Cardiovascular Risk Factors and Mortality. Long-Term Follow-up (up to 20 years) in

8501005.pdf (application/pdf Object)
Luiz Alberto de Souza Ciorlia e Moacir Fernandes de Godoy
Objetivo
A queda da mortalidade por doenças cardiovasculares (DCV) está sendo conseguida nos Estados Unidos e o mesmo declínio está ocorrendo em países em desenvolvimento, graças a mudanças favoráveis alcançadas no estilo de vida e nos fatores de risco.
Apesar dessa consideração, o volume de informações de que se dispõe sobre a distribuição e comportamento desse tipo de doença e seus fatores de risco no Brasil ainda é pequeno.
Métodos
Foi realizada avaliação das alterações do colesterol total (CT), níveis de pressão arterial (PA), índice de massa corporal (IMC) e tabagismo, além da ocorrência de eventos cardiovasculares fatais (F) e não fatais (NF), sob intervenção dietética e comportamental e seguimento em longo prazo (até 20 anos) em um grupo fechado, composto por 621 eletricitários de ambos os sexos, com idade média de 29,1±7,1 anos, variando de 15 a 59 anos. Foram
construídas curvas atuariais para analisar os eventos cardiovasculares F e NF.
Resultados
A média do CT apresentou redução significativa por efeito da orientação dietética. O hábito de fumar diminuiu significativamente com mudanças comportamentais. A média das PAs diminuiu significativamente com uma melhor detecção e medidas higiênicas, e a adesão dos hipertensos definitivos ao tratamento mostrou um índice de 56,6%. Por outro lado, o IMC apresentou um aumento expressivo e gradativo. A probabilidade de os indivíduos Continuarem
livres de qualquer evento cardiovascular foi de 98,1%, enquanto que para os eventos fatais foi de 99,2%.
Conclusão
Esses resultados comprovam que iniciativas voltadas para a prevenção devem ser prioritárias, com a intenção de se modificar as taxas de morbimortalidade das DCV.

Annual Cost of Ischemic Heart Disease in Brazil. Public and Private Perspective

8501002.pdf (application/pdf Object)
Rodrigo A. Ribeiro, Renato G. B. Mello, Raquel Melchior, Juliana C. Dill, Clarissa B. Hohmann,
Angélica M. Lucchese, Ricardo Stein, Jorge Pinto Ribeiro, Carisi A. Polanczyk
(AUTORES FAZEM PARTE DA LISTA AMICOR)
Métodos
Estudo de coorte, incluindo pacientes ambulatoriais com DAC comprovada. Considerou-se para estimar custos diretos: consultas, exames, procedimentos, internações e medicamentos. Valores de consultas e exames foram obtidos da tabela SUS e da Lista de Procedimentos Médicos (LPM). Valores de eventos cardiovasculares foram obtidos de internações em hospital público e privado com estas classificações diagnósticas em 2002. O preço dos fármacos utilizado foi o de menor custo no mercado.
Resultados
Os 147 pacientes (65±12 anos, 63% homens, 69% hipertensos, 35% diabéticos e 59% com IAM prévio) tiveram acompanhamento médio de 24±8 meses. O custo anual médio estimado por paciente foi de R$ 2.733,00, pelo SUS, e R$ 6.788,00, para convênios. O gasto com medicamentos ($ 1.154,00) representou 80% e 55% dos custos ambulatoriais, e 41% e 17% dos gastos totais, pelo SUS e para convênios, respectivamente. A ocorrência de evento cardiovascular teve grande impacto (R$ 4.626,00 vs. R$ 1.312,00, pelo SUS, e R$ 13.453,00 vs. R$ 1.789,00, para convênios, p<0,01).
Conclusão
O custo médio anual do manejo da DAC foi elevado, sendo o tratamento farmacológico o principal determinante dos custos públicos.
Essas estimativas podem subsidiar análises econômicas nesta área, sendo úteis para nortear políticas de saúde pública.

