Health in Brazil

• Home
• |
• Journals
  • The Lancet
  • The Lancet Infectious Diseases
  • The Lancet Neurology
  • The Lancet Oncology
• |
• Specialties
• |
• Audio
• |
• Conferences
  • The Lancet Conferences
  • Conference Collaborations
  • Meet the Editors at Conferences
• |
• Education
  • At the Limits
  • The Lancet Seminars
  • The Lancet Core Clinical Collection
  • The Lancet Student
• |
• The Lancet Series
• |
• Information for
  • Authors
  • Advertisers
  • Press
• |
• Careers

Health in Brazil

Launched in Brasília May 9, 2011

Brazil has made significant improvements in maternal and child health, emergency care, and in reducing the burden of infectious diseases. But the news is not all good. The country continues to have a burden of injury mortality that is different from other countries due to the large number of murders, especially using firearms. Obesity levels are increasing and caesarean section rates are the highest in the world.

Brazil now has the opportunity to move closer towards its ultimate goal of universal, equitable, and sustainable health care as enshrined in the 1988 Constitution. To highlight this opportunity, The Lancet is publishing a Series of six papers that critically examine what the country’s policies have achieved and where future challenges lie. As Cesar Victora and colleagues conclude in the final paper of the Series: "the challenge is ultimately political, requiring continuous engagement by Brazilian society as a whole to secure the right to health for all Brazilian people."

Series Comments

Brazil: towards sustainability and equity in health

Sabine Kleinert, Richard Horton

Full Text | PDF

Brazil: structuring cooperation for health

Paulo Buss

Full Text | PDF

Brazil’s health-care reform: social movements and civil society

Sonia Fleury

Full Text | PDF

Higher education and health care in Brazil

Naomar Almeida-Filho

Full Text | PDF

The impact of the Brazil experience in Latin America

Ricardo Uauy

Full Text | PDF

Series Papers

The Brazilian health system: history, advances, and challenges

Jairnilson Paim, Claudia Travassos, Celia Almeida, Ligia Bahia, James Macinko

Summary | Full Text | PDF

Maternal and child health in Brazil: progress and challenges

Cesar G Victora, Estela M L Aquino, Maria do Carmo Leal, Carlos Augusto Monteiro, Fernando C Barros, Celia L Szwarcwald

Summary | Full Text | PDF

Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs

Mauricio L Barreto, M Gloria Teixeira, Francisco I Bastos, Ricardo A A Ximenes, Rita B Barata, Laura C Rodrigues

Summary | Full Text | PDF

Chronic non-communicable diseases in Brazil: burden and current challenges

Maria Inês Schmidt, Bruce Bartholow Duncan, Gulnar Azevedo e Silva, Ana Maria Menezes, Carlos Augusto Monteiro, Sandhi Maria Barreto, Dora Chor, Paulo Rossi Menezes

Summary | Full Text | PDF

Violence and injuries in Brazil: the effect, progress made, and challenges ahead

Michael Eduardo Reichenheim, Edinilsa Ramos de Souza, Claudia Leite Moraes, Maria Helena Prado de Mello Jorge, Cosme Marcelo Furtado Passos da Silva, Maria Cecília de Souza Minayo

Summary | Full Text | PDF

Health conditions and health-policy innovations in Brazil: the way forward

Cesar G Victora, Mauricio L Barreto, Maria do Carmo Leal, Carlos A Monteiro, Maria Ines Schmidt, Jairnilson Paim, Francisco I Bastos, Celia Almeida, Ligia Bahia, Claudia Travassos, Michael Reichenheim, Fernando C Barros,

Summary | Full Text | PDF

Return to Series page

 

The Lancet, Early Online Publication, 9 May 2011

doi:10.1016/S0140-6736(11)60135-9Cite or Link Using DOI

Chronic non-communicable diseases in Brazil: burden and current challenges

Prof Maria Inês Schmidt MD a , Bruce Bartholow Duncan MD a, Gulnar Azevedo e Silva MD b, Ana Maria Menezes MD c, Carlos Augusto Monteiro MD d, Sandhi Maria Barreto MD e, Dora Chor MD f, Paulo Rossi Menezes MD g

Summary

Non-communicable diseases (NCDs) have become a major health priority in Brazil—72% of all deaths were attributable to NCDs in 2007. They are also the main source of disease burden, with neuropsychiatric disorders being the single largest contributor. Morbidity and mortality due to NCDs are greatest in the poor population. Although the crude NCD mortality increased 5% between 1996 and 2007, age-standardised mortality declined by 20%. Declines were primarily for cardiovascular and chronic respiratory diseases, in association with the successful implementation of health policies that lead to decreases in smoking and the expansion of access to primary health care. Of note, however, the prevalence of diabetes and hypertension is rising in parallel with that of excess weight; these increases are associated with unfavourable changes of diet and physical activity. Brazil has implemented major policies for the prevention of NCDs, and its age-adjusted NCD mortality is falling by 1·8% per year. However, the unfavourable trends for most major risk factors pose an enormous challenge and call for additional and timely action and policies, especially those of a legislative and regulatory nature and those providing cost-effective chronic care for individuals affected by NCDs.

