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Annotated Bibliography on Equity in Health, 1980-2001
James A Macinko, Barbara Starfield
International Journal for Equity in Health , 2002, DOI: 10.1186/1475-9276-1-1
Abstract: The purposes of this bibliography are to present an overview of the published literature on equity in health and to summarize key articles relevant to the mission of the International Society for Equity in Health (ISEqH). Equity, as defined by the ISEqH, is: "the absence of potentially remediable, systematic differences in one or more aspects of health across socially, economically, demographically, or geographically defined population groups or subgroups." [1]The intent is to show the directions being taken in health equity research including theories, methods, and interventions to understand the genesis of inequities and their remediation. Therefore, the bibliography includes articles from the health equity literature that focus on mechanisms by which systematic differences arise and approaches to reducing them where and when they exist. Because the International Society for Equity in Health is collaborating with SEIH (Socioeconomic Inequalities in Health) group in the Netherlands to make available an indexed bibliography on the literature of social disparities and social variations in health, many of these articles are not included in this review.This bibliography is the result of a literature search on the National Library of Medicine's PubMed database http://www.ncbi.nlm.nih.gov/entrez/query.fcgi webcite conducted in Summer 2001. As a first step, the search was limited to English-language articles from any year, published in peer-reviewed journals, and containing the terms "equity" or "inequity" in their titles. The first search yielded 672 references. Deleting duplicates and incomplete references, and inspecting titles for relevance left a total of 414 articles eligible for inclusion in the review. The list of eligible articles was further reduced by soliciting suggestions from several well-known researchers in the area of health equity.To a considerable extent, the final choice of articles included was dictated by a decision to provide examples of different a
Horizontal equity in health care utilization in Brazil, 1998–2008
James Macinko, Maria Fernanda Lima-Costa
International Journal for Equity in Health , 2012, DOI: 10.1186/1475-9276-11-33
Abstract: Data are from nationally representative surveys repeated in 1998, 2003, and 2008. We apply established methods for assessing horizontal inequity in healthcare access (the principle that people with the same healthcare needs should have similar access to healthcare services). Horizontal inequity is calculated as the difference between observed healthcare utilization and utilization predicted by healthcare needs. Outcomes examined include the probability of a medical, dental, or hospital visit during the past 12?months; any health service use in the past two weeks; and having a usual source of healthcare. We use monthly family income to measure differences in socioeconomic position. Healthcare needs include age, sex, self-rated health, and chronic conditions. Non-need factors include income, education, geography, health insurance, and Family Health Strategy coverage.The probability of having at least one doctor visit in the past 12?months became substantially more equitable over time, ending with a slightly pro-rich orientation in 2008. Any hospitalization in the past 12?months was found to be pro-poor in all periods but became slightly less so in 2008. Dental visits showed the largest absolute decrease in horizontal inequity, although they were still the most inequitably (pro-rich) distributed outcome in 2008. Service use in the past two weeks showed decreased inequity in 2003 but exhibited no significant change between 2003 and 2008. Having a usual source of care became less pro-rich over time and was nearly income-neutral by 2008. Factors associated with greater inequities include income, having a private health plan, and geographic location. Factors associated with greater equity included health needs, schooling, and enrolment in the Family Health Strategy.Healthcare utilization in Brazil appears to have become increasingly equitable over the past 10?years. Although this does not imply that equity in health outcomes has improved correspondingly, it does suggest th
La renovación de la atención primaria de salud en las Américas
Macinko,James; Montenegro,Hernán; Nebot Adell,Carme; Etienne,Carissa; ,;
Revista Panamericana de Salud Pública , 2007, DOI: 10.1590/S1020-49892007000200003
Abstract: at the 2003 meeting of the directing council of the pan american health organization (paho), the paho member states issued a mandate to strengthen primary health care (resolution cd44.r6). the mandate led in 2005 to the document "renewing primary health care in the americas. a position paper of the pan american health organization/who [world health organization]," and it culminated in the declaration of montevideo, an agreement among the governments of the region of the americas to renew their commitment to primary health care (phc). scientific data have shown that phc, regarded as the basis of all the health systems in the region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. the new, global health paradigm has given rise to changes in the population's health care needs. health services and systems must adapt to address these changes. building on the legacy of the international conference on primary health care, held in 1978 in alma-ata (kazakhstan, union of soviet socialist republics), paho proposes a group of strategies critical to adopting phc-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. the main objective of the strategies is to develop and/or strengthen phc-based health systems in the entire region of the americas. a substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. this document explains the strategies that must be employed at the national, subregional, regional, and global levels.
