Contribution of primary care expansion to Sustainable Development Goal 3 for health: a microsimulation of the 15 largest cities in Brazil

Abstract

ObjectivesAs middle-income countries strive to achieve the Sustainable Development Goals (SDGs), it remains unclear to what degree expanding primary care coverage can help achieve those goals and reduce within-country inequalities in mortality. Our objective was to estimate the potential impact of primary care expansion on cause-specific mortality in the 15 largest Brazilian cities.DesignMicrosimulation model.Setting15 largest cities by population size in Brazil.ParticipantsSimulated populations.InterventionsWe performed survival analysis to estimate HRs of death by cause and by demographic group, from a national administrative database linked to the Estratégia de Saúde da Família (Family Health Strategy, FHS) electronic health and death records among 1.2 million residents of Rio de Janeiro (2010–2016). We incorporated the HRs into a microsimulation to estimate the impact of changing primary care coverage in the 15 largest cities by population size in Brazil.Primary and secondary outcome measuresCrude and age-standardised mortality by cause, infant mortality and under-5 mortality.ResultsIncreased FHS coverage would be expected to reduce inequalities in mortality among cities (from 2.8 to 2.4 deaths per 1000 between the highest-mortality and lowest-mortality city, given a 40 percentage point increase in coverage), between welfare recipients and non-recipients (from 1.3 to 1.0 deaths per 1,000), and among race/ethnic groups (between Black and White Brazilians from 1.0 to 0.8 deaths per 1,000). Even a 40 percentage point increase in coverage, however, would be insufficient to reach SDG targets alone, as it would be expected to reduce premature mortality from non-communicable diseases by 20% (vs the target of 33%), and communicable diseases by 15% (vs 100%).ConclusionsFHS primary care coverage may be critically beneficial to reducing within-country health inequalities, but reaching SDG targets will likely require coordination between primary care and other sectors.

COVID-19, SDGs and public health systems: Linkages in Brazil

“…Multiple studies connect the 2030 agenda and COVID-19 [70] , [110] , [46] , [47] . In addition, studies have explored the connection between Brazilian National Health Service (SUS) and the SDGs [107] , [10] , [5] ; with one study exploring the resilience of health systems in Brazil in light of COVI-19 [11] ; nevertheless, a gap remains on studies covering links between the Covid-19 pandemic and SDGs in the context of the SUS. This study aimed to highlight existing and added connections in Brazil's health system and implications for SDGs, answering the following Research Question (RQ) “Using the SDGs as an analytical framework, what lessons can be drawn from Brazil's experience with the COVID-19 pandemic and its linkages with multiple aspects of sustainable development to support public health systems?“ .…”