementation. The selected cities were Manaus (Amazonas, North), Jo\u0026atilde;o Pessoa (Para\u0026iacute;ba, Northeast), Campo Grande (Mato Grosso do Sul, Center-West), S\u0026atilde;o Paulo (S\u0026atilde;o Paulo, Southeast), and Curitiba (Paran\u0026aacute;, South). In each location, interviews were conducted within developments in the \u003cem\u003eMCMV\u003c/em\u003e program\u0026rsquo;s Faixa 1 category, which serve households with the lowest income levels through fully subsidized housing units, ensuring access to homeownership for the most economically vulnerable populations.\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Research Ethics Committee of the research institution (CAAE 87845925.6.0000.0020). All participants provided informed consent and were assured of confidentiality and the voluntary nature of participation. Audio recordings were stored securely and deleted after transcription. Identifying details were removed from transcripts, and findings were reported in aggregate form.\u003c/p\u003e\n\u003ch4\u003eParticipants and recruitment\u003c/h4\u003e\n\u003ch5\u003eResidents\u003c/h5\u003e\n\u003cp\u003eRecruitment followed a purposive sampling approach to capture a wide range of perspectives related to housing, health, and environmental experiences. Trained local interviewers conducted in-person recruitment in August 2025 in selected MCMV tier 1 developments in each city. Before fieldwork, interviewers participated in remote training sessions in July 2025, organized by the coordination team, which provided standardized guidance on eligibility screening, ethical procedures, and strategies to ensure sample heterogeneity.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Interviewers were instructed to seek heterogeneity in gender and age group (including young adults, adults, and older adults), prioritizing overall balance across these criteria within the practical constraints of field access and residents\u0026rsquo; availability. Local partners and community contacts (e.g., residents\u0026rsquo; associations and community leaders, when present) assisted in identifying eligible participants and facilitating trust within communities. When appropriate, snowball sampling was employed by asking interviewed residents to recommend other eligible participants within the same housing development, particularly to reach residents who were less connected to formal community networks. This strategy ensured that the sample represented the variety of experiences and perceptions across different cities, housing developments, and household compositions.\u003c/p\u003e\n\u003ch5\u003eStakeholders\u003c/h5\u003e\n\u003cp\u003eTo contextualize the perspectives of residents, key informants were interviewed, representing diverse sectors directly or indirectly involved in housing and urban development. Participants included professionals from the public sector, academic institutions, non-governmental organizations, and private consulting firms with recognized expertise in housing policy, urban planning, sustainability, or health-related research. Stakeholder recruitment also followed a purposive sampling approach, initiated through recommendations from the project\u0026rsquo;s advisory committee, which identified relevant actors with direct experience in the MCMV program or related policy agendas. These initial contacts were invited by the research team and, when interviewed, were asked to recommend additional participants with complementary roles or perspectives. This snowball strategy enabled the inclusion of stakeholders across different governance levels and sectors, enriching the institutional analysis of MCMV implementation, constraints, and opportunities for strengthening equity and climate-resilient housing.\u003c/p\u003e\n\u003ch4\u003eData collection\u003c/h4\u003e\n\u003ch5\u003eInstruments\u003c/h5\u003e\n\u003cp\u003eTwo semi-structured interview guides (Supplementary file S1) were developed and conducted in Brazilian Portuguese, the native language of interviewees, to capture complementary perspectives of residents and stakeholders. The resident interview guide focused on participants\u0026rsquo; experiences of living in MCMV housing, including perceptions of safety, mobility patterns, access to services, community relationships, environmental conditions, and perceived health impacts. The stakeholder interview guide explored institutional viewpoints on the implementation of MCMV, highlighting barriers and opportunities for equity and sustainability, policy design processes, strategies for climate resilience, and contributions to community well-being. Both instruments were informed by the E-SEM framework and were pretested during interviewer training sessions with four Brazilian researchers\u0026mdash;experts in urban planning and public health\u0026mdash;for refinement, ensuring clarity and consistency. The guides consisted of open-ended questions accompanied by flexible probes designed to encourage narrative depth, reflection, and the inclusion of contextual details.\u003c/p\u003e\n\u003ch5\u003eFieldwork procedures for resident interviews\u003c/h5\u003e\n\u003cp\u003eResident interviews were conducted in person with an average duration of 45 to 60 minutes. The fieldwork followed standardized procedures detailed in a training manual developed to ensure methodological rigor, data reliability, ethical compliance, and the safety of both participants and interviewers. All field researchers participated in a remote training session prior to data collection, where the study\u0026rsquo;s objectives, ethical protocols, and the use of the semi-structured interview guide were thoroughly discussed. The training emphasized respectful engagement with participants, accurate application of the instrument, and strict adherence to the research protocol. Interviewers received a printed and digital manual outlining detailed guidance for participant approach, consent procedures, data recording, and fieldwork conduct. They were instructed to carry all necessary materials, including the consent form, interview guide, and a reliable recording device, and to maintain a professional, impartial, and empathetic posture throughout the process.\u003c/p\u003e\n\u003cp\u003eAt the beginning of each encounter, interviewers introduced themselves as members of the research team, explained the purpose and scope of the study in accessible language, and confirmed whether it was a convenient time for the participant. The consent form was then presented and read together when necessary, ensuring full understanding of the study\u0026rsquo;s objectives, confidentiality measures, and the voluntary nature of participation. Only after participants provided written consent did the interview proceed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterviews followed the standardized guide in sequence but were conducted conversationally and flexibly, allowing participants to elaborate on their experiences and perceptions. Interviewers were trained to maintain neutrality, avoid suggestive or leading questions, and use non-directive prompts such as \u0026ldquo;Could you tell me more about that?\u0026rdquo; to encourage depth and clarity. Participants were reminded at the outset and again during the interview that their involvement was voluntary, they could decline to answer any question, and their responses would remain strictly confidential.