Alberto Pellegrini Filho

A saúde e seus determinantes sociais

RESUMO Este artigo busca analisar as relacoes entre saude e seus determinantes sociais, apresentando inicialmente o conceito de determinantes sociais de saude (DSS) e uma breve evolucao historica dos diversos paradigmas explicativos do processo saude/doenca no âmbito das sociedades, desde meados do seculo XIX. Em seguida sao discutidos os principais avancos e desafios no estudo dos DSS, com enfase em novos enfoques e marcos de referencia explicativos das relacoes ente os diversos niveis de DSS e a situacao de saude. Com base nesses estudos e marcos explicativos, discutese, em seguida, uma serie de possibilidades de intervencoes de politicas e programas voltados para o combate as iniquidades de saude geradas pelos DSS. Finalmente, sao apresentados os objetivos, linhas de atuacao e principais atividades da Comissao Nacional sobre Determinantes Sociais da Saude, criada em marco de 2006, com o objetivo de promover estudos sobre os DSS, recomendar politicas para a promocao da equidade em saude e mobilizar setores da sociedade para o debate e posicionamento em torno dos DSS e do enfrentamento das iniquidades de saude.

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 The content analysis (n = 269) covered the period 1971 to 1995 and included unpublished material.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.

Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.

Public policy and the social determinants of health: the challenge of the production and use of scientific evidence

This article serves as an introduction to the others published in this thematic issue of the Cadernos de Saude Publica. The author makes a brief historical review of the concepts, approaches and methodologies used to study the relationships between social determinants and health outcomes. By analyzing the current global movement around social determinants of health he emphasizes that the distinctive feature of this movement is the explicit commitment to action through intersectoral public policies that are based on evidence and implemented with the support and participation of broad segments of society. As this special issue of the Cadernos de Saude Publica is dedicated to presenting the results of research related to social determinants of health, the author focuses on an analysis of the difficulties in the production and use of scientific evidence that supports the definition, implementation and evaluation of policies to combat health inequities through action on social determinants of health. To conclude, he presents some recommendations for overcoming these difficulties.

Mapping of capacities for research on health and its social determinants in Brazil

Este artigo descreve as tendencias na producao de pesquisa sobre os determinantes sociais da saude (DSS) no Brasil (2005-2012) e mapeia as estruturas do sistema de pesquisa sobre saude e seus determinantes sociais. O pais tem um solido sistema nacional de pesquisa e conta com uma rica producao sobre DSS e suas iniquidades ancoradas em uma longa tradicao de pesquisa e compromisso politico nesse campo. Apesar das estrategias inovadoras que buscam fortalecer os vinculos entre pesquisa, politicas e praticas, o impacto da investigacao sobre DSS continua a ser em grande parte restrito a comunidade academica, com repercussoes notaveis, mas ainda insuficientes sobre a politica publica e os determinantes sociais das iniquidades em saude. Portanto, a pesquisa sobre DSS no Brasil necessita tornar-se ainda mais sensivel as urgencias sociais e desenvolver uma melhor sintonia com os processos politicos, aumentando a sua capacidade de influenciar decisoes estrategicas que possam afetar as iniquidades em saude e mobilizar agendas para a promocao da equidade.This article describes tendencies in research on social determinants of health (SDH) and health inequities in Brazil (2005-2012) and maps research system structures to analyze capacities for research on health and its social determinants. Brazil has a strong national research system and counts on a wealth of research in the field of SDH drawing on a long tradition of research and political commitment in this area. While innovative strategies seeking to strengthen the links between research, policy and practice have been developed, the impact of SDH research continues to be largely restricted to the academic community with notable but still insufficient repercussions on public policy and the social determinants of health inequities. SDH research in Brazil will therefore need to become even more responsive to social urgencies and better attuned to political processes, enhancing its capacity to influence strategic policy decisions affecting health inequities and mobilize strategic agendas for health equity.

Brazilian studies on social determinants of health inequities

Este Suplemento sobre Determinantes Sociais da Saude (DSS) de Cad. Saude Publica apresenta artigos que abordam distintos temas dos DSS, considerando diferentes perspectivas conceituais e enfoques metodologicos. Inclui estudos originais sobre mortalidade, cuidado perinatal, uso de servicos de saude, saude bucal, autoavaliacao em saude e violencia, entre outros. Esses estudos foram apoiados pelo Departamento de Ciencia e Tecnologia do Ministerio da Saude (DECIT/MS), em parceria com o Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) e a Comissao Nacional sobre Determinantes Sociais da Saude (CNDSS). Os trabalhos apresentados neste Suplemento refletem a capacidade instalada no pais para a geracao de evidencias neste tema, que ganhou renovada proeminencia com a criacao da Comissao sobre Determinantes Sociais da Saude (CSDH) pela Organizacao Mundial da Saude (OMS) em 2005. O movimento global desencadeado pela CSDH contribuiu para uma tomada de consciencia de governos e sociedade civil sobre a importância dos determinantes sociais e sobre a necessidade do combate as iniquidades em saude por eles geradas. O Brasil integrou-se precoce e decisivamente a esse movimento, criando a sua propria Comissao em marco de 2006. A criacao da CNDSS responde a uma tradicao do movimento sanitario brasileiro de aprofundar o conhecimento das relacoes entre os determinantes socioeconomicos e a situacao de saude, e de promover acoes concretas baseadas nesse conhecimento. As pesquisas apresentadas neste suplemento foram conduzidas em diferentes cenarios e locais do pais, e enfatizam a importância das iniquidades sociais sobre a saude na populacao brasileira. Esses achados estao em consonância com o relatorio final da CNDSS, intitulado As Causas Sociais das Iniquidades em Saude no Brasil, que incluiu uma revisao das transformacoes economicas e sociais ocorridas no pais nas ultimas decadas, alem de uma analise dos avancos e desafios representados pelas iniquidades de saude na situacao de saude dos brasileiros. A publicacao deste Suplemento de Cad. Saude Publica foi organizada pelo Centro de

