Abstract
An urban health index (UHI) was used to quantify health inequalities within Rio de Janeiro, Brazil, for the years 2002-2010. Eight main health indicators were generated at the ward level using mortality data. The indicators were combined to form the index. The distribution of the rank ordered UHI-values provides information on inequality among wards, using the ratio of the extremes and the gradient of the middle values. Over the decade the ratio of extremes in 2010 declined relative to 2002 (1.57 vs. 1.32) as did the slope of the middle values (0.23 vs. 0.16). A spatial division between the affluent south and the deprived north and east is still visible. The UHI correlated on an ecological ward-level with socioeconomic and urban environment indicators like square meter price of apartments (0.54, p < 0.01), low education of mother (-0.61, p < 0.01), low income (-0.62, p < 0.01) and proportion of black ethnicity (-0.55, p < 0.01). The results suggest that population health and equity have improved in Rio de Janeiro in the last decade though some familiar patterns of spatial inequality remain.
Highlights
Latin America in general, and Brazil in particular, experienced rapid urbanization during the period between the 1960s and 1990s
The results suggest that population health and equity have improved in Rio de Janeiro in the last decade though some familiar patterns of spatial inequality remain
The disparity gradient declined, reaching a nadir of 0.18 in 2010. Both these trends reflect an overall decrease in the range of the Urban Health Index (UHI) distribution
Summary
Latin America in general, and Brazil in particular, experienced rapid urbanization during the period between the 1960s and 1990s. Mean income tends to decrease from south (the upper-class neighborhoods) to north (the suburbs) and from east (the city center) to west. These patterns predated urban planning efforts in the 20th century, since rising social inequalities were a product of a fast, massive rural-to-urban migration in combination with insufficient industrialization and inadequate infusion of national capital into Brasilia during the 1960s. A whole package of interventions, focusing on neighborhood-upgrading, social housing, security, primary health care and transportation [4,5] was created to integrate former marginalized areas and generate permanent improvements from mega-events 6, such as the 2014 FIFA World Cup and the 2016 Summer Olympics Games. Some investigators argue that the majority of urban interventions have only selective impact and their influence on health outcomes may not be detectable [7,8,9]
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