[Similarities and diferences between Academic and Professional Master Programs as Educational Public Policy in the field of Public Health]. / Similaridades e diferenças entre o Mestrado Acadêmico e o Mestrado Profissional enquanto política pública de formação no campo da Saúde Pública.

In the attempt to find a specificity for the Professional Master Program in Public Health (PM), we asked, what is, from the point of view of its means and purposes, kept or broke from the training models of the Academic (traditional) Masters Program (AM). In the public health field, this discussion possess an extra "flavor", as both program aim, in Brazil, to prepare health professionals to the Brazilian Unified Health System (SUS). Therefore, this research sought to investigate the heuristic and innovative vocation of the PM vis-à-vis the AM as an education public policy. From a comparative approach, we analyzed the main characteristics and differences among AM and PM, face the flexibilization process of graduate programs in Brazil, and discussed if these features would characterize the PM into an educational public policy. Data was analyzed by the Content Analysis method. We conclude that educational institutions tend to reproduce the AM training model in the PM and the expectation of making the health service matter and reason for training is not sufficient to distinguish both modes.

Ao buscar uma especificidade para o Mestrado Profissional (MP) em Saúde Pública, interrogamos, o que ele, ao se instituir, procurou do ponto de vista de seus meios e finalidades, conservar ou romper com os modelos de formação dos Mestrados Acadêmicos (MA). No campo da Saúde Pública, o tema ganha outros temperos se considerarmos que tanto o MP quanto o MA preservam na finalidade a formação para o Sistema Único de Saúde. Nesse sentido, a pesquisa buscou investigar a vocação heurística e inovadora do MP face ao MA como uma política pública de formação. Em uma perspectiva comparada, analisamos as principais características dos cursos de MP em saúde pública, frente ao processo de flexibilização da pós-graduação brasileira que o diferencia do MA, e discutimos se essas características tornam o MP uma política pública de formação. Na análise dos dados utilizamos o método da Análise de Conteúdo. Concluímos que as instituições de ensino tendem a reproduzir o modelo de formação do MA no MP e a expectativa de tornar o serviço de saúde matéria e motivo para a formação não é suficiente para distinguir ambas modalidades.

Similaridades e diferenças entre o Mestrado Acadêmico e o Mestrado Profissional enquanto política pública de formação no campo da Saúde Pública / Similarities and diferences between Academic and Professional Master Programs as Educational Public Policy in the field of Public Health

Resumo Ao buscar uma especificidade para o Mestrado Profissional (MP) em Saúde Pública, interrogamos, o que ele, ao se instituir, procurou do ponto de vista de seus meios e finalidades, conservar ou romper com os modelos de formação dos Mestrados Acadêmicos (MA). No campo da Saúde Pública, o tema ganha outros temperos se considerarmos que tanto o MP quanto o MA preservam na finalidade a formação para o Sistema Único de Saúde. Nesse sentido, a pesquisa buscou investigar a vocação heurística e inovadora do MP face ao MA como uma política pública de formação. Em uma perspectiva comparada, analisamos as principais características dos cursos de MP em saúde pública, frente ao processo de flexibilização da pós-graduação brasileira que o diferencia do MA, e discutimos se essas características tornam o MP uma política pública de formação. Na análise dos dados utilizamos o método da Análise de Conteúdo. Concluímos que as instituições de ensino tendem a reproduzir o modelo de formação do MA no MP e a expectativa de tornar o serviço de saúde matéria e motivo para a formação não é suficiente para distinguir ambas modalidades.

Abstract In the attempt to find a specificity for the Professional Master Program in Public Health (PM), we asked, what is, from the point of view of its means and purposes, kept or broke from the training models of the Academic (traditional) Masters Program (AM). In the public health field, this discussion possess an extra "flavor", as both program aim, in Brazil, to prepare health professionals to the Brazilian Unified Health System (SUS). Therefore, this research sought to investigate the heuristic and innovative vocation of the PM vis-à-vis the AM as an education public policy. From a comparative approach, we analyzed the main characteristics and differences among AM and PM, face the flexibilization process of graduate programs in Brazil, and discussed if these features would characterize the PM into an educational public policy. Data was analyzed by the Content Analysis method. We conclude that educational institutions tend to reproduce the AM training model in the PM and the expectation of making the health service matter and reason for training is not sufficient to distinguish both modes.

[The concept of vulnerability and its meanings for public policies in health and social welfare]. / O conceito de vulnerabilidade e seus sentidos para as políticas públicas de saúde e assistência social.

Are concepts of vulnerability capable of influencing social practices and citizenship in the fields of health and social welfare? The article critically assesses this question through a comprehensive-interpretative approach to hermeneutics-dialectics and a review of the literature produced on the theme in the last two decades. There is no vast theoretical output on the theme. However, although conceptually imprecise, the term "vulnerability" expands the understanding of the multiple factors that weaken subjects in the exercise of their citizenship. Professional action in the sphere of health and social welfare policies and the social imaginary are forged by the incorporation of concepts that can either reduce or reinforce vulnerabilities.

Conceitos de vulnerabilidade são capazes de influenciar práticas sociais e produção de cidadania nos campos da saúde e assistência social? Este artigo de reflexão crítica discute essa questão por meio da abordagem compreensiva-interpretativa da hermenêutica-dialética e pelo método de revisão da literatura produzida nas duas últimas décadas sobre o tema. Não há vasta produção teórica que contemple a temática. Contudo, mesmo conceitualmente impreciso, o termo vulnerabilidade amplia a compreensão dos múltiplos fatores que fragilizam os sujeitos no exercício de sua cidadania. As ações profissionais no âmbito das políticas de saúde e assistência social e o imaginário social são forjados pela incorporação de conceitos que podem tanto reduzir quanto reforçar vulnerabilidades.

