Abstract
This article discusses trends in health inequalities and access to health services across the regions of Brazil using data from household surveys conducted between 1998 and 2013. Social inequality was measured based on the ratio between the extremes of years of schooling considering two age groups (18 to 59 years and 60 years and over). The findings show a decline in health status and increase in prevalence of diabetes and hypertension in both age groups, which may be related to the expansion of primary healthcare. The findings regarding the percentage of people who had had a medical appointment in the last 12 months show that low levels of inequalities persist despite a general improvement in access. Despite an increase in the percentage of people with up to 3 years of schooling who had had a dental appointment in the last year, significant inequalities persist. The percentage of people who reported being admitted to hospital in the last 12 months was greater among people with up to 3 years of schooling throughout the study period. The hospitalization rate decreased in both age groups across almost all regions. The proportion of women aged between 50 and 69 years with up to 3 years of schooling who had had a mammogram increased, leading to a decrease in inequality. The findings show the need to ensure the continuity of household surveys to monitor inequalities in access to health care services by region and social group.
Highlights
Population surveys are key tools for tackling inequalities in health and in access to health services since they provide a deep understanding of health needs, demand for services, and socioeconomic conditions
The findings show a decline in health status and increase in prevalence of diabetes and hypertension in both age groups, which may be related to the expansion of primary healthcare
The results show that the proportion of the overall sample with good or very good health status fell from around 72% in 1998 to approximately 65% in 2013
Summary
Population surveys are key tools for tackling inequalities in health and in access to health services since they provide a deep understanding of health needs, demand for services, and socioeconomic conditions. According to Travassos et al.[2], living conditions data from household surveys showed that there was only a slight reduction in inequalities between 1989 and 1997. Based on this finding, additional surveys including population health data were suggested, leading to the development of three complementary health surveys as part of the National Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios - PNAD) conducted by the IBGE in 1998, 2003, and 20083-5. PNS data shows an overall improvement in access to and the use of health services across all regions. Szwarcwald and Macinko[9] recently published a panorama of health inequalities in Brazil based on PNS data
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