Os Objetivos do Desenvolvimento Sustentável e a tuberculose no Brasil: desafios e potencialidades

Abstract

Several of the 17 Sustainable Development Goals (SDG) deal with health issues. The third goal, health and wellbeing, aims to "ensure healthy lives and promote wellbeing for all at all ages" and is clearly related to the tenth goal, the reduction of inequalities, and other SDG 1. The SDG agenda, which succeeds the Millennium Development Goals (MDG), proposes to leave no one behind. In terms of health, the most coherent and accessible proposal to achieve these goals is universal health care through a strong primary health care system 2. There are many challenges for meeting the targets within the SDG. An example is tuberculosis (TB). TB still poses a huge global health threat, with some 10 million new cases per year. In 2016, 1.3 million people died of TB, and another 370 deaths occurred in people living with HIV/AIDS 3. Among the global efforts to control the disease, TB was included in target 3.3 of SDG 3. The challenge is to eliminate TB as an endemic through 90% reduction in mortality and 80% in incidence by 2030, in order to eliminate the disease by 2050. The World Health Organization (WHO) launched the End TB Strategy to support these targets, with the additional goal that no patient should need to bear the catastrophic costs and social repercussions of the disease 4. This concern reflects the view that TB maintains the most vulnerable populations in a vicious circle, a view that sustains target 3.8 of the SDG 1 , which deals with achieving universal health coverage, includes protection from financial risk, and complements TB control. To reach these targets, three lines of action are recommended for governments: patient-centered care and prevention integrated with other care, bold policies and strong health systems, and acceleration of research and innovation 4. At the current rate of reduction, these targets will not be reached within the deadlines laid out in international agreements 5. Different tools are needed, since TB has biological, clinical, and socioeconomic determinants, including coinfection with HIV, malnutrition, smoking, poverty, overcrowding, and insufficient access to health care 4. In Brazil, many determinants of TB overlap in poor urban communities, making it increasingly unlikely to meet the targets. In these neighborhoods, TB incidence exceeds 300/100,000 inhabitants, compared to 32.4/100,000 inhabitants in the country as a whole 6. Another extremely vulnerable urban group is Brazil's prison population, with 31 times higher odds of catching TB compared to the general population 7. Such TB hotspots, which must be identified and controlled in order to reduce transmission 8 , reflect the country's health inequalities and pose a special challenge for controlling the disease.

O financiamento da saúde no Brasil e as metas da Agenda 2030: alto risco de insucesso

“…Políticas de austeridade fiscal implantadas em resposta a crises econômicas têm sido apontadas como fator determinante da piora da situação de saúde da população em todo o mundo, especialmente entre os grupos socioeconomicamente mais vulneráveis 28,29 . No Brasil, o impacto dessas políticas sobre o SUS tem gerado preocupação quanto à possiblidade de retrocessos na oferta de bens e serviços de saúde 30 e no alcance: das metas relativas ao controle de doenças crônicas não transmissíveis 31 ; dos ODS, de forma geral 32 ; e da meta do ODS 3 relacionada à tuberculose 33 . O fato de a União ser o ente federativo com maior capacidade fiscal faz com que se espere maior esforço do governo federal no financiamento do SUS, posto que estados e municípios já se encontram no limite de suas possibilidades financeiras 4 .…”

Tuberculosis cases in a prison in the extreme south of Brazil

“…Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis in humans, is a global health threat, with approximately 10 million new cases per year [1]. Among the global efforts to control the disease, TB was included in the Sustainable Development Goals – World Health Organization (WHO), with the challenge of reducing mortality rates by 90 % and incidence rates by 80 % by 2030 to eliminate the disease by 2050 [1–3].…”

Perfil Epidemiológico Dos Abandonos De Tuberculose Em Uma Capital Do Nordeste Do Brasil

“…Estudos revelam que o maior abandono observado entre indivíduos adultos jovens está intimamente ligado a fatores sociais, por estarem em uma fase da vida com maior predisposição ao consumo de drogas e ao etilismo, sendo esta a primeira causa de ruptura do vínculo do paciente com o serviço de saúde. Além disso, há a falta de informação e as representações negativas sobre o tratamento (PERNAMBUCO, 2016;SILVA, 2018;TRAJMAN;SARACENI;DUROVNI, 2018).…”