Economic Impact of Chronic Ischemic Cardiopathy Treatment in Brazil. The Challenge of

8501001.pdf (application/pdf Object)
Denizar Vianna Araujo e Marcos Bosi Ferraz
As doenças cardiovasculares são as principais causas de morbidade e mortalidade no Brasil, com impacto significativo no orçamento do Ministério da Saúde, principalmente na atenção da alta complexidade.
A crescente demanda por recursos desencadeou a elaboração da Política Nacional de Atenção Cardiovascular de Alta Complexidade pela Secretaria de Atenção à Saúde do Ministério da Saúde.
No ano de 2002, ocorreram 1.216.394 internações decorrentes de doenças do aparelho circulatório, representando 10,3% do total das internações no Sistema Único de Saúde (SUS). Em relação ao valor financeiro, a parcela das internações em cardiologia clínica e cirúrgica correspondeu a 17% do total, superando todos os outros grupos de especialidades isoladamente1.

A framework for measuring health inequity -- Asada 59 (8): 700 -- Journal of Epidemiology and Community Health

A framework for measuring health inequity -- Asada 59 (8): 700 -- Journal of Epidemiology and Community Health
Yukiko Asada

Correspondence to:
Dr Y Asada
Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada; yukiko.asada@dal.ca

Background: Health inequality has long attracted keen attention in the research and policy arena. While there may be various motivations to study health inequality, what distinguishes it as a topic is moral concern. Despite the importance of this moral interest, a theoretical and analytical framework for measuring health inequality acknowledging moral concerns remains to be established.

Study objective: To propose a framework for measuring the moral or ethical dimension of health inequality—that is, health inequity.

Design: Conceptual discussion.

Conclusions: Measuring health inequity entails three steps: (1) defining when a health distribution becomes inequitable, (2) deciding on measurement strategies to operationalise a chosen concept of equity, and (3) quantifying health inequity information. For step (1) a variety of perspectives on health equity exist under two categories, health equity as equality in health, and health inequality as an indicator of general injustice in society. In step (2), when we are interested in health inequity, the choice of the measurement of health, the unit of time, and the unit of analysis in health inequity analysis should reflect moral considerations. In step (3) we must follow principles rather than convenience and consider six questions that arise when quantifying health inequity information. This proposed framework suggests various ways to conceptualise the moral dimension of health inequality and emphasises the logical consistency from conception to measurement.

The 2nd People's Health Assembly - 18-23 July 2005, Cuenca, Equador

The 2nd People's Health Assembly - 18-23 July 2005, Cuenca, Equador: "n the beginning, there were thousands of people across the world working very hard in big and little ways to promote the dream of a world where a healthy life is a reality for all. In the optimistic, joyous, compassionate 1970’s it seemed that this would be possible. And was not the Alma Ata Declaration signed by 134 governments in 1978? Did not the declaration promise Health For All by 2000? When the millennium edged closer and equitable health policy was still nowhere the optimists did not give up. They knew that the Third World had been plunged into debt and health care was in danger of complete privatization. To remind the world of the commitment made in more hopeful times the optimists came together in solidarity.

When the optimists met

People's organizations, civil society organizations, NGOs, social activists, health professionals, academics and researchers came together to make a strong statement against the studied indifference in this crucial area of human life. The First People's Health Assembly was organized in Savar, Bangladesh in December 2000 to discuss the Health for All Challenge. The 5 day meet led to sharing of experiences from across the globe.

