Public health interventions and their impact on social inequalities in health

Authors

  • José Leopoldo Ferreira Antunes Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia

DOI:

https://doi.org/10.1590/0103-20702015018

Abstract

This article summarizes the evaluation of three public health programs in relation to their efficacy and impact on social inequalities in health. These programs involved the fluoridation of the public water supply in the Brazilian context, the provision of antiretroviral therapeutics to Aids patients, and the distribution of flu vaccinations to elderly people in São Paulo. These three interventions were judged to be effective insofar as they led to a reduction in disease among the population. However, they achieved conflicting results in terms of their impact on inequalities in health. The article concludes that public health programs need to be implemented with an immediately and effectively universal reach, channelling additional resources to those groups with greater health needs. This strategy would simultaneously reduce the overall level of illness in the population and of inequalities in how diseases are experienced among different social strata.

Downloads

Download data is not yet available.

References

Antunes, José Leopoldo F. & Narvai, Paulo C. (2010), “Políticas de saúde bucal no Brasil e seu impacto sobre as desigualdades em saúde”. Revista de Saúde Pública, 44 (2): 360-365.

Antunes, José Leopoldo F.; Waldman, Eliseu A. & Borrell, Carme. (2005), “Is it possible to reduce Aids deaths without reinforcing socioeconomic inequalities in health?”. International Journal of Epidemiology, 34 (3): 586-592.

Antunes, José Leopoldo F.; Waldman, Eliseu A.; Borrell, Carme & Paiva, Teresinha M. (2007), “Effectiveness of influenza vaccination and its impact on health inequalities”. International Journal of Epidemiology, 36 (6): 1319-26.

Bastos, Francisco I. & Barcellos, Christovam. (1995), “Geografia social da Aids no Brasil”. Revista de Saúde Pública, 29 (1): 52-62.

Brasil. (2010a); Pesquisa Nacional de Saneamento Básico 2008. Rio de Janeiro, Fundação Instituto Brasileiro de Geografia e Estatística, Coordenação de População e Indicadores Sociais.

______. (2010b); Saúde Brasil 2010: Uma análise da situação de saúde e de evidências selecionadas de impacto de ações de vigilância em saúde. Brasília, Ministério da Saúde, Secretaria de Vigilância em Saúde.

______. (2013), Atlas do Censo Demográfico 2010. Rio de Janeiro, ibge.

Burt, Brian A. (2002), “Fluoridation and social equity”. Journal of Public Health Dentistry, 62 (4): 195-200.

Centers for Diseases Control and Prevention. (1999), “Achievements in public health, 1900-1999: fluoridation of drinking water to prevent dental caries”. Morbidity and Mortality Weekly Report, 44 (rr-13): 1-40.

Chequer, Pedro; Cuchí, Paloma; Mazin, Rafael & Calleja, Jesus M. G. (2002), “Access to antiretroviral treatment in Latin American countries and the Caribbean”. Aids, 16 (3): S50-7.

Egger, Matthias; Boulle, Andrew; Schechter, Mauro & Miotti, Paolo. (2005), “Antiretroviral therapy in resource-poor settings: scaling up inequalities?”. International Journal of Epidemiology, 34 (3): 509-512.

Fonseca, Maria G.; Bastos, Francisco I.; Derrico, Monica; Andrade, Carla L. T.; Travassos, Cláudia & Szwarcwald, Célia L.(2000), “Aids e grau de escolaridade no Brasil: evolução temporal de 1986 a 1996”. Cadernos de Saúde Pública, 16 (1): 77-87.

Freire, Maria do Carmo M.; Reis, Sandra C. G. B.; Figueiredo, Nilcema; Peres, Karen G.; Moreira, Rafael S. & Antunes, José Leopoldo F. (2013), “Determinantes individuais e contextuais da cárie dentária em crianças brasileiras de 12 anos em 2010”. Revista de Saúde Pública, 47 (3): 40-49.

Frias, Antonio C.; Narvai, Paulo C.; Araujo, Maria E.; Zilbovicius, Celso & Antunes, José Leopoldo F. (2006), “Custo da fluoretação das águas de abastecimento público (estudo de caso): Município de São Paulo, Brasil, período de 1985-2003”. Cadernos de Saúde Pública, 22 (6): 1237-1246.