¿Los conceptos de vulnerabilidad son capaces de influenciar prácticas sociales y producción de ciudadanía en los campos de la salud y asistencia social? Este artículo de reflexión crítica discute esta cuestión, mediante el enfoque comprensivo-interpretativo de la hermenéutica-dialéctica y el método de revisión de la literatura producida en las dos últimas décadas sobre el tema. No existe una vasta producción teórica que contemple la temática. No obstante, aunque sea conceptualmente impreciso, el término vulnerabilidad amplía la comprensión de los múltiples factores que debilitan a las personas en el ejercicio de su ciudadanía. Las acciones profesionales en el ámbito de las políticas de salud y asistencia social y el imaginario social se forjan por la incorporación de conceptos que pueden tanto reducir como reforzar vulnerabilidades.

The role of municipal public policies in oral health socioeconomic inequalities in Brazil: A multilevel study.

OBJECTIVES: It is known that fluoridation has a contextual effect on oral health socioeconomic inequalities, but broad public policies have not been investigated. Thus, the aim of this study was to determine the effects of municipal public policies on oral health across different social strata. METHODS: This was a cross-sectional study with 7328 12-year-old children and 5445 15-19-year-old adolescents from 177 Brazilian municipalities. Information at municipal level was collated for dental services, educational services, sanitation and water fluoridation. The main individual-level exposure was the disposable equivalent household income. The dichotomous outcomes were as follows: untreated dental caries (≥1 tooth), missing teeth (≥1 tooth) and filled teeth (≥1 tooth). Analyses were carried out using multilevel logistic regression. Interaction terms were tested between individual-level income and policy variables. RESULTS: The prevalence of untreated dental caries, missing and filled teeth was 47.0%, 15.1% and 47.5%, respectively. There was no significant interaction between income and policy indicators. Individuals living in municipalities with no water fluoridation had 1.42 (95% CI: 1.08-1.86) higher odds of having untreated dental caries; the odds ratio (OR) for those in municipalities with less education policies was 1.36 (95% CI: 1.07-1.73); those in municipalities with less sanitation had OR = 1.05 (95% CI: 0.78-1.40); and those in municipalities with less dental care had OR = 1.36 (95% CI: 1.02-1.80). CONCLUSIONS: Fluoridation and policies about sanitation, education and dental care were similarly associated with oral health in different social strata. Other policies on social and economic fields may be further explored.

O conceito de vulnerabilidade e seus sentidos para as políticas públicas de saúde e assistência social / The concept of vulnerability and its meanings for public policies in health and social welfare / El concepto de vulnerabilidad y su sentido para las políticas públicas de salud y asistencia social

Conceitos de vulnerabilidade são capazes de influenciar práticas sociais e produção de cidadania nos campos da saúde e assistência social? Este artigo de reflexão crítica discute essa questão por meio da abordagem compreensiva-interpretativa da hermenêutica-dialética e pelo método de revisão da literatura produzida nas duas últimas décadas sobre o tema. Não há vasta produção teórica que contemple a temática. Contudo, mesmo conceitualmente impreciso, o termo vulnerabilidade amplia a compreensão dos múltiplos fatores que fragilizam os sujeitos no exercício de sua cidadania. As ações profissionais no âmbito das políticas de saúde e assistência social e o imaginário social são forjados pela incorporação de conceitos que podem tanto reduzir quanto reforçar vulnerabilidades.

Are concepts of vulnerability capable of influencing social practices and citizenship in the fields of health and social welfare? The article critically assesses this question through a comprehensive-interpretative approach to hermeneutics-dialectics and a review of the literature produced on the theme in the last two decades. There is no vast theoretical output on the theme. However, although conceptually imprecise, the term "vulnerability" expands the understanding of the multiple factors that weaken subjects in the exercise of their citizenship. Professional action in the sphere of health and social welfare policies and the social imaginary are forged by the incorporation of concepts that can either reduce or reinforce vulnerabilities.

¿Los conceptos de vulnerabilidad son capaces de influenciar prácticas sociales y producción de ciudadanía en los campos de la salud y asistencia social? Este artículo de reflexión crítica discute esta cuestión, mediante el enfoque comprensivo-interpretativo de la hermenéutica-dialéctica y el método de revisión de la literatura producida en las dos últimas décadas sobre el tema. No existe una vasta producción teórica que contemple la temática. No obstante, aunque sea conceptualmente impreciso, el término vulnerabilidad amplía la comprensión de los múltiples factores que debilitan a las personas en el ejercicio de su ciudadanía. Las acciones profesionales en el ámbito de las políticas de salud y asistencia social y el imaginario social se forjan por la incorporación de conceptos que pueden tanto reducir como reforzar vulnerabilidades.

