Equidad en la salud: evaluación de políticas públicas en Belo Horizonte, Minas Gerais, Brasil, 1993-1997

Abstract

This article evaluates government measures to reduce inequity in the health sector in Belo Horizonte from 1993 to 1997. Our hypothesis is that a municipal administration committed to equity can reduce disparities in health with the support of the Unified National Health System (SUS). The methodology used an urban quality of life index in Belo Horizonte to detect social inequalities in living conditions, as well as differences between the component indices in the infant mortality rate. Other municipal measures were assessed according to the investment resulting from the implementation of a participatory local budget and open planning process. The urban quality of life index appeared to be an appropriate measure for orienting municipal administration. The infant mortality rate proved to be a good indicator for measuring inequality in health. There was a reduction in IMR and mortality reducing gaps in the districts studied. We observed greater investment of physical and financial resources in the districts with the lowest urban quality of life index, and it can thus be stated that the municipal administration reduced the prevailing inequalities.

State Downsizing as a Determinant of Infant Mortality and Achievement of Millennium Development Goal 4

“…Most analyses associate IMR with a country's wealth and income distribution. Health care or education expenditures, the existence of social inequalities, public sector involvement as a percentage of GDP, and the level of democracy have also been linked to IMR (8,11). The present data highlight the association between income inequality and a country's probability of attaining MDG4, adding further weight to the effect of inequality (46) over that of economic growth indicators.…”

“…Infant mortality in countries throughout the world is determined by a range of living-condition variables: poverty (1,2); unemployment (3,4); economic barriers such as income, prices (5), and payment of medical services (6); housing conditions such as location (7) and cleanliness (5); illiteracy (8); mother's level of education (9,10); racial (11) and ethnic (12) discrimination; access to services such as health (5), water (13), electricity (14), environmental sanitation, and credit (5); and land availability (5). Clearly, infant/child mortality rates are not linked to a single factor but are affected by multiple manifestations of a disadvantaged population's living conditions-particular or structural determinants for the World Health Organization Social Determinants of Health (15), and particular determinants for Breilh (16)-which have a hierarchical and interdependent relationship with other "general or socioeconomic and political" factors that, in turn, determine them.…”

“…Clearly, infant/child mortality rates are not linked to a single factor but are affected by multiple manifestations of a disadvantaged population's living conditions-particular or structural determinants for the World Health Organization Social Determinants of Health (15), and particular determinants for Breilh (16)-which have a hierarchical and interdependent relationship with other "general or socioeconomic and political" factors that, in turn, determine them. Different studies of this level of determinants have demonstrated that infant/child mortality is associated with a country's dependency situation (17), level of democracy (18), governing party's public policy (19), structural adjustments (20), neoliberal economic development (21), social classes (22), level of economic transfers from the state to the population (11), level of economic inequality (23,24), and gross domestic product (14,25).…”

Desafios para a saúde coletiva no século XXI

“…Diversas iniciativas têm procurado reduzir a iniqüidade na distribuição de recursos do próprio SUS, seja combinando critérios técnicos da alocação para uma "Municipalização Solidária" (LIMA et al, 2002), seja favorecendo o desenvolvimento de metodologias para a análise das desigualdades em saúde (SZWARCWALD et al, 2002) e a realização de investigações em política e economia da saúde (JUNQUEIRA et al, 2002;PORTO, 2002) que auxiliem a formulação de políticas de saúde orientadas para a eqüidade. Outros receiam "que as fórmulas adotadas tornem-se complexas e de difícil compreensão, podendo não trazer ganhos reais no âmbito da eqüidade" (CAZELLI et al, 2002).…”