social determinants of health in brazil alberto pellegrini filho center for studies, policies and...
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Social Determinants of Health in Brazil
Alberto Pellegrini FilhoCenter for Studies, Policies and Information in
Social Determinants of Health ENSP/FIOCRUZ
(CEPI-DSS)
• Brazilian Commission on SDH
• Center for Studies, Policies and Information on SDH (CEPI-DSS/ENSP/FIOCRUZ)
• Post BNCSDH Initiatives
Brazilian Commission on SDH
1978
1993
2000
1982
SDH in WHO Constitution (1948)
Social dimension lost relevance in the era of campaigns (1950s).
SDH reappear in the health for All agenda (1978)
1990s: health as a private good
2000s: new opportunities for action on SDH
SDH in the global agenda (Tim Evans modified)
1948
WHO Commission
on SDH
World Conference on SDH
WHO
PHC-U
PHC-S
Health Reforms M
DG
CSDH
WCSDH
2005
2011
Process of creation of BNCSDH• Commission was created in March, 2006 with
sixteen personalities of social, economic, cultural and scientific life
• This diversity is an expression of the
recognition that health is a public good, constructed with the participation of all segments of the society
Composition of BNCSDH• Adib Jatene• Aloísio Teixeira• César Victora• Dalmo Dallari• Eduardo E. G. Vieira• Elza Berquó• Jaguar• Jairnilson Paim
• Lucélia Santos• Moacyr Scliar• Roberto Smeraldi• Rubem C. Fernandes• Sandra de Sá• Sônia Fleury• Zilda Arns• Paulo Buss (coord.)• A. Pellegrini (tech.
secretary)
Population Economically Active accordingly to economic sectorsBrazil – 1940 to 2000
Source: Instituto Brasileiro de Geografia e Estatística (IBGE).
61
55
46
31
25
1922
29
20 212022
32
40
55
60
67
171713
27
0
10
20
30
40
50
60
70
80
1940 1950 1960 1970 1980 1996 2000
Anos
%
Primário Secundário Terciário
Distribution of population (%) - Brazil – 1940 a 2000 Source: Instituto Brasileiro de Geografia e Estatística (IBGE).
3136
45
56
68
7681
6964
55
44
32
2419
0
10
20
30
40
50
60
70
80
90
100
1940 1950 1960 1970 1980 1991 2000
Anos
%
Urbana Rural
Fertility rate – Brazil – 1940 a 2000 Source: Census (1940-2000). IBGE
Fertility rates according to socio-demographic characteristics 1996 - 2006.
2,5 2,3
3,5
5,0
3,6
3,0
2,4
1,71,51,8 1,8 2,0
4,2
2,8 2,8
2,11,6
1,0
0
2
4
6
Total urban rural none 1 to 3 4 5 to 8 9 to 11 12 or more
1996
2006
Brazil Residence Years of Schooling
Tot
al F
erti
lty
Rat
e
Life expectancy - Brazil and Regions – 1960-2006Source: IBGE e Simões
41,0
72,4 71,369,4
73,8 74,4 73,5
51,6 53,4
57,2 60,3 56,7
66,0 66,0
59,6
71,0 71,071,5
0
10
20
30
40
50
60
70
80
Brasil Norte Nordeste Sudeste Sul Centro- Oeste
Evo
luçã
o d
a e
sp
era
nça
de
vid
a a
o n
asce
r
1960 1990 2006
BNCSDH recommendations• To establish an ‘ SDH Observatory’ for monitoring health
inequities and evaluation of policies and interventions on SDH; • To develop training courses on SDH approach for managers,
health professionals and other social workers; • To develop studies and research projects on SDH;
• To develop communication strategies about SDH to diverse social sectors
• To create a mechanism in the Presidential Cabinet to coordinate intersectorial SDH actions (MoH acting as technical secretariat)
• To create a high level Office in the Ministry of Health to promote SDH actions
Center for Studies, Policies and Information on SDH
(CEPI-DSS/ENSP/FIOCRUZ)
Center for Studies, Policies and Information on SDH (CEPI-DSS)
General Objective
To support activities developed by government and civil society for the promotion of health equity through the production and dissemination of knowledge and information, training of personnel and evaluation of policies and programs on SDH
Center for Studies, Policies and Information on SDH (CEPI-DSS)
• Observatory on Health Inequities: monitoring health inequities, follow-up and evaluation of interventions on SDH