The assembly in a single voice condemned the international institutions, multinational corporations and governments which are willingly pursuing anti-people policies. The multi-national corporations who push for policies which put profits before people and the proponents of liberalisation who recommend that governments should cut expenditure on social sector like health and education came in for scathing criticism. In all 1453 participants from 75 countries came together to create and endorse a consensus document called the People's Charter for Health. The charter reflects the vision, goals, principles and calls for action that unite all the members of the PHM coalition It is most widely endorsed consensus document on health since the Alma Ata Declaration"

Public Health in a Globalized World: Breaking down Political, Social and Economic Barriers

ABRASCO: "The World Federation of Public Health Associations (WFPHA) – in a 2004 policy resolution - defined “public health as an art and a science; and also a movement dedicated to the equitable improvement of health and well-being (of communities with their full participation). First and foremost, public health leaders must be catalysts for the public health movement. Individually and collectively around the world, public health leaders must maintain and strengthen their roles and capacities as advocates for public health. The Federation recognizes as “key challenges having a global dimension: the promotion of human rights; the reduction of the burden of disease; the guarantee of appropriate nutrition; the education on all aspects of health promotion; the protection of the environment; and the achievement of worldwide access to essential drugs at reasonable cost” (1).

Although technical and scientific progress provides broad-ranging preventative, and curative resources, and economic and social progress in many developed countries has extended life expectancy and enhanced the quality of life of large segments of the population, yet poverty, hunger, preventable diseases and violence continue to threaten the health and livelihoods of over three quarters of the population of the planet. (2)


There is growing consensus that “to tackle the major global health challenges effectively, the practice of public health will need to change. It is not sufficient to focus only on urgent health priorities, for example, HIV/AIDS, tuberculosis, and malaria in sub-Saharan Africa, or just the Millennium Development Goals. Programs and policies are required that respond to poverty—the basic cause of much of the global burden of disease—prevent the emerging epidemics of non-communicable disease, and address global environmental change, natural, and man-made disasters, and provide for sustainable health development. The justification for action is that health is both an end in itself—a human right—as well as a prerequisite for human development.” (3)

Today’s smaller and faster world -- brought about by advancements in communications and information technology -- has yet to address the daunting task of breaking down the barriers that stand in the way of promoting health and delivering appropriate care to hundreds of millions of human beings. Ethical principles need to be revisited and reinforced. Public health leaders have an enormous challenge to draw attention to these social, economic and political barriers and focus their talents and energy in engaging political and social forces as part of a global and united commitment to actively pulling down these barriers.

The World Federation of Public Health Associations (WFPHA) and the Brazilian Association of Collective Health (ABRASCO) invite the public health leadership from all parts of the world to come to Rio de Janeiro, Brazil, and join the 11th World Congress on Public Health, and the 8th Brazilian Congress on Collective Health in addressing the Congress theme: “Public Health in a Globalized World: Breaking down Political, Social and Economic Barriers”.

1 WFPHA, 2004. Resolution on global public health leadership.
2 ABRASCO, 2003. Declaration on International Public Health.
3 Beaglehole R et al., 2004. Public health in the new era: improving health through collective action. Lancet 363:2084-2086."

The Global Health Watch

PLoS Medicine: The Global Health Watch
Mike Rowson*, David McCoy, Amit Sen Gupta, Armando de Negri Filho
At the World Health Assembly in May 2003, three civil society groups—the People's Health Movement, the Global Equity Gauge Alliance, and Medact—discussed the need for civil society to produce its own alternative to the World Health Organisation's World Health Report. We felt strongly that we needed to produce a global health report that had equity and the right to health at its heart. We also needed a way to monitor the performance of global health institutions themselves. The idea of an alternative to the World Health Report has developed into an initiative called the Global Health Watch, which we are launching next year.
The Three Key Players

Medact (http://www.medact.org) is a United Kingdom–based global health charity, undertaking education, research, and advocacy on conflict, poverty, and the environment.

The Global Equity Gauge Alliance (http://www.gega.org.za) was created to participate in and support an active approach to monitoring health inequalities and promoting equity within and between societies. The Alliance currently includes 11 member-teams, called Equity Gauges, located in ten countries in the Americas, Africa, and Asia.