This is the fourth in a Series of six papers on Health in Brazil

Introduction

Chronic non-communicable diseases (NCDs) are a global health problem and a threat to human health and development. The burden of these diseases falls mainly on low-income and middle-income countries.1 Leading scientists2 and WHO3 have raised a call to action, as effective interventions are available,4 which define strategies to be taken. The United Nations is convening a high-level meeting of the General Assembly in September, 2011, on the prevention and control of NCDs.5 To contribute to the preparation of this meeting, The Lancet Series of papers was launched in November, 2010,6 in which 23 countries, including Brazil, were assessed with respect to NCD burden and national capacity to respond to the NCD challenge.7 A comprehensive and critical view of the NCD scenario in Brazil, a large middle-income country, is thus timely.

The burden of chronic NCDs

In 2007, about 72% of all deaths in Brazil were attributable to NCDs (cardiovascular diseases, chronic respiratory diseases, diabetes, cancer, and others, including renal diseases), 10% to infectious or parasitic diseases, and 5% to maternal and child health disorders. This distribution contrasts with that of 1930, when infectious diseases accounted for 46% of all deaths in Brazilian state capitals.8 As addressed in greater detail elsewhere in this Series,9 this radical change happened within the context of economic and social development, in which major advances toward the resolution of the then reigning public health concerns were made. In parallel with this change in disease burden was a rapid demo-graphic transition in Brazil that produced an age pyramid weighted more towards adults and elderly people.10 Greater income, more mechanisation and industrialisation, improved access to food, urbanisation, and globalisation of unhealthy habits have produced a rapid nutritional transition11 and have increasingly exposed the population to a greater risk of chronic disease. Within this context, less privileged ethnic and racial groups bear a disproportionately large share of the resultant burden (panel 1)./.../

@TheLancetTech

Announcements

New: The Lancet is starting a column about information technology and medicine. If you’ve got anything we may be interested in – from new apps to innovative ways of disseminating health information – please tweet us at @TheLancetTech or emailniall.boyce@lancet.com.

Niall Boyce

@TheLancetTech London, New York, Beijing

I'm Niall Boyce, one of the Senior Editors at @TheLancet. I'll be writing about innovations in IT and health. Please feel free to tweet me items of interest.

http://www.thelancet.com

Quality of health news reporting found lacking

Incomplete articles about new treatments can mislead patients and waste valuable time in the exam room, physicians say.

By KEVIN B. O'REILLY, amednews staff. Posted May 9, 2011. 

Articles in the most-read American news outlets usually fail to adequately discuss the pros and cons of new medical treatments, tests, products and procedures, according to an analysis of nearly 1,500 health stories from the last five years.

The finding is based on reviews done by a panel of more than 30 physicians, scientists, public health researchers, medical journalists and other experts affiliated with the website HealthNewsReview.org, which marked its fifth anniversary in April. Less than 30% of stories explicitly discussed the cost of new treatments, and only about one-third adequately covered their benefits and harms or addressed the quality of the medical evidence offered in their support.

FELIZ DIA DAS MÃES

DESEJO PARA TODAS AS MÃES AMICOR

e seus parceiros que contribuiram para tal,

também para aquelas que não tiveram filhos

mas que contribuem para o grande projeto humano

Stiglitz: O que é bom para o Brasil, é bom para os Estados Unidos

7 de maio de 2011 às 13:43

Artigo recomendado pela AMICOR Maria Inês Reinart Azambuja

The IMF’s change of heart

The International Monetary Fund has realised that a nation’s economic well-being depends on social equality and justice [O Fundo Monetário Internacional se deu conta de que o bem-estar econômico de uma nação depende de igualdade e justiça social]

Joseph E Stiglitz, 07 May 2011 15:14

do Project Syndicate, na Al Jazeera

O encontro anual de primavera do Fundo Monetário Internacional foi notável ao marcar uma tentativa do FMI de se distanciar de suas próprias doutrinas de longo prazo sobre controle de capitais e flexibilização do mercado de trabalho. Parece que um novo FMI tem gradualmente, e cautelosamente, emergido sob a liderança de Dominique Strauss-Kahn.