\u003c/p\u003e\n\u003cp\u003eWith the participant\u0026rsquo;s permission, interviews were audio-recorded using mobile devices to ensure the accuracy of transcription. When participants declined recording, interviewers took detailed written notes in real time. Before each session, fieldworkers verified the functionality of the recording equipment, checked available storage capacity and battery charge, and set devices to silent mode to avoid interruptions. Each interview was assigned a unique identification code and securely uploaded to the coordination team for transcription and storage, in compliance with data protection standards.\u003c/p\u003e\n\u003cp\u003eEfforts were made to ensure diversity among participants in each city, aiming for an approximate balance across gender (around five women and five men per city) and age groups (young adults aged 18\u0026ndash;30, adults aged 31\u0026ndash;59, and older adults aged 60+). While exact quotas were not mandatory, the aim was to capture a broad range of experiences reflecting different life stages and household circumstances. All interviews were conducted within a single MCMV development per city, chosen for accessibility and representativeness, thereby ensuring contextual consistency and facilitating logistical coordination.\u003c/p\u003e\n\u003cp\u003eTo ensure quality control, the supervisory team reviewed all audio files and field notes for completeness, clarity, and adherence to the interview guide. Cases of incomplete data, technical failures, or significant deviations from the protocol were identified and excluded from analysis. Any form of data fabrication, editing, or manipulation was explicitly prohibited and monitored as part of the study\u0026apos;s ethical oversight.\u003c/p\u003e\n\u003ch5\u003eProcedures for stakeholder interviews\u003c/h5\u003e\n\u003cp\u003eAll interviews were conducted online via \u003cem\u003eZoom\u003c/em\u003e, according to each participant\u0026rsquo;s availability, and lasted 45-60 minutes. This remote format enabled the inclusion of national- and local-level actors from across Brazil, enhancing the representativeness of institutional viewpoints. Before each interview, participants received an information sheet describing the study, along with the informed consent form, and were reminded that participation was voluntary, confidential, and unrelated to any institutional assessment.\u003c/p\u003e\n\u003cp\u003eThe stakeholder interviews aimed to explore institutional perspectives on the implementation and outcomes of MCMV, including barriers and opportunities for promoting equity, sustainability, and climate resilience. These conversations also sought to capture insights into governance processes, intersectoral coordination, and potential strategies for improving the integration of housing and health agendas in Brazil.\u003c/p\u003e\n\u003ch4\u003eData analysis\u003c/h4\u003e\n\u003cp\u003eData were analyzed using qualitative content analysis, following the procedures outlined by Bardin, (2011) and Mozzato \u0026amp; Grzybovski (Mozzato \u0026amp; Grzybovski, 2021). The analytical process began with a phase of familiarization, during which transcripts were read multiple times to develop a holistic understanding of participants\u0026rsquo; narratives. This was followed by initial coding, where meaningful units of text related to housing, health, environmental conditions, and social dynamics were identified. In the next step, codes were grouped into categories aligned with the study\u0026rsquo;s analytical axis, examining the impacts and possibilities of the MCMV program for promoting healthy lives in cities. These categories were then organized into socioecological levels: individual, interpersonal, neighborhood or built environment, policy or societal, and environmental. Finally, a synthesis stage integrated themes across participant groups and study sites, allowing the identification of recurring patterns, divergences, and contextual nuances. Coding was carried out by trained researchers through a collaborative and iterative process, and emerging themes were reviewed and validated by the full research team to ensure analytical rigor, coherence, and interpretive consistency. After inductive coding, categories were mapped onto E-SEM levels to examine how experiences and determinants were distributed across individual, social, environmental, and policy domains.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eParticipant characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe analyzed 64 qualitative interviews: 52 residents living in Minha Casa, Minha Vida (MCMV) Faixa 1 developments across five Brazilian cities: Jo\u0026atilde;o Pessoa (n=8; Northeast), Manaus (n=12; North), Campo Grande (n=10; Central-West), Curitiba (n=10; South), and S\u0026atilde;o Paulo (n=12; Southeast); and 12 institutional stakeholders working in planning, financing, delivery, or oversight of the MCMV program. Descriptive statistics for participant characteristics are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eAmong the 52 residents, women predominated (n=32, 61.5%) over men (n=20, 38.5%). Most participants\u0026apos; ethnic self-identification was pardo (n=28, 53.8%), followed by white (n=14, 26.9%) and black (n=10, 19.2%). Residents\u0026rsquo; birth cohorts spanned the 1950s through the 2000s, with the 1990s (n=17, 32.7%) and 1980s (n=13, 25.0%) representing the largest groups, followed by the 1970s (n=12, 23.1%); smaller proportions were born in the 2000s (n=4, 7.7%), 1950s (n=3, 5.8%), and 1960s (n=2, 3.8%), and birth year was unclear for one participant (n=1, 1.9%). Education levels were concentrated in secondary schooling, complete or ongoing (n=25, 48.1%), with smaller numbers reporting incomplete or completed higher education (n=8, 15.4%) and a small subset reporting primary education (n=5, 9.6%). Household income clustered predominantly between 1\u0026ndash;2 minimum wages per family (n=26, 50.0%) and \u0026gt;2\u0026ndash;3 minimum wages (n=15, 28.8%), although a minority reported earnings below 1 minimum wage (n=2, 3.8%) or above 3\u0026ndash;4 minimum wages (n=3, 5.8%). Time living in the current unit varied substantially: \u0026lt;1 year (n=5, 9.6%), 1\u0026ndash;5 years (n=28, 53.8%), 6\u0026ndash;10 years (n=9, 17.3%), and 11\u0026ndash;15 years (n=10, 19.2%). Most residents were born in their current city (n=35, 67.3%), suggesting largely local migration trajectories. Employment arrangements included formal employees (n=15, 28.8%), informal employees (n=8, 15.4%), and self-employed workers (n=12, 23.1%), alongside homemakers (n=10, 19.2%), unemployed individuals (n=3, 5.8%), retirees (n=2, 3.8%), and one resident currently on medical leave (n=1, 1.9%).\u003c/p\u003e\n\u003cp\u003eAmong the 12 institutional stakeholders interviewed, birth years ranged from the 1950s through the 1990s, with most born in the 1970s (n=6, 50.0%), followed by the 1990s (n=2, 16.7%); one stakeholder each was born in the 1950s, 1960s, and 1980s (each n=1, 8.3%), and birth year was not reported for one participant (n=1, 8.3%). Women predominated (n=8; 66.7%), followed by men (n=2; 16.7%); gender was not reported for two participants (16.7%). Most stakeholders self-identified as white (n=10; 83.3%); race/color was not reported for two (16.7%). Stakeholders represented a range of governmental, academic, and civil society institutions. Work jurisdictions were concentrated in Curitiba\u0026ndash;PR (n=6; 50.0%), followed by S\u0026atilde;o Paulo\u0026ndash;SP (n=2; 16.7%), Rio de Janeiro\u0026ndash;RJ (n=1; 8.3%), Bras\u0026iacute;lia\u0026ndash;DF (n=1; 8.3%), and one currently in the USA (8.3%).