Health in Brazil
Healthcare in Brazil is a Constitutional right. It is provided by both private and government institutions. The Health Minister administers national health policy. Primary health care remains the responsibility of the federal government, elements of which (such as the operation of hospitals) are overseen by individual states. Public health care is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Health Care System, known as Unified Health System - SUS. The SUS is universal and free for everyone.
- 1 Health
- 2 Life expectancy
- 3 Infant mortality
- 4 Health care system
- 5 Emergency medicine
- 6 See also
- 7 External links
- 8 References
- Childhood mortality: about 2.51% of childhood mortality, reaching 3.77% in the northeast region.
- Motherhood mortality: about 73.1 deaths per 100,000 born children in 2002.
- Mortality by non-transmissible illness: 151.7 deaths per 100,000 inhabitants caused by heart and circulatory diseases, along with 72.7 deaths per 100,000 inhabitants caused by cancer.
- Mortality caused by external causes (transportation, violence and suicide): 71.7 deaths per 100,000 inhabitants (14.9% of all deaths in the country), reaching 82.3 deaths in the southeast region.
The life expectancy of the Brazilian population increased from 69.66 years in 1998 to 74.6 years in 2012, according to the Brazilian Institute of Geography and Statistics (IBGE). The data indicate a significant progress compared with 45.50 years in 1940. According to the IBGE, Brazil will need some time to catch up with Japan, Hong Kong (China), Switzerland, Iceland, Australia, France and Italy, where the average life expectancy is already over 81. Research has shown that Brazil would achieve that level by 2040.
Demographic projections foresee the continuation of this process, estimating a life expectancy in Brazil around 77.4 years in 2030. The decline in mortality at young ages and the increase in longevity, combined with the decline of fecundity and the accentuated increase of degenerative chronic diseases, caused a rapid process of demographic and epidemiologic transition, imposing a new public health agenda in the face of the complexity of the new morbidity pattern.
Child health is a central issue on the public policy agenda of developing countries. Several policies geared to improving child health have been implemented over the years, with varying degrees of success. In Brazil, such policies have led to a significant decline in infant mortality rates over the last 30 years. Despite this improvement, however, mortality rates are still high by international standards and there is substantial variation across Brazilian municipalities, which suggests that differentiated policies should be devised. For example, mortality among indigenous infants in 2000 was more than triple that of the general population, highlighting the importance of tailored health policies to address disparities in health outcomes for Brazil's Indigenous Peoples. Sanitation, education and per capita income are the most important explanatory factors of poor child health in Brazil. Moreover, ethnographic findings of infant mortality rates (IMR) in northeast Brazil are not accurate because the government tends to overlook infant morality rates in rural areas. These issues tend to be inaccurate due to a huge amount of underreporting and causes us to question the cultural validity and the contextual soundness of these mortality statistics. There is a solution to this issue however and scientists stress that quality local-level cultural data can serve to craft as the alternative and appropriate method to measure infant death in Brazil accurately. In order to not overlook infant mortality rates it is also stressed that there needs to be a focus on an ethnography of experience, a vision that cuts to the core of human suffering as it flows from daily life and experiences. For example, one must get down to the flesh, blood and souls of infant death in the impoverished households of Brazilians in order to understand and live with those who have to suffer its tragic consequences. Methods of gathering mortality data also need to be respectful of local death customs and must be implemented in places where death is experienced through a different cultural lens.
UNICEF report shows a rising rate of survival for Brazilian children under the age of five. UNICEF says that out of a total of 195 countries analyzed, Brazil is among the 25 nations with the best improvement in survival rates for children under the age of 5. The report shows that Brazil's infant mortality rate for live births in 2012 was 14 per thousand. Mortality rates for children at one year of age was 18 per thousand, a reduction of 60%. The study went on to show that malnutrition among children of less than two years of age during the period between 2000 and 2008 fell by 77%. There was also a substantial drop in the number of school age children who were not in school, falling from 920,000 to 570,000 during the same period. Cristina Albuquerque, coordinator of the UNICEF Infant Survival and Development Program called the numbers "an enormous victory" for Brazil. She added that with regard to public policy aimed at reducing social disparities, Brazil's Bolsa Família program had become an international benchmark in combating poverty, reducing vulnerability and improving quality of life. "Brazil is going through a great moment, but much remains to be done. So, along with the celebrating it is a good time to reflect on the many challenges still to be overcome," Albuquerque declared.
Health care system
National health policies and plans: The national health policy is based on the Federal Constitution of 1988, which sets out the principles and directives for the delivery of health care in the country through the Unified Health System (SUS). Under the constitution, the activities of the federal government are to be based on multiyear plans approved by the national congress for four-year periods. The essential objectives for the health sector were improvement of the overall health situation, with emphasis on reduction of child mortality, and political-institutional reorganization of the sector, with a view to enhancing the operative capacity of the SUS. The plan for the next period (2000–2003) reinforces the previous objectives and prioritizes measures to ensure access at activities and services, improve care, and consolidate the decentralization of SUS management.
