Harvard SP 2013 · 7/1/2014 5 A. Infant and child mortality 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 Infant Mortality Rate (o/oo) Child Mortality Rate (o/oo) Life Expectancy

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Health related MDGs in Brazil:policies and progress

Ricardo Paes de BarrosDiana Coutinho

Rosane Mendonça

São Paulo, January 2013

A. Infant and child mortality (MDG 4)

B. Malnutrition and food insecurity (MDG 1)

C. Reproductive and sexual health (MDG 5and 6)

Presentation Plan

A. Infant and childmortality

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A. Infant and child mortality

Infant mortality rate in Brazilian Municipalities: 1991

Source: HDI M Atlas

LEGENDA

Infant mortality rate in Brazilian Municipalities: 2010

LEGENDA

Source: HDI M Atlas



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LEGENDA

Child mortality (up to 5 years old) rate in BrazilianMunicipalities: 1991

Source: HDI M Atlas


Child mortality (up to 5 years old) rate in BrazilianMunicipalities: 2010

Source: HDI M Atlas

LEGENDA



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Life expectancy in Brazilian Municipalities: 1991

Source: HDI M Atlas

LEGENDA


Life expectancy in Brazilian Municipalities: 2010

Source: HDI M Atlas

LEGENDA



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0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

Infant Mortality Rate (o/oo) Child Mortality Rate (o/oo) Life Expectancy (years)

Evolution of Infant and Child Mortality and LifeExpectancy: Brazil 1991 and 2010

1991 2010

4th MDG

4th MDG

1/2 per year

1/3 per year

Inequality among socioeconomic groups alsodeclined at a fast pace

greater equality of opportunity


0

10

20

30

40

50

60

70

80

90

100

110

Socioeconomic conditions and sectorial publicprograms of two decades ago

Current socioeconomic conditions andsectorial public programs

Mortalid

adeprecoce

1992

=100

Decomposition of the drop in child mortality betweensectoral social programs and socio economic status

Drop inmortality rates

64%


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0,50

0,52

0,54

0,56

0,58

0,60

0,62

0,64

1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

GiniInd

ex

Evolution of income inequalityBrazil 1976 2001

Source: SAE/PR based on the PNADs from 1976 to 2011.


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0,50

0,52

0,54

0,56

0,58

0,60

0,62

0,64

1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

GiniInde

x

Evolution of income inequalityBrazil 1976 2011

Source: SAE/PR based on the PNADs from 1976 to 2011.


0,25

0,30

0,35

0,40

0,45

0,50

0,55

0,60

0,65

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012

Gin

i Ind

ex

Evolution of the degree of inequalityBrazil and China: 1981 2011

Source: Brazil, SAE/PR based on IPEA for 1976-2009 (averages for the years of 1980,1991,2000) and on the PNAD for 2011.

China

Brazil



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2000

2010



0

10

20

30

40

50

60

70

80

90

100

110

Socioeconomic conditions and sectorial publicprograms of two decades ago

Current socioeconomic conditions andsectorial public programs of two decades ago

Current socioeconomic conditions andsectorial public programs

Mortalid

adeprecoce

1992

=100

Decomposition of the drop in child mortality betweensectoral social programs and socio economic status

Change due to change insocioeconomic status

Change due tosocial program

30%

70%


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Health:34 thousand family health care teams �– ESF,55% of population covered,260 thousand community health agents �– PACS and21 thousand dental care teams �– ESD.

Social Assistance:8 thousand one stop shops for social protection �–CRAS,91% with Program of integrated family care �– PAIF,98% of the brazilian municipalities with at least oneone stop shop for social protection.

Education:2 million children attending 46 thousand childcare centers.More of 20% of the 0 3 population covered.

Supply of basic care services for early childhood


Innovative Local Early Childhood Programs


Child and Adolescent Rights Statute �– ECA.

Signing the UN document �“A World Fit for Children�”.

Strenghtening and expansion of the number of Child GuardianshipCouncils (Conselhos Tutelares)�– present in 98% of municipalities.

Strenghtening of the State and Municipal Councils for the Protectionof the Rights of Children �– present in 92% of municipalities.

Strenghtening of Childhood and Adolescense Development Funds(FIA).

National guidelines for the Integrated Care of Children and Familiessubjected to domestic violence.

Legislation and Institutional Advances


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Rede Cegonha (R$1,000 per year per newborn)

Método Canguru

Programa Nacional de Triagem Neonatal �– PNTN

Programa Nacional de Imunização �– PNI

Programa Saúde na Escola PSE

Programa Nacional DST e AIDS PN DST/AIDS (R$6,000 per yearper beneficiary)

Estratégia Saúde da Família PSF

Brasil Sorridente

Major Reproductive Health Federal Programs


B. Malnutrition

0 10 20 30 40 50 60 70 80 90 100

Cartão pré natal

Vacina anti tetânica

Consulta pós parto

Aleitamento exclusivo

Subnutrição: altura poridade

Subnutrição: peso por altura

Subnutrição: peso por idade

Situação ao final da década em relação à situção no início

Reduçãonas carências ao longo da última década:Saúdematerno infantil e subnutrição

