social determinants of health in brazil
DESCRIPTION
Social Determinants of Health in Brazil. Alberto Pellegrini Filho Center 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) - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/1.jpg)
Social Determinants of Health in Brazil
Alberto Pellegrini FilhoCenter for Studies, Policies and Information in
Social Determinants of Health ENSP/FIOCRUZ
(CEPI-DSS)
![Page 2: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/2.jpg)
• Brazilian Commission on SDH
• Center for Studies, Policies and Information on SDH (CEPI-DSS/ENSP/FIOCRUZ)
• Post BNCSDH Initiatives
![Page 3: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/3.jpg)
Brazilian Commission on SDH
![Page 4: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/4.jpg)
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
![Page 5: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/5.jpg)
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
![Page 6: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/6.jpg)
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)
![Page 7: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/7.jpg)
![Page 8: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/8.jpg)
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
![Page 9: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/9.jpg)
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
![Page 10: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/10.jpg)
Fertility rate – Brazil – 1940 a 2000 Source: Census (1940-2000). IBGE
![Page 11: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/11.jpg)
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
![Page 12: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/12.jpg)
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
![Page 13: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/13.jpg)
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
![Page 14: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/14.jpg)
Center for Studies, Policies and Information on SDH
(CEPI-DSS/ENSP/FIOCRUZ)
![Page 15: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/15.jpg)
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
![Page 16: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/16.jpg)
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)
![Page 17: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/17.jpg)
Mortality by diabetes mellitus in people with 15 years or older according to years of schooling
![Page 18: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/18.jpg)
Women between 50 and 69 years old that never did mamography according to years of schooling
![Page 19: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/19.jpg)
Mortality by homicide in people with 15 years or older according to years of schooling
![Page 20: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/20.jpg)
Mortality by homicide in people with 15 years or older according to years of schooling
![Page 21: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/21.jpg)
Distribution of people (15 years or older) according to region and years of schooling
Northeast Southeast
![Page 22: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/22.jpg)
Child Mortality (less than 5 years) and illiteracy in Brazilian municipalities
source: Celso Simões
Northeast South
![Page 23: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/23.jpg)
Special Issue on SDH of REPORTS IN PUBLIC HEALTH
![Page 24: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/24.jpg)
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
![Page 25: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/25.jpg)
![Page 26: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/26.jpg)
![Page 27: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/27.jpg)
Post BNCSDH Initiatives
![Page 28: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/28.jpg)
Participation in Global and Regional Initiatives
• Global: WCSDH, Rio +20, SDG and post-2015 development agenda
• Region of Americas: OPS, UNASUR and MERCOSUR
![Page 29: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/29.jpg)
![Page 30: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/30.jpg)
![Page 31: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/31.jpg)
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.
![Page 32: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/32.jpg)
National Initiatives: Definition of strategies to implement WCSDH recommendations
Regional Conferences on SDH
![Page 33: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/33.jpg)
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
![Page 34: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/34.jpg)
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.
![Page 35: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/35.jpg)
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
![Page 36: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/36.jpg)
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
![Page 37: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/37.jpg)
![Page 38: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/38.jpg)
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”.
![Page 39: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/39.jpg)
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
![Page 40: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/40.jpg)
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
![Page 41: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/41.jpg)
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
![Page 42: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/42.jpg)
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
![Page 43: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/43.jpg)
Coeficiente de Gini en Argentina, Brasil y Mexico 1992-2010Fuente: Nora Lustig, Luis F. Lopez-Calva e Eduardo Ortiz-Juarez
![Page 44: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/44.jpg)
Technical cooperation on capacity building to implement Rio Declaration
Institutional Development
Methodologies/Technologies
Human Resources development
Governance
Social participation
Health sector
Global action
Monitoring
![Page 45: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/45.jpg)
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
![Page 46: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/46.jpg)
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
![Page 47: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/47.jpg)
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
![Page 48: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/48.jpg)
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
![Page 49: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/49.jpg)
Women with 25 years or older that never did screening for cervix cancer according to years of
schooling
![Page 50: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/50.jpg)
% of live newborns in hospital births according to years of schooling
![Page 51: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/51.jpg)
% of live newborns in hospital births according to years of schooling
![Page 52: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/52.jpg)
% of live newborns with 7 or more pre-natal visits according to mother’s years of schooling
![Page 53: Social Determinants of Health in Brazil](https://reader036.vdocuments.us/reader036/viewer/2022062423/56814e35550346895dbb9c3a/html5/thumbnails/53.jpg)
% of live newborns with 7 or more pre-natal visits according to mother’s years of schooling