The People's Health Movement (http://www.phmovement.org) is a global network of activists, organisations, and social movements. Its goal is to re-establish health and equitable development as top priorities in local, national, and international policy-making, with comprehensive primary health care as the strategy to achieve these priorities.

HEALTH: Sick of Globalisation

HEALTH: Sick of Globalisation
Kintto Lucas

CUENCA, Ecuador, Jul 21 (IPS) - Alternative reports on global health, presented at the second People's Health Assembly in Ecuador this week, question the free-market, neoliberal economic model and view it as the cause of many of the health problems facing humanity today.

These include the indiscriminate use of toxic products in agriculture, pollution caused by the oil industry, the consumption of transgenic crops, the destruction of the urban environment by pollution, and the commercialisation of health services.

The reports by the Global Health Watch and the Observatorio Latinoamericano de Salud see a healthy life as a fundamental human right, the enjoyment of which depends on economic, political and social factors.

The Global Health Watch is a broad collaboration of public health experts, non-governmental organisations, civil society activists, community groups, health workers and academics.

Beyond the divides: Towards critical population health research

Taylor & Francis Group - Article: "Abstract:
Ronald Labonte, Michael Polanyi, Nazeem Muhajarine, Tom McIntosh, Allison Williams
The term ‘population health’ has supplanted that of public health and health promotion in many Anglophone countries. The ideas underlying the term are not new and owe much to the legacies of nineteenth-century public health radicalism, Latin American social medicine and, more recently, social epidemiology. Its influential modeling by the Canadian Institute for Advanced Research in the early 1990s, however, was criticized for a lack of theory, reliance on large data sets, a simplistic modeling of the healthcare/economy relationship, little attention to the physical environment and an absence of human agency. While researchers working under the rubric of population health have addressed many of these early limitations, there has yet to be an articulation of what comprises a critical population health research practice. This article, based on the discussions and work of an interdisciplinary group of researchers in the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) in Canada, argues that such a practice proceeds from a theoretical engagement (theories of knowledge, society and social change), community engagement (a politicization of research knowledge) and policy engagement (which must extend beyond the simplistic notions of ‘knowledge translation’ that now permeate the research communities). A critical population health research practice, it concludes, is a moral praxis built upon explicit social values and analyses."

Shifting discourses on health in Canada: from health promotion to population health

155.pdf (application/pdf Object)
ANN ROBERTSON
SUMMARY
This paper argues that discourses on health are products of the particular social, economic and political context within which they are produced. In the early 1980s, the discourse on health in Canada shifted from a post-Lalonde Report lifestyle behaviour discourse to one shaped by the discourse on the `social determinants of health'. In Canada, we are currently witnessing the emergence of another discourse on health population health as a guiding framework for health policy and practice. Grounded in a critical social science perspective on health and health promotion, this paper critiques the
population health discourse in terms of its underlying epistemological assumptions and the theoretical and political implications which follow. Does it matter whether we talk about `heterogeneities in health' or `inequities in health'? This paper argues that it does, and concludes that population health is becoming a prevailing discourse on health at this particular historical time in Canada because it provides powerful rhetoric for the retreat of the welfare state. This paper argues further that it is health promotion's alignment with the moral economy of the welfare state that makes it a countervailing discourse on health and its determinants.

