harvard sp 2013 · 7/1/2014 5 a. infant and child mortality 0 5 10 15 20 25 30 35 40 45 50 55 60 65...
TRANSCRIPT
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Health related MDGs in Brazil:policies and progress
Ricardo Paes de BarrosDiana Coutinho
Rosane Mendonça
São Paulo, January 2013
A. Infant and child mortality (MDG 4)
B. Malnutrition and food insecurity (MDG 1)
C. Reproductive and sexual health (MDG 5and 6)
Presentation Plan
A. Infant and childmortality
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A. Infant and child mortality
Infant mortality rate in Brazilian Municipalities: 1991
Source: HDI M Atlas
LEGENDA
Infant mortality rate in Brazilian Municipalities: 2010
LEGENDA
Source: HDI M Atlas
A. Infant and child mortality
A. Infant and child mortality
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LEGENDA
Child mortality (up to 5 years old) rate in BrazilianMunicipalities: 1991
Source: HDI M Atlas
A. Infant and child mortality
Child mortality (up to 5 years old) rate in BrazilianMunicipalities: 2010
Source: HDI M Atlas
LEGENDA
A. Infant and child mortality
A. Infant and child mortality
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Life expectancy in Brazilian Municipalities: 1991
Source: HDI M Atlas
LEGENDA
A. Infant and child mortality
Life expectancy in Brazilian Municipalities: 2010
Source: HDI M Atlas
LEGENDA
A. Infant and child mortality
A. Infant and child mortality
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A. Infant and child mortality
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
Infant Mortality Rate (o/oo) Child Mortality Rate (o/oo) Life Expectancy (years)
Evolution of Infant and Child Mortality and LifeExpectancy: Brazil 1991 and 2010
1991 2010
4th MDG
4th MDG
1/2 per year
1/3 per year
Inequality among socioeconomic groups alsodeclined at a fast pace
greater equality of opportunity
A. Infant and child mortality
0
10
20
30
40
50
60
70
80
90
100
110
Socioeconomic conditions and sectorial publicprograms of two decades ago
Current socioeconomic conditions andsectorial public programs
Mortalid
adeprecoce
1992
=100
Decomposition of the drop in child mortality betweensectoral social programs and socio economic status
Drop inmortality rates
64%
A. Infant and child mortality
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A. Infant and child mortality
A. Infant and child mortality
0,50
0,52
0,54
0,56
0,58
0,60
0,62
0,64
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
GiniInd
ex
Evolution of income inequalityBrazil 1976 2001
Source: SAE/PR based on the PNADs from 1976 to 2011.
A. Infant and child mortality
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0,50
0,52
0,54
0,56
0,58
0,60
0,62
0,64
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
GiniInde
x
Evolution of income inequalityBrazil 1976 2011
Source: SAE/PR based on the PNADs from 1976 to 2011.
A. Infant and child mortality
0,25
0,30
0,35
0,40
0,45
0,50
0,55
0,60
0,65
1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012
Gin
i Ind
ex
Evolution of the degree of inequalityBrazil and China: 1981 2011
Source: Brazil, SAE/PR based on IPEA for 1976-2009 (averages for the years of 1980,1991,2000) and on the PNAD for 2011.
China
Brazil
A. Infant and child mortality
A. Infant and child mortality
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A. Infant and child mortality
A. Infant and child mortality
A. Infant and child mortality
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2000
2010
A. Infant and child mortality
A. Infant and child mortality
0
10
20
30
40
50
60
70
80
90
100
110
Socioeconomic conditions and sectorial publicprograms of two decades ago
Current socioeconomic conditions andsectorial public programs of two decades ago
Current socioeconomic conditions andsectorial public programs
Mortalid
adeprecoce
1992
=100
Decomposition of the drop in child mortality betweensectoral social programs and socio economic status
Change due to change insocioeconomic status
Change due tosocial program
30%
70%
A. Infant and child mortality
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Health:34 thousand family health care teams �– ESF,55% of population covered,260 thousand community health agents �– PACS and21 thousand dental care teams �– ESD.
Social Assistance:8 thousand one stop shops for social protection �–CRAS,91% with Program of integrated family care �– PAIF,98% of the brazilian municipalities with at least oneone stop shop for social protection.
Education:2 million children attending 46 thousand childcare centers.More of 20% of the 0 3 population covered.
Supply of basic care services for early childhood
A. Infant and child mortality
Innovative Local Early Childhood Programs
A. Infant and child mortality
Child and Adolescent Rights Statute �– ECA.
Signing the UN document �“A World Fit for Children�”.
Strenghtening and expansion of the number of Child GuardianshipCouncils (Conselhos Tutelares)�– present in 98% of municipalities.
Strenghtening of the State and Municipal Councils for the Protectionof the Rights of Children �– present in 92% of municipalities.
Strenghtening of Childhood and Adolescense Development Funds(FIA).
National guidelines for the Integrated Care of Children and Familiessubjected to domestic violence.