Redução a 1/3em 25 anos

Redução a 1/2em 25 anos

Mais lento que orequerido pelas

ODM

Mais rápidooque orequerido pelas

ODM

Redução

Grau de carência remanescente

19972007

Malnu

trition

Basic

health

services

B. Malnutrition and food insecurity

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The degree of severe food insecurity in the country is alreadylow, and much lower than the degree of extreme poverty


Poverty in Brazil is a result of bad distribution, not of resourcescarcity (Josué de Castro)


Brazil's food production can feed the entire population withgreat ease (Josué de Castro)


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Brazil's food production can feed the entire population withgreat ease (Josué de Castro)


Gasto com alimentos como porcentagem do gasto total por centésimos da distribuição das pessoas segundo o consumo per

capita

0

5

10

15

20

25

30

35

40

0 10 20 30 40 50 60 70 80 90 100

Centésimos da distribuição

Porc

enta

gem

do

gast

o to

tal c

om a

limen

tos

(%)

Hundreths of the per capita consumption distribution

Shareof

food

spen

ding

intotalexpen

diture

(%)

What proportion of income Brazilian families dedicateto food purchase?

Share of food spending as a percentage of total expenditureby hundreths of the per capita consumption distribution


What proportion of Brazilian families do not have enough incometo meet their nutritional needs?

020406080

100120140160180200220240260280300320340360380400

0 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Rend

afamiliar

percapita

(R$/mês)

Percentil (%)

Distribuição das pessoas segundo a renda familiar percapita: Brasil, 2009

Toda renda gastacom alimentação

Parcela da renda gastacom alimentação igual

a do pobre

Renda gasta comalimentação igual ao

necessário

All income spenton food

Same share ofincome spent onfood as the poor

Income spent onfood equal to the

required

Percentile (%)

Percap

itafamily

income(R$/mon

th)

The distribution of people according to per capita family income:Brazil, 2009


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Over half of the malnourished children are not extremely poor

Porcentagem acumulada de crianças com peso em relação a idade por décimos da distribuição da renda:

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80 90 100Décimos da distribuição da renda per capita

porc

enta

gem

de

cria

nças

Hundredths of the per capita income distribution

Percen

tage

ofchild

ren(%

)

Cumulative percentage of children with inadequate weight/age ratioamong the poorest hundredths of the income distribution: Brazil, 2006


Extremepoor

Extreme poverty line

Over two thirds of the households with food insecurityare not extremely poor

Proporção de domicílios com segurança alimentar entre os décimos mais pobres da distribuição da renda per capita

0

10

20

30

40

50

60

70

80

90

100

0 10 20 30 40 50 60 70 80 90 100

Décimos da distribuição da renda per capita

Porc

enta

gem

de

dom

icíli

os (%

)

Fonte: Estimativas produzidas com base na Pesquisa Nacional por Amostra de Domicílios (PNAD) de 2004.

Hundredths of the per capita income distribution

Shareof

househ

olds

(%)

Cumulative percentage of households with food insecurity among thepoorest hundredths of the per capita income distribution: Brazil, 2004


Extremepoor

Extreme poverty line

Relação entre a proporção de crianças abaixo da altura recomendada e a porcentagem de pessoas em famílias com renda per capita abaixo da

linha de extrema pobreza

0

5

10

15

20

25

30

35

40

45

50

0 5 10 15 20 25 30 35 40 45 50

Porcentagem de pessoas em famílias extremamente pobres (%)

Porc

enta

gem

de

cria

nças

aba

ixo

da a

ltura

re

com

enda

da (%

)

Fonte: Estimativas produzidas com base no Human Development Report (2007-2008) PNUD.Universo: Países do mundo para os quais há dados disponíveis no HDR.

Brasil Observado

Brasil Predito

Percentage of people who belong to extreme poor families (%)

Percen

tage

ofchild

renwith

height

byagebe

lowthe

recomen

ded(%

)

PredictedBrazil

ObservedBrazil

Percentage of children below the recommended height by age byextreme poverty headcount

Countries with the same degree of extreme poverty as Braziltend to show higher degrees of malnutrition.

More effective solidarity networks?


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Programa Nacional de Suplementação de Vitamina A

Prevenção e Controle de Distúrbios de Deficiência de Iodo �–Pro Iodo

Iniciativa Hospital Amigo da Criança IHAC

Bancos de Leite Humano

Estratégia Amamenta e Alimenta Brasil

Programa do Leite

Major Nutritional Federal Programs


C. Reproductiveand Sexual Health

C. Reproductive and sexual health

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Treatment (drugs) R$ 770million

Prevention (drugs) R$ 96million

Control, prevention andmonitoring

R$ 395million

Total R$1,261million

HIV/AIDS and Other Sexually TransmittedDiseases: Brazilian Annual Budget


Early motherhood (15 to 17 yearls old) in BrazilianMunicipalities: 1991

LEGENDA

Source: HDI M Atlas

Early motherhood (15 to 17 yearls old) in BrazilianMunicipalities: 2010

LEGENDA

Source: HDI M Atlas


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Documents

Harvard SP 2013 · 7/1/2014 5 A. Infant and child mortality 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 Infant Mortality Rate (o/oo) Child Mortality Rate (o/oo) Life Expectancy