Efficiency Analysis in Brazil's Sao Paulo State Local Unified Health System (SUS): From Gender-Ethnicity-Power Inequities to the Dissolution of Health Effectiveness.

Simone Schenkman,Aylene Bousquat,Maria Paula Ferreira

doi:10.3390/ijerph19052990

Abstract

Health equity is cross sectioned by the reproduction of social relations of gender, ethnicity and power. The purpose of this article is to assess how intersectional health equity determines societal health levels, in a local efficiency analysis within Brazil’s Unified Health System (SUS), among Sao Paulo state municipalities. Fixed Panel Effects Model and Data Envelopment Analysis techniques were applied, according to resources, health production and intersectoral dimensions. The effect variables considered were expectation of life at birth and infant mortality rates, in 2000 and 2010, according to local health regions (HR) and regionalized healthcare networks (RRAS). Inequity was assessed both socioeconomically and culturally (income, education, ethnicity and gender). Both methods demonstrated that localities with higher inequities (income and education, gender and ethnicity oriented), associated or not to vulnerability (young and low-income families, in subnormal urban agglomerations), were the least efficient. Health production contributes too little to health levels, especially at the local level, which is highly correlated to the intersectoral dimension. Intersectional health equity, reinforced in its intertwining with ethnicity, gender and social position, is essential in order to achieve adequate societal health levels, beyond health access or sanitary and clinical efficacy.

Highlights

IntroductionA joint effort must be made to appreciate the richness contained in the transversality of gender, social class, occupation, ethnicity and spatial position in the social determination of health
The results obtained through the bivariate analysis of the Fixed Effects (FE) panel model demonstrate that the financial resources had more significant results than the physical ones
In order to decide which variables were to be tested for the distinct dimensions, as well as the complete set model, we selected the relevant variables from the bivariate analysis (Table 1)

Summary

Introduction

A joint effort must be made to appreciate the richness contained in the transversality of gender, social class, occupation, ethnicity and spatial position in the social determination of health. Power relations permeate the entire framework that determines inequities in society, in an intersectoral perspective, overflowing their effects on the health levels [1–3]. In the case of gender and ethnic differences in the productive insertion, it is necessary to take into account the qualification and discrimination levels, which are reflected in the design of positions, salaries and institutional hierarchies, against a patriarchal and racist society, determining the gender-imposed role choices. It is known that the discrimination factors in the world of work are greater in relation to gender than to ethnicity, as the latter suffers a more profound type of discrimination, related to education and qualification, which has its roots in social and power relations of the historically constructed slave society [4,5]. The ideal society for the capitalist system to function is the patriarchal society, with the white man exercising control over others, including nature [6,7]

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