\u003c/p\u003e\n\u003cp\u003eTable 1. Participant characteristics (N = 64 qualitative interviews)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidents (n=52)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInstitutional stakeholders (n=12)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e32 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e10 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e20 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace/color (self-identified)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eBrown/Pardo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e28 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e14 (26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e10 (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eNot reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (birth-year band)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1950\u0026ndash;1959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1960\u0026ndash;1969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1970\u0026ndash;1979\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e12 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1980\u0026ndash;1989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e13 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1990\u0026ndash;1999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e17 (32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e2 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e2000\u0026ndash;2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e4 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eNot reported\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e1 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eSecondary (complete or ongoing)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e25 (48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eHigher education (incomplete or complete)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e8 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eOther / not specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e14 (26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold income (minimum wages / family)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1\u0026ndash;2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e26 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026gt;2\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e15 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026gt;3\u0026ndash;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eOther / not reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e6 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime living in current unit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u0026lt;1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e28 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e9 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBorn in current city\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e35 (67.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eNo / not reported\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e17 (32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eFormal employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e15 (28.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eInformal employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e8 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e12 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eHomemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eMedical leave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eContent Analysis Findings\u0026nbsp;\u003c/em\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e This section presents the results of the qualitative content analysis based on semi-structured interviews with institutional stakeholders and, subsequently, with residents of \u003cem\u003eMCMV Faixa 1\u003c/em\u003e developments. Findings are organized into five thematic axes reflecting the program\u0026rsquo;s impacts and possibilities for promoting healthy, equitable, and climate-resilient lives in cities \u003cem\u003e(Table 1)\u003c/em\u003e.\u003c/p\u003e\n\u003ch4\u003eHow MCMV shapes equity and access to sustainable urban living\u003c/h4\u003e\n\u003cp\u003eStakeholders emphasized that the equity and sustainability outcomes of MCMV are largely determined by municipal governance capacities, land regulation, and local political priorities. While the program is federally designed, its implementation varies markedly across regions due to differences in zoning powers, land availability, and institutional coordination. Reliance on low-cost peripheral land is viewed as a primary mechanism for reproducing spatial inequities, distancing families from work, services, and social networks. As one stakeholder explained, MCMV developments are often placed \u003cem\u003e\u0026ldquo;in the most peripheral areas of the city, which usually have the most precarious urban infrastructure, the least and worst public transport, and fewer leisure and cultural spaces,\u0026rdquo;\u003c/em\u003e so that families are \u003cem\u003erelocated \u0026ldquo;to places farther from where they previously lived, increasing the daily cost of working, studying, and simply reproducing their lives,\u0026rdquo;\u0026nbsp;\u003c/em\u003ethereby reinforcing poverty rather than reducing it. Stakeholders also highlighted weak integration across policy sectors, housing, transportation, social assistance, and health, and noted the dominance of market logics over environmental, social, and equity considerations in development decisions.\u003c/p\u003e\n\u003cp\u003eResidents\u0026rsquo; narratives reflect these institutional dynamics through lived experience. Across cities, most beneficiaries reported limited autonomy in the housing allocation process, with units commonly assigned through lotteries or on the basis of urgent need. While some residents selected units based on proximity to transport or quieter blocks, choice was generally constrained by financial pressure and limited availability. Despite these restrictions, ownership was widely associated with dignity, safety, and emotional stability compared with prior housing conditions. Yet, residents also identified major limitations in their neighborhoods, including scarce public spaces, long distances to essential services, limited commercial infrastructure, and inadequate state presence. Desired transformations centered on mobility improvements, green areas, security, maintenance, and structured opportunities for participation.\u003c/p\u003e\n\u003cp\u003eThese perspectives show how MCMV simultaneously expands access to secure housing and reproduces disparities in urban opportunity. Equity gains at the household level often coexist with structural barriers at the neighborhood scale, reinforcing the importance of aligning affordable housing provision with sustainable, service-rich urban environments.\u003c/p\u003e\n\u003ch4\u003eClimate risks and adaptation, environmental comfort, and sustainable design\u003c/h4\u003e\n\u003cp\u003eStakeholders consistently described climate adaptation as an underdeveloped dimension within MCMV. While federal directives mention sustainability and resilience on paper, interviewees reported limited translation into practice: \u003cem\u003e\u0026ldquo;If we look at the manuals and documents linked to the program, there\u0026rsquo;s certainly a lot written about resilience and climate change. But in practice, at least what I know, they don\u0026rsquo;t apply these guidelines.