Health in Brazil

Health Indicators
Life expectancy female	77.3
Life expectancy male	69.7
Infant mortality	22.58
Fertility	1.76
Sanitation	77%
Smoker	16%
Obesity female	18.3%
Obesity male	8.7%
Malnutrition	6%
HIV	0.6%

The healthcare in Brazil is provided by both private and government institutions. The Minister for Health and Ageing 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 is free at the point of need (being paid for from general taxation). The country is home to a number of international health organizations, such as the Latin American and Caribbean Center on Health Sciences Information, and the Edumed Institute for Education in Medicine and Health.

Health

Surgery in Porto Alegre.

According to the Brazilian Government, the most serious health problems are:

• 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.

In 2002, Brazil accounted for 40% of malaria cases in the Americas. Nearly 99% are concentrated in the Legal Amazon Region, which is home to not more than 12% of the population.

Life expectancy

Senior citizens dancing in the city of Santos.

The life expectancy of the Brazilian population increased from 69.66 years in 1998 to 72.86 years in 2008, according to the Brazilian Institute of Geography and Statistics (IBGE) and Tuesday's Brazilian Official Gazette. Men's life expectancy was 69.11 years and women's was 76. 71 years last year. 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.

The data came 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.

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.

Infant mortality

A Brazilian mother and her children in Brasília.

Cândido Fontoura Children's Hospital in São Paulo.

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. The aim of this paper is to investigate the determinants of infant mortality at the municipal level, and to provide a more detailed analysis by considering the factors that affect child health at the individual level. To analyze the mortality rate, static and dynamic panel data models are estimated using four censuses covering the period 1970-2000. The demand for child health is addressed through a household decision model, estimated using anthropometric data from the 1996 Standard of Living Survey. The results indicate that sanitation, education and per capita income contributed to the decline in infant mortality in Brazil, the effects being stronger in the long run than in the short run. The fixed effects associated with municipality characteristics help explain the observed dispersion in child mortality rates. The results of the decision model are in line with the mortality model findings: education, sanitation and poverty are the most important explanatory factors of poor child health in Brazil.

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 2008 was 22 per thousand, a drop of 61% since 1990. 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

Sarah Kubitschek Hospital in Brasília.

Portuguese Hospital in Porto Alegre.

Memorial of Medicine in Recife.

Albert Einstein Hospital in São Paulo.

Hospital in Belo Horizonte.

Maternity in Natal.

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Institute of Cancer of São Paulo.

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. An important instrument of support for regionalization is the Project to Strengthening and Reorganization the SUS.

Regulatory actions

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 1998.

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 1999, 66% of the country's 7,806 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. 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.

Health supplies

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.

Human resources

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.

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

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.

Emergency medicine

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A Brazilian ambulance with a SAMU marking in the State of São Paulo.

SAMU Motorbike in the Brazilian Federal District.

Brazilian emergency medical service is locally called SAMU, an acronym for "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.

See also

• Sistema Único de Saúde
• HIV/AIDS in Brazil
• Education in Brazil
• Demography of Brazil

External links

• World Health Organization: Brazil