Assessing the relevance of indicators in tracking social determinants and progress toward equitable population health in Brazil

Abstract

BackgroundThe importance of the social determinants of health (SDH) and barriers to the access and utilization of healthcare have been widely recognized but not previously studied in the context of universal healthcare coverage (UHC) in Brazil and other developing countries.ObjectiveTo evaluate a set of proposed indicators of SDH and barriers to the access and utilization of healthcare – proposed by the SDH unit of the World Health Organization – with respect to their relevance in tracking progress in moving toward equitable population health and UHC in Brazil.DesignThis study had a mixed methodology, combining a quantitative analysis of secondary data from governmental sources with a qualitative study comprising two focus group discussions and six key informant interviews. The set of indicators tested covered a broad range of dimensions classified by three different domains: environment quality; accountability and inclusion; and livelihood and skills. Indicators were stratified according to income quintiles, urbanization, race, and geographical region.ResultsOverall, the indicators were adequate for tracking progress in terms of the SDH, equity, gender, and human rights in Brazil. Stratifications showed inequalities. The qualitative analysis revealed that many of the indicators were well known and already used by policymakers and health sector managers, whereas others were considered less useful in the Brazilian context.ConclusionsMonitoring and evaluation practices have been developed in Brazil, and the set of indicators assessed in this study could further improve these practices, especially from a health equity perspective. Socioeconomic inequalities have been reduced in Brazil in the last decade, but there is still much work to be done in relation to addressing the SDH.

Equality and poverty: views from managers and professionals from public services and household heads in the Belo Horizonte Metropolitan Area, Brazil

“…It is known that contexts of socioeconomic crises affect families living in poverty in ways that further aggravate situations of unemployment, stigma related to unemployment and social exclusion. In turn, chronic stress is prone to worsen and physical and psychological illness, such as depression [ 38 ], further intensify as observed in a large number of this study’s results ( “Depression is the most common illness as their children do drugs and the mothers just suffer”; “ Alcohol and drug abuse and dependence” was identified by 48.2% of HHs as the main social determinant of health). In this regard, a study focusing on social support for mothers with mental health problems and children in situations of vulnerability observed that social support represents a protective factor that contributes to getting families out of poverty [ 39 ].…”

A Acessibilidade da Atenção Básica no Brasil na avaliação dos usuários

“…No Brasil, estudos revelam aumento no acesso e na utilização dos serviços de saúde, especialmente pela população urbana (mesmo que com percentual ainda inferior ao observado em outros países) 5 . Além disso, há reconhecimento de que a consolidação da Estratégia Saúde da Família (ESF) tem sido associada aos efeitos benéficos sobre a equidade de acesso à saúde e maior vínculo entre usuários e equipes de saúde, bem como de ser a principal referência de cuidados 5,6 .…”

Dilemma in the Brazilian Tropical Medicine: ‘Is speed more important than direction?’

“…Social determinants of health, however, are usually not taken into account. Socioeconomic inequalities have been reduced in Brazil in the last decade, but there is still much work to be done in regards to addressing local social idiosyncrasies (Rasella et al 2016). Regardless of a non-centralized system, in which municipalities have the role of executing the actions, and the state and federal governments supervise and provide technical advice, respectively, public health decisions made in the federal centralized government still believe that 'one size fits all'.…”