\u0026rdquo;\u003c/em\u003e\u0026nbsp; \u0026nbsp;In their accounts, implementation continues to be shaped by land costs and construction budgets, which push projects toward peripheral, often environmentally fragile areas. Several highlighted weak enforcements of standards, fragmented institutional responsibilities, and resistance to new building technologies by contractors and financing agencies: \u003cem\u003e\u0026ldquo;We\u0026rsquo;ve been thinking about more sustainable materials\u0026hellip; people talk a lot about new construction models, but when you have to get them approved within Caixa [the major financing agency in Brazil], they\u0026rsquo;re still resistant to new construction formats; it still goes back to the traditional\u0026mdash;cement and masonry.\u0026rdquo;\u003c/em\u003e Although there are notable municipal climate resilience interventions, such as the installation of solar panels, rainwater reuse facilities, and the Caximba redevelopment in Curitiba, which focuses on infrastructure improvements and solar panel installations on houses, these remain exceptions rather than the norm. Stakeholders also pointed out that current program structures favor standardized new construction and do not adequately support retrofitting, environmental improvements, or upgrades to existing developments.\u003c/p\u003e\n\u003cp\u003eResidents\u0026rsquo; experiences expose the health and well-being consequences of these structural gaps. Across all cities, participants described significant thermal discomfort in their homes, very hot in summer, cold in winter, linked to poor ventilation and building materials. Mold, dampness, leaks, and noise further affected daily comfort. Neighborhood-level environmental hazards were widely reported, including smoke from fires and land clearing, industrial noise, air pollution, stagnant water, mosquito infestations, and localized flooding. As one resident explained, \u003cem\u003e\u0026ldquo;There is a lot of rubbish and debris on the streets, and pollution brings many dengue mosquitoes and stagnant water, which is harmful.\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u003cu\u003e\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cu\u003e\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/u\u003e\u003c/strong\u003eMany residents valued the emotional security of homeownership, yet stressed financial pressure, limited green spaces, and difficulties accessing timely healthcare. The absence of shaded public areas and tree cover was seen as exacerbating heat exposure and constraining outdoor socialization: \u003cem\u003e\u0026ldquo;Because of the weather. Sometimes it is extremely hot, and if we had more green areas with trees and plants, it would be cooler. Summer here is very hot. If there were more green areas, it would be better.\u0026rdquo;\u003c/em\u003e\u003cbr\u003e\u0026nbsp;These perspectives highlight the disconnection between the program\u0026rsquo;s stated environmental ambitions and the everyday lived experience within MCMV developments. Structural decisions related to siting, design, and construction compound environmental stressors and undermine climate resilience, particularly for households already facing socioeconomic vulnerability.\u0026nbsp;\u003c/p\u003e\n\u003ch4\u003eLocation, transportation mobility, and access to essential services\u003c/h4\u003e\n\u003cp\u003eStakeholders consistently identified location as the central determinant shaping living conditions in MCMV developments. They emphasized that, especially in \u003cem\u003eFaixa 1\u003c/em\u003e, the siting of projects is largely driven by land price, resulting in concentrations of new housing in peripheral or peri-urban areas (\u0026ldquo;urban fringes\u0026rdquo;), where infrastructure networks are incomplete and social services scarce. This pattern reflects what they described as a tension between social goals and market logic: cheap land enables large-scale delivery, but systematically distances vulnerable populations from employment, education, healthcare, and transport networks. \u0026nbsp;As one participant noted, construction companies \u0026ldquo;\u003cem\u003ealways look for the cheapest plots, which are often the most environmentally fragile and most exposed to risk.\u0026rdquo;\u0026nbsp;\u003c/em\u003eAnother reflected that site selection \u0026ldquo;has a lot to do with land value,\u0026rdquo; and that instead of promoting urban densification and more compact cities, MCMV \u0026ldquo;has, to a large extent, contributed to urban sprawl, with direct impacts on mobility.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eSeveral highlighted that decisions at the municipal and developer level, such as prioritizing low-cost land, enclosed condominium typologies, and weak environmental criteria, often undermine goals of equity and healthy living. Proposed solutions included transit-oriented development, mixed-use planning, smaller-scale projects, and intersectoral urban governance to align housing, transport, and service provision.\u003c/p\u003e\n\u003cp\u003eResidents\u0026rsquo; accounts illustrate the lived consequences of these structural conditions. Experiences varied across cities and household profiles, but a recurring pattern emerged: while some residents benefited from proximity to neighborhood-level services (schools, small markets, health posts), daily commuters faced significant mobility burdens. Long and costly trips were particularly prevalent in Manaus and Jo\u0026atilde;o Pessoa, where insufficient public transport and peripheral location increased dependence on private vehicles or informal transport. In Campo Grande and Curitiba, mobility outcomes depended heavily on occupation and gender roles, with homemakers and caregivers reporting improved access to schools and shops. At the same time, formal workers cited worsening commute times. S\u0026atilde;o Paulo residents reported some improvements compared with previous informal housing arrangements, yet they still highlighted infrequent bus service, road deterioration, and gaps in modal integration. Deficiencies in local infrastructure further constrained mobility and service access.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcross multiple cities, residents reported broken sidewalks, poor drainage, recurring sewage problems, flooding, irregular waste collection, water shortages, lack of shaded public spaces, and insufficient plazas or recreation areas. As one resident summarize\u003cem\u003ed, \u0026ldquo;Sewage is terrible here, sewage is terrible - this is the only place where the water flows over the sewage instead of inside the pipes.\u0026rdquo;\u0026nbsp;\u003c/em\u003eAccess to healthcare and education varied widely, and limited local formal employment opportunities reinforced the need for long-distance travel. Many residents expressed a pervasive sense of abandonment by public authorities: \u0026ldquo;\u003cem\u003eWe need the services provided by the government to be quickly accessible. When someone is sick, they cannot be left waiting; there cannot be a long distance between home, where they are ill, and the place where they will be treated. That is my opinion.