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Geographical Locations - Brazil
Categories
Country Information
- (Statistical) Number of Inhabitants per Doctor: 685
- CIA - World Factbook : Brazil
Organisations and Networks
UN and Multinational
Government
Non-Government
- ABIA - the leading Brazilian AIDS organisation
- CARE Brasil
- GAPA-MG - a NGO providing information on HIV/AIDS and STDs ( everything's in Portuguese )
- Landless Workers Movement
"We are conscious of the importance of our struggle in the present and for future generations. We are growing continually; after 15 years we are now present in 23 states of Brazil. Thus as our struggle for Agrarian Reform grows in this vast country in which so many citizens live in absolute misery, so grow our ideals. We have today a project for the reorganization of the agrarian situation that includes solving and discussing problems such as health, education and organization of agricultural production. we prioritize the discussion with those who are directly linked to the problems in the countryside: the landless."
- LEAD BRAZIL - Foundation for Sustainable Development
- MSF - Médecins Sans Frontières / Doctors Without Borders
- Novartis Foundation - Community development in Brazil
- Saúde Total - an electronic network regarding all aspects of prevention and health
Academic Institutions
National Policy and Related Documents
Reports, Guidelines, and Projects
- Access to antiretroviral drugs in Brazil
Since 1996, the Brazilian Ministry of Health has guaranteed free and universal access to antiretroviral treatment for people living with HIV/AIDS. Implementation of this policy has had political, financial, and logistical challenges. I have investigated the history and context of antiretroviral policy in Brazil, the logistics of the drugs’ distribution, and the government’s strategies for acquisition of the drugs. Many antiretrovirals used in Brazil are produced domestically; the remainder, including some of the most expensive drugs, are purchased from abroad. Although the Brazilian policy of antiretroviral distribution has had notable success, it remains threatened by the high cost of acquisition of drugs, which has led to disputes with international pharmaceutical companies over prices and patents. Whether or not the Brazilian model of guaranteeing access to antiretroviral treatment for people living with HIV/AIDS can be applied in other countries or regions, much can be learnt from the country’s experience. [author abstract] [The Lancet, Published online November 5, 2002]
- Acquired Immunodeficiency Syndrome in Brazil
Aim: To describe the acquired immunodeficiency syndrome (AIDS) epidemic in Brazil and analyze the impact of federal government measures addressing the problem since its onset. Method: Retrospective review of AIDS epidemic data from its onset in 1980 up to the last published data in June 2001. Results: AIDS was first reported in Brazil in 1980. By 1988, all 27 Brazilian states had diagnosed cases, and until June 2000 more than half of Brazilian municipalities had recorded at least one case of the disease. The AIDS incidence reached its peak between 1996 and 1997 (14.7 per 100,000 population), and then declined between 1998 and 2000 to 9 per 100,000 population. In the last two decades, the proportion of deaths has been also significantly reduced. These were not random events, but reflected the efficiency of the program implemented by the Brazilian Health Ministry’s Coordination on Sexually Transmitted Diseases and AIDS. The program includes an epidemiological surveillance modeling system, which records cases from several regular epidemiological bulletins; national network of diagnosis and monitoring of HIV-infected individuals (ill or not); highly active antiretroviral therapy available free to all patients; mother-infant protection program; educational programs on condom use; the introduction of the female condom; development of AIDS studies in different areas to provide practical solutions; constant preoccupation about drug costs accounting for the patent breaking; and national production of many drugs currently in use. Conclusion: Well-planned and implemented national program against AIDS can significantly reduce the burden of this disease to the population. [author abstract] [Croatian Medical Journal, 43(4): 475-479, 2002]
- Addressing the HIV Prevention, Testing, and Treatment Needs of Mobile Populations: Focus on Truckers in Brazil
"Highly mobile populations such as transport workers, migrant laborers, and construction crews are key audiences for HIV/AIDS prevention and treatment efforts but can be difficult to reach with traditional programs. Truck drivers, for example, spend much of their time on the road, where — away from family and community — they may be more likely to engage in sexual risk behaviors. Their mobility also makes it less likely that they will receive sustained prevention messages from public health campaigns, or use stationary health and prevention services that are appropriate for stable populations. The Horizons Program/Population Council, with additional support from the USAID Mission in Brazil and the Municipal Secretariat of Health of Foz do Iguaçu, conducted operation research to examine the feasibility and impact of an intervention for truckers crossing the southern border of Brazil. The intervention included HIV/STI prevention activities, voluntary counseling and testing (VCT), and general health services. This research update summarizes the formative research and preliminary results of the intervention." [Horizons Research Update (Population Council), October 2006]