A produção das desigualdades: análise da relação entre trabalho infantil e indicadores sociais / The production of inequalities: analysis of the relationship between child labor and social indicators

A Organização Internacional do Trabalho (OIT) estima que haja cerca de 118 milhões de crianças em todo o mundo submetidas ao trabalho infantil. No Brasil, há 3,5 milhões de trabalhadores entre 5 e 17 anos. Esse exercício de exploração constitui um grave problema da sociedade, inclusive de Saúde Pública, já que esses trabalhadores estão expostos a uma gama de riscos, quais sejam à saúde, à integridade física e até à vida, podendo torná-los adultos doentes e/ou interrompendo precocemente suas vidas. Diante do exposto, esta pesquisa tem como objetivo investigar a relação entre a frequência de trabalho infantil na faixa etária de 10 a 13 anos e alguns indicadores socioeconômicos. Trata-se de uma pesquisa quantitativa em um desenho ecológico cujos níveis de análise são os municípios brasileiros agrupados em 161 regiões, definidas a partir de critérios socioeconômicos. A variável dependente deste estudo foi a prevalência de trabalho infantil na faixa etária de 10 a 13 anos. As variáveis independentes foram selecionadas após realizada uma correlação entre o Censo de 2010 do trabalho infantil na faixa etária de 10 a 13 anos e dados secundários, adotando duas variáveis independentes principais: recursos do Programa Bolsa Família (PBF) por 1000 habitantes e Recursos do Programa de Erradicação do Trabalho Infantil (PETI) por mil habitantes. Foi realizada inicialmente uma análise descritiva das variáveis do estudo, posteriormente, uma análise bivariada, e construída a matriz de correlação. Por fim, foi feita a análise de Regressão Liner Múltipla. Foram construídos dois modelos de Regressão. O primeiro modelo, no qual os recursos do PBF é a variavél independente principal, explica 57,8% de toda a variação do trabalho infantil e a equação final permite inferir que a cada 100 reais de recursos do PBF alocados produz uma diminuição de 1,4% na taxa de trabalho infantil na faixa etária de 10 a 13.

No segundo, no qual os recursos do PETI explicam 58,8% de todo o modelo, constatou-se que a cada R$ 100 reais investidos, a taxa de trabalho infantil diminui em 2,16%. Outras variáveis de ajuste mostraram significância, entre elas o IDH municipal, anos de Estudos aos 18 anos, analfabetismo em 15 anos ou mais, empregados sem carteira com 18 anos e o Índice de Gini. Compreende-se que a questão do trabalho infantil é complexa. O problema está associado, embora não esteja restrito à pobreza, à desigualdade e à exclusão social existentes no Brasil, mas há outros fatores de natureza cultural, econômica e de organização da produção, respondem também pelo seu agravamento. Para enfretamento do trabalho infantil necessita de uma ampla articulação intersetorial compartilhada e integrada com diversas políticas públicas entre elas saúde, esporte, cultura, agricultura, trabalho e direitos humanos, tendo, como horizonte, a garantia da integralidade dos direitos de crianças e adolescentes em situação de trabalho e de suas respectivas famílias. (AU)

The International Labor Organization (OIT) estimates that there are around 118 million children subjected to child labor around the world. In Brazil, there are 3.5 million workers aged between 5 and 17. This exploitation practice constitutes a serious social problem, including of Public Health, since these workers are exposed to a wide range of risks, such as those related to health, physical integrity and even to life, which may cause them to become sick adults and/or interrupt their lives prematurely. Therefore, this research aims to investigate the relationship between the frequency of child labor in the age group of 10 to 13 years and some socio-economic indicators. It is a quantitative research in an ecological study whose levels of analysis are the Brazilian municipalities grouped in 161 regions, defined from socioeconomic criteria. The dependent variable of this study was the prevalence of child labor in the age group of 10 to 13 years. The independent variables were selected after a correlation between the 2010 Census of child labor in the age group of 10 to 13 years and secondary data had been conducted, adopting two main independent variables: funds from the Family Allowance Program (PBF) per 1,000 inhabitants and Funds from the Child Labor Eradication Program (PETI) per a thousand inhabitants. Initially, it was conducted a descriptive analysis of the variables of the study, then, a bivariate analysis, and the correlation matrix was built. At last, the Multiple Linear Regression stratified analysis was performed. The results of this survey indicate that public policies , like the Bolsa Familia Program Features per 1000 inhabitants and Resources Program for the Eradication of Child Labour to be allocated to municipalities with HDI < 0.697 represent a decrease in the rate of child labor ; These programs have the resources to be invested in municipalities with HDI > = 0.697 have no effect on the rate of child labor.

Other adjustment variables showed significance, among these the municipal Human Development Index (IDH), years of schooling at 18 years of age, illiteracy at 15 years of age or more, employees without employment contract at 18 years of age and the Gini Index. It is understood that the child labor issue is complex. The problem is associated, although not restricted to, poverty, the social exclusion and inequality that exist in Brazil, but other factors of cultural and economic nature, as well as of organization of production, also account for its aggravation. Fighting child labor involves a wide intersectoral articulation, shared and integrated with several public policies, among them health, sports, culture, agriculture, labor and human rights, with a view to guaranteeing the integrality of the rights of children and adolescents in situation of labor and of their respective families. (AU)

Ideología política y justificación de la inequidad en dos muestras limeñas de sectores socioeconómicos opuestos / Political ideology and justification of the inequity in two samples of the city of lima from opposing socioeconomic sectors

Este estudio analiza y compara la relación entre la ideología política y la justificación de la inequidad en dos muestras de la ciudad de Lima que se encuentran en situaciones socioeconómicas diferentes: (a) un grupo con una situación económica bastante favorable y niveles educativos universitarios o de posgrado, que fue denominado socialmente favorecido y (b) un grupo en situación de pobreza y con estudios técnicos como máximo, que fue denominado socialmente desfavorecido. Los resultados muestran que el grupo socialmente desfavorecido presenta mayores puntuaciones en el Autoritarismo de ala derecha (RWA) y en algunas de las dimensiones de la justificación de la inequidad. Otro hallazgo importante es que el grupo socialmente desfavorecido parece mostrar una organización ideológica diferente a la que presenta el grupo socialmente favorecido, el mismo que muestra una organización ideológica más consistente con lo encontrado en estudios previos en el ámbito urbano...