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThese perspectives demonstrate that the location of MCMV developments profoundly influences mobility patterns, access to services, and everyday well-being. While formal housing offers stability, peripheral siting and uneven infrastructure provision create structural mobility disadvantages, especially for low-income, caregiving, and disabled residents, ultimately shaping both social participation and health outcomes.\u003c/p\u003e\n\u003ch4\u003eCommunity relations, collective life, and perceived safety\u003c/h4\u003e\n\u003cp\u003eStakeholders highlighted community organization as fundamental for the long-term success and resilience of MCMV developments. They emphasized that mutual support networks, neighborhood-based trust, and opportunities for participation are essential to maintaining well-being and preventing social isolation, particularly among vulnerable groups reassigned from areas of risk. However, they also identified significant structural barriers. Large, high-density developments were seen as undermining social cohesion by fostering anonymity, increasing resident turnover, and weakening local identity. As one stakeholder noted, \u003cem\u003e\u0026ldquo;In many situations, we have many people or families who arrive without any prior neighborhood ties. I believe that creating or rebuilding a sense of community is more difficult in these cases\u0026rdquo;.\u003c/em\u003e Interviewees stressed the lack of systematic post-occupancy social support, suggesting that municipal teams and social workers often disengage after the initial delivery phase. Some pointed to promising practices, such as intersectoral working groups and participatory forums like \u003cem\u003eFala Curitiba (Prefeitura de Curitiba, 2017)\u003c/em\u003e, as ways to strengthen voice, accountability, and collective engagement. Nonetheless, the overall perception was that MCMV remains primarily an individual housing solution, offering limited mechanisms for community building. Several stakeholders highlighted the central role of social workers: \u003cem\u003e\u0026ldquo;I think the work of social workers is very important for creating these bonds, especially because many residents (...) come from situations of significant social vulnerability.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eResident narratives indicate that community relations are central to everyday life in MCMV developments, yet yet they often remain informal and weakly structured. As one resident explained,\u003cem\u003e\u0026nbsp;\u0026ldquo;It\u0026rsquo;s very peaceful here, because of the friendships we have inside; everyone looks out for each other\u0026mdash;if the kids are playing, whoever is downstairs keeps an eye on them, and if someone\u0026rsquo;s mother isn\u0026rsquo;t around\u0026hellip;\u0026rdquo;\u003c/em\u003eAcross cities, interactions among neighbors were generally described as cordial but intermittent, marked by proximity rather than deep ties. Organized collective life and participation in formal community groups varied widely: some residents reported joining occasional initiatives (e.g., courses offered through local services or municipal programs). In contrast, others avoided community involvement altogether (\u0026ldquo;I don\u0026rsquo;t really like talking to neighbors\u0026rdquo;).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhere it existed, it was often driven by volunteer initiatives rather than institutional coordination. Limited or poorly equipped public spaces, the absence of consistent community mediation, and few structured policies for social strengthening contributed to fragile and individualized bonds. Residents also described how long work hours and time away from the condominium constrained opportunities to interact \u003cem\u003e(\u0026ldquo;My time is really tight\u0026hellip; I don\u0026rsquo;t have time to participate\u003c/em\u003e\u0026rdquo;). Despite this, residents frequently described spontaneous practices of solidarity: sharing childcare, borrowing food or tools, organizing voluntary cleaning, forming informal support networks in moments of illness or crisis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePerceptions of safety were highly context dependent. In several developments, residents associated community proximity with protection and tranquility. Conversely, in Manaus and parts of S\u0026atilde;o Paulo, residents reported feelings of fear, episodes of violence, or criminal factions acting as informal regulators, simultaneously enforcing rules and exposing residents to power asymmetries. Regarding the presence of these groups, one resident noted: \u003cem\u003e\u0026ldquo;Even though it\u0026rsquo;s controlled by a faction, we\u0026rsquo;re not very afraid to go out, because they monitor everything. There have been cases of people robbing here, and they handle them themselves. So it\u0026rsquo;s very rare to have robberies because of that. If you steal, you\u0026rsquo;re judged inside. It\u0026rsquo;s not about public safety, it\u0026rsquo;s their own \u0026lsquo;security.\u0026rsquo; So we actually feel safer because of them.\u0026rdquo;\u0026nbsp;\u003c/em\u003eThis dual experience, calm within the condominium boundaries yet insecure in the surrounding territory, was recurrent.\u003c/p\u003e\n\u003cp\u003eCollectively, these results reveal that while MCMV offers physical stability, the social fabric remains thin yet capable of mobilizing care and cooperation. The absence of sustained institutional presence, lack of shared public spaces, limited mechanisms for participation, and the burden of long working hours all constrain the consolidation of cohesive community life. Yet residents continuously improvise forms of collective resilience.\u003c/p\u003e\n\u003ch4\u003eHealth, well-being, and environmental conditions\u003c/h4\u003e\n\u003cp\u003eStakeholders emphasized that health outcomes in MCMV developments are deeply shaped by structural factors linked to the built and social environment. \u0026nbsp;Poor insulation and ventilation, which lead to thermal discomfort, high humidity, and mold growth, were viewed as a major determinant of respiratory and emotional distress. Interviewees noted that peripheral siting of MCMV developments reinforces inequalities in access to healthcare, nutritious food, and recreational spaces, while also weakening existing social support networks for caregivers, older adults, and people with disabilities. They also highlighted mental-health burdens associated with abrupt relocations, loss of community ties, and daily stressors linked to economic precarity. Proposed solutions centered on intersectoral action: expanding community-based services, integrating social assistance into post-occupancy phases, enhancing local provision of public spaces and health-promotion infrastructure (parks, sports courts, open-air gyms), and improving environmental comfort and housing performance. They argued that MCMV has transformative potential, but that health benefits are contingent on location, design quality, and sustained municipal engagement.\u003c/p\u003e\n\u003cp\u003eResidents confirmed a dual experience: psychological security derived from stable homeownership, alongside persistent environmental and infrastructural stressors. Across cities, many participants described emotional relief after leaving precarious rental or informal settlements, with reduced anxiety, improved sleep, and increased sense of safety. However, these gains were often offset by worsening physical discomfort and new everyday burdens. Health concerns raised by residents included: excessive indoor heat and cold, mold and dampness, smoke and airborne pollution from nearby fires or industrial sites, noise disturbances, and difficulties accessing specialized healthcare. \u0026nbsp;Regarding air and noise pollution, one resident shared\u003cem\u003e: \u0026ldquo;Because of the industries and the terminal, there\u0026rsquo;s a lot of noise and smoke. Nowadays it doesn\u0026rsquo;t bother me anymore; I\u0026rsquo;ve learned to live with it.