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      Transição da saúde e da doença no Brasil e nas Unidades Federadas durante os 30 anos do Sistema Único de Saúde Translated title: Changes in health and disease in Brazil and its States in the 30 years since the Unified Healthcare System (SUS) was created

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          Abstract

          Resumo O Sistema Único de Saúde (SUS) foi criado para garantir cuidados de saúde universais, gratuitos e abrangentes para a população. O estudo atual visa comparar indicadores de saúde em 1990 e 2015, para Brasil e Unidades Federadas, contribuindo assim na compreensão do papel do SUS na mudança do perfil sanitário do país. Nas análises foram utilizadas estimativas do estudo Carga Global de Doença (GBD) para o Brasil e estados, comparando 1990 e 2015. Como principais resultados ocorreu queda acentuada da mortalidade por doenças transmissíveis, da morbimortalidade materno-infantil e causas evitáveis de morte, e o consequente aumento da expectativa de vida saudável da população. As Doenças Crônicas Não Transmissíveis (DCNT) lideram como principal causa de morte, seguidas das violências. A dieta inadequada lidera entre os fatores de risco, seguida de fatores metabólicos; também ocorreu queda do consumo do tabaco, enquanto o maior destaque foi a expressiva redução da desnutrição infantil no período. Conclui-se que no curso dos trinta anos da implantação do Sistema Único de Saúde (SUS) houve melhorias nos indicadores de saúde e um significativo avanço na redução das desigualdades em saúde entre as regiões brasileiras.

          Translated abstract

          Abstract The Unified Healthcare System (SUS) was created to ensure the population’s right to universal, free and comprehensive healthcare. This study compares the health indicators measured in 1990 to those measured in 2015 in Brazil and its states. The goal is to contribute to understanding the role SUS played in changing the nation’s health profile. Analyses use estimates in the Global Burden of Disease (GBD) study for Brazil and its states, and compares 1990 and 2015. The main results are increased life expectancy, as well as an increase in the population’s longevity measured in health-adjusted life expectancy. These in turn are due to a sharp decline in mortality due to transmissible diseases, in maternal and infant morbi-mortality, and avoidable causes of death. NTCDs are the leading cause of death, followed by violence. Poor diet is the leading risk factor, followed by metabolic issues. Tobacco use decreased over the period, as did infant malnutrition. In the thirty years since the SUS was created, health indicators in this country have improved, and major progress has been made to reduce inequality across the country’s regions.

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          Health conditions and health-policy innovations in Brazil: the way forward.

          Brazil is a large complex country that is undergoing rapid economic, social, and environmental change. In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Going to scale with community-based primary care: an analysis of the family health program and infant mortality in Brazil, 1999-2004.

            This article assesses the effects of an integrated community-based primary care program (Brazil's Family Health Program, known as the PSF) on microregional variations in infant mortality (IMR), neonatal mortality, and post-neonatal mortality rates from 1999 to 2004. The study utilized a pooled cross-sectional ecological analysis using panel data from Brazilian microregions, and controlled for measures of physicians and hospital beds per 1000 population, Hepatitis B coverage, the proportion of women without prenatal care and with no formal education, low birth weight births, population size, and poverty rates. The data covered all the 557 Brazilian microregions over a 6-year period (1999-2004). Results show that IMR declined about 13 percent from 1999 to 2004, while Family Health Program coverage increased from an average of about 14 to nearly 60 percent. Controlling for other health determinants, a 10 percent increase in Family Health Program coverage was associated with a 0.45 percent decrease in IMR, a 0.6 percent decline in post-neonatal mortality, and a 1 percent decline in diarrhea mortality (p<0.05). PSF program coverage was not associated with neonatal mortality rates. Lessons learned from the Brazilian experience may be helpful as other countries consider adopting community-based primary care approaches.
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              O Programa de Saúde da Família e a construção de um novo modelo para a atenção básica no Brasil

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                June 2018
                : 23
                : 6
                : 1737-1750
                Affiliations
                [2] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais orgdiv1Escola de Enfermagem Brazil
                [1] Rio de Janeiro Rio de Janeiro orgnameUniversidade do Estado do Rio de Janeiro orgdiv1Instituto de Medicina Social Brazil fatima.marinho@ 123456saude.gov.br
                [4] Salvador Bahia orgnameUniversidade Federal da Bahia orgdiv1Instituto de Saúde Coletiva Brazil
                [3] Belo Horizonte Minas Gerais orgnameUniversidade Federal de Minas Gerais orgdiv1Faculdade de Medicina Brazil
                Article
                S1413-81232018000601737
                10.1590/1413-81232018236.04822018
                29972483
                b52af526-62bc-461e-badf-d4ae9cf80033

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 12 January 2018
                : 27 February 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 45, Pages: 14
                Product

                SciELO Brazil


                Unified Healthcare System,Healthcare policies,Child mortality,Non-Transmissible,Chronic Diseases (NTCDs),Violence,Politicas de saúde,Mortalidade infantil,Sistema Único de Saúde,Doenças crônicas não transmissíveis,Violências

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