This research analyzes and compares the association between political ideology and justification of inequity in two samples from Lima, city, which are in different socio-economic situations: (a) a group with a very favorable economic situation and higher educative levels or postgraduate, which was called socially advantaged group; and (b) a group in situation of poverty with technical studies as maximum, named socially disadvantaged group. The results show that the socially disadvantaged group presents higher scores in Right-Wing Authoritarianism (RWA) and some of the dimensions of the justification of inequity. Furthermore, another important finding is that the socially disadvantaged group appears to show a different ideological organization in comparison with the socially advantaged group, which shows an ideological organization more consistent with the found in previous studies in urban areas...

Intersectoral Action and Health Equity in Latin America: An Analytical Approach / Intersectorialidad y equidad en salud en América Latina: una aproximación analítica

[Background]. Intersectoral action is a recurrent theme in public health management. However, there is very little systematic documentation on how it is implemented, especially in the field of health. Nor does an explicit theory exist on how to construct a framework in the health sphere to determine what kinds of intersectoral actions are feasible under different scenarios, or the kind of intersectoral action needed to address the social determinants of health and reduce inequities in health (Solar et al., 2009). This work proposes a preliminary conceptual framework to help identify and characterize experiences and studies on the intersectoral approach that have contributed to the objectives of health equity in Latin America in the past and present. We present elements of analysis to determine the context of the experiences and their specific features and scope, emphasizing the aspects that have characterized the origins and evolution of the intersectoral approach in the Region [...] In fact, in the Region of the Americas, the term “HiAP” has been almost completely absent from public policymaking. This seems to be because the concept is linked to a European social-historical context and, within this, to promotion of the concept by Finland’s European Union presidency in 2006. In the Region of the Americas, “intersectorality” has been the preferred concept, based on the Declaration of Alma-Ata of 1978 and its call for “health for all,” which had great influence in Latin America and the Caribbean. Added to this were the important contributions of the Ottawa Charter for Health Promotion in 1986 and, at the same time, developments and debates taking place in the Region of the Americas around Local Health Systems (SILOS). These were part of the health sector’s response to the democratization processes unfolding in the Region. The emphasis was on the need to reorganize and reorient health systems on the basis of decentralization and local development, and to strengthen and renew the primary care strategy approved in Alma-Ata, stepping up the effort to achieve equity with solidarity and justice for the entire population...

O papel das políticas públicas municipais sobre as iniquidades socioeconômicas em saúde bucal no Brasil: um estudo multinível / The role of Municipal Public Policies on the socioeconomic inequalities in oral health in Brazil: a multilevel study

Introdução: Sabe-se que as políticas públicas têm efeito contextual sobre iniquidades socioeconômicas em saúde bucal. Assim, este estudo teve como objetivo explorar os efeitos das políticas públicas municipais sobre as iniquidades socioeconômicas em saúde bucal no Brasil. Método: Estudo transversal de crianças de 12 anos de idade (n=7.328) e adolescentes de 15-19 anos de idade (n=5.445), agrupadas em 177 municípios. As informações das Políticas Públicas Municipais foram reunidas em serviços odontológicos, educação, saneamento e fluoretação da água. As variáveis de desfecho foram dicotomizadas: cárie não tratada (≥1 dente), dentes perdidos (≥1 dente) e dentes restaurados (≥1 dente). A variável de exposição principal foi a renda familiar equivalente. As análises foram realizadas por meio de regressão logística multinível com intercepto aleatório e termos de interação entre as variáveis foram testadas de renda e políticas ajustadas para variáveis de nível individual. Resultados: A prevalência de cárie dentária não tratada, dentes perdidos e restaurados foi de 49.34%, 12.69% e 37.97% respectivamente. Não houve interação significativa entre os indicadores de renda e as políticas. Cárie não tratada foi a condição mais suscetível as políticas. Indivíduos que vivem em municípios sem fluoretação tiveram um OR=1,42 (IC 95% 1,08-1,86), aqueles em municípios com piores políticas de educação um OR=1,36 (IC 95% 1,07-1,73), aqueles em municípios com piores políticas de saneamento OR=1,05 (95% CI 0,78-1,40), e aqueles em municípios com políticas de serviços de saúde piores um OR=1,36 (IC 95% 1,02-1,80). Conclusão: Os resultados mostram que a fluoretação e as demais políticas públicas tiveram efeito independente sobre a saúde bucal e beneficiaram de forma semelhante as diferentes camadas sociais.

Introduction: It is known that public policies have contextual effects on socioeconomic inequalities in oral health. Thus, this study aimed to explore the effects of municipal public policies on socioeconomic inequalities in oral health in Brazil. Method: Cross-sectional study of 12 year-old children (n=7.328) and 15-19 year-old adolescents (n=5.445), clustered in 177 municipalities. Information was collated for Municipal Public Policies on dental services, education, sanitation, and water fluoridation. The dichotomous outcome variables were: untreated caries (≥1 tooth), missing teeth (≥1 tooth) and filled teeth (≥1 tooth). Main exposure variable was equivalent household income. Analyses were carried out using multilevel logistic regression with random intercept, and interaction terms were tested among income and policy variables adjusted for individual level variables. Results: Prevalence of untreated dental caries, missing teeth and filled teeth was, respectively 49.34%, 12.69% and 37.97%. There was no significant interaction among income and policy indicators. Untreated dental caries was the most susceptible outcome to policies. Individuals living in municipalities with no fluoridation had an OR=1.42(95% CI 1.08-1.86), those in municipalities with worse education policies an OR=1.36(95% CI 1.07-1.73), those in municipalities with worse sanitation policies OR=1.05(95% CI 0.78-1.40), and those in municipalities with worse health service policies an OR=1.36(95% CI 1.02-1.80). Conclusion: The results show that fluoridation and public policies had independent beneficial effect on oral health and their effect was similar across different social strata.