\u0026rdquo; Regarding heat, another resident noted: \u0026ldquo;The heat affects the house because it isn\u0026rsquo;t well ventilated\u0026mdash;you can\u0026rsquo;t stay inside for long during the summer.\u0026rdquo;\u0026nbsp;\u003c/em\u003eSeveral participants linked mobility strain to exhaustion, stress, and reduced time for leisure or rest. Environmental conditions were repeatedly tied to well-being. The scarcity of shade, trees, and accessible green spaces was perceived as a barrier to relaxation, physical activity, and children\u0026rsquo;s play. In every city, residents described how the physical apartment, the immediate surroundings, and the wider neighborhood combined to influence comfort, mental health, and daily functioning. Overall, resident narratives demonstrate that health improvements are neither automatic nor evenly distributed, but mediated by climate exposure, housing performance, proximity to services, and social life within the developments.\u003c/p\u003e\n\u003ch4\u003eIntegrated Synthesis\u0026nbsp;\u003c/h4\u003e\n\u003cp\u003eStakeholder and resident perspectives converge around structural challenges that shape everyday life in MCMV developments, especially peripheral siting, fragmented intersectoral coordination, and limited attention to climate resilience and social cohesion. Stakeholders describe these issues at the level of governance, land markets, and policy design, while residents articulate how they are experienced in practice: long commutes, heat stress, exposure to environmental hazards, insecurity, and weak community ties, alongside improved residential stability and dignity.\u003c/p\u003e\n\u003cp\u003eGuided by the Enhanced Socioecological Model (E-SEM), this analysis demonstrates how institutional decisions and environmental conditions cascade across individual, interpersonal, community, and neighborhood levels to influence health and well-being. By doing so, it showcases how the same upstream program decisions are expressed across nested levels of influence, and how resident experiences \u0026ldquo;translate\u0026rdquo; structural choices into daily exposures,\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Four leverage points emerged as especially critical for transforming housing impacts: (1) location and connectivity, (2) environmental and thermal performance, (3) access to services and green infrastructure, and (4) social support networks. Strengthening these dimensions is essential for repositioning MCMV from a housing delivery mechanism to a platform that promotes healthier, more equitable, and climate-resilient urban living. In the integrated interpretation, stakeholder and resident accounts are examined at each E-SEM level, specifying key barriers, corresponding opportunities, and how mechanisms cascade across levels. For example, policy/structural decisions (e.g., governance fragmentation and market-driven land allocation) shape neighborhood environments (e.g., peripheral siting, weak infrastructure, and limited services), which in turn influence community conditions (e.g., thin social cohesion, perceived insecurity, and limited participation) and ultimately interpersonal and individual outcomes (e.g., time poverty, chronic stress, thermal discomfort, and constrained well-being). \u0026nbsp;Table 2 provides an integrated interpretation that synthesizes stakeholder and resident accounts at each E-SEM level, highlighting key barriers and opportunities and indicating how upstream mechanisms cascade into downstream outcomes.\u003c/p\u003e\n\u003ch5\u003eTable\u0026nbsp;2. Integrated thematic synthesis mapped to E-SEM levels.\u003c/h5\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eE-SEM Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStakeholder themes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResident themes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMechanism linking levels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntegrated interpretation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePolicy / Structural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMCMV, equity \u0026amp; sustainability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eResidential trajectories; access to housing; perceptions \u0026amp; desires for territorial transformation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eGovernance, equity, autonomy in access to housing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBarrier: structural governance fragmentation \u0026amp; market-driven land allocation. Opportunity: more participatory, equity-oriented governance \u0026amp; integrated housing policy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eNeighborhood environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eLocation, infrastructure \u0026amp; access to services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMobility, infrastructure \u0026amp; access to services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eSpatial integration, transport, public services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBarrier: spatial isolation produces time poverty \u0026amp; inequitable access\u0026mdash;opportunity: transit-oriented location, service clustering \u0026amp; mixed-use strategies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eNeighborhood environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eClimate risk management \u0026amp; sustainable strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHealth, climate \u0026amp; green spaces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eEnvironmental comfort, climate resilience, green infrastructure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBarrier: environmental vulnerability built into design \u0026amp; siting. Opportunity: integrate climate adaptation, green infrastructure \u0026amp; environmental comfort standards.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eCommunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eCommunity \u0026amp; social relations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCommunity relations \u0026amp; shared spaces; perception of safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eSocial cohesion, trust, safety, participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBarrier: fragile social fabric \u0026amp; institutional absence. Opportunity: community hubs, social work \u0026amp; participatory structures.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eIndividual + Interpersonal (downstream outcomes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eHealth \u0026amp; well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHealth, climate \u0026amp; green spaces\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePhysical \u0026amp; mental health determinants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBarrier: cumulative strain across environment, mobility \u0026amp; isolation. Opportunity: integrated territorial health strategy \u0026amp; improved environmental design.