MEASUREMENT AND ANALYSIS TO APPROACH INEQUALITIES AND BUILD ACCOUNTABILITY ON HEALTH POLICIES IN BRAZIL
Resumo
Health inequalities have been broadly documented especially by the Commission on Social Determinants of Health. To reducetheir impact on health outcomes, policy encompassed intersectoral approach should be taken into consideration. This paper draws on the recommendations of the Rio Political Declaration on Social Determinants of Health (2011) specifically on monitoring inequalities and accountability, which is one of the themes of the conference. The paper is divided into four sections: brief history of the social determinants, measuring and monitoring inequalities and accountability to reduce health inequalities. Finally, obesity is taken as an example to clarify how to use monitoring and accountability to design strategies and inform policies.
It concludes by emphasizing the need for adequate information in terms of equity to monitor health inequalities. There is a
lack of indicators on the impact of different policies on social determinants of health. This requires a high degree of political
commitment from all sectors of society, as well as to strengthen citizen participation to enhance accountability and promote
health equity nationally and globally.
Referências
Whitehead M. The concepts and principles of equity and
health. Regional Office for Europe Copenhagen: World Health
Organization; 1990.
World Health Organization - WHO. A conceptual framework
for action on the social determinants of health. Geneva:
Baum F. Cracking the nut of health equity: top down and
bottom up pressure for action on the social determinants of
health. Promotion & education 2007;XIV(2):90-5.
Shaw M, Dorling D, Smith G. Poverty, social exclusion and
minorities. Second ed. Oxford/UK: Oxford University; 1999.
Renaud M. The future: Hygeia versus Panakeia. In: Evans
R, Morris L, Marmor T, editors. Why are Some People Healthy
and Others Not? The Determinants of Health of Populations.
New York: Aldine de Gruyter; 1994. p. 317-34.
World Health Organization. World Health Report 2004:
Changing History. Geneva; 2004.
Evans R MLMT. Why are Some People Healthy and Others
Not? The Determinants of Health of Populations. New York:
Marmot M, Wilkinson R. Social Determinants of Health: the
solid facts. 2 ed. Copenhagen/Denmark: WHO; 2003.
Marmot M, Wilkinson R. Social determinants of Health.
Oxford-UK: Oxford University; 1999.
Waitzkin H. The social origins of illness: a neglected
history. International Journal of Health Services
;11(1):77-103.
Declaration of Alma-Ata. 1978 Sep 6; 1978.
The Ottawa Charter for Health Promotion. 1986 Nov 21;
Millennium Development Goals . http://www who int/
topics/millennium_development_goals/en/ 2012 [cited 2012
Aug 1];
Buss P, Pellegrine Filho A. A saúde e seus determinantes
sociais. Physis: Revista de Saúde Coletiva 2007;17:77-93.
World Health Organization - WHO. World conference
on social determinants of health: Meeting report. Rio de
Janeiro, Brazil 19-21 October 2011.
Labonté R, Shrecker T. Globalization and social
determinants of health: Introduction and methodological
background (part 1 of 3). Globalization and Health 2007;3(5).
Goel V. Why Are Some People Healthy and Others
Not? The Determinants of Health of Populations. CMAJ
;152(12):2004-5.
Link B, Phelan J. Understanding Sociodemographic
Differences in Health-The Role of Fundamental Social Causes.
American Journal of Public Health 1996;86(4):471-3.
Canadian International Development Agency. A synthesis
of Canada’s corporation strategy in Brazil 2005-2010.
Avaliable at: http://www acdi-cida gc ca/acdi-cida/ACDICIDA
nsf/eng/NIC-22312535-N32 Accessed on July 10, 2010
Houweling T, Kunst A, Huisman M, Mackenbach J.
Using relative and absolute measures for monitoring health
inequalities: experiences from cross-national analyses on
maternal and child health. International Journal for Equity
in Health 2007;6(1):15.
Duarte EC, Schneider MC, Paes-Sousa R, Ramalho WM,
Sardinha LMV, Da Silva Junior JBS, et al. Epidemiologia das
desigualdades em saude no Brasil: Um estudo exploratorio.
Brasilia Organizacao Panamericana de Saude 2002.
Comissão Nacional dos Determinantes Sociais da Saúde
(CNDSS). As causas sociais das iniquidades em saúde no
Brasil. Brasília-DF/Brasil; 2008.
Lindoso JAL, Lindoso AAPB. Neglected Tropical Disease
in Brazil. Rev Inst Med Trop S Paulo 2009;51(5):247-53.
Galal O, Quereshi A. Dispersion index: measuring trend
assessment of geographical inequality in health- The
example of under-five ortality in the Middle East North
African region, 1980-1994. Social Science and Medicine
;44(12):1893-902.