Desigualdades socioespaciais relacionadas à tuberculose no município de Itaboraí, Rio de Janeiro

INTRODUCTION Tuberculosis remains as a global public health problem and its occurrence and distribution is associated with social inequalities. Itaboraí is among the priority Brazilian municipalities for tuberculosis control. The study aimed to combine social indicators into a composite indicator to measure differences in living conditions of the population in Itaboraí, as well as evidence of health inequalities related to tuberculosis. METHODS An ecological study, with spatial analysis of tuberculosis and its relation to socioeconomic and demographic status of households. Data were obtained from individuals declared in the Mortality Information System (SIM), notified in the Notification of Injury Information System - SINAN or Tuberculosis Special Treatment Information System - SITETB from 2007 to 2013. RESULTS Evidence indicates association between sociodemographic inequalities and occurrence of tuberculosis in the population. Findings point to a lower percentage of healing and a higher percentage of abandonment and death in areas with high social vulnerability, with a relative risk over twice as high than that found in areas of lower vulnerability. CONCLUSION The study showed strong evidence that the influence of unequal sociodemographic conditions have a negative impact on health conditions of the population in Itaboraí.

Mapeo de capacidades para la investigación sobre determinantes sociales de la salud en Brasil

Este artigo descreve as tendencias na producao de pesquisa sobre os determinantes sociais da saude (DSS) no Brasil (2005-2012) e mapeia as estruturas do sistema de pesquisa sobre saude e seus determinantes sociais. O pais tem um solido sistema nacional de pesquisa e conta com uma rica producao sobre DSS e suas iniquidades ancoradas em uma longa tradicao de pesquisa e compromisso politico nesse campo. Apesar das estrategias inovadoras que buscam fortalecer os vinculos entre pesquisa, politicas e praticas, o impacto da investigacao sobre DSS continua a ser em grande parte restrito a comunidade academica, com repercussoes notaveis, mas ainda insuficientes sobre a politica publica e os determinantes sociais das iniquidades em saude. Portanto, a pesquisa sobre DSS no Brasil necessita tornar-se ainda mais sensivel as urgencias sociais e desenvolver uma melhor sintonia com os processos politicos, aumentando a sua capacidade de influenciar decisoes estrategicas que possam afetar as iniquidades em saude e mobilizar agendas para a promocao da equidade.This article describes tendencies in research on social determinants of health (SDH) and health inequities in Brazil (2005-2012) and maps research system structures to analyze capacities for research on health and its social determinants. Brazil has a strong national research system and counts on a wealth of research in the field of SDH drawing on a long tradition of research and political commitment in this area. While innovative strategies seeking to strengthen the links between research, policy and practice have been developed, the impact of SDH research continues to be largely restricted to the academic community with notable but still insufficient repercussions on public policy and the social determinants of health inequities. SDH research in Brazil will therefore need to become even more responsive to social urgencies and better attuned to political processes, enhancing its capacity to influence strategic policy decisions affecting health inequities and mobilize strategic agendas for health equity.

Mapeamento da produção e das estruturas de pesquisa sobre determinantes sociais da saúde no Brasil

Este artigo descreve as tendencias na producao de pesquisa sobre os determinantes sociais da saude (DSS) no Brasil (2005-2012) e mapeia as estruturas do sistema de pesquisa sobre saude e seus determinantes sociais. O pais tem um solido sistema nacional de pesquisa e conta com uma rica producao sobre DSS e suas iniquidades ancoradas em uma longa tradicao de pesquisa e compromisso politico nesse campo. Apesar das estrategias inovadoras que buscam fortalecer os vinculos entre pesquisa, politicas e praticas, o impacto da investigacao sobre DSS continua a ser em grande parte restrito a comunidade academica, com repercussoes notaveis, mas ainda insuficientes sobre a politica publica e os determinantes sociais das iniquidades em saude. Portanto, a pesquisa sobre DSS no Brasil necessita tornar-se ainda mais sensivel as urgencias sociais e desenvolver uma melhor sintonia com os processos politicos, aumentando a sua capacidade de influenciar decisoes estrategicas que possam afetar as iniquidades em saude e mobilizar agendas para a promocao da equidade.This article describes tendencies in research on social determinants of health (SDH) and health inequities in Brazil (2005-2012) and maps research system structures to analyze capacities for research on health and its social determinants. Brazil has a strong national research system and counts on a wealth of research in the field of SDH drawing on a long tradition of research and political commitment in this area. While innovative strategies seeking to strengthen the links between research, policy and practice have been developed, the impact of SDH research continues to be largely restricted to the academic community with notable but still insufficient repercussions on public policy and the social determinants of health inequities. SDH research in Brazil will therefore need to become even more responsive to social urgencies and better attuned to political processes, enhancing its capacity to influence strategic policy decisions affecting health inequities and mobilize strategic agendas for health equity.