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study qualitatively demonstrates that while MCMV has generated substantial gains in residential stability and formal housing access, its ability to promote health, equity, and climate resilience remains uneven across cities. Stakeholders highlighted structural and governance gaps, whereas residents emphasized daily challenges related to location, mobility, safety, and environmental comfort. While stakeholders spoke in abstract systemic terms (i.e., land market dynamics, policy fragmentation, governance failures), residents expressed these same forces through direct, embodied experience (i.e., indoor temperature, hours spent commuting, financial strain, or fear of violence and crime in the neighborhood). Climatic and environmental discomfort was reported more frequently by residents than by stakeholders, illustrating how daily living and climate vulnerabilities remain largely invisible in institutional discourse.\u003c/p\u003e\n\u003cp\u003eOur results align with international evidence demonstrating that housing is a powerful socio-environmental determinant of health (Bentley et al., 2025), particularly for low-income populations in rapidly urbanizing regions (Mehdipanah, 2023). Studies have shown that poorly located or inadequately serviced housing developments can reinforce socio-spatial inequality (Leite et al., 2022), increase exposure to environmental risks (Chakraborty Jayajit and Koul, 2024; de Sousa \u0026amp; Braga, 2020), and hinder access to health-promoting infrastructure (Leite et al., 2022; Linke et al., 2016). The patterns observed in MCMV communities mirror well-documented dynamics in other large-scale social housing programs, especially in Latin America (Mart\u0026iacute;nez et al., 2018; Zunino \u0026amp; Hidalgo, 2009), where peripheral siting (Souza \u0026amp; Sugai, 2018) and infrastructural fragility undermine health and mobility outcomes (Teixeira et al., 2023). At the same time, our findings extend this literature by illustrating how these mechanisms operate across diverse Brazilian urban contexts and climatic regions. Importantly, residents\u0026rsquo; narratives highlight how physical, social, and environmental drivers compound in everyday life, amplifying vulnerability.\u003c/p\u003e\n\u003cp\u003eThe study also reveals the dual nature of MCMV\u0026rsquo;s impacts, as residents gain stability, legal tenure, and distance from unsafe or precarious former housing, significant trade-offs often accompany these benefits. Peripheral siting increases commuting time and financial strain; limited transport options constrain employment and education opportunities; and environmental challenges, from heat stress to poor ventilation, affect health and comfort. Social fragmentation and restricted community life further limit the transformative potential of relocation. These findings echo broader debates in Latin America about the tension between rapid housing delivery and integrated urban development (Habitat III Secretariat, 2017), underscoring the need to balance quantity with the quality of location, infrastructure, and community support (Gabriel et al., 2024). Importantly, they also reinforce the relevance of the program\u0026rsquo;s 2023 reframing, which explicitly positions MCMV not only as a housing provision but also as a policy intended to promote the right to the city alongside the right to housing (Minist\u0026eacute;rio das Cidades, 2023a). This shift strengthens the argument that program success should be evaluated not only by the number of units delivered but also by their integration into urban systems, access to services and opportunities, and the everyday conditions that enable health, well-being, and climate resilience.\u003c/p\u003e\n\u003cp\u003eClimate and environmental concerns were especially prominent among residents, who frequently reported heat discomfort, poor thermal performance (de Carvalho et al., 2021), pollution, a lack of shaded public space, and low unit layout adaptation (Araujo \u0026amp; Villa, 2020). These findings reinforce emerging evidence linking climate vulnerability to housing design (Gabriel et al., 2024), neighborhood environmental quality, and access to green and blue infrastructure (Carneiro et al., 2021). As extreme heat, flooding, and air pollution intensify, the resilience of social housing will increasingly depend on integrating climate-aware design and maintenance standards, strengthening not only building performance but also essential infrastructure such as sanitation systems (Nishimura, 2020). The MCMV experience illustrates how climate exposure intersects with poverty, location, and infrastructural deficits, signaling the urgency of embedding adaptation strategies into affordable housing policy.\u003c/p\u003e\n\u003cp\u003eThe findings from this study underscore that housing impacts on health and climate resilience operate simultaneously across the individual, household, community, and policy levels. Applying the E-SEM framework (Reis, Favar\u0026atilde;o Le\u0026atilde;o, et al., 2025) enabled the interpretation of how thermal discomfort, mobility barriers, social fragmentation, and governance gaps are connected rather than isolated challenges. By linking household-level experiences to community infrastructure and to broader institutional and environmental conditions, E-SEM highlights how decisions regarding land use, construction standards, transport planning, and climate adaptation cascade into daily living conditions. This multi-level perspective reinforces that improving health and resilience in MCMV requires coordinated action across sectors, including housing, mobility, social protection, and environmental planning, rather than isolated upgrades within residences.\u003c/p\u003e\n\u003cp\u003eFindings point to pressing implications for both research and policy. From a research standpoint, longitudinal studies are needed to understand how health and climate-related outcomes evolve as families transition from informal settlements to formal MCMV housing. Robust causal research designs are needed to isolate the effects of MCMV from broader urban or socioeconomic trends. In this context, the evolution of the program itself offers a valuable natural experiment: the earlier phase of MCMV (2009\u0026ndash;2020), widely associated with peripheralization and uneven urban insertion, can be contrasted with the post-2023 reforms that place greater emphasis on location, infrastructure, and sustainability standards (Reis et al., 2026). There is also an urgent need for improved data collection on and measurement of thermal performance, environmental exposure, mobility access, and social cohesion. Intersectional analyses are also necessary to capture differentiated impacts across residents of varying gender, race, disability, and age. Future work should additionally investigate how housing conditions shape daily health-related behaviors, including physical activity, caregiving, and social participation.