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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Demography: The
Federative Republic of Brazil, with a surface of 8.5 million km2
and a population of 169.6 million in 2000, has an average population density
of 19.8 per km2, with values ranging from 77.9 in the Southeast to
3.3 per km2 in the North. Urban areas comprised 81.2% of the population
in 2000. The government system is democratic with a president as head of state.
The countries political-administrative organization comprises 26 states. The
legislative branch, the executive, and the judicial branch govern the country
jointly. The Federal Constitution of 1988 consolidated the return of the democratic
government after two decades of military regimes.
Economy:
The estimated per capita income in 1999 was US$ 4,271 and the level of poverty
was 28%. In 2000, the total fertility rate decreased to 2.3 children per woman,
and life expectancy at birth increased to 64.8 years for men and to 72.6 years
for women. From 1991 to 1999, the adult population aged 60 years and older grew
by more than a percent of the total male population and by almost 2% of the
total female population. As of the late 1990s, the economically active population
was around 80 million. Women in the workforce, increasing since the 1960s, reached
38.5% in 1999, while the proportion of workers between 10 to 14 years old decreased
from 16.9% to 13.2% between 1995 and 1999. Access to school, which was ensured
by the network of public education in 1999, covered 93% of the demand in the
first four years of primary school and 87% in secondary school.
Mortality: The
mortality information system registered almost one
million deaths annually in the country as a whole.
The proportion of deaths attributed to ill-defined
causes fell 25% in the last 10 years; in 1998 it
was around 15% overall. Male deaths (55% of total
deaths) were greater in virtually all age groups
than female deaths. The distribution by age reveals
that the number of deaths of children under one
year as a proportion of all deaths decreased from
24% in 1980 to 8% in 1998. Diseases of the
circulatory system (1/3 of all deaths annually)
continued to be the leading cause in all regions.
The mortality rates per 100,000 population were
158.4 for diseases of the circulatory system, 72.2
for external causes, 68.5 for neoplasms, and 51.9
for communicable diseases.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children:
In 1999, infant mortality was 33 per 1,000 live births - 30% below the 1990
rate of 48 per 1,000. Substantial inequalities exist in infant mortality among
regions and states. The Northeast registered high rates throughout the period,
while the opposite occurred in the South. Among children aged 1-4 years, the
leading causes of death in 1998 were communicable diseases (43.0%), external
causes (22.5%), diseases of the respiratory system (8.2%), acute diarrheal diseases
and acute respiratory infections (7% each).
Schoolchildren: Fewer
than 0.6% of all deaths occurred in this age group, where 46% of the deaths
were caused by accidents and violence, followed by communicable diseases (18%)
and malignant neoplasms (13%).
Adolescents:
In 1998, 47% of deaths in those aged 10-14 years and 68% of those aged 15 to
19 years were due to external causes, mainly by homicide. In 1998, adolescents
10-19 years of age comprised 24% of all deliveries and 0.9% of all live births
were in the age group 10-14 years of age.
Adults: The
male mortality rate 471 per 100,000 males was double that of females, 209 per
100,000 females. The leading causes of death were: external causes (32%), diseases
of the circulatory system (23%), and malignant neoplasms (14%). The average
maternal mortality is estimated around 127 deaths per 100,000 live births. In
1999, excluding hospitalization related to pregnancy, childbirth and puerperium,
(41%), principal reasons for hospitalization were diseases of the digestive
system (13.9%), genitourinary system (13.7%) and circulatory system (11.0%)
were.
Elderly: In
1998, diseases of the circulatory system (46%), malignant neoplasms (17%) and
respiratory diseases (11%) were the leading defined causes of death. A high
percentage of deaths were attributed to ill-defined causes (18%), and this percentage
tended to rise in the oldest subgroups of the elderly population. Older adults
represented 18% of hospitalizations in the public health system in 2000, where
leading causes were diseases of the circulatory systems (28%), respiratory system
(20%) and digestive system (10%).
Disabled: According
to data from 1991, the prevalence rate of disabled persons is 1.1% of the total
population.
Indigenous and other special groups:The indigenous population 350,000 constituted only
0.2% of the total population. Their health situation is characterized by a high
incidence and mortality from malaria, tuberculosis and other respiratory diseases,
and vaccine-preventable diseases. Since 1999, indigenous health care is under
the direct responsibility of the Ministry of Health.