- Analysis of medicine advertisement produced in Brazil
Objective: To analyze the compliance of drug advertisements with regulations in Brazil, subject to Resolution RDC No. 102/2000 since 2000, which abides by the WHO’s (World Health Organization) Ethical Criteria for Medicinal Drug Promotion, published in 1988. Methods: Drug advertisements running within the period of October 2002 to October 2003 were collected and recorded. Media sources included various AM and FM radio stations, television channels, newspapers, and magazines, as well as printed material distributed in doctors’ offices, hospitals, drugstores, conferences, billboards, and bus doors. All sources were located in Curitiba City, Brazil, and its surrounding area. Advertisement content was analyzed according to a conformity checklist prepared based on the legal requirements of RDC No. 102/00. Results: A total of 827 advertisements for 517 different products, 83.91% regularly registered as medicinal drugs and 16.09% unregistered products that should be registered according to the Brazilian regulations, were recorded and collected. Approximately 74.73% of the advertisements did not comply with regulations; on average, such advertisements had 4.6 infractions each. Conclusions: The results of this research suggest that RDC No. 102/00 is not followed, which strengthens the need to adopt new forms of regulation to prohibit excesses of the pharmaceutical industry and to protect the population from abusive and misleading drug advertising. [author abstract] [Pharmacy Practice 2007; 5(3): 105-108]
- Are health interventions implemented where they are most needed? District uptake of the Integrated Management of Childhood Illness strategy in Brazil, Peru and the Republic of Tanzania
In this article from the Bulletin of the World Health Organisation (2006;84:792-801), "... Cesar Victora et al. assess the Integrated Management of Childhood Illness (IMCI) strategy by looking at how well it reached poor areas within three countries. Their findings are sobering: overall, the strategy seemed to be implemented least energetically in the areas where it was most needed. This illustrates one of the many cruel ironies of efforts to help the poor: the tendency of service programmes to be much weaker in deprived areas than elsewhere."
- Brazil: Are Health and Nutrition Programs Reaching the Neediest?
Background: Brazil has one of the greatest income concentrations in the planet. Most adverse health outcomes are more common among the poor. The Family Health Program (PSF) was introduced in the 1990s to provide high quality primary health care specially to the poorest. Study Objectives: To assess the PSF in terms of coverage and focus, and estimate the actual use of the program by people from different economic levels. Methods: A cross-sectional study was performed in areas covered by the PSF in Porto Alegre (South Brazil). Information on utilization of health services and socioeconomic and demographic conditions was obtained. Also, data on PSF utilization by under-five children and on antenatal care from a cross-sectional study carried out in the State of Sergipe (Northeast Brazil) were analyzed. Results: In Porto Alegre, 11% of total population and 19% in poorest quintile were covered by PSF. Program focus was 36% for the population registered, and 41% for those actually using it in the previous 6 months. Overall access to health services was high, without socioeconomic differences, but utilization patterns were markedly different in terms of motive and type of service sought. The richer and those covered by private health insurance were less likely to use primary health care. In Sergipe, PSF coverage was higher (55% among the poor) and focus lower (27%). Despite high coverage, the proportion of mothers not attending antenatal care was higher (21%) in the poorest quintile than in the wealthiest quintile (4%). Similarly, inadequate antenatal care was more common among the poorest (50% vs. 19%). Conclusions: PSF seems to have an important role guaranteeing access to the poor. However, the program is not well focused, and coverage among the poor is still inadequate. Findings from this study will be fed back to policy makers to help improve the program. [author abstract] [HNP Discussion Paper: Reaching the Poor Program Paper No. 9 (World Bank), April 2005]
- Community Health Efforts in the Tapajós National Forest, Brazil