Deported Mexican migrants: health status and access to care / Migrantes mexicanos deportados: exploração do estado de saúde e acesso a serviços de saúde

OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required. .

OBJETIVO Analisar o estado de saúde e o acesso aos serviços de saúde de imigrantes mexicanos deportados na fronteira entre México e Estados Unidos. MÉTODOS Foram analisados dados secundários do Inquérito sobre Migração na Fronteira do Norte do México de 2012. O inquérito é contínuo e desenhado para descrever fluxos migratórios na fronteira entre México e Estados Unidos com amostra de população móvel. Foram analisados indicadores de saúde e de acesso aos serviços de saúde dos imigrantes deportados em comparação aos imigrantes que retornaram voluntariamente. Nossa amostra análise incluiu 2.680 migrantes de retorno voluntário, e 6.862 deportados. Foi utilizado modelo de regressão logística ordinal para comparar as probabilidades da pior autopercepção de saúde entre os grupos estudados. RESULTADOS Em comparação com os migrantes de retorno voluntário, deportados foram menos propensos a ter seguro médico em os Estados Unidos (OR = 0,05, IC95% 0,04;0,06). No modelo de regressão uma pior saúde auto-percebida foi associado com ser deportado (OR = 1,71, IC95% 1,52;1,92), bem como a idade (OR = 1,03, IC95% 1,02;1,03) e os anos de escolaridade (OR = 0,94, IC95% 0,93;0,95). CONCLUSÕES De acordo com nossos resultados, deportados tinha menos acesso aos cuidados, enquanto em os Estados Unidos, em comparação com os migrantes de retorno voluntário. Nossos resultados também mostraram uma associação independente e estatisticamente significativa entre a deportação e ter pior saúde auto-percebida. Novas políticas de saúde pública são necessárias para promover a saúde e o acesso aos serviços de saúde nos imigrantes mexicanos deportados dos Estados Unidos. .

Social protection systems in vulnerable families: their importance for the public health / Sistemas de protección social en familias vulnerables: su importancia en la salud pública

OBJECTIVE To analyze the effectiveness of the Chilean System of Childhood Welfare in transferring benefits to socially vulnerable families. METHODS A cross-sectional study with a sample of 132 families from the Metropolitan Region, Chile, stratified according to degree of social vulnerability, between September 2011 and January 2012. Semi-structured interviews were conducted with mothers of the studied families in public health facilities or their households. The variables studied were family structure, psychosocial risk in the family context and integrated benefits from the welfare system in families that fulfill the necessary requirements for transfer of benefits. Descriptive statistics to measure location and dispersion were calculated. A binary logistic regression, which accounts for the sample size of the study, was carried out. RESULTS The groups were homogenous regarding family size, the presence of biological father in the household, the number of relatives living in the same dwelling, income generation capacity and the rate of dependency and psychosocial risk (p ≥ 0.05). The transfer of benefits was low in all three groups of the sample (≤ 23.0%). The benefit with the best coverage in the system was the Single Family Subsidy, whose transfer was associated with the size of the family, the presence of relatives in the dwelling, the absence of the father in the household, a high rate of dependency and a high income generation capacity (p ≤ 0.10). CONCLUSIONS The effectiveness of benefit transfer was poor, especially in families that were extremely socially vulnerable. Further explanatory studies of benefit transfers to the vulnerable population, of differing intensity and duration, are required in order to reduce health disparities and inequalities. .

OBJETIVO Analizar la efectividad de las transferencias de beneficios del Sistema de Protección Integral de la Infancia a familias de Chile socialmente vulnerables. MÉTODOS Estudio transversal analítico con 132 familias, estratificadas según vulnerabilidad social en la Región Metropolitana, Chile, entre septiembre de 2011 y enero de 2012. Se aplicó entrevista semiestructurada a madres de familias en centros de salud públicos o en sus domicilios. Las variables fueron: estructura familiar, riesgo psicosocial del entorno familiar y beneficios integrados del sistema de protección social requeridos en las familias que cumplían con el requisito de aplicabilidad para la transferencia del beneficio. Se calcularon estadígrafos descriptivos, de posición y dispersión. Fue realizada regresión logística binaria, pertinente por el tamaño de la muestra. RESULTADOS Los grupos fueron homogéneos en cuanto a tamaño de la familia, presencia del progenitor y número de allegados, capacidad generadora de ingresos, tasa de dependencia y riesgo psicosocial (p ≥ 0,05). La transferencia de los beneficios fue baja en los tres grupos (≤ 23,0%). La mejor cobertura estuvo representada por el Subsidio Único Familiar, cuya entrega se relacionó con el tamaño de la familia, la presencia de allegados, progenitor ausente, la alta tasa de dependencia y alta capacidad generadora de ingresos (p ≤ 0,10). CONCLUSIONES La efectividad de entrega de los beneficios fue baja, especialmente en familias de extrema vulnerabilidad social. Nuevos estudios explicativos de formas de transferencia de beneficios deben ser realizados con diferentes niveles de intensidad y tiempos de exposición en poblaciones vulnerables, para disminuir las disparidades y desigualdades en salud. .