Reducing Health inequalities in Canada

CJPH_96_Suppl_2.pdf (application/pdf Object)
Morton Beiser, MD, FRCP, CM
Miriam Stewart, PhD
Despite Canada’s generally high standard of living and despite a system that promises universal access to high quality care, disparities in health remain a pressing national concern. These disparities are not randomly distributed. Specific subpopulations suffer a burden of illness and distress greater than other residents of Canada. For this reason, they can be characterized as “vulnerable populations”. Aboriginal peoples, immigrants, refugees, the disabled, the poor, the homeless, people with stigmatizing conditions, the elderly, children and youth in disadvantaged circumstances, people with poor literacy skills, and women in precarious circumstances are vulnerable populations – more likely than others to become ill and less likely to receive appropriate care.
Despite our commitment to equity and access – in health and opportunity – 18% of Canadians live in deep poverty, and income inequality is increasing. The wealthy live longer than the poor, and experience fewer chronic illnesses, less obesity, and lower levels of mental distress. According to the 2001 census, at least 14,000 people in Canada are homeless. Homeless people are at risk for premature death, infectious diseases, mental illness and substance abuse. The middle-aged homeless – people in their 40s and 50s – often have health disabilities more commonly seen in individuals who are decades older.
Canada’s Aboriginal population is just under 1 million, and its rate of growth is double that of the population as a whole. Although there has been progress – neonatal death rates in Aboriginal communities have dropped in recent years to a point where they now approximate the national average – equity in health for this population is still a distant goal. An Aboriginal baby, for example is almost three times more likely than a non-Aboriginal baby to die during the first year of life, and the rate of chronic illness among adult Aboriginal people is three times higher than the national average.
Canada’s newest settlers, like indigenous peoples, are subject to inequities in health and health care. The 250,000 immigrants admitted each year are, on the whole, healthier than native-born Canadians. However, during their first decade in Canada, immigrants are far more likely than the native-born to develop tuberculosis. Over their total life span, some immigrant groups experience a particularly high risk for cardiovascular disorders, obesity, and cancer of the colon. Moreover, crisis and conflict create mental suffering for refugees, who constitute about 10% of the immigrant population.
People with physical and mental disabilities constitute another subpopulation vulnerable to assaults on health. They suffer a double disadvantage, having to cope not only with the disability itself, but with the added burdens of compromised health and inaccessible, inadequate health-related services. Stigma and public censure create additional distress and erect barriers to care for persons suffering from chronic mental disorders, such as schizophrenia, and from various forms of addiction.
Almost half of all Canadian adults lack the literacy skills necessary to participate fully in our knowledge-based economy. They face high levels of unemployment and are often forced to live in unstable environments. Families face direct health risks as a result of lack of literacy, having difficulty, for example, in reading instructions for baby formulae, medications, or educational materials about health and safety.

Assembly meets to tackle health needs of the poor -- Richards 331 (7509): 128 -- BMJ

Assembly meets to tackle health needs of the poor -- Richards 331 (7509): 128 -- BMJ
"Assembly meets to tackle health needs of the poor
London Tessa Richards
More than a thousand members of the People's Health Movement from about 90 mostly poor countries will meet at the People's Health Assembly in Cuenca, Ecuador, next week. The movement (www.phmovement.org) is a global advocacy network of people's organisations, civil society groups, non-governmental organisations, women's groups, social activists, academics, health professionals, and policy makers. This will be the second time that they have come together in a meeting, aimed at giving a voice to the poor.
The first People's Health Assembly, was held in Savar in Bangladesh in 2000, and attracted almost 1500 health activists. It was convened by Zafrullah Chowdhury and his colleagues to discuss the failure to achieve the goal of health for all by the year 2000 (BMJ 2004;329:1127). This was the ambitious target that health ministers from 134 countries signed up to at the Alma-Ata conference in Kazakhstan in 1978.
Poverty, widening economic inequality, globalisation, unfair trade, and poor health governance were held to blame. Governments and the United Nations' agencies concerned with health were charged with failing to enact the principles set out in the Alma-Ata declaration, which called for the development of comprehensive equitable primary health care services (BMJ 2000;321:1361-2). "

Fundamental Sources of Health Inequalities

071-Part 2-Chapter 5.pdf (application/pdf Object)
Fundamental Sources of Health Inequalities

BRUCE G. LINK AND JO C. PHELAN
The primacy of social conditions as determinants of health has been observed for centuries. The idea was forcefully articulated by nineteenth-century proponents of “social medicine,” who noted strong relationships between health and the dire housing circumstances, poor sanitation, inadequate nutrition, and horrendous work conditions that poor people encountered at that time. This social patterning of ill health led to Virchow’s famous declaration that “medicine is a social science” and “politics nothing but medicine on a grand scale” (1848). The idea is also prominent in the work of McKeown, who focused attention on dramatic secular trends toward improved population health (1976). The McKeown thesis, as it has come to be called, states that the enormous improvements in health experienced over the past two centuries owe more to changes in broad economic and social conditions than to specific medical advances.