"The ‘Community Health Efforts in the Tapajós National Forest’ project is a model of health care for remote communities on the banks of the Tapajós river in northern Brazil. The initiative pays special attention to the problems of children’s and women’s health using the community’s own resources and those of the forest, so that quality care can be offered by means of simple and feasible systems. This model could be used to improve medical care coverage in the remote areas of all countries in the region. The project came fifth out of 1,600 entries for the 2004-2005 cycle of the ‘Experiences in social innovation’ competition, an initiative of the Economic Commission for Latin America and the Caribbean (ECLAC) supported by the W.K. Kellogg Foundation." [Economic Commission for Latin America and the Caribbean (UN), 2004/05]
- Description of Hepatitis B Virus Genotypes in Selected Groups of Subjects from Paraguay and Brazil
Hepatitis B virus genotyping was conducted among 11560 healthy blood donors and haemodialysis patients in Brazil and Paraguay. Genotypes A, D and F were found in Brazil and genotypes D and F in Paraguay. This is the first report showing HBV genotype diversity in individuals in Paraguay. [author abstract] [American Journal of Infectious Diseases 4 (4): 220-223, 2008]
- Ecological study of socio-economic indicators and prevalence of asthma in schoolchildren in urban Brazil
Background: There is evidence of higher prevalence of asthma in populations of lower socioeconomic status in affluent societies, and the prevalence of asthma is also very high in some Latin American countries, where societies are characterized by a marked inequality in wealth. This study aimed to examine the relationship between estimates of asthma prevalence based on surveys conducted in children in Brazilian cities and health and socioeconomic indicators measured at the population level in the same cities. Methods: We searched the literature in the medical databases and in the annals of scientific meeting, retrieving population-based surveys of asthma that were conducted in Brazil using the methodology defined by the International Study of Asthma and Allergies in Childhood. We performed separate analyses for the age groups 6–7 years and 13–14 years. We examined the association between asthma prevalence rates and eleven health and socio-economic indicators by visual inspection and using linear regression models weighed by the inverse of the variance of each survey. Results: Six health and socioeconomic variables showed a clear pattern of association with asthma. The prevalence of asthma increased with poorer sanitation and with higher infant mortality at birth and at survey year, GINI index and external mortality. In contrast, asthma prevalence decreased with higher illiteracy rates. Conclusion: The prevalence of asthma in urban areas of Brazil, a middle income country, appears to be higher in cities with more marked poverty or inequality. [author abstract] [BMC Public Health 2007, 7:205]
- Economic impact of pneumococcal conjugate vaccination in Brazil, Chile, and Uruguay
Objectives: To evaluate the economic impact of vaccination with the pneumococcal 7-valent conjugate vaccine (PCV7) in Brazil, Chile, and Uruguay. Methods: A decision analytic model was constructed to compare pneumococcal vaccination of children 0–5 years old with no vaccination in Brazil, Chile, and Uruguay. Costs and health outcomes were analyzed from the societal perspective. Vaccine, demographic, epidemiologic, and cost data were incorporated into this economic analysis. Results: At the rate of diphtheria-tetanus-pertussis (DTP) vaccine coverage and a vaccine price of US$ 53 per dose, PCV7 was projected to prevent 23 474 deaths per year in children under 5 years old in the three countries studied, thus averting 884 841 disability-adjusted life years (DALYs) yearly. To vaccinate the entire birth cohort of the three countries, total vaccine costs would be US$ 613.9 million. At US$ 53 per dose, the cost per DALY averted from a societal perspective would range from US$ 664 (Brazil) to US$ 2 019 (Chile). At a cost of US$ 10 per dose, vaccine cost is lower than the overall cost of illness averted (US$ 125 050 497 versus US$ 153 965 333), making it cost effective and cost-saving. Conclusions: The results of this study demonstrate that the incorporation of PCV7 vaccine at US$ 53 per dose confers health benefits at extra costs. It is unclear whether vaccination at the current price is affordable to these countries. [author abstract] [Rev Panam Salud Publica, 2008; 24(2): 101–12]
- End-Stage Renal Disease and Chronic Kidney Disease in Brazil
The world is facing an epidemic of chronic kidney disease (CKD). This report discusses the present state of chronic kidney disease care in Brazil. We report frequency of dialysis treatment and prevalence of kidney transplantation throughout Brazil. We estimated the number of CKD patients in the country through a mathematical extrapolation based on data generated by the NHANES. On January 2007, 73,605 patients were on dialysis, which corresponds to 390 patients per million of population (pmp); the majority of these patients (~90%) were funded by the Brazilian Public Health System. If we aggregate patients with a functioning kidney graft, unofficially estimated by ABTO as 27,500 (~150 pmp), the whole adjusted prevalence of end-stage renal disease patients in Brazil by January 2007 is ~540 pmp. We estimate that the number of patients with glomerular filtration rate <60 mL/min/1.73 m2 of body surface approximates 15 million people in Brazil, many of whom are not in treatment. [publication abstract] [Ethn Dis 2009; 19 [Suppl 1]:S1-7–S1-9]