Health sector reform
The current legal provisions governing the operation of the health system, instituted in 1996, seek to shift responsibility for administration of the SUS to municipal governments, with technical and financial cooperation from the federal government and states. Another regionalization initiative is the creation of health consortia, which pools the resources of several neighboring municipalities. A vital instrument of support for regionalization is the project for strengthening and reorganizing the SUS.
Procedures for the registration, control, and labeling of foods are established under federal legislation, which assigns specific responsibilities to the health and agriculture sectors. In the health sector, health inspection activities have been decentralized to the state and municipal governments. The environmental policy derives from specific legislation and from the Constitution of 1988.
Public health care services
The main strategy for strengthening primary health care is the Family Health Program, introduced by the municipal health secretariats in collaboration with the states and the Ministry of Public Health. The federal government supplies technical support and transfers funding through Piso de Atenção Básica. Disease prevention and control activities follow guidelines established by technical experts in the Ministry of Public Health. The National Epidemiology Center (CENEPI), an agency of the National Health Foundation (FUNASA) coordinates the national epidemiological surveillance system, which provides information about and analysis of the national health situation.
Individual health care services
In 2014 there were 6,706 hospitals in Brazil. Over 50% of hospitals are found in 5 states: Sao Paulo, Minas Gerais, Bahia, Rio de Janeiro and Parana.
Throughout the country, 78% of hospitals practice general medicine while 16% are specialized and 6% provide outpatient care only. In 2012, 66% of the country's hospitals, 70% of its 485,000 hospital beds, and 87% of its 723 specialized hospitals belonged to the private sector. In the area of diagnostic support and therapy, 95% of the 7,318 establishments were also private. 73% of the 41,000 ambulatory care facilities were operated by the public.
The public hospital infrastructure required hospitals to be spread over a territory of 8.516 million square kilometres (3.288 million square miles). As such, the public hospital infrastructure relies on a vast network of small hospitals. Over 55% of public hospitals have less than 50 beds.
Hospital beds in the public sector were distributed as follows: surgery (21%), clinical medicine (30%), pediatrics (17%), obstetrics (14%), psychiatry (11%) and other areas (7%). In the same year, 43% of public hospital beds, and half the hospital admissions were in municipal establishments.
Since 1999, the Ministry of Public Health has been carrying out a health surveillance project in Amazonia that includes epidemiological and environmental health surveillance, indigenous health and disease control components. With US 600 million dollars from a World Bank loan, efforts are being made to improve the operational infrastructure, training of human resources and research studies. An estimated 25% of the population is covered by at least one form of health insurance; 75% of the insurance plans are offered by commercial operators and companies with self-managed plans.
Brazil is among the greatest consumers markets for drugs, accounting for 3.5% share of the world market. To expand the access of the population to drugs, incentives have been offered for marketing generic products, which cost an average of 40% less than brand-name products. In 2000, there were 14 industries authorized to produce generic drugs and about 200 registered generic drugs were being produced in 601 different forms. In 1998, the National Drug Policy was approved, whose purpose is to ensure safety, efficacy, and quality of drugs, as well as the promotion of rational use and access for the population to essential products. The responsibility for national production of immunobiologicals is entrusted to public laboratories; which have a long-standing tradition of producing vaccines and sera for use in official programs. The Ministry of Public Health invested some US$120 million in the development of the capacity of these laboratories. In 2000, the supply of products was sufficient to meet the need for heterologous sera, such as those used in the vaccines against tuberculosis, measles, diphtheria, tetanus, whooping cough, yellow fever, and rabies. In 1999, quality control of the transfused blood consisted of 26 coordinating centers and by 44 regional centers.
In 1999, the country had some 237,000 physicians, 145,000 dentists, 77,000 nurses, 26,000 dietitians and 56,000 veterinarians. The national average ratio was of 14 physicians per 10,000 population. In 1999, of the 665,000 professional positions, 65% were occupied by physicians, followed by nurses (11%), dentists (8%), pharmacists, biochemists (3.2%), physical therapists (2.8%) and by other professionals (10%). An estimated 1.4 million health sector jobs are occupied by technical and auxiliary personnel.
In 2009, for the first time, more new medical licenses were given for women than for men.
As of 2010, the country had 364,757 physicians. In 2011, there were 1.95 physicians for each 1000 Brazilians, with higher concentrations in south, southeast and mid-western than in north and northeastern Brazil. For each 1000 private health insurance users there were 7.6 occupied work posts for physicians, and for each 1000 Sistema Único de Saúde users, there were 1.95 occupied work posts for physicians, making an average of 3.33 occupied work posts for physicians for each 1000 Brazilians. As to the distribution of physicians between medical specialties and primary care, 55.09% of all Brazilian physicians were specialists.