The Limits of Social Capital: Durkheim, Suicide, and Social Cohesion

[Este artigo, disponível para quem solicitar para nosso endereço (achutti@cardiol.br) uma copia, fui sugerido pela Dra. Maria Inês Reinert Azambuja. O autor discute a validade da utilização da teoria do capital social (coesão e integração social) para explicar riscos de morbi-mortalidade em nível populacional.]

The Limits of Social Capital: Durkheim, Suicide, and Social Cohesion
Howard I. and Claire E. Sterk, PhD
Recent applications of social capital theories to population health often draw on classic sociological theories for validation of the protective features of social cohesion and social integration.
Durkheim’s work on suicide has been cited as evidence that modern life disrupts social cohesion and results in a greater risk of morbidity and mortality—including selfdestructive behaviors and suicide.
We argue that a close reading of Durkheim’s evidence supports the opposite conclusion and that the incidence of self-destructive behaviors such as suicide is often greatest among those with high levels of social integration.
A reexamination of Durkheim’s data on female suicide and suicide in the military suggests that we should be skeptical about recent studies connecting improved population health to social capital.
(Am J Public Health. 2005; 95:1139–1143. doi:10.2105/AJPH.2004.053314)

G8 2005: a missed opportunity for global health

The Lancet: "This year people in bars and at football matches were asking about the Group of 8 (G8) nations summit in Gleneagles, Scotland. Such unprecedented popular interest was prompted by Bob Geldof's Live 8 concerts and the Make Poverty History campaign. These initiatives were organised to raise awareness about African poverty and to pressure politicians into tackling the preventable global burden of disease afflicting billions of people living in low-income settings. When asked if his lobbying had paid off, Geldof said, “A great justice has been done”. He should have said “No”. While the concerts were successful as entertainment and the Make Poverty History campaign certainly raised awareness, they failed as political levers for change."

THE MILLENIUM PROJECT: A PLAN FOR MEETING THE MILLENIUM DEVELOPMENT GOALS

The Lancet: "The Millennium Project: a plan for meeting the Millennium Development Goals

JD Sachs and JW McArthur

Practical approaches to achieve the MDGs;
Diagnosis of the shortfall in achieving MDG;
Identifying key interventions and policies;
Creation of national-level processes for scaling up;
Mobilisation of global science;
Global costs and benefits;
The importance of 2005.
References

Published online January 12, 2005 http://image.thelancet.com/extras/04art12121web.pdf

This year marks a pivotal moment in international efforts to fight extreme poverty. During the United Nations (UN) Millennium Summit in 2000, 147 heads of state gathered and adopted the Millennium Development Goals (MDGs, panel 1) to address extreme poverty in its many dimensions—income poverty, hunger, disease, lack of adequate shelter, and exclusion—while promoting education, gender equality, and environmental sustainability, with quantitative targets set for the year 2015. The UN committed to reviewing progress towards the goals in 2005, recognising that by this time only a decade would be left to fulfil the MDGs."

Social capital and health -- Kunitz 69 (1): 61 -- British Medical Bulletin

Social capital and health -- Kunitz 69 (1): 61 -- British Medical Bulletin:
"Social capital refers to bonds between individuals, both in intimate relationships (primary groups) and in voluntary associations (secondary groups) that make it possible for individuals and groups to achieve a variety of goals. Such bonds have also been claimed to have health promoting effects. In this chapter, I review a variety of empirical studies at both levels of analysis and suggest that the results are mixed, much depending upon the context in which such relationships occur."