- Equity of access to health care for older adults in four major Latin American cities
Objectives: To identify if older adults have equitable access to health services in four major Latin American cities and to determine if the inequities that are found follow the patterns of economic inequality in each of the four nations studied. Methods: Data from persons age 60 and over in the cities of São Paulo, Brazil (n = 2 143); Santiago, Chile (n = 1 301); Mexico City, Mexico (n = 1 247); and Montevideo, Uruguay (n = 1 450) were collected through a collaboration led by the Pan American Health Organization. For our study, three process indicators of access (availability, accessibility, and acceptability) and one indicator of actual health services use (visit to a medical doctor in the past 12 months) were analyzed by wealth quintiles, health insurance type, education, health status, and demographic characteristics. Results: Each of the four cities had a different level of access to care, and those levels of access were only weakly related to per capita national wealth. Given the relatively high level of wealth inequality in Brazil and the lower level in Uruguay, older persons in São Paulo had better-than-expected equity in access to care, while older persons in Montevideo had less equity than expected. Inequity in Mexico City was driven primarily by low levels of health insurance coverage. In Santiago, inequity followed socioeconomic status more than it did health insurance. Conclusions: In the four cities studied, health insurance and the operation of health systems mediate the link between economic inequality and inequitable access to health care. Therefore, special attention needs to be paid to equity of access in health services, independent of differences in economic inequality and national wealth. [author abstract] [Rev Panam Salud Publica, 2005; 17(5/6): 394–409]
- Evolution of the health sector and tuberculosis control in Brazil
Objective: To summarize the epidemiological situation of tuberculosis (TB) in Brazil, especially as it relates to the evolution of the health sector in recent decades, the process of health sector reform, and current proposals of the Brazilian Ministry of Health. Methods: A review was conducted of data from the Ministry of Health of Brazil on tuberculosis in the country over the last 20 years, as well as of the history of changes in the health sector. Results: There have been major changes in the epidemiological situation of TB and also in the structure of the health system in Brazil. Conclusions: The overall prospects are promising for Brazil’s National Plan for Tuberculosis Control. [author abstract] [Rev Panam Salud Publica/Pan Am J Public Health 9(5), 2001, pp.306-310]
- Financing Health Policies in Brazil: Achievements, Challenges and Proposals
"This article tries to assess the decentralization process of the Brazilian health sector, evaluating the principal measures used by the government to address financing and equity issues in the composition and distribution of the expenditures. Based on this analysis, it describes some of the problems that still persist in relation to the public financing of health services in Brazil, pointing out some of the possible solutions." [Inter-American Development Bank, November 2002]
- Global Pharmaceutical Development and Access: Critical Issues of Ethics and Equity
The article presents global data on access to pharmaceuticals and discusses underlying barriers. Two are highly visible: pricing policies and intellectual property rights; two are less recognized: the regulatory environment and scientific and technological capacities. Two ongoing transitions influence and even distort the problem of universal access to medications: the epidemiologic transition to an increasing burden of chronic non-communicable diseases; and the growing role of biotechnology products (especially immunobiologicals) in the pharmacopeia. Examples from Cuba and Brazil are used to explore what can and should be done to address commercial, regulatory, and technological aspects of assuring universal access to medications. [author abstract] [MEDICC Review Vol. 13, No 3, PP.16-22, July 2011]
- Health in the Americas 2007: Brazil
As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on Brazil addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in Brazil, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
- Health Reform in Brazil: Lessons to Consider