Analysis by type of health problem Vector-borne diseases: In
1999, 632,600 new cases of malaria were recorded, the greatest number since
the seventies. Between 1986 and 1998 malaria mortality was reduced from 0.7
to 0.1 deaths per 100,000 population. A dengue epidemic hit its peak in 1998,
with nearly 570,000 reported cases. In 1999 and 2000 there were nearly 4,000
cases each year of visceral leishmaniasis and in 2000 there were 34,513 cases
of cutaneous leishmaniosis reported.
Vaccine-preventable diseases:In
1997, a measles epidemic occurred with 53,664 cases and 61 deaths especially
affecting young adults, who were not part of the immunization target group.
Between 1999-2000 the number of confirmed cases of measles declined 95% from
890 to 36. The number of rubella cases reported in 1999 and 2000 remained at
about 14,000 annually. The incidence among adults aged 20-29 increased from
5.7 per 100,000 in 1999 to 11.9 in 2000. In 1989, the last cases of poliomyelitis
were recorded. In 1994, the interruption of the transmission of poliomyelitis
was certified. In 1999, 66 cases of neonatal tetanus were reported and 41 in
2000. Diphtheria manifested little variation from 56 to 54 cases in 1999 and
2000. In 2000 there were 4,263 reported cases of hepatitis B.
Chronic communicable diseases: In
1999 there were reported 78,870 cases of tuberculosis of all forms, with a incidence
rate of 48.1 cases per 100,000 population.
Leprosy: Leprosy
remains an important problem, with a prevalence rate of 4.9 cases per 10,000
population in 1998 with 78,000 patients recorded.
Acute Respiratory Infections (ARIs): ARIs
are among the leading causes of morbidity and mortality of children under five
years of age.
HIV/AIDS: In
1997, 23,172 new cases and 7,545 deaths were confirmed. The male:female ratio
of new cases was 2:1 in 1999.
Sexually transmitted infections:A
total of 166 deaths from syphilis in 1999 were reported. In 1998, the average
rate of congenital syphilis was 1.2 cases per 10,000 live births.
Intestinal infectious diseases: In 1999, 4,620
cases of cholera were reported. In 2000, only 753 cases were reported, the lowest
number since 1991. Mortality from acute gastroenteritis declined from 9,391
deaths in 1996 to 7,214 in 1999.
Zoonoses: Cases
of rabies were 26 human cases and 1,227 canines reported in 1999; There were
also 26 human cases reported in 2000. During 1986-2000, 83 cases of human rabies
were transmitted by bats (6.3% of the total). During 1995-2000, 22,651 cases
and 1,951 deaths of leptospirosis were registered.
Accidents and violence: Nearly
15% of deaths from defined causes are due to external causes, which accounted
for the highest rate in 1996 (76 per 100,000). While the overall rates are declining,
significant inequalities exist in their distribution by cause, age, and sex.
Malignant neoplasms: In
1999, cancer mortality was 75.5 deaths per 100,000 males and 62.5 deaths per
100,000 females. Among men, the lung was the leading site for cancer mortality
(12 per 100,000) followed by stomach and prostate. Among women, breast cancer
remained the leading site for cancer mortality, followed by lung and the cervix.
Diseases of the circulatory system: The
leading causes of mortality were due to ischemic heart diseases (25% of total
deaths) and cerebrosvascular diseases (34%). This group of diseases was the
third leading cause of hospitalization in the public health care system (10%
of hospitalizations).
Diabetes mellitus:
In 1999, diabetes caused 31,000 deaths or 3.4% of total mortality.
Malnutrition and obesity: In
1996, the average prevalence of malnutrition among children under 5 was 5.7%.
The average prevalence of acute malnutrition among children under 5 was 2.3%.
The prevalence of stunting (height for age) was around 10.5%. The prevalence
of obesity has increased among children and adults of both sexes in all regions
and income levels. The most important nutritional deficiency is iron deficiency,
which is found in all regions. The prevalence in preschool children ranges from
48% to 51%.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:The national health policy is based on the Federal
Constitution of 1988, which sets out the principles and directives for the delivery
of health care in the country through the Unified Health System (SUS). Under
the constitution, the activities of the federal government are to be based on
multiyear plans approved by the national congress for four-year periods. The
essential objectives for the health sector were improvement of the overall health
situation, with emphasis on reduction of child mortality, and political-institutional
reorganization of the sector, with a view to enhancing the operative capacity
of the SUS. The plan for the next period (2000-2003) reinforces the previous
objectives and prioritizes measures to ensure access at activities and services,
improve care, and consolidate the decentralization of SUS management.
