Abstract
SummaryBackgroundPolitical, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses.MethodsWe analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries.FindingsNationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index.InterpretationHealth improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.FundingBill & Melinda Gates Foundation and the Brazilian Ministry of Health.
Highlights
Brazil has undergone important structural and economic changes over the past 50 years. 21 years of military dictatorship came to an end in 1985, and in 1988, a Constitutional Assembly edited a new constitution establishing health as a “right for all” and a “duty of the state”, leading to health care reforms to create the universal Brazilian Unified Health System (SUS).[1,2] National immunisation programmes have provided vaccines to all citizens since 1973,3 and since 1994, the Estratégia Saúde da Família[4] (ESF–Family Health Strategy) has reorganised primary health services to guarantee universal access, improve health education, and increase health promotion
Between 1990 and 2016, life expectancy at birth (LE) in Brazil increased by 6·8 years, from 68·4 years (95% uncertainty interval [uncertainty intervals (UIs)] 68·0–68·9) to 75·2 years (74·7–75·7; table 2)
Health outcomes improved in states in the north and northeast, higher rates of years of life lost (YLLs) and years lived with disability (YLDs) persist in many states in those regions compared with states in the south and southeast, and LE and healthy life expectancy (HALE) remain generally higher in the south and southeast
Summary
Brazil has undergone important structural and economic changes over the past 50 years. 21 years of military dictatorship came to an end in 1985, and in 1988, a Constitutional Assembly edited a new constitution establishing health as a “right for all” and a “duty of the state”, leading to health care reforms to create the universal Brazilian Unified Health System (SUS).[1,2] National immunisation programmes have provided vaccines to all citizens since 1973,3 and since 1994, the Estratégia Saúde da Família[4] (ESF–Family Health Strategy) has reorganised primary health services to guarantee universal access, improve health education, and increase health promotion. 21 years of military dictatorship came to an end in 1985, and in 1988, a Constitutional Assembly edited a new constitution establishing health as a “right for all” and a “duty of the state”, leading to health care reforms to create the universal Brazilian Unified Health System (SUS).[1,2] National immunisation programmes have provided vaccines to all citizens since 1973,3 and since 1994, the Estratégia Saúde da Família[4] (ESF–Family Health Strategy) has reorganised primary health services to guarantee universal access, improve health education, and increase health promotion These reforms have taken place within an increasingly urban and globalised national context that has shifted social structures and further affected patterns of disease. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses
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