[How to reduce health inequities by targeting social determinants: the role of the health sector in Mexico]. / Cómo reducir las inequidades de salud actuando sobre sus determinantes sociales: el papel del sector salud en México.

OBJECTIVE: To study lines of action implemented in Mexico by the health sector from 2007 to 2012 in order to combat health inequities by targeting social determinants. To contribute to better understanding and knowledge of how health system inequalities in the Region of the Americas can be reduced. To formulate recommendations for designing a future public policy agenda to address the social determinants associated with health inequities in Mexico. METHODS: The policies and programs established in the National Health Program (PRONASA) 2007 - 2012 were reviewed, and those that met four criteria were selected: i) they affected the social determinants of health (SDH); ii) they developed specific lines of action aimed at reducing health inequities; iii) they set concrete goals; and iv) they had been evaluated to determine whether those goals had been met. Three programs were selected: Seguro Popular, Programa de Desarrollo Humano Oportunidades (PDHO), and Caravanas de la Salud. Once each program's specific lines of action targeting SDH had been identified, the monitoring and evaluation indicators established in PRONASA 2007 - 2012, along with other available evaluations and empirical evidence, were used to measure the extent to which the goals were met. RESULTS: The findings showed that Seguro Popular had had a positive impact in terms of the financial protection of lower-income households. Moreover, the reduction in the gap between workers covered by the social security system and those who were not was more evident. By reducing poverty among its beneficiaries, the PDHO also managed to reduce health inequities. The indicators for Caravanas de la Salud, on the other hand, did not show statistically significant differences between the control localities and the localities covered by the program, except in the case of Pap tests. CONCLUSIONS: These findings have important public policy implications for designing an agenda that promotes continued targeting of SDH and heightening its impact in terms of reducing inequities. Guaranteeing the effective exercise of social rights, without socioeconomic, employment, ethnic, or gender-based exclusion, will be key. Action to provide comprehensive, inclusive, equitable, effective, and quality coverage, supported by a preventive and remedial model of primary health care, are recommended. Strategies should be centered on primary health services, because at that level, more comprehensive care focusing on the person rather than the disease can be provided. It will also be necessary to include periodic monitoring and evaluation phases to offer the comprehensive social protection system scientific armor and guarantee its effectiveness.

Cómo reducir las inequidades de salud actuando sobre sus determinantes sociales: el papel del sector salud en México / How to reduce health inequities by targeting social determinants: the role of the health sector in Mexico

OBJETIVO: Analizar las vías de acción implementadas en México por el sector salud entre 2007 y 2012 para atender las inequidades en salud, incidiendo en sus determinantes sociales. Contribuir a mejorar la comprensión y el conocimiento sobre cómo incidir en la reducción de las desigualdades de los sistemas de salud en la Región de las Américas. Formular recomendaciones para definir una agenda futura de política pública que permita atender los determinantes sociales asociados a las inequidades en salud en México. MÉTODOS: Se revisaron las políticas o programas definidos en el Programa Nacional de Salud (PRONASA) 2007 - 2012, seleccionando aquellos que cumplieran con cuatro criterios: i) que incidieran en los determinantes sociales de la salud (DSS); ii) que formulasen líneas de acción específicas para reducir las inequidades en salud; iii) que definieran metas concretas y iv) que hubieran sido evaluados en cuanto al cumplimento de dichas metas. Se seleccionaron tres programas: el Seguro Popular, el Programa de Desarrollo Humano Oportunidades (PDHO) y Caravanas de la Salud. Una vez identificadas las líneas de acción específicas de cada programa -dirigidas a incidir en los DSS- se evaluó el cumplimiento de las metas trazadas a partir de los indicadores de seguimiento y evaluación definidos en el PRONASA 2007 - 2012, así como de las evaluaciones y la evidencia empírica disponibles. RESULTADOS: La evidencia encontrada sobre el Seguro Popular mostró efectos positivos en la protección financiera de las familias de más bajos ingresos. Más aún, la reducción de las diferencias fue más evidente entre los trabajadores afiliados a la seguridad social y los no afiliados. El PDHO, al incidir en las condiciones de pobreza de sus beneficiarios, ha logrado también reducir las inequidades en salud. Los indicadores correspondientes a Caravanas de la Salud, en cambio, no mostraron diferencias estadísticamente significativas entre las localidades control y las localidades cubiertas por este programa, salvo en el caso de la prueba de Papanicolaou (PAP). CONCLUSIONES: Estos hallazgos tienen implicancias de política pública que resultan relevantes para diseñar una agenda que permita seguir incidiendo en los DSS y potenciar su impacto en la reducción de las inequidades. Es clave garantizar el ejercicio efectivo de los derechos sociales, sin que nadie sea excluido por razones socioeconómicas, laborales, étnicas o de género. Se sugiere realizar acciones destinadas a brindar una cobertura integral, incluyente, equitativa, efectiva y de calidad, sustentada en un modelo preventivo y resolutivo de atención primaria de la salud. Las diversas estrategias deben estar focalizadas en la atención primaria de la salud, porque en este nivel se puede brindar una atención más integral y con una perspectiva que haga hincapié en la persona y no en la enfermedad. Será necesario también incorporar etapas de evaluación y seguimiento que proporcionen al sistema de protección social integral un blindaje científico para garantizar su eficacia.

