Social determination and health inequities in Brazil today

7/31/2019 Social determination and health inequities in Brazil today

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Socialdeterminationandhealthinequities

inBraziltoday


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1964-1985

Military dictatorship US dependent foreign policy External debt (economic

miracle)

Political repression National security ideology


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1986-2002

1988 Constitution

Hyperinflation Economic crisis External debt explosion Political freedom Neoliberal ideology


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2003-present

Reconstruction of the State Economic growth Environmental challenges Technological dependency Independent foreign policy Expanded social policies


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PARADOX:

More political participation Reduction of economic

inequality

Increasing social inequityin health


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Between 2006 and 2012, the middle-income social

segment (class C)* increased from 36% to 55%

mainly because of upward mobility from thelower-level classes . Today, this social segment

represents the majority of Brazilian population,

accounting for 104.5 million people.

* Social classification: class A/B: monthly income > R$ 7,500; class C: income > R$1,500;

class D: income > R$850; class E: income < R$850. Source: IPEA

Social mobility of the Brazilian population


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Evolution of Social Class Profile.

Brasil 1992-2009


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0,559

0,552

0,548

0,534

0,530

0,524


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0,5590,552

0,548

0,534

0,530

0,524

0,571

0,551

0,557

0,539

0,539

0,535

0,5

0,51

0,52

0,53

0,54

0,55

0,56

0,57

0,58

2004 2005 2006 2007 2008 2009

Brasil

Nordeste

EvolutionGiniCoef:icient.Brasil2004-2009


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Source: Brazil - IPEA; other countries - Central Intelligence Agency's WorldFactbook


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EvolutionGiniCoef:icient.Brasil1960-2009


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EvolutionoftheSocialPyramid

Brasil2003-2011


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Brasil health system structure


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FamilyHealthProgram(PSF) PrimaryHealthCare/healthpromotion CommunityHealthAgents(>200,000) multi-professionalhealthteams(>60,000)

SpecialPrograms

HIV/AIDS EpidemiologicalSurveillance PharmaceuticalCare

HighComplexityCareManagement

Pro-Sade(healthprofessionstrainingprogram)

SUS highlights


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complexdialectic


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socialinequity

Dynamics of SUS-induced inequity

failure of

integrality unequalaccess

unequal

quality

low

SocialValue

financialinstability

Complexregressivetax system

biased

educationofhealthworkforce


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HowtounderstandBrazils20-yearexperienceinbuildingauniversal-access,state-funded,sociallycontrolledHealthSystemfromwithin,andmostlyincontradictionto,thesocialcontextofinequalitywhichwelivein?


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Most approaches currently proposed

for analyzing health inequities

take for granted (or neglect)


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Neo-Durkheimian Model of Health Determinants

?


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SocialResources HealthCare

LifeConditions

MODELING HEALTH INEQUITIES


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SOCIAL INEQUALITIES >======> HEALTH INEQUITIES

Social

Resources

Health

Care

Life

Conditions

SocialHealth

Situation

MODELING HEALTH INEQUITIES

?


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MODELING HEALTH INEQUITY

SOCIAL INEQUALITY >>>>>>>>> HEALTH INEQUITY

Social

Resources

Health

Care

Life

Conditions

Health Practices

Socio-economic determination

Mode

of Life


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DISTRIBUTION

CONSUMPTIONSURPLUS

VALUE

LABOR

PROCESS

HEALTH

PRACTICES

SOCIAL

CONSTRUCTION

RISK CONFIGURATIONS

WORK

HEALTH-DISEASE-CARE

SIGNS &

MEANINGS

CULTURAL

CONTEXT

SOCIAL

PRODUCTION

SOCIAL

DETERMINATION

CLASSSTRUCTURE


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Jaime Breilh


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Gilles Bibeau Juan Samaja


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ObrigadoThank you

Documents

Social determination and health inequities in Brazil today