\u003c/p\u003e\n\u003cp\u003eFrom a policy perspective, the results indicate several strategic priorities for strengthening MCMV and advancing healthier, more equitable, and climate-resilient housing in Brazil. First, improving location and connectivity is essential and must prioritize access to employment, healthcare, education, and public transport, supported by integrated mobility planning and Transit-Oriented Development strategies. Second, to strengthen environmental and thermal performance, climate adaptation must be embedded into design and retrofitting standards, not as optional innovations, through improved ventilation, better insulation, shaded public spaces, expanded tree cover, water reuse systems, and flood-safe locations. Third, expanding access to services and green infrastructure requires coordinated investments in neighborhood-level public space, recreation facilities, and basic commercial services, as well as upgrades to surrounding infrastructure networks. Fourth, social support networks must be intentionally cultivated through participatory governance structures, ongoing social assistance, and mechanisms for resident input across planning, allocation, delivery, and post-occupancy phases. Finally, overcoming fragmentation will require strengthened intersectoral coordination across housing, transport, social services, health, and environmental management, supported by aligned financing instruments and shared monitoring systems that track social and climate outcomes over time.\u003c/p\u003e\n\u003cp\u003eStrengths and Limitations\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;This study has several strengths, and, to our knowledge, this is the first qualitative study to examine MCMV through a climate resilience and health lens across five Brazilian regions. First, it draws on data collected across five Brazilian regions, encompassing diverse sociocultural, economic, and climatic contexts, thereby enhancing the findings\u0026apos; variability and transferability. Second, it integrates perspectives from both residents and institutional stakeholders, allowing for a multi-level understanding of the MCMV program and its impacts. Third, the analysis was guided by the E-SEM framework, which supported a structured and comprehensive interpretation of the connections between housing, health, and climate resilience. Fourth, the study addresses a major national social housing initiative for which empirical evidence on health and climate outcomes remains limited. Finally, given the program\u0026apos;s recent reinstatement (2023), the findings provide timely insights relevant to current policy reforms and implementation debates.\u003c/p\u003e\n\u003cp\u003eNonetheless, important limitations should be acknowledged. As a qualitative and exploratory study, the results are not statistically generalizable to all MCMV residents. While the sample included 52 residents, this number remains modest relative to the program\u0026apos;s national scale. Recruitment relied on purposive and snowball sampling, which may introduce selection bias and limit representativeness. Variation in interview documentation formats (audio-transcribed vs interviewer-annotated) may have influenced the richness and depth of accounts. Additionally, the research captures a single moment in time, and residents\u0026rsquo; experiences, particularly in rapidly changing urban environments, are likely to evolve.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that while MCMV has expanded access to stable housing for low-income families, spatial, environmental, and governance constraints continue to limit its capacity to promote health equity and climate resilience. By foregrounding residents\u0026rsquo; lived experiences alongside institutional perspectives, the findings show how peripheral siting, environmental discomfort, and weak service integration translate into daily burdens that undermine well-being, despite gains in safety and tenure security. To our knowledge, this is the first qualitative study to examine MCMV across five Brazilian regions through a health and climate resilience lens. Addressing these challenges will require reorienting the program toward stronger urban integration, climate-adapted design, and sustained community support, alongside improved coordination across housing, health, mobility, and environmental sectors. These results highlight critical directions for future evaluation and policy innovation as Brazil advances in the provision of social housing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAgache, I., Hernandez, M. L., Radbel, J. M., Renz, H., \u0026amp; Akdis, C. A. (2025). 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Spatial and Socioeconomic Effects of Social Housing Policies Implemented in Neoliberal Chile: The Case of Valpara\u0026iacute;so. \u003cem\u003eUrban Geography\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(5), 514\u0026ndash;542. https://doi.org/10.2747/0272-3638.30.5.514\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"affordable housing, climate resilience, health equity, active living, Brazil, qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-8853378/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8853378/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Climate change exacerbates social inequalities in urban areas, disproportionately increasing disadvantaged communities’ exposure to environmental hazards. Housing shapes exposure, vulnerability, and adaptive capacity to climate risks, making it a key determinant of health and climate resilience. In Brazil, Minha Casa, Minha Vida (MCMV) is the largest federal affordable housing program, yet evidence on its health and climate implications remains limited. This study explores how MCMV affects health and climate resilience from the perspectives of residents and institutional stakeholders. We conducted semi-structured interviews with 52 residents (61.5% women; 53.8% self-identified as Brown/Pardo; primarily aged 30–49) and 12 institutional stakeholders (50% working in Curitiba–PR; 66.7% women; 83.3% self-identified as White; ages primarily 30–59) across five Brazilian cities. Guided by the Enhanced Socioecological Model (E-SEM), qualitative content analysis examined barriers and opportunities across individual, social, neighborhood, policy, and planetary levels. Across cities, residents described psychological security and emotional relief associated with stable homeownership (e.g., reduced anxiety and improved sleep), alongside challenges linked to peripheral siting and uneven infrastructure (long commutes, limited services, inadequate sidewalks/drainage, sewage problems, and weak state presence). Residents also reported environmental and infrastructure, worsened by lack of shade and green spaces. Stakeholders emphasized upstream drivers aligning with these experiences, including land-market pressures, zoning and governance constraints, fragmented intersectoral coordination, and limited incorporation/enforcement of climate adaptation. Overall, MCMV improves basic living conditions but often reinforces spatial inequities and climate vulnerability; advancing health and resilience will require improvements in location, intersectoral coordination, climate-responsive design, and community engagement.","manuscriptTitle":"Affordable housing, health, and climate resilience: Insights from residents and stakeholders in the Brazil’s Minha Casa, Minha Vida Program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-02 14:51:02","doi":"10.21203/rs.3.rs-8853378/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"651f65df-d57f-4eb1-a82a-864eba990fd4","owner":[],"postedDate":"April 2nd, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"298139562374947134815930823822945999727","date":"2026-04-29T19:32:29+00:00","index":20,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-02T14:51:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-02 14:51:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8853378","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8853378","identity":"rs-8853378","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}