Predictors of 10-year hospital use in a community-dwelling population of Brazilian elderly: the Bambuí cohort study of aging
Macinko, James;Camargos, Vitor;Firmo, Josélia O. A.;Lima-Costa, Maria Fernanda;
Cadernos de Saúde Pública , 2011, DOI: 10.1590/S0102-311X2011001500003
Abstract: we use data from a population-based cohort of elderly brazilians to assess predictors of hospitalizations during ten years of follow-up. participants were 1,448 persons aged 60 years and over at baseline (1997). the outcome was self-reported number of hospitalizations per year. slightly more than a fifth (23%) experienced no hospitalizations during the 10 year follow-up. about 30% had 1-2 events, 31% had between 3 and 7 events, and about 18% had 8 or more events during this time. results of multivariable hurdle and cox proportional hazards models showed that the risk of hospitalization was positively associated with male sex, increased age, chronic conditions, and visits to the doctors in the previous 12 months. underweight was a predictor of any hospitalization, while obesity was an inconsistent predictor of hospitalization.
Tendências em dez anos das condi??es de saúde de idosos brasileiros: evidências da Pesquisa Nacional por Amostra de Domicílios (1998, 2003, 2008)
Lima-Costa,Maria Fernanda; Matos,Divane Leite; Camargos,Vitor Passos; Macinko,James;
Ciência & Saúde Coletiva , 2011, DOI: 10.1590/S1413-81232011001000006
Abstract: data from a representative national household survey were used to examine 10-year trends (1998-2008) in health conditions of brazilian elderly. a random sample of 105,254 individuals aged > 60 years participated. the mean age was 69 years and 56% were women. there was a gradual increase in the prevalence of good or excellent self-rated health (39.3%, 43.5% and 45.0%, in 1998, 2003 and 2008, respectively) and a decrease in self-reported arthritis, heart disease, and depression. the prevalence of self-reported hypertension (43.9%, 48.8%, and 53.3%, respectively) and diabetes (10.3%, 13.0% and 16.1% respectively) increased sharply. the prevalence of inability to perform activities of daily living (eating, bathing or using the toilet) remained stable (6.5%, 6.4% and 6.9%, respectively). the achievement of three or more physician visits over the previous 12 months increased by 21% from 1998 to 2008. hospitalization decreased by 10% in the corresponding period. the above mentioned trends persisted after adjustments for age and sex. the results showed improvements in some health dimensions of the elderly, but not all. changes in the use of health services occurred as expected with the expansion of primary healthcare activities in brazil.
Who experiences discrimination in Brazil? Evidence from a large metropolitan region
Macinko James,Mullachery Pricila,Proietti Fernando A,Lima-Costa Maria Fernanda
International Journal for Equity in Health , 2012, DOI: 10.1186/1475-9276-11-80
Abstract: Introduction Perceived discrimination is related to poor health and has been offered as one explanation for the persistence of health inequalities in some societies. In this study, we explore the prevalence and correlates of perceived discrimination in a large, multiracial Brazilian metropolitan area. Methods The study uses secondary analysis of a regionally representative household survey conducted in 2010 (n=12,213). Bivariate analyses and multiple logistic regression assess the magnitude and statistical significance of covariates associated with reports of any discrimination and with discrimination in specific settings, including when seeking healthcare services, in the work environment, in the family, in social occasions among friends or in public places, or in other situations. Results Nearly 9% of the sample reported some type of discrimination. In multivariable models, reports of any discrimination were higher among people who identify as black versus white (OR 1.91), higher (OR 1.21) among women than men, higher (OR 1.33) among people in their 30’s and lower (OR 0.63) among older individuals. People with many health problems (OR 4.97) were more likely to report discrimination than those with few health problems. Subjective social status (OR 1.23) and low social trust (OR 1.27) were additional associated factors. Perceived discrimination experienced while seeking healthcare differed from all other types of discrimination, in that it was not associated with skin color, social status or trust, but was associated with sex, poverty, and poor health. Conclusions There appear to be multiple factors associated with perceived discrimination in this population that may affect health. Policies and programs aimed at reducing discrimination in Brazil will likely need to address this wider set of interrelated risk factors across different populations.