• Training activities for managers in the diverse spheres of public administration;
• Studies and Research on SDH;• Promotion and participation on collaborative networks
of researchers and managers; • Information and communication about SDH to
government, professionals and general public: Portal SDH (www.dssbr.org) and VHL SDH (http://bvsdss.icict.fiocruz.br)
Mortality by diabetes mellitus in people with 15 years or older according to years of schooling
Women between 50 and 69 years old that never did mamography according to years of schooling
Mortality by homicide in people with 15 years or older according to years of schooling
Mortality by homicide in people with 15 years or older according to years of schooling
Distribution of people (15 years or older) according to region and years of schooling
Northeast Southeast
Child Mortality (less than 5 years) and illiteracy in Brazilian municipalities
source: Celso Simões
Northeast South
Special Issue on SDH of REPORTS IN PUBLIC HEALTH
Portal on SDHwww.dssbr.org
• Observatory: Indicators and analysis• News of interest on SDH• Summaries and analysis of articles on SDH• Basic and reference documents • Opinions• Interviews• Bank of Experiences• Blog; Twitter; Selected Links
Post BNCSDH Initiatives
Participation in Global and Regional Initiatives
• Global: WCSDH, Rio +20, SDG and post-2015 development agenda
• Region of Americas: OPS, UNASUR and MERCOSUR
Rio Declaration
1. Governance to tackle the root causes of health inequities:implementing action on social determinants of health;2. Promoting participation: community leadership for actionon social determinants;3. The role of the health sector, including public healthprograms, in reducing health inequities;4. Global action on social determinants: aligning priorities and stakeholders;5. Monitoring progress: measurement and analysis to informpolicies and build accountability on social determinants.
National Initiatives: Definition of strategies to implement WCSDH recommendations
Regional Conferences on SDH
Objectives• To perform regional health situation analysis with
SDH approach• To review on going policies and programs on
SDH in the Region• To discuss implementation of WCSDH
recommendations in the regional context• To make recommendations for actions in the
Region with respective follow-up and evaluation mechanisms
Participants
• Representatives of different sectors of the three spheres of government;
• Representatives of civil society active in the Region;
• Regional and national specialists;
• Regional Institutions of education, research and administration;
• CONASS, CONASEMS, ABRASCO.
Activities
• Definition of regional institution: Aggeu Magalhães Institute/FIOCRUZ for the first Conference in Northeast
• Publication of documents, news, opinions, interviews, experiences and other source of information about the Region in www.dssbr.org;
• Elaboration of working documents:- description and analysis of regional health situation with SDH approach;- on going policies and programs including recommendations to overcome identified problems;
• Regional Conference with 400 invited participants and Web broadcasting
Regional Conference on SDH Northeast, september 2013:
Why Northeast?• Region with the biggest social and health inequities
in the country
• Presence o research centers to analyze different aspects of regional situation
• Important economic, political and social changes with impact on SDH
• Good representation of government, civil society and academic leadership
• FIOCRUZ NE
Regional Conference on SDHNortheast
• Plenary Sessions: “Northeast: recent development, challenges ahead”, “SDH and Health situation in NE” and “Polices and Programs in NE related to SDH”;
• Parallel sessions: “Water and Sanitation”, “Big projects and their impact in Health”, “Access and quality of health services”, “Violence and drugs” and “Food and nutrition security”.
Thank you!