Cerca de 13 anos antes, no encontro do FMI em Hong Kong, em 1997, o fundo tinha tentado emendar sua carta para ganhar mais poder para empurrar países à liberalização do mercado de capitais. O momento não poderia ter sido pior: a crise do Sudeste da Ásia estava em gestação — uma crise que foi resultado principalmente da liberalização do mercado de capitais naquela região que, dado o alto índice de poupança, era desnecessária./.../

Série The Lancet sobre o Brasil

Do AMICOR: Cesar Victora

....
Estaremos lançando segunda feira a serie Lancet sobre o Brasil (ver abaixo) e gostariamos de contar com o apoio do AMICOR em sua divulgacao. A questao das doenças nao transmissiveis mereceu um artigo de autoria de Maria Ines, Bruce e varios outros colegas.
Um grande abraço
Cesar

A revista inglesa The Lancet, a publicação médica mais influente do mundo, lançará em maio uma série de seis artigos intitulada “A Saúde dos Brasileiros”, uma ampla revisão sobre os determinantes e as condições de saúde da nossa população. Baseados em uma extensa revisão de documentos existentes, e em análises originais de dados epidemiológicos, uma equipe de 29 especialistas em saúde pública preparou seis artigos científicos que descrevem a história da assistência à saúde no Brasil, com ênfase na implantação do Sistema Único de Saúde (SUS), assim como a evolução recente dos principais problemas de saúde que afligem nossa população, bem como dos seus principais determinantes e fatores de risco.  Artigos específicos descrevem o desenvolvimento do nosso sistema de saúde, a saúde de mães e crianças; as doenças infecciosas; as doenças crônicas não transmissíveis; e as lesões físicas e violências. Embora importantes problemas de saúde estejam sendo reduzidos, muito ainda precisa ser feito para que todos brasileiros atinjam níveis de saúde compatíveis com aqueles observados em países desenvolvidos.  Na busca de atingir tal objetivo, a série de artigos culmina com um chamado para a ação dirigido a todos os setores da nossa sociedade: governo, trabalhadores de saúde, setor privado, universidades e instituições de ensino e pesquisa e a sociedade civil em geral. A série completa com os seis artigos e com comentários redigidos pelos editores da revista e por pesquisadores convidados poderá ser acessada a partir de 9 de maio de 2011 no seguinte endereço: http://www.thelancet.com/series/health-in-brazil

WHO Ministerial meetings in Moscow

The WHO recently held a series of events in Moscow, Russia in anticipation of the UN High-Level Meeting on NCDs in September 2011. The two events were the "WHO global forum: Addressing the challenge of NCDs" (27 April) and the "First global ministerial conference on healthy lifestyles and NCD control" (28-29 April).

The first event, the WHO global forum, brought together various individuals, organizations, and other stakeholders to discuss the challenges and opportunities in NCD prevention and control. In addition to identifying and committing to global priority actions, the forum helped define the expectations and roles of different stakeholders leading up to the High-Level Meeting. For more information about the global forum: http://bit.ly/hKlNgj /.../;

Global Youth Action on Non-Communicable Diseases (NCDs)

posted by Phillip Baker on Mon, 04/18/2011 - 11:04

For immediate release: 18th April, 2011

Download the press release in PDF format here: Youth_Action_April182011.pdf.

Download the press release in Word format here: Youth_Action_April182011.doc.

 

"Chronic non-communicable diseases are the social justice issue of our generation. We place emphasis on political rather than individual responsibility for this global epidemic. It is time for the world to assert the rights of the child and stop blaming victims for their illness. There are solutions. What we want is political leadership on this issue.”

 

Youth and young professionals worldwide are mobilizing to battle global chronic diseases, delivering key recommendations and building a social movement ahead of the United Nations High-Level Summit on Non-Communicable Diseases. Two global networks: the Young Professionals Chronic Disease Network (www.ypchronic.org) and the NCD Action Network (www.ncdaction.org) are working side-by-side to achieve exactly this.  /.../

 

Structured Exercise Training May Improve Glycemic Control

Laurie Barclay, MD

http://jama.ama-assn.org/content/305/17/1790.short

May 6, 2011 — Structured exercise training, including aerobic, resistance, or both, is linked to a greater reduction in hemoglobin A1c (HbA1c) levels in patients with diabetes, according to the results of a systematic review and meta-analysis reported in the May 4 issue of the Journal of the American Medical Association.

"Current guidelines recommend that patients with type 2 diabetes should perform at least 150 minutes per week of moderate-intensity aerobic exercise and should perform resistance exercise 3 times per week," write Daniel Umpierre, MSc, from the Hospital de Clinicas de Porto Alegre in Brazil, and colleagues. "Previous meta-analyses demonstrated that structured exercise training including aerobic and resistance exercises reduces ...HbA1c levels by approximately 0.6%. However, only 1 previous review separately analyzed associations of aerobic exercise, resistance training, and the combination of aerobic exercise and resistance training on change in HbA1c levels./.../

Physical Activity Advice Only or Structured Exercise Training and Association With HbA_1c Levels in Type 2 Diabetes

A Systematic Review and Meta-analysis

1. Daniel Umpierre, MSc; 
2. Paula A. B. Ribeiro, MSc; 
3. Caroline K. Kramer, MD, ScD;
4. Cristiane B. Leitão, MD, ScD; 
5. Alessandra T. N. Zucatti, PED; 
6. Mirela J. Azevedo, MD, ScD; 
7. Jorge L. Gross, MD, ScD; 
8. Jorge P. Ribeiro, MD, ScD; 
9. Beatriz D. Schaan, MD, ScD

[+] Author Affiliations