Health sector expenditure
In 1998 national health expenditure amounted to US$62,000 million, which corresponded to nearly 7.9% of GDP. Of that total, public spending accounted for 41.2% and private expenditure accounted for 58.8%. In per capita terms, public spending is estimated at US$158 and private expenditure at US$225.
Technical cooperation projects are carried out with different countries, as well as with the World Bank and UNESCO among many others. International foundations also provide direct financing for projects or individuals. Brazil is also engaged in an intense exchange with the Mercosul countries, aimed at establishing common health regulations.
Brazilian emergency medical service is locally called SAMU ("Serviço de Atendimento Móvel de Urgência (Mobile Emergency Attendance Service)"). Emergency medicine (EM) is not a new field in Brazil. In 2002, the Ministry of Health outlined a document, the "Portaria 2048," which called upon the entire health care system to improve emergency care in order to address the increasing number of victims of road traffic accidents and violence, as well as the overcrowding of emergency departments (EDs) resulting from an overwhelmed primary care infrastructure. The document delineates standards of care for staffing, equipment, medications and services appropriate for both pre-hospital and in-hospital. It further explicitly describes the areas of knowledge that an emergency provider should master in order to adequately provide care. However, these recommendations have no enforcement mechanism and, as a result, emergency services in Brazil still lack a consistent standard of care.
Pre-hospital emergency medical services use a combination of basic ambulances staffed by technicians and advanced units with physicians on board. No universal phone number exists for emergency calls, and the dispatch center physician determines whether the call merits an emergency transport or not. Pre-hospital physicians have variable training in emergency care, with training backgrounds ranging from internal medicine to obstetrics to surgery.
Similar to the early years of EM in the United States, emergency department physicians in Brazil come from different specialty backgrounds, many of them having taken the job as a form of supplementary income or as a result of unsuccessful private clinical practice. Since 50% of medical school graduates in Brazil do not get residency positions, these new physicians with minimal clinical training look for work in emergency departments. In larger tertiary hospitals, the ED is divided into the main specialty areas, internal medicine, surgery, psychiatry, pediatrics, and staffed by the corresponding physicians. Still, significant delays in care can occur when patients are inappropriately triaged or when communication between the areas is inadequate. In the non-tertiary care centers, which make up the majority of hospitals in the country, emergency department physicians are largely under-trained, underpaid and overstressed by their working conditions. This has compromised patient care and created an incredible need for improvement in the emergency care system.
A current plan in action in Brazil called the CATCH plan. (Commission for the Advancement of Technology for Communications and Health). Funding is provided by the WHO, ITU, and voluntary countries and benefactors for existing and future projects. This CATCH program approbates the best advancements to accommodate the nation of Brazil's health issues.
- Health Indicators of Brazil and the World
- Total fertility in Brazil - 2008
- Life expectancy in Brazil (2012) (English)
- Infant Mortality in Brazil (2012) (Portuguese)
- Smokers in Brazil (2011) (Portuguese)
- Ministério do Planejamento website, "Constituição Federal (Artigos 196 a 200)".
- Ministério do Planejamento website, "Saúde" (fact sheet, 2002). Retrieved 12 June 2007.
- "World Health Organization: Brazil: Malaria" (PDF).
- From the IBGE's Complete Mortality Tables for Brazil's population, which have been published annually since 1999. They are used by the Ministry of Social Security as one of the parameters for the retirement fund factor under the General System of Social Security.Life Expectancy in Brazil (2008)
- Demographic projections in Brazil
- Coelho, V; Shankland, A. (2011). "Making The Right To Health A Reality For Brazil’s Indigenous Peoples: Innovation, Decentralization And Equity". MEDICC Review 13 (3). Retrieved 24 May 2012.
- History - Infant Mortality - Brazil
- Nations, Marilyn K.; Mara Lucia Amaral (1991). "Flesh, Blood, Souls, and Households: Cultural Validity in Mortality". Medical Anthropology Quarterly 5 (4): 204–220. doi:10.1525/maq.1991.5.3.02a00020.
- Nations, Marilyn K.; Mara Lucia Amaral (1991). "Flesh, Blood, Souls, and Households: Cultural Validity in Mortality". Medical Anthropology Quarterly 5 (4): 204-220.
- Infant Mortality in Brazil (2009)
- Global Health Intelligence, "Global Health Intelligence". Retrieved 16 January 2015.
- Ministry of Health; Registry of healthcare facilities and their installations, "Ministry of Health; Registry of healthcare facilities and their installations". Retrieved 7 January 2014.
- Demografia médica no Brasil: Volume 1 (Medical demography in Brazil: volume 1) http://portal.cfm.org.br/images/stories/pdf/demografiamedicanobrasil.pdf (in Portuguese)
- About Health in Brazil
- Portal da saúde website, "SAMU". Retrieved 28 April 2009.
- Emergency medicine in Brazil