OBJECTIVE: To study lines of action implemented in Mexico by the health sector from 2007 to 2012 in order to combat health inequities by targeting social determinants. To contribute to better understanding and knowledge of how health system inequalities in the Region of the Americas can be reduced. To formulate recommendations for designing a future public policy agenda to address the social determinants associated with health inequities in Mexico. METHODS: The policies and programs established in the National Health Program (PRONASA) 2007 - 2012 were reviewed, and those that met four criteria were selected: i) they affected the social determinants of health (SDH); ii) they developed specific lines of action aimed at reducing health inequities; iii) they set concrete goals; and iv) they had been evaluated to determine whether those goals had been met. Three programs were selected: Seguro Popular, Programa de Desarrollo Humano Oportunidades (PDHO), and Caravanas de la Salud. Once each program's specific lines of action targeting SDH had been identified, the monitoring and evaluation indicators established in PRONASA 2007 - 2012, along with other available evaluations and empirical evidence, were used to measure the extent to which the goals were met. RESULTS: The findings showed that Seguro Popular had had a positive impact in terms of the financial protection of lower-income households. Moreover, the reduction in the gap between workers covered by the social security system and those who were not was more evident. By reducing poverty among its beneficiaries, the PDHO also managed to reduce health inequities. The indicators for Caravanas de la Salud, on the other hand, did not show statistically significant differences between the control localities and the localities covered by the program, except in the case of Pap tests. CONCLUSIONS: These findings have important public policy implications for designing an agenda that promotes continued targeting of SDH and heightening its impact in terms of reducing inequities. Guaranteeing the effective exercise of social rights, without socioeconomic, employment, ethnic, or gender-based exclusion, will be key. Action to provide comprehensive, inclusive, equitable, effective, and quality coverage, supported by a preventive and remedial model of primary health care, are recommended. Strategies should be centered on primary health services, because at that level, more comprehensive care focusing on the person rather than the disease can be provided. It will also be necessary to include periodic monitoring and evaluation phases to offer the comprehensive social protection system scientific armor and guarantee its effectiveness.

Uma metodologia para explicar diferenças entre dados administrativos e pesquisas amostrais, com aplicação para o Bolsa Família e o Benefício de Prestação Continuada na PNAD / /A methodology for explaining differences between administrative data and findings from sample-based surveys regarding the Family Allowance Program and the Continuous Cash Benefit Program / Una metodología para explicar diferencias entre datos administrativos y encuestas por muestreo, con aplicación para el Bolsa Familia y el Beneficio de Prestación Continuada en la PNAD

Estimativas feitas com base em pesquisas domiciliares amostrais muitas vezes diferem bastante dos dados administrativos. Nas PNADs, o número estimado de beneficiários do Programa Bolsa Família (PBF) e do Benefício de Prestação Continuada (BPC) é sempre bem inferior ao número oficial. O objetivo deste artigo é apresentar uma metodologia simples, baseada nas características do desenho amostral das pesquisas domiciliares, para explicar essa diferença, decompondo-a em três termos: o viés de representatividade (derivado da escolha dos locais, áreas censitárias ou municípios para a pesquisa); o viés de captação (decorrente de problemas de captação nos locais selecionados); e a interação entre ambos. A aplicação dessa metodologia ao PBF e ao BPC mostra que, no primeiro caso, o viés de representatividade explica boa parte do problema: a seleção de municípios pesquisados é responsável por 40% da diferença observada entre os dados oficiais e os da PNAD. No caso do BPC, o viés de representatividade tenderia a agir no sentido oposto. Portanto, o viés de captação é inteiramente responsável pela diferença observada. Além disso, a declaração equivocada do BPC como benefício previdenciário na PNAD parece ocorrer, sobretudo, no período anterior a 2004 e não explica inteiramente o pequeno número de beneficiários identificados nas PNADs.

Estimates based on household surveys often differ considerably from administrative records. In the National Household Sample Surveys (PNADs) of the Brazilian Statistics Department, the estimated number of beneficiaries of the Family Allowance (Bolsa Família) Program (PBF), and of beneficiaries of the Continuous Cash Benefit (Benefício de Prestação Continuada) Program (BPC) is always lower than official figures. This paper presents a simple methodology, based on the sampling design of household surveys, to explain these differences, by decomposing them into three terms: the representativeness bias (derived from the choice of places, census tracts or municipalities for the survey); the data collection bias (derived from data collection problems at the chosen sites); and the interaction between them. The application of this methodology to the present cases shows that the representativeness bias of the PBF accounts for 40% of the difference between official records and the PNAD. For the BPC, the representativeness bias tends to act in the opposite direction. That is, In other words, the data collection bias is entirely responsible for the observed difference. Also, the erroneous reporting of the BPC as a Social Security benefit on the PNAD seems to have occurred mostly in the years prior to 2004, and does not entirely explain the low number of beneficiaries identified in the PNADs.

Estimaciones realizadas en base a encuestas de hogares por muestreo muchas veces difieren bastante de los datos administrativos. En la Pesquisa Nacional por Amostra de Domicílios - PNAD , el número estimado de beneficiarios del Programa Bolsa Familia (PBF) y del Beneficio de Prestación Continuada (BPC) siempre es bastante inferior al número oficial. El objetivo de este artículo es presentar una metodología simple, basada en las características del diseño por muestreo de las encuestas de hogares, para explicar esta diferencia, descomponiéndola en tres aspectos: el factor de representatividad (derivado de la elección de los sitios, áreas censitarias o municipios para la encuesta); el factor de captación (resultante de problemas de captación en los sitios seleccionados); y la interacción entre ambos. La aplicación de dicha metodología al PBF y al BPC muestra que, en el primer caso, el sesgo de representatividad explica una gran parte del problema: la selección de municipios investigados es la responsable por un 40% de la diferencia observada entre los datos oficiales y los de la PNAD. En el caso del BPC, el sesgo de representatividad tendería a actuar en el sentido opuesto. Por lo tanto, el sesgo de captación es totalmente responsable por la diferencia observada. Además, la declaración equivocada del BPC como beneficio de la previsión social en la PNAD parece ocurrir sobre todo en el periodo anterior a 2004 y no explica por completo el pequeño número de beneficiarios identificados en las PNADs.

