Auto-avaliação do estado de saúde no Brasil: análise dos dados da PNAD/2003 / Health self-rating in Brazil: analysis of data of the PNAD/2003

Este trabalho confirma que os principais determinantes da auto-avaliação do estado de saúde são as condições econômicas. Surgem dois resultados importantes adicionais. O primeiro mostra que além das condições atuais, medidas pela renda per capita do domicílio, têm grande importância as condições pregressas, medidas por um índice de bens que serve como indicador da capacidade de acumulação de riqueza do domicílio. Fica também demonstrada a grande importância da escolaridade como mediadora das condições econômicas na determinação da avaliação de saúde. Foram usados modelos de regressão logística, usando sexo e idade como co-variáveis para quantificar a importância dos vários determinantes, que incluíram também a área rural de residência, a cor da pele ou raça da pessoa, bem como quem forneceu a informação na entrevista. A avaliação de saúde ruim ou muito ruim é menor na área rural e aumenta marginalmente quando a pessoa que informa é "outro morador do próprio domicílio". Depois de ajustada para as co-variáveis (idade e sexo) e as condições econômicas e escolaridade, não existe nenhuma relação da avaliação ruim ou muito ruim com a cor da pele ou raça. É também feita a sugestão de mudar de posição a pergunta sobre auto-avaliação no questionário de futuros inquéritos.

This paper confirms the economic situation as the main determinant in the health self-rating of individuals. There are however two important additional results: The first shows that besides the current situation the former capacity of the household to accumulate wealth - measured by means of an index of assets - have independent effects on the rating of bad or very bad health. Secondly, we found that the economic status was strongly influenced by the educational level. Considering sex and age as co-variables, we developed logistic models to quantify the importance of the socio-economic determinants, including: reside in a rural area; which household member responded to the interview; skin color/race of the individual. Bad or very bad health self-rating is less frequent in rural areas and increases slightly when the respondent is "another resident of the same household". After adjustment of the co-variables (sex and age) and the economic and educational characteristics, we found that skin color/race were not significant as determinants of self-rated bad or very bad health. We also suggest that in future surveys the questions regarding health self-rating should be moved to another position in the questionnaire.

Strengthening health information systems to address health equity challenges.

Special studies and isolated initiatives over the past several decades in low-, middle- and high-income countries have consistently shown inequalities in health among socioeconomic groups and by gender, race or ethnicity, geographical area and other measures associated with social advantage. Significant health inequalities linked to social (dis)advantage rather than to inherent biological differences are generally considered unfair or inequitable. Such health inequities are the main object of health development efforts, including global targets such as the Millennium Development Goals, which require monitoring to evaluate progress. However, most national health information systems (HIS) lack key information needed to assess and address health inequities, namely, reliable, longitudinal and representative data linking measures of health with measures of social status or advantage at the individual or small-area level. Without empirical documentation and monitoring of such inequities, as well as country-level capacity to use this information for effective planning and monitoring of progress in response to interventions, movement towards equity is unlikely to occur. This paper reviews core information requirements and potential databases and proposes short-term and longer term strategies for strengthening the capabilities of HIS for the analysis of health equity and discusses HIS-related entry points for supporting a culture of equity-oriented decision-making and policy development.

Research on health inequalities in Latin America and the Caribbean: bibliometric analysis (1971-2000) and descriptive content analysis (1971-1995).

We conducted a bibliometric and content analysis of research on health inequalities produced in Latin American and Caribbean countries. In our bibliometric analysis (n = 576), we used indexed material published between 1971 and 2000. The content analysis (n = 269) covered the period 1971 to 1995 and included unpublished material. We found recent rapid growth in overall output. Brazil, Chile, and Mexico contributed mostly empirical research, while Ecuador and Argentina produced more conceptual studies. We found, in the literature reviewed, a relative neglect of gender, race, and ethnicity issues. We also found remarkable diversity in research designs, however, along with strong consideration of ecological and ethnographic methods absent in other research traditions.

Inequities in access to and use of drinking water services in Latin America and the Caribbean.

OBJECTIVE: To identify and evaluate inequities in access to drinking water services as reflected in household per capita expenditure on water, and to determine what proportion of household expenditures is spent on water in 11 countries of Latin America and the Caribbean. METHODS: Using data from multi-purpose household surveys (such as the Living Standards Measurement Survey Study) conducted in 11 countries from 1995 to 1999, the availability of drinking water as well as total and per capita household expenditures on drinking water were analyzed in light of socioeconomic parameters, such as urban vs. rural setting, household income, type and regularity of water supply service, time spent obtaining water in homes not served by running water, and type of water-purifying treatment, if any. RESULTS: Access to drinking water as well as total and per capita household expenditures on drinking water show an association with household income, economic conditions of the household, and location. The access of the rural population to drinking water services is much more restricted than that of the urban population for groups having similar income. The proportion of families having a household water supply system is comparable in the higher-income rural population and the lower-income urban population. Families without a household water supply system spend a considerable amount of time getting water. For poorer families, this implies additional costs. Low-income families that lack a household water supply spend as much money on water as do families with better income. Access to household water disinfection methods is very limited among poor families due to its relatively high cost, which results in poorer drinking water quality in the lower-income population. CONCLUSIONS: Multi-purpose household surveys conducted from the consumer's point of view are important tools for research on equity and health, especially when studying unequal access to, use of, and expenditures on drinking water. It is recommended that countries improve their portion of the surveys that deals with water and sanitation in order to facilitate national health assessments and the establishment of more equitable subsidy programs.

Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries.

OBJECTIVE: To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. METHODS: A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and place of residence (urban vs. rural area). For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. RESULTS: Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small differences between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. CONCLUSIONS: Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on self reported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these sources of data. Despite their shortcomings, household interview surveys are very useful in understanding the dimensions of health inequalities in these countries.

Determinantes das desigualdades na auto-avaliação do estado de saúde no Brasil: análise dos dados da PNAD/1998 / Factors determining inequalities in the health condition self-assessment in Brazil: analysis of data of PNAD/1998

O trabalho apresenta um panorama geral das desigualdades nos determinantes considerados na explicação das desigualdades na auto-avaliação do estado de saúde a partir dos dados da PNAD/1998. Mostra-se como existem gradientes na classificação do estado de saúde autopercebido de acordo com os níveis de educação, de renda per capita, de acordo com a raça ou cor de pele das pessoas, por grandes regiões do país e especialmente com o aumento da idade. Usando modelos de regressão logística, tenta-se explicar quais as determinações importantes dessa autoclassificação. Os resultados mais importantes indicam que educação e rendimento têm efeitos que se somam e que há diferenças entre homens e mulheres e de acordo com populações urbanas e rurais. As desigualdades na classificação do estado de saúde de acordo com a raça ou cor de pele das pessoas deixam de ser estatisticamente significativas depois de se controlar por nível de educação e de renda. Discute-se a utilidade desse tipo de informação sobre classificação autopercebida de saúde e a importância de melhorar, em futuros inquéritos, a qualidade dos dados por meio de sugestões sobre alterações nos procedimentos de entrevista.

Apreciaçäo crítica do uso da estatística na epidemiologia; oficina de trabalho / Critical analysis of the statistical use in epidemiology; workshop

Analisa o estado atual das interrelaçöes da estatística e epidemiologia, no contexto brasileiro oferecendo sugestöes que contribuem para o aprimoramento dessas relaçöes (AMSB)