Health sector reform: The
current legal provisions governing the operation of the health system, instituted
in 1996, seek to shift responsablilty for administration of the SUS to municipal
governments, with technical and financial cooperation from the federal government
and states. Another regionalization initiative is the creation of health consortia,
which pools the resources of several neighboring municipalities. An important
instrument of support for regionalization is the Project to Strengthening and
Reorganization the SUS.
Regulatory actions: Procedures
for the registration, control, and labeling of foods are established under federal
legislation, which assigns specific responsibilities to the health and agriculture
sectors. In the health sector, health inspection activities have been decentralized
to the state and municipal governments. The environmental policy derives from
specific legislation and from the Constitution of 1998.
Public health care services: The
main strategy for strengthening primary health care is the Family Health Program,
introduced by the municipal health secretariats in collaboration with the states
and the Ministry of Public Health. The federal government supplies technical
support and transfers funding through Piso de Atençao Básica. Disease prevention
and control activities follow guidelines established by technical experts in
the Ministry of Public Health. The National Epidemiology Center (CENEPI), an
agency of the National Health Foundation (FUNASA) coordinates the national epidemiological
surveillance system, which provides information about and analysis of the national
health situation.
Individual health care services:In
1999, 66% of the country's 7,806 hospitals, 70% of its 485,000 hospital beds,
and 87% of its 723 specialized hospitals belonged to the private sector. In
the area of diagnostic support and therapy, 95% of the 7,318 establishments
were also private. 73% of the 41,000 ambulatory care facilities were operated
by the public.Hospital beds in the public
sector were distributed as follows: surgery (21%), clinical medicine (30%),
pediatrics (17%), obstetrics (14%), psychiatry (11%) and other areas (7%). In
the same year, 43% of public hospital beds, and half the hospital admissions
were in municipal establishments. Since 1999, the Ministry of Public Health
has been carrying out a health surveillance project in Amazonia that includes
epidemiological and environmental health surveillance, indigenous health and
disease control components. With US 600 million dollars from a World Bank loan,
efforts are being made to improve the operational infrastructure, training of
human resources and research studies. An estimated 25% of the population is
covered by at least one form of health insurance; 75% of the insurance plans
are offered by commercial operators and companies with self-managed plans.
Health Supplies:
Brazil is among the greatest consumers markets for drugs, accounting for 3.5
% share of the world market. To expand the access of the population to drugs,
incentives have been offered for marketing generic products, which cost an average
of 40% less than brand-name products. In 2000, there were 14 industries authorized
to produce generic drugs and about 200 registered generic drugs were being produced
in 601 different forms. In 1998, the National Drug Policy was approved, whose
purpose is to ensure safety, efficacy, and quality of drugs, as well as the
promotion of rational use and access for the population to essential products.
The responsibility for national production of immunobiologicals is entrusted
to public laboratories; which have a long-standing tradition of producing vaccines
and sera for use in official programs. The Ministry of Public Health invested
some US$ 120 million in the development of the capacity of these laboratories.
In 2000, the supply of products was sufficient to meet the need for heterologous
sera, such as those used in the vaccines against tuberculosis, measles, diphtheria,
tetanus, whooping cough, yellow fever, and rabies. In 1999, quality control
of the transfused blood consisted of 26 coordinating centers and by 44 regional
centers.
Human resources: In
1999, the country had some 237,000 physicians, 145,000 dentists, 77,000 nurses,
26,000 dietitians and 56,000 veterinarians. The national average ratio was of
14 physicians per 10,000 population. In 1999, of the 665,000 professional positions,
65 % were occupied by physicians, followed by nurses (11%), dentists (8%), pharmacists,
biochemists (3.2%), physical therapists (2.8%) and by other professionals (10%).
An estimated 1.4 million health sector jobs are occupied by technical and auxiliary
personnel.
Health sector expenditure: In
1998 national health expenditure amounted to US$ 62,000 million, which corresponded
to nearly 7.9% of GDP. Of that total, public spending accounted for 41.2 % and
private expenditure accounted for 58.8%. In per capita terms, public spending
is estimated at US$ 158 and private expenditure at US$ 225.
Technical cooperation: Technical
cooperation projects are carried out with different countries, as well as with
the World Bank and UNESCO among many others. International foundations also
provide direct financing for projects or individuals. Brazil is also engaged
in an intense exchange with the MERCOSUR countries, aimed at establishing common
health regulations.