Influence of material and behavioural factors on occupational class differences in health -- Laaksonen et al. 59 (2): 163 -- Journal of Epidemiology a

Influence of material and behavioural factors on occupational class differences in health -- Laaksonen et al. 59 (2): 163 -- Journal of Epidemiology and Community Health: "Objective: To examine material and behavioural factors as explanations for occupational class differences in health, while taking into account the interrelations between these two groups of factors.

Methods: Data from cross sectional surveys among middle aged women and men employed by the City of Helsinki (n = 6062, response rate 68%) were used. The contribution of four material and seven behavioural factors to occupational class differences in self rated health was examined by logistic regression techniques. After examining the contribution of each material and behavioural factor individually these were combined into two groups, whose independent and shared effects on occupational class differences in health were examined.

Results: In women, each material factor reduced the association between occupational class and health, while only financial difficulties and financial satisfaction were statistically significant in men. Smoking, dietary habits, and relative body weight were the strongest behavioural factors explaining the association in both women and men. When grouped, both material and behavioural factors explained a large part of occupational class differences in health. The direct effect of material factors was larger than their effect through behavioural factors, and the effect of behavioural factors depending on material factors was about half of their independent effect.

Conclusions: Material and behavioural factors explained more than a half of occupational class differences in self rated health among women and one third among men. The effects of material and behavioural factors were mostly independent of each other, although some part of their contribution was shared, especially in women."

Primary Care, Social Inequalities, and All-Cause, Heart Disease, and Cancer Mortality in US Counties, 1990 -- Shi et al. 95 (4): 674 -- American Journ

Primary Care, Social Inequalities, and All-Cause, Heart Disease, and Cancer Mortality in US Counties, 1990 -- Shi et al. 95 (4): 674 -- American Journal of Public Health: "Objectives. We tested the association between the availability of primary care and income inequality on several categories of mortality in US counties.

Methods. We used cross-sectional analysis of data from counties (n=3081) in 1990, including analysis of variance and multivariate ordinary least squares regression. Independent variables included primary care resources, income inequality, and sociodemographics.

Results. Counties with higher availability of primary care resources experienced between 2% and 3% lower mortality than counties with less primary care. Counties with high income inequality experienced between 11% and 13% higher mortality than counties with less inequality.

Conclusions. Primary care resources may partially moderate the effects of income inequality on health outcomes at the county level."

Why is Violence More Common Where Inequality is Greater? -- WILKINSON 1036 (1): 1 -- Annals of the New York Academy of Sciences

Why is Violence More Common Where Inequality is Greater? -- WILKINSON 1036 (1): 1 -- Annals of the New York Academy of Sciences:
"The most well-established environmental determinant of levels of violence is the scale of income differences between rich and poor. More unequal societies tend to be more violent. If this is a relation between institutional violence and personal violence, how does it work and why is most of the violence a matter of the poor attacking the poor rather than the rich? This paper begins by showing that the tendency for rates of violent crime and homicide to be higher where there is more inequality is part of a more general tendency for the quality of social relations to be poorer in more hierarchical societies. Research on the social determinants of health is used to explore these relationships. It is a powerful source of insights because health is also harmed by greater inequality. Because epidemiological research has gone some way towards identifying the nature of our sensitivity to the social environment and to social status differentials in particular, it provides important insights into why violence is related to inequality. The picture that emerges substantiates and explains the common intuition that inequality is socially corrosive. With an evolutionary slant, and informed by work on ranking systems in non-human primates, this paper focuses on the sharp distinction between competitive social strategies appropriate to dominance hierarchies and the more affiliative social strategies associated with more egalitarian social structures. The implications for policy seem to echo the importance to the quality of life of the three inter-related dimensions of the social environment expressed in the demand for 'liberty, equality, fraternity.'"