Carr-Hill R, Chalmers-Dixon P. A review of methods for
monitoring and measuring social inequality, deprivation,
and health inequality. Available at: http://www ihs ox ac
uk/sephp/publications/carrhill 2002.
Braveman P. Health Disparities and Health Equity:
Concepts and Measurement. Annual Review of Public Health
Apr 1;27(1):167-94.
Scalan J. Can we actually measure health disparities?
American Statistical Association 2006;19(2):47-52.
Veras M, Zakus D. Equity aspects of Canadian immunization
program: differences within and between countries. Health,
Culture and Society 2011;1(1):112-31.
Braveman P. Monitoring equity in health: a policyoriented
approach in low- and middle-income countries.
WHO/CHS/HSS/981 - Equity Initiative Paper 1998;(3).
Signal L. Tacking inequalities through health promotion
action. Health promotion forum of New Zeland: Newsletter
:10. 2002.
Magalhaes R. Monitoramento das desigualdades sociais
em saude: significados e pontencialidades das fontes de
informacao. Ciencia e Saude Coletiva 2007;12(3):667-73.
Wirth M, Delamonica E, Sacks E, Balk D, Storeygard
A, Minujin A. Monitoring Health Equity in the MDGs: A
Practical Guide. Avaliable at http://www.ciesin.columbia.
edu/repository/povmap/analysis/Health_equity_Guidelines.
pdf. 2006.
Marmot MFS, Bell R, Houweling TA, Taylor S. Closing the
gap in a generation: health equity through action on the social
determinants of health. The Lancet 2008;372(9650):1661-9.
Brinkerhoff D. Accountability and health systems:
overview, framework and strategies. Bethesda, MD: The
partners for health reformplus project, Abt Associates Inc;
Harber B, Ball T. From the blame game to accountability
in health care. Available at: http://www irpp org/po/
archive/nov03/harber pdf Acessed on August 04 2012.
Braga C. Enfermagem transcultural e as crencas, valores
e praticas do povo cigano. Revista da Escola de Enfermagem
;31(3):498-516.
Pereira C. A Política Pública como Caixa de Pandora:
Organização de Interesses, Processo Decisório e Efeitos
Perversos na Reforma Sanitária Brasileira - 1985-1989. Dados
;39.
Wensing M. Evidence-based empowerment. Qual Health
Care 2000;9:200-1.
ALMEIDA VL. Saude e cidadania: a experiencia de Icapui-
CE. Fortaleza. Fundacao Cearense de pesquisa e Cultura 1999.
VERAS MMS. A satisfacao dos usuarios dos SUS com o
servico de ouvidoria em saude de Fortaleza-CE. Dissertacao
de mestrado. 2005. Available at: http://www repositorio
ufc br:8080/ri/bitstream/123456789/1339/1/2005_dis_
mmsveras pdf Accessed on August 21 2011.
IMBROISI DO. Ouvidoria como instrumento de eficiencia e
eficacia da administracao publica. In: Encontro Nacional de
ouvidores/ombudsman, 2002. Recife-PE, Brazil. Available at:
http://www abonacional org br/min_fazenda htm Accessed
on September 24 2011.
World Health Organization (WHO). 10 facts on obesity.
Available at: http://www who int/features/factfiles/obesity/
en/ Acessed on: August 05 2012.
Bambra C, Hillier F, Moore H, Summerbell C. Tackling
inequalities in obesity: a protocol for a systematic review of
the effectiveness of public health interventions at reducing
socioeconomic inequalities in obesity amongst children.
Systematic Reviews 2012;1(1):16.
Nahal S, Lucas-Leclin V, King J. Globesity- the global
fight against obesity. Equity/Global/ESG & Sustainability
;1-141.
Swinburn BA. Obesity prevention: the role of policies,
laws and regulations. Australia and New Zealand Health
Policy 2008;5(12):1-7.
Milio N. Nutrition and health: patterns and policy
perspectives in food-rich countries. Soc Sci Med
;29(3):413-23.
Bell AC SB. School canteens: using ripples to create a
wave of healthy eating. MJA 2005;183(1):5-6.
Swinburn B, Egger G, Raza F. Dissecting obesogenic
environments: the development and application of a framework
for identifying and prioritizing environmental intervention
for obesity. Preventive Medicine 1999;29(6):563-70.
Whitehead M. A typology of actions to tackle
social inequalities health. J Epidemiol Community Health
;61:473-8.
Panigassi G, Segall-Correa AM, Marin-Leon L, Sampaio
MFA, Maranha LK. Inseguranca alimentar como indicador de
inquidade: analise de inquerito populacional. Cadernos de
Saude Publica 2008;24(10):2376-84.
Franklin B, Jones A, Love D, Puckett S, Macklin J,
White-Means S. Exploring mediators of food insecurity and
obesity: a review of recent literature. Journal Community
Health 2012;37(1):253-64.