US analysts and decision-makers interested in comparative health policy typically turn to European perspectives, but Brazil — notwithstanding its far smaller gross domestic product and lower per capita health expenditures and technological investments — offers an example with surprising relevance to the US health policy context. Not only is Brazil comparable to the United States in size, racial/ethnic and geographic diversity, federal system of government, and problems of social inequality [sic]. Within the health system the incremental nature of reforms, the large role of the private sector, the multitiered patchwork of coverage, and the historically large population excluded from health insurance coverage resonate with health policy challenges and developments in the United States. [publication abstract] [Am J Public Health, 2003; 93: 44–48]
- Inadequate Use of Prenatal Services Among Brazilian Women: The Role of Maternal Characteristics
Context: To improve the uptake of prenatal care, it is important to know how the use of prenatal care varies by maternal attitudes and social and demographic factors. Methods: Information about social and demographic variables, prenatal care, parity, pregnancy planning, abortion attempts, satisfaction with pregnancy and satisfaction with the relationship with the child’s father was collected from 611 postpartum women in Porto Alegre in southern Brazil. Multinomial logistic regression was used to evaluate associations between these variables and whether the women’s use of prenatal care was adequate, partially inadequate or inadequate. Results: About 40%ofwomen had inadequate or partially inadequate prenatal care. After adjustment for other covariates, including satisfaction with the pregnancy, women having an unplanned pregnancy were significantly more likely to have had inadequate care than women who had planned their pregnancy (odds ratio,2.0).Not living with the child’s father (2.8) and dissatisfaction with pregnancy (2.1)were also associated with inadequate use of prenatal care. Women having their second or higher order birth were significantly more likely to report inadequate use of prenatal care than women having their first birth (3.9–9.0).Household income was inversely associated with inadequate use of care. Conclusions: The study suggests that maternal attitudes may be important for adequate prenatal care. Interventions should be created to encourage women with negative maternal attitudes to use prenatal care and to ensure that they have access to the care they need. [author abstract] [International Perspectives on Sexual and Reproductive Health, 2009, 35(1): 15–20]
- Inequitable distribution of health resources in Brazil: An analysis of national priority setting
The purpose of this paper is to describe the national priority setting process for the public health system in Brazil, evaluating the process using the ethical framework Accountability for Reasonableness, and equity considerations highlighted in the 2008 WHO Commission on Social Determinants of Health. We searched the Brazilian Ministry of Health website for documents that described priority setting within the Brazilian Universal Health Care System (SUS). The National Health Conference (CNS) has been defined by the Ministry of Health as the democratic priority setting forum for SUS. The most recent such conference (13th CNS, 2007) is the subject of this paper. Our analysis suggests that the process of priority setting within SUS has not yet achieved the ethical standards of legitimacy and fairness, and that inequitable distribution of decision making power under- represents users in poor areas. The unmet need for hospital care for children in Brazil, which reflects a remarkable inequality of opportunity for human development, may be a product of poor priority setting processes and inequity in representation. [author abstract] [Acta Bioethica 2009; 15 (2): 179-183]
- Intellectual Property and Public Health: copying of HIV/Aids drugs by Brazilian public and private pharmaceutical laboratories
This article, written by Maurice Cassier and Marilena Correa, and published in the Electronic Journal of Communication, Information and Innovation in Health (vol.1, no.1, pp. 83-90 (2007)), examines how "Brazilian public and private laboratories' experience in copying ARVs since 1993 has been a technological learning process that in some cases has produced innovations. Reproducing drugs and synthesizing their active principles involves the combination of information available in patent documents and the partial rediscovery of certain know-how through laboratory manipulations. Chemists have to reconstruct the numerous “cat leaps” in patent documents, and in so doing often improve on the published processes or formulae. Generics laboratories are also able to use this knowledge base to invent new formulae, combinations of existing molecules, or to discover new molecules. Since 2000 the five laboratories studied have filed about ten patents on ARVs. We pieced together this technological learning process by interviewing chemists at generics laboratories, using the methods of the sociology of science." [author abstract]. Also published in Portuguese.