[Men, health and public policies: gender equality in question]. / Homens, saúde e políticas públicas: a equidade de gênero em questão.

The scope of this article is to pose questions on the theme of Men, Health and Public Policies to render debate on the subject viable, based on theoretical and empirical references related to these issues. Initially, some historical landmarks on the theme are presented to provide guidelines for debate. An overview of the gender agenda in public policies is then presented to introduce the discussion about the inclusion of a gender perspective in healthcare policies. After this discussion, queries are raised about whether or not policies geared to men's health promote gender equality. In the closing remarks, the complexity involved in the development, implementation and evaluation of health policies aimed at gender equality is highlighted. The need for the Brazilian policy geared towards men's health to be implemented with other policies such that the gender matrix is transversal in the healthcare field is also stressed.

Los Determinantes Sociales de Salud y la lucha por la equidad en Salud: desafíos para el Estado y la

The social, economic and political context in which people grow, live, work and age has enormous impact on their health status. These wider struc-tural determinants of health lie largely outside the health sector. The level and coverage of social protection systems is one key determinant. Social protection measures and mechanisms directly contribute to poverty reduction and human resource development by providing recipients with in-kind or cash transfers. They also allow beneficiaries to gain better access to social services, including health facilities, drugs, etc

Every mother and child count: overcoming invisibility.

While statistics document shocking and sobering facts about disparities in women's health and women's quality of life around the world, they do not portray the lives of women individually or recognize the importance of listening to their voices. Reasons for the continuing invisibility of women include issues related to mission, attitudes, evaluation, translation, prevention, integration, empowerment, organization, advocacy and leadership. This article explains the underpinnings of these contributors to women's invisibility and offers readers ways to become more fully engaged in global health initiatives to make women and children more visible.

Borders, laborers, and racialized medicalization Mexican immigration and US public health practices in the 20th century.

Throughout the 20th century, US public health and immigration policies intersected with and informed one another in the country's response to Mexican immigration. Three historical episodes illustrate how perceived racial differences influenced disease diagnosis: a 1916 typhus outbreak, the midcentury Bracero Program, and medical deportations that are taking place today. Disease, or just the threat of it, marked Mexicans as foreign, just as much as phenotype, native language, accent, or clothing. A focus on race rendered other factors and structures, such as poor working conditions or structural inequalities in health care, invisible. This attitude had long-term effects on immigration policy, as well as on how Mexicans were received in the United States.

A classificação dos domicílios indígenas no censo demográfico 2000: subsídios para análise das condições de saúde / The classification of indigenous households in the census in 2000: subsidies for analysis of health conditions

Informações coletadas em um censo demográfico podem dizer muito a respeito das condições de vida de uma população e são amplamente utilizadas na formulação e implementação das políticas públicas sociais. Quanto maior a qualidade dos dados censitários, mais fidedigno será o painel da realidade da população. Baseando-se em microdados do Censo Demográfico 2000, o presente estudo trata de descrever as freqüências de domicílios cujos responsáveis se auto classificaram como indígenas e que foram classificadas como coletivo ou improvisado pelos recenseadores na área rural dos municípios brasileiros. Para este tipo de classificação não são coletados dados que caracterizam os domicílios, tais como perfil socioeconômico e condições de saneamento. Na análise para os grupos de cor/raça, os indígenas foram os que tiveram as maiores freqüências de domicílios classificados como coletivos (4,4%) em relação aos não indígenas (0,1%). A classificação como coletivo foi mais freqüente na macrorregião Centro Oeste, especificamente no estado de Mato Grosso (mais de 40% deste tipo de classificação ocorreu em apenas cinco municípios de MT). Os domicílios indígenas classificados como improvisados (3,5%) também foram superiores aos não-indígenas (1,3%) e ao contrário dos coletivos, ocorreram em diferentes regiões do Brasil, com destaque para municípios da macrorregião Sul (6,6%) e o estado de Mato Grosso do Sul (17,9%). Para os municípios que estavam fora dos limites da Amazônia Legal houve 1,5 mais domicílios indígenas classificados como improvisados do que na Amazônia Legal. ...

Census data can say a lot about the living conditions of a population and are widely used in the formulation and implementation of public social policies. The higher the quality of census data, the more reliable will be the picture of the reality of the population. Based onmicrodata from the 2000 Demographic Census, this study describes the frequency of households whose heads self-classified as indigenous and which were classified as collective or improvised by the enumerators in rural municipalities. For households in thesecategories, additional data are not collected to characterize the households with respect to such aspects as socioeconomic profile and sanitation. In the analysis of color and race categories, indigenous people were those with the highest frequency of households classified as collective (4.4%) compared to non-indigenous people (0.1%). Classification as a collective was more frequent in the Central-West macro-region, specifically in the state of Mato Grosso (over 40% of households classified as collective nationally occurred in only five municipalities of MT). The number of indigenous households classified as improvised (3.5%) was also higher than for non-Indigenous households (1.3%). Unlike collective households, improvised households occurred in different regions of Brazil, especially inmunicipalities in the South macro-region (6.6% ) and in the state of Mato Grosso do Sul (17.9%). There were 1.5 times more households classified as improvised in municipalities located inside than outside the Legal Amazon...