The role of communitarian and institutional social capital

Taylor & Francis Group - Article
Marisela B. Gomez and Carles Muntaner
The authors show how the private institution driving redevelopment in this neighborhood affects and is affected by the social capital of this community (communitarian and institutional forms of social capital).

Brazil and Peru Setting Health Agenda

news.pdf (application/pdf Object)

International Conference on Urban Health

International Conference on Urban Health:
"You are invited to submit research abstracts related to the conference theme, “Achieving Social Justice in Urban Communities”, and particularly in relation to the following focus areas as outlined in the Call for Abstracts:

* Conceptualizing and measuring social justice
* Environmental justice
* Healthcare availability and access
* Health status of disadvantaged populations
* International perspectives on urban health
* Interventions to improve the health of urban communities
* Models of community-based participatory research
* Policies promoting social justice"

A Hora dos Objetivos do Milênio é agora

PNUD Brasil:
"O momento para combater a pobreza é agora. Quem afirma é o secretário-geral das Nações Unidas, Kofi Annan. Segundo ele, pela primeira vez na história países desenvolvidos e em desenvolvimento começam a aceitar suas responsabilidades em relação aos pobres de mundo e estão dando apoio político inédito às metas dos Objetivos de Desenvolvimento do Milênio. Annan discursou em um evento anti-pobreza na Catedral de São Paulo, em Londres, onde reforçou a importância de atingir os ODM no prazo estabelecido, 2015. "

Brazil Poverty Assessment

Brazil Poverty Assessment: "


Brazil - Inequality and Economic Development
Poverty Assessment Report

Brazil is a continent-sized nation, marked by profound contrasts and diversity. Some of these are geographic or climactic in nature, others are racial or ethnic. Brazil's population draws on Native American, African, and European roots, and successive waves of immigrants, principally from Asia and Europe, have added to the mix.

Yet other contrasts are social in nature and generally less welcome. Living conditions for Brazil's 170 million people vary dramatically, and income disparities in Brazil are significant—not only across regions but also between metropolitan centers, nonmetropolitan urban centers, and rural areas.

This report is motivated by the coming together of three widespread perceptions about inequality, two somewhat newer and one long-standing. The two newer ones are

* that inequality may matter for the country's economic development, poverty reduction, and social progress, and
* that public policy and reforms, for example in the areas of social security and taxes, can and should do something about it.


The old perception, which is well borne out by the facts, is that Brazil occupies a position of very high inequality in the international community.

The report concludes that, to reduce inequality, public policy must be active in four areas:

1. Raising the level and reducing the inequities of educational attainment, which would involve making the education system more efficient for the poor (reduce the repetition and dropout rates) and taking advantage of transient demographic opportunities to cut the educational gap between Brazil and middle-income countries.

2. Reducing the wage skill premium of postsecondary education by promoting its expansion and increasing
their availability in the labor market.

3. Reallocating public expenditure away from excessive and regressive transfers, such as the implicit subsidies imbedded in the Federal pensions regime.

4. Taking advantage of the opportunity to implement an indirect tax reform that can reduce the inequity of indirect taxation avoiding any additional efficiency costs."

Experts Analyze Links of Health and Social Problems

: "Washington, D.C., July 5, 2005 (PAHO)—A joint PAHO/WHO regional meeting on the global Commission for the Social Determinants of Health opened Monday with a call by a senior health official to deal with the current 'very complex health development landscape.'

'What good does it to treat people's illnesses . . . then send them back to the conditions that made them sick,' said Dr. Timothy Evans, Assistant Director General of the World Health Organization (WHO) for Evidence and Information for Policy.

'We need to recognize that we are in a very complex health development landscape at the moment,' Evans told the opening session of the two-day Regional Consultation on the Work of the Commission for the Social Determinants of Health being held at the Pan American Health Organization (PAHO) in Washington, D.C."