- Medical Geography in Public Health and Tropical Medicine: Case Studies from Brazil
Within the last few decades, the multitude of infrastructural and environmental changes associated with population growth, human migration, and economic development have catalyzed the emergence and re-emergence of many infectious diseases worldwide. The morbidity and mortality associated with these diseases have in turn led to an increased and renewed impetus to gain a better understanding of the etiology, epidemiology, prevention, and control of these diseases in order to achieve better health and well-being, especially for underprivileged populations. Two traditionally separate fields, medical geography and tropical medicine, have recently seen complex and radical paradigm shifts in response to this global situation: medical geography has been developing many new and sophisticated methods of data collection, data manipulation, and spatial analysis that make it more suited for the study of health-related problems; and tropical medicine has been revisiting the fundamental notion that disease is intimately linked to the physical and cultural geographic environments in which humans live. As a result, concepts of medical geography are being more readily employed within tropical disease research, and tropical medicine is embracing geographic methods as a central mainstay in the control, management, and prevention of tropical diseases. As the associations between these two fields continue to grow, a clearer understanding of how they compliment each other will be needed in order to better define their interrelated roles in augmenting human health. This dissertation examines the multifarious relationships that have developed between the fields of medical geography and tropical medicine in recent years by presenting the reader with a brief history of their common origins and a comprehensive review of the techniques and methodologies in medical geography that are frequently employed in tropical disease research. Following this background information, several case studies are investigated that provide examples of how geographic methods can be easily and effectively employed in the analysis of several tropical diseases, including tungiasis, intestinal helminthes, leprosy, and tuberculosis. These case studies demonstrate some of the advantages and disadvantages of current geographic methods employed in health research, and offer a framework for readers who are interested in applying basic geographic concepts to analyze questions of health. [author abstract] [PhD thesis, Louisiana State University and Agricultural and Mechanical College, December 2008]
- New drugs in Brazil: Do they meet Brazilian public health needs?
Objectives: To describe the new drugs marketed in Brazil during the period 2000–2004, compare the description to the country’s burden of disease, and suggest initiatives capable of addressing the situation from the perspective of a developing country. Methods: Records of new drugs were surveyed in an official drug registration database. The new drugs were categorized by Anatomical Therapeutic Chemical classification, indication, and innovation, and compared with the needs of the country’s burden of disease. Data on the morbidity and mortality rates of selected diseases (diabetes, Hansen’s disease, hypertension, tuberculosis) were retrieved from official documents and the literature. Results: During the period investigated, 109 new drugs were launched. Most were general anti-infectives for systemic use (19), followed by antineoplastic and immunomodulating agents (16). The number of new drugs launched in 2004 was roughly one-third that of 2000. Of 65 new drugs, only one-third can be classified as innovative. Most new drugs were intended to treat noninfectious diseases that typically affect developed countries, diseases that constitute only a fraction of the country’s challenges. Conclusions: A mismatch occurs between public health needs and the new drugs launched on the Brazilian market. Not only did the number of new drugs decrease in the study period, but only a few were actually new in therapeutic terms. Developing countries must acquire expertise in research and development to strengthen their capacity to innovate and produce the drugs they need. [author abstract] [Rev Panam Salud Publica. 2008; 24(1): 36–45]
- Spatial Distribution of Leprosy in the Amazon Region of Brazil
To detect areas with increased case-detection rates, we used spatial scan statistics to identify 5 of 10 clusters of leprosy in the Amazon region of Brazil. Despite increasing economic development, population growth, and road infrastructure, leprosy is endemic to this region, which is a source of case exportation to other parts of Brazil. [publication summary] [Emerging Infectious Diseases, Vol. 15, No. 4, April 2009, pp.650-652]
- Sub-national assessment of inequality trends in neonatal and child mortality in Brazil
