Regional Inequalities in Infant Mortality and Primary Health Care in the State of Minas Gerais, Brazil

• Autor(a) principal: Faria, Rivaldo Mauro de
• Data de Publicação: 2014
• Outros Autores: Santana, Paula
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/102688; https://doi.org/10.4000/eps.5852
• topic: primary healthcare; regional inequality; infant mortality; soin de santé primaire; inégalité régionale; mortalité infantile

Infant mortality has declined in Brazil in recent years, partly as a result of increased Primary Health Care (PHC) coverage and better access to it. However, there are still enormous regional inequalities in these indicators, and therefore spatial variations in infant mortality. In a country like Brazil that is of continental proportions, it is important to analyse/assess health policies in the context of regional inequalities in order to ensure equity. This study thus aims to analyse the regional impacts of PHC and assess the importance of socioeconomic contexts upon infant mortality rates (IMRs) in the state of Minas Gerais. This is the fourth biggest state in Brazil, with a population of almost 20 million, distributed over 66 microregions. The IMR was assessed for the periods 2002-2006 and 2007-2011 in the 66 microregions, considering three operative dimensions: i. indexes of families aided by PHC; ii. indexes of prenatal care; iii. and the Index of Sociomaterial Deprivation (ISD). The data were collected from secondary official sources, and modelled on temporal and spatial scales defined and worked in a Geographical Information System. The ISD, which is a composite indicator used to express social and regional inequalities, was constructed on the basis of three indicators: i) illiteracy; ii) wages; and iii) homes without indoor bathrooms. The results showed a reduction in IMR in almost all the microregions of Minas Gerais between 2002-2006 and 2007-2011. However, there were inequalities in this decrease, with a continuing concentration of mortality in microregions with higher ISD. The expansion of PHC is more marked in the microregions with higher ISD, which is a positive sign from the Brazilian Health System. However, the expansion of these services as an isolated sectorial policy, though important, has not on its own been able to reduce the geographical inequalities in infant mortality in Minas Gerais. Hence, it is necessary to consider the social and economic contexts of families when attempting to improve indicators that go beyond mere healthcare intervention. In other words, infant health is the result of integrated public policies (eg. housing, employment/wages, education/training) and multi-level decisions and actions (local, municipal, regional, federal).