Water fluoridation in Brazilian cities at the first decade of the 21st century

Abstract

OBJECTIVE To assess the coverage of the fluoridation of the public water supply in Brazilian municipalities at the first decade of the 21st century, according to population size and municipal human development index (MHDI).METHODS We have used data produced by national information agencies and the United Nations Development Programme. Population size was separated into < 10,000, 10,000–50,000, and > 50,000 inhabitants. The MHDI was classified into < 0.600, 0.600–0.699, 0.700–0.799, and > 0.799. Absolute and relative inequalities between categories were evaluated using indicators of effect and total impact.RESULTS We have obtained information for 5,558 municipalities. The coverage rate of water fluoridation increased from 67.7% to 76.3%. Approximately 884 (15.9%) municipalities and 29,600,000 inhabitants started being benefited by the measure. We have observed a significant expansion in municipalities with < 10,000 inhabitants (increase of 21.0 percentage points) and low or very low MHDI (17.7 percentage points).CONCLUSIONS Population coverage of the public policy has increased 8.6%, and we can also see significant reductions in absolute and relative inequality according to population size and MHDI. Regarding municipal coverage rate, there was also a reduction in inequality in all comparisons except for absolute inequality between the categories of MHDI. The public policy has operated as a factor of health protection in the context of the ongoing social protection policies in the country.

Empresas de saneamento e a fluoretação da água dos sistemas de abastecimento: estudo ecológico nos municípios do Brasil, 2008/2010*

“…The findings resemble those of research carried out with data from the year 2000, according to which municipalities with more than 50,000 inhabitants and those with higher MDHI also had higher fluoridation provision. 11 Results found in both studies suggest that the efforts made at the federal and state levels of government have not been sufficient to accelerate the expansion of this measure in municipalities with a very low or low MDHI, demonstrating the need to readjust deployment strategies.…”

“…10 Based on the population in each location, a longitudinal study involving 5,558 Brazilian municipalities showed that in less than a decade water fluoridation population coverage rose from 115 (67.7%) to 144 (76.3%) million inhabitants, representing an increase of 8.6% between 2000 and 2008. 11 The same study also found, in relation to the year 2000, that the characteristics of municipalities, such as population size and Municipal Human Development Index (MDHI), influenced the extent of fluoridation service provision. 11 Knowledge is not available as to this influence with regard to the type of concessionary company.…”

“…11 The same study also found, in relation to the year 2000, that the characteristics of municipalities, such as population size and Municipal Human Development Index (MDHI), influenced the extent of fluoridation service provision. 11 Knowledge is not available as to this influence with regard to the type of concessionary company. As such, more careful analysis of the dependence relationship of these variables and updating of available information is necessary.…”

The role of municipal public policies in oral health socioeconomic inequalities in Brazil: A multilevel study

“…For example, in Brazil, water fluoridation was implemented first in municipalities with better socioeconomic indicators, taking some time to reach individuals in poorer places . In 2008, nearly 75% of the Brazilian population had access to fluoridated water, and those without it were living in municipalities with average to high Municipal Human Development Index …”

Características contextuais associadas à fluoretação da água de abastecimento público no Brasil em 2008

“…10 Com base na população de cada localidade, um estudo longitudinal envolvendo 5.558 municípios brasileiros mostrou que, em menos de uma década, a cobertura populacional de fluoretação da água se ampliou de 115 (67,7%) para 144 (76,3%) milhões de habitantes, representando um aumento de 8,6% entre os anos 2000 e 2008. 11 O mesmo estudo também observou, para o ano 2000, que características próprias dos municípios, como porte populacional e índice de desenvolvimento humano municipal (IDHM), implicaram o grau da oferta do serviço de fluoretação. 11 Não se tem conhecimento dessa implicação no que se refere ao tipo de empresa concessionária, pelo que se faz necessária uma análise mais criteriosa da relação de dependência dessas variáveis e atualização da informação disponível.…”