Objective: Brazil's large socioeconomic inequalities together with the increase in neonatal mortality jeopardize the MDG-4 child mortality target by 2015. We measured inequality trends in neonatal and under five mortality across municipalities characterized by their socio-economic status in a period where major pro poor policies were implemented in Brazil to infer whether policies and interventions in newborn and child health have been successful in reaching the poor as well as the better off. Methods: Using data from the 5,507 municipalities in 1991 and 2000, we developed accurate estimates of neonatal mortality at municipality level and used these data to investigate inequality trends in neonatal and under five mortality across municipalities characterized by socio-economic status. Results: Child health policies and interventions have been more effective in reaching the better off than the worst off. Reduction of under five mortality at national level has been achieved by reducing the level of under five mortality among the better off. Poor municipalities suffer from worse newborn and child health than richer municipalities and the poor/rich gaps have increased. Conclusion: Our analysis highlights the importance of monitoring progress on MDGs at sub-national level and measuring inequality gaps to accurately target health and inter-sectoral policies. Further efforts are required to improve the measurement and monitoring of trends in neonatal and under five mortality at sub-national level, particularly in developing countries and countries with large socioeconomic inequalities. [author abstract] [International Journal for Equity in Health 2010, 9: 21]
- The Brazilian Health Informatics and Information Policy: building the consensus
This paper describes the construction of the Brazilian Health Information Policy. The Introduction gives an overview of the health informatics scenario in the country and the motivation for the definition of a national policy for the area. The process adopted and the strategies to reach consensus among the different players of the healthcare arena are discussed. The interface with the national health card project and the standards already established are also depicted. The current document and the strategies so far proposed are presented with their respective time table and goals. At the end, a comparison with other national initiatives is drawn. [publication abstract] [Chinese Medical and Biological information, Medinfo, 2004]
- The Social Causes of Health Inequities in Brazil
"The report of the National Commission on Social Determinants of Health (NCSDH)
has three objectives: (i) to outline a general panorama of the health situation in Brazil, with emphasis on data, information and knowledge about health inequities generated by the social determinants; (ii) to propose policies, programs and interventions related to the social determinants, based on an evaluation of the policies and interventions currently underway and the experiences reported in the national and international literature; [and] (iii) to describe the activities developed by the Commission to comply with its objectives." [National Comission [sic] on Social Determinants of Health and Editora Fiocruz, 2008]
- What Brazil is doing to promote healthy diets and active lifestyles
Objectives: To present the way the Brazilian government is addressing the prevention of nutrition-related non-communicable diseases (NR-NCDs). Results: Innovative legislative and regulatory actions, mass communications and capacity building have been combined to create a comprehensive approach for addressing poor dietary and activity patterns in Brazil that are leading to obesity and NR-NCDs. Included are new nutrition-related initiatives in the labelling area, shifts in the types of food purchased for the school food programme, use of mass media to communicate components of the food guidelines, establishment of a smart shopping initiative, and training of teachers and health workers. Conclusions: The entire effort has taken several years to get underway. This paper describes the process and some of the initial changes seen. [author abstract] [Public Health Nutrition: 5(1A), 263–267, 2002]
- WHO-AIMS report on mental health system in Brazil
"The World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was used to collect information on the mental health system in Brazil. The goal of collecting this information is to improve the mental health system and to provide a baseline for monitoring the change. This will enable Brazil to develop information-based mental health plans with clear base-line information and targets. It will also be useful to monitor progress in implementing reform policies, providing community services, and involving users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation. The country has started several innovative services and interventions, such as the CAPS, and the Return Home program. In little more than one decade, hundreds of services were established and older services were revised according to general guidelines to maximize limited resources. The revised system includes a mix of mental health outpatient services, day hospitals, and therapeutic workshops. Brazil has sound legislation on mental health and a new mental health policy, which resulted in a major reform of the mental health system. Custodial care is being abolished, and the system is now providing care in the community, allowing free access to a variety of mental health services and essential psychotropic medicines… However, services are unequally distributed across regions of the country, and the growth of the elderly population is creating an increased gap in mental health care. This gap may get even wider if funding does not increase and mental health services are not expanded in the country. There is no solid data to show the impact of policy change in terms of cost-effectiveness. Moreover, despite some acknowledgement of advances made many hurdles have to be overcome." [WHO and [Brazilian] Ministry of Health, 2007]
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