Legislation and Institutional Advances
A. Infant and child mortality
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Rede Cegonha (R$1,000 per year per newborn)
Método Canguru
Programa Nacional de Triagem Neonatal �– PNTN
Programa Nacional de Imunização �– PNI
Programa Saúde na Escola PSE
Programa Nacional DST e AIDS PN DST/AIDS (R$6,000 per yearper beneficiary)
Estratégia Saúde da Família PSF
Brasil Sorridente
Major Reproductive Health Federal Programs
A. Infant and child mortality
B. Malnutrition
0 10 20 30 40 50 60 70 80 90 100
Cartão pré natal
Vacina anti tetânica
Consulta pós parto
Aleitamento exclusivo
Subnutrição: altura poridade
Subnutrição: peso por altura
Subnutrição: peso por idade
Situação ao final da década em relação à situção no início
Reduçãonas carências ao longo da última década:Saúdematerno infantil e subnutrição
Redução a 1/3em 25 anos
Redução a 1/2em 25 anos
Mais lento que orequerido pelas
ODM
Mais rápidooque orequerido pelas
ODM
Redução
Grau de carência remanescente
19972007
Malnu
trition
Basic
health
services
B. Malnutrition and food insecurity
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The degree of severe food insecurity in the country is alreadylow, and much lower than the degree of extreme poverty
B. Malnutrition and food insecurity
Poverty in Brazil is a result of bad distribution, not of resourcescarcity (Josué de Castro)
B. Malnutrition and food insecurity
Brazil's food production can feed the entire population withgreat ease (Josué de Castro)
B. Malnutrition and food insecurity
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Brazil's food production can feed the entire population withgreat ease (Josué de Castro)
B. Malnutrition and food insecurity
Gasto com alimentos como porcentagem do gasto total por centésimos da distribuição das pessoas segundo o consumo per
capita
0
5
10
15
20
25
30
35
40
0 10 20 30 40 50 60 70 80 90 100
Centésimos da distribuição
Porc
enta
gem
do
gast
o to
tal c
om a
limen
tos
(%)
Hundreths of the per capita consumption distribution
Shareof
food
spen
ding
intotalexpen
diture
(%)
What proportion of income Brazilian families dedicateto food purchase?
Share of food spending as a percentage of total expenditureby hundreths of the per capita consumption distribution
B. Malnutrition and food insecurity
What proportion of Brazilian families do not have enough incometo meet their nutritional needs?
020406080
100120140160180200220240260280300320340360380400
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Rend
afamiliar
percapita
(R$/mês)
Percentil (%)
Distribuição das pessoas segundo a renda familiar percapita: Brasil, 2009
Toda renda gastacom alimentação
Parcela da renda gastacom alimentação igual
a do pobre
Renda gasta comalimentação igual ao
necessário
All income spenton food
Same share ofincome spent onfood as the poor
Income spent onfood equal to the
required
Percentile (%)
Percap
itafamily
income(R$/mon
th)
The distribution of people according to per capita family income:Brazil, 2009
B. Malnutrition and food insecurity
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Over half of the malnourished children are not extremely poor
Porcentagem acumulada de crianças com peso em relação a idade por décimos da distribuição da renda:
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100Décimos da distribuição da renda per capita
porc
enta
gem
de
cria
nças
Hundredths of the per capita income distribution
Percen
tage
ofchild
ren(%
)
Cumulative percentage of children with inadequate weight/age ratioamong the poorest hundredths of the income distribution: Brazil, 2006
B. Malnutrition and food insecurity
Extremepoor
Extreme poverty line
Over two thirds of the households with food insecurityare not extremely poor
Proporção de domicílios com segurança alimentar entre os décimos mais pobres da distribuição da renda per capita
0
10
20
30
40
50
60
70
80
90
100
0 10 20 30 40 50 60 70 80 90 100
Décimos da distribuição da renda per capita
Porc
enta
gem
de
dom
icíli
os (%
)
Fonte: Estimativas produzidas com base na Pesquisa Nacional por Amostra de Domicílios (PNAD) de 2004.
Hundredths of the per capita income distribution
Shareof
househ
olds
(%)
Cumulative percentage of households with food insecurity among thepoorest hundredths of the per capita income distribution: Brazil, 2004
B. Malnutrition and food insecurity
Extremepoor
Extreme poverty line
Relação entre a proporção de crianças abaixo da altura recomendada e a porcentagem de pessoas em famílias com renda per capita abaixo da
linha de extrema pobreza
0
5
10
15
20
25
30
35
40
45
50
0 5 10 15 20 25 30 35 40 45 50
Porcentagem de pessoas em famílias extremamente pobres (%)
Porc
enta
gem
de
cria
nças
aba
ixo
da a
ltura
re
com
enda
da (%
)
Fonte: Estimativas produzidas com base no Human Development Report (2007-2008) PNUD.Universo: Países do mundo para os quais há dados disponíveis no HDR.
Brasil Observado
Brasil Predito
Percentage of people who belong to extreme poor families (%)
Percen
tage
ofchild
renwith
height
byagebe
lowthe
recomen
ded(%
)
PredictedBrazil
ObservedBrazil
Percentage of children below the recommended height by age byextreme poverty headcount
Countries with the same degree of extreme poverty as Braziltend to show higher degrees of malnutrition.
More effective solidarity networks?
B. Malnutrition and food insecurity
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Programa Nacional de Suplementação de Vitamina A
Prevenção e Controle de Distúrbios de Deficiência de Iodo �–Pro Iodo
Iniciativa Hospital Amigo da Criança IHAC
Bancos de Leite Humano
Estratégia Amamenta e Alimenta Brasil
Programa do Leite
Major Nutritional Federal Programs
B. Malnutrition and food insecurity
C. Reproductiveand Sexual Health
C. Reproductive and sexual health
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C. Reproductive and sexual health
Treatment (drugs) R$ 770million
Prevention (drugs) R$ 96million
Control, prevention andmonitoring
R$ 395million
Total R$1,261million
HIV/AIDS and Other Sexually TransmittedDiseases: Brazilian Annual Budget
C. Reproductive and sexual health
Early motherhood (15 to 17 yearls old) in BrazilianMunicipalities: 1991
LEGENDA
Source: HDI M Atlas
Early motherhood (15 to 17 yearls old) in BrazilianMunicipalities: 2010
LEGENDA
Source: HDI M Atlas
C. Reproductive and sexual health
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C. Reproductive and sexual health
C. Reproductive and sexual health
C. Reproductive and sexual health