Gutierrez, Eliana B.; Li, Ho Y.; Santos, Ana Catarina S. & Lopes, Marta H. (2001), “Effectiveness of influenza vaccination in elderly outpatients in São Paulo city, Brazil”. Revista do Instituto de Medicina Tropical de São Paulo, 43 (6): 317-320.

Jefferson, T.; Rivetti, D.; Rivetti, A.; Rudin, M.; Di Pietrantonj, C. & Demicheli, V. (2005), “Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review”. Lancet, 366 (9492): 1165-1174.

Jones, C. M.; Taylor, G. O.; Whittle, J. G.; Evans, D. & Trotter, D. P., C. M. (1997), “Water fluoridation, tooth decay in 5 year olds and social deprivation measured by the Jarman score: analysis of data from British dental surveys”. British Medical Journal, 315: 514-517.

Lowndes, Catherine M.; Bastos, Francisco I.; Giffin, Karen M.; Reis, Ana C. G. V.; D’orsi, Eleonora & Alary, Michel. (2000), “Differential trends in mortality from Aids in men and women in Brazil (1984-1995)”. Aids, 14 (9): 1269-1273.

Murray, John J. ([1985] 2003), “Fluoride and dental caries”. In: Murray, John J.; Nunn, June H. & Steele, James G. (orgs.). Prevention of oral disease. Oxford, Oxford University Press.

Narvai, Paulo C. (2000), “Cárie dentária e flúor: uma relação do século xx”. Ciência & Saúde Coletiva, 5 (2): 381-392.

Narvai, Paulo C.; Frazão, Paulo; Roncalli, Angelo G. & Antunes, José Leopoldo F. (2006), “Cárie dentária no Brasil: declínio, iniquidade e exclusão social”. Revista Panamericana de Salud Pública, 19 (6): 385-393.

Paiva, Vera; Ayres, José Ricardo; Buchalla, Cássia M. & Hearst, Norman. (2002), “Building partnerships to respond to hiv/Aids: non-governmental organizations and universities”. Aids, 16 (3): S76-S82.

Peres, Marco A.; Antunes, José Leopoldo F. & Peres, Karen G. (2006),“Is water fluoridation effective in reducing inequalities in dental caries distribution in developing countries?” Sozial- und Präventivmedizin, 51 (5): 302-310.

Projeto sb Brasil 2003. (2004), Condições de saúde bucal da população brasileira 2002-2003, resultados principais. Brasília, Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Coordenação Nacional de Saúde Bucal.

Ramadan, Páris A.; Araújo, Francisco B & Ferreira Jr., Mario. (2001), “A 12-month follow-up of an influenza vaccination campaign based on voluntary adherence: report on upper-respiratory symptoms among volunteers and non-volunteers”. São Paulo, Medical Journal, 119 (4): 142-145.

Rose, Geoffrey, Khaw, Kay-Tee & Marmot, Michael. (2008), Rose’s strategy of preventive medicine. Oxford, Oxford University Press.

Simonsen, Lone et al. (2005), “Impact of influenza vaccination on seasonal mortality in the us elderly population”. Archives of Internal Medicine, 165: 265-272.

Smith, George D. (2005), “Infection, medical care and inequalities”. International Journal of Epidemiology, 34 (3): 507-508.

Victora, César G.; Vaughan, J. Patrick, Barros, Fernando C.; Silva, Anamaria C. & Tomasi, Elaine. (2000), “Explaining trends in inequities: evidence from Brazilian child health studies”. Lancet, 356: 1093-1098.

Wood, Evans, Montaner, Julio S. G.; Chan, Keith; Tyndall, Mark W.; Schechter, Martin T.; Bangsberg, David, O’Shaughnessy, Michael V. & Hogg, Robert S. (2002), “Socioeconomic status, access to triple therapy, and survival from hiv-disease since 1996”. Aids, 16 (15): 2065-2072.

Published

2015-06-01

Issue

Section

Dossier - Social Health

How to Cite

Antunes, J. L. F. (2015). Public health interventions and their impact on social inequalities in health . Tempo Social, 27(1), 161-175. https://doi.org/10.1590/0103-20702015018