Cause-specific mortality and income inequality in São Paulo, Brazil

Filho, Alexandre Dias Porto Chiavegatto; Gotlieb, Sabina Léa Davidson; Kawachi, Ichiro

doi:10.1590/s0034-89102012005000039

Cited by 8 publications

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References 8 publications

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“…Recent studies have indicated a correlation between the place of residence in the MRSP and presence of chronic and mental diseases. 7 , 8 However, in the present study, use of health care services appeared to be unaffected by the place of residence. In the null model, without the inclusion of individual or contextual independent variables, the variance attributable to the place of residence was not statistically significant for any of the dependent variables studied.…”

Section: Discussioncontrasting

confidence: 61%

“…Estudos recentes têm apontado para a associação entre características do local de residência na RMSP e presença de doenças crônicas e mentais. 7 , 8 Entretanto, no presente estudo, o uso de serviços de saúde parece não ser afetado pelo local de residência. O modelo nulo, sem a inclusão de variáveis independentes individuais ou contextuais, não apresentou resultado estatisticamente significativo da variância atribuível ao local de residência para nenhuma das variáveis dependentes no presente estudo.…”

Section: Discussionunclassified

“…The presumed universality of access and the known social inequality allow for interesting opportunities for analysis of the contextual determinants of the use of health services in Brazil, particularly with regard to income inequality and violence, in which the Brazilian indicators are consistently worse compared with other developed countries. c Previous studies have indicated the contextual importance of income inequality and violence on the health of residents of Sao Paulo, 7 , 8 and this should stimulate an analysis of the use of health care services as a possible mediator of the correlation between contextual factors and health.…”

Section: Introductionmentioning

confidence: 99%

“…Principalmente no caso da desigualdade de renda e da violência, em que os indicadores brasileiros são consistentemente piores em relação a qualquer país desenvolvido. c Estudos apontam para a importância contextual da desigualdade de renda e da violência na saúde dos residentes de São Paulo, 7 , 8 o que traz interesse para uma análise do uso de serviços como um possível mediador da associação entre fatores contextuais e saúde.…”

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Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

et al. 2015

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OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo.METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care.RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician.CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

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Section: Discussioncontrasting

confidence: 61%

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Section: Introductionmentioning

confidence: 99%

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Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

et al. 2015

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“…However, more recent articles, ecological or with multilevel analysis, incorporated variables or indexes of inequality income distribution 12 , 16 .…”

Section: Introductionmentioning

confidence: 99%

Social inequality in health: revisiting moments and trends in 50 years of publication of RSP

Barros

2017

Rev. Saúde Pública

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This study describes the frequency and types of articles on social inequalities in health published in 50 years of the Revista de Saúde Pública, taking as reference some milestones that were used as guidelines to develop the research on this theme. Checking titles, keywords and abstracts or full texts, we identified 288 articles whose central or secondary focus was social inequalities in health. Corresponding to just 1.8% in the initial years, articles on social inequalities in health have represent 10.1% of the articles published in the last decade. The designs used were mainly cross-sectional (58.0%) and ecological (18.1%). The most analyzed themes were: food/nutrition (20.8%), mortality (13.5%), infectious diseases (10.1%), oral health (9.0%), and health services (8.7%). Articles focused on the analysis of racial inequalities in health amounted to 6.9%. Few articles monitored the trends of social inequalities in health, essential enterprise to assess and support interventions, and an even smaller number evaluated the impact of policies and programs on the reduction of social inequalities in health.

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Poverty, inequality and a political economy of mental health

Burns

2015

Epidemiol Psychiatr Sci

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The relationship between poverty and mental health is indisputable. However, to have an influence on the next set of sustainable global development goals, we need to understand the causal relationships between social determinants such as poverty, inequality, lack of education and unemployment; thereby clarifying which aspects of poverty are the key drivers of mental illness. Some of the major challenges identified by Lund (2014) in understanding the poverty–mental health relationship are discussed including: the need for appropriate poverty indicators; extending this research agenda to a broader range of mental health outcomes; the need to engage with theoretical concepts such as Amartya Sen's capability framework; and the need to integrate the concept of income/economic inequality into studies of poverty and mental health. Although income inequality is a powerful driver of poor physical and mental health outcomes, it features rarely in research and discourse on social determinants of mental health. This paper interrogates in detail the relationships between poverty, income inequality and mental health, specifically: the role of income inequality as a mediator of the poverty–mental health relationship; the relative utility of commonly used income inequality metrics; and the likely mechanisms underlying the impact of inequality on mental health, including direct stress due to the setting up of social comparisons as well as the erosion of social capital leading to social fragmentation. Finally, we need to interrogate the upstream political, social and economic causes of inequality itself, since these should also become potential targets in efforts to promote sustainable development goals and improve population (mental) health. In particular, neoliberal (market-oriented) political doctrines lead to both increased income inequality and reduced social cohesion. In conclusion, understanding the relationships between politics, poverty, inequality and mental health outcomes requires us to develop a robust, evidence-based ‘political economy of mental health.’

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Cause-specific mortality and income inequality in São Paulo, Brazil

Abstract: OBJECTIVE:To analyze cause-specifi c mortality rates according to the relative income hypothesis.

Cited by 8 publications

References 8 publications

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

Social inequality in health: revisiting moments and trends in 50 years of publication of RSP

Poverty, inequality and a political economy of mental health

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