Alberto Pellegrini FilhoDirectorCenter for Studies, Policies and Information on SDH (CEPI-DSS) National School of Public Health/FIOCRUZ.phone: 55-21-2598-2894e-mail: [email protected]: dssbr.org and bvsdss.icict.fiocruz.br
Modes of Production of Knowledge (Gibbons)
“Traditional”(Mode 1)
Socially distributed(Mode 2)
“Locus” of production of knowledge
Institutions with walls, mainly universities and research institutions
Collaborative networks of institutions
Research agenda
Agendas defined by researchers according to development of their disciplines
Agendas defined in contexts of application
Types of research
Basic (to know to understand) vs. Applied (to know to utilize)
Problem solving
Approach Disciplinary
Transdisciplinary
Modes of Production of Knowledge (Gibbons)
Relationship between producers and users of knowledge
Unidirectional and “a posteriori” transfer of knowledge
Continuing exchange of knowledge
Criteria for evaluation
Scientific Merit
Scientific merit and social relevance
Means of dissemination of results
Scientific Journal
Several media
Financing Public resources Diversity of public and private sources
Management of scientific activity
Centralized planning Creation of spaces/opportunities for interaction
Disminución de la desigualdad em A. Latina por país 2000-2010 (% de cambio anual del Gini)
Fuente: Nora Lustig, Luis F. Lopez-Calva e Eduardo Ortiz-Juarez
Coeficiente de Gini en Argentina, Brasil y Mexico 1992-2010Fuente: Nora Lustig, Luis F. Lopez-Calva e Eduardo Ortiz-Juarez
Technical cooperation on capacity building to implement Rio Declaration
Institutional Development
Methodologies/Technologies
Human Resources development
Governance
Social participation
Health sector
Global action
Monitoring
Causes of Infant MortalitySource: César Victora, CNDSS
Cause Ano North NE SE South CO Brazil
Perinatal 1985-872003-05
42.1 61.2
42.962.2
48.961.0
46.458.7
48.757.2
46.560.9
Malformations 1985-872003-05
4.912.7
3.611.4
8.118.3
11.421.5
8.620.0
7.115.7
Respiratory Infections
1985-872003-05
11.5 8.2
11.4 6.9
15.7 6.6
14.2 5.9
12.9 6.8
13.9 6.9
Diarrhea 1985-872003-05
30.1 5.1
27.0 7.1
11.8 1.8
12.5 1.9
12.9 3.1
17.3 4.2
Other infections 1985-872003-05
5.35.2
6.14.2
5.34.2
6.03.1
7.13.8
5.74.2
Other causes 1985-872003-05
6.17.6
9.08.2
10.2 8.1
9.58.9
9.89.1
9.58.1
Ill-defined Causes
1985-872003-05
23.911.0
45.59.7
6.03.9
11.0 4.3
11.6 2.7
23.0 6.9
Participation of Ministries in selected actions – 2004-2006
2,3 4,7 1,27,0
22,1
2,311,65,8
8,1
4,7
11,6
4,73,5
5,8 3,51,2
MAPA
MCID
MCID
MDA
MDS
ME
MEC
MI
MJ
MMA
MS
MTRE
PR
PR/SEDH
PR/SEPM
PR/SEPPIR
Participation in selected actions by theme – 2007
9,3
18,6
9,3
16,33,5
18,6
24,4
Agricultura
Ambiente/Habitação
Prev. e Combate a Violência e Prom. Direitos
Trabalho e Inclusão Produtiva
Alimentação
Educação, Esporte e Cultura
Proteção Social para Grupos Vulneráveis
Total values executed by theme - 2006
US$ (1.000) %
Agriculture 78,289 0,86
Nutrition 770,950 8,47
Environment/
Housing
87,377 0,96
Education, Sport and culture
42,865 0,47
Prevention of Violence
29,977 0,33
Socail Protection 8,081,656 88,75
Employment and productive inclusion
15,367 0,17
Total 9,106,481 100
Women with 25 years or older that never did screening for cervix cancer according to years of
schooling
% of live newborns in hospital births according to years of schooling
% of live newborns in hospital births according to years of schooling
% of live newborns with 7 or more pre-natal visits according to mother’s years of schooling
% of live newborns with 7 or more pre-natal visits according to mother’s years of schooling