Diferenciais intra-urbanos de vulnerabilidade da popula??o idosa
Braga, Luciana de Souza;Macinko, James;Proietti, Fernando Augusto;César, Cibele Comini;Lima-Costa, Maria Fernanda;
Cadernos de Saúde Pública , 2010, DOI: 10.1590/S0102-311X2010001200009
Abstract: this study examined the adequacy of a health vulnerability index (hvi) for identifying intra-urban differences in vulnerability in the elderly population. study participants (n = 1,055) were selected by probabilistic sampling of residents in the city of belo horizonte, minas gerais state, brazil, aged 60 years or older (mean = 70.1 years). the hvi was constructed with indicators of socioeconomic conditions and premature mortality at the census tract level. based on its location and hvi value, each participant's household was classified as low, medium, or high-risk. results of multivariate ordinal logistic regression models showed graded and statistically significant associations between the household's risk level and the social and physical environment, health conditions and behaviors, and health service needs (adjusted prevalence ratios ranging from 1.17; 95%ci: 1.02-1.34 to 1.65; 95%ci: 1.45-1.88). the hvi appears to be a useful instrument for identifying health and social service needs among the elderly.
Principais causas de interna??o por condi??es sensíveis à aten??o primária no Brasil: uma análise por faixa etária e regi?o
Moura, Bárbara Laisa Alves;Cunha, Renata Castro da;Aquino, Rosana;Medina, Maria Guadalupe;Mota, Eduardo Luís Andrade;Macinko, James;Dourado, Inês;
Revista Brasileira de Saúde Materno Infantil , 2010, DOI: 10.1590/S1519-38292010000500008
Abstract: objectives: to analyze the main reasons for admission to hospital of patients who could be treated by the brazilian primary care system (icsap) by age group and region between 1999 and 2006. methods: a mixed ecological study was carried out of the main three reasons for icsap in those aged under 20 years. secondary data were gathered from the hospital information system (sih-sus) and the brazilian institute of geography and statistics' 2001 population census (ibge). results: the three main reasons for icsap, in those aged under twenty years, were gastroenteritis, asthma and bacterial pneumonia. there was a reduction in the hospitalization rate for gastroenteritis (-12.0%) and asthma (-31.8%) and an increase of 142.5% in admissions to hospital for bacterial pneumonia, and these trends took a distinct form for each age group and region. conclusions: the description of the trends over time revealed positive changes in the rates of admission to hospital for asthma and infectious gastroenteritis and negative changes in the case of pneumonia. since these health problems are a high priority for primary health care, these findings show the need to undertake more in-depth analysis and reflect further on the determining factors underlying this pattern of admissions to hospital in the country.
Interna??es por condi??es sensíveis à aten??o primária: a constru??o da lista brasileira como ferramenta para medir o desempenho do sistema de saúde (Projeto ICSAP - Brasil)
Alfradique, Maria Elmira;Bonolo, Palmira de Fátima;Dourado, Inês;Lima-Costa, Maria Fernanda;Macinko, James;Mendon?a, Claunara Schilling;Oliveira, Veneza Berenice;Sampaio, Luís Fernando Rolim;Simoni, Carmen de;Turci, Maria Aparecida;
Cadernos de Saúde Pública , 2009, DOI: 10.1590/S0102-311X2009000600016
Abstract: ambulatory care sensitive hospitalizations are a set of conditions for which access to effective primary care can reduce the likelihood of hospitalization. these hospitalizations have been used as an indicator of primary care performance in several countries and in three brazilian states, but there is little consensus on which conditions should be included in this indicator. this paper presents a description of the steps undertaken to construct and validate a list for brazil. the final list includes 20 groups of diagnostic conditions that represented 28.3% of a total of 2.8 million hospitalizations in the national unified health system in 2006. gastroenteritis and complications, congestive heart failure, and asthma represented 44.1% of all ambulatory care sensitive hospitalizations. from 2000 to 2006, ambulatory care sensitive hospitalizations decreased by 15.8%, and this reduction was more significant than that observed in all other hospitalizations. the article concludes with potential applications and limitations of the proposed brazilian list.
Uma metodologia de avalia??o do desempenho do sistema de saúde brasileiro
Viacava,Francisco; Almeida,Célia; Caetano,Rosangela; Fausto,Márcia; Macinko,James; Martins,M?nica; Noronha,José Carvalho de; Novaes,Heligonda Maria Dutilh; Oliveira,Eliane dos Santos; Porto,Silvia Marta; Silva,Ligia M Vieira da; Szwarcwald,Célia Landmann;
Ciência & Saúde Coletiva , 2004, DOI: 10.1590/S1413-81232004000300021
Abstract: this paper is the result of a brazilian multidisciplinary public health working group and consists of a methodology developed to: a) identify the factors that influence the efficiency, effectiveness, and equity of the brazilian public health system and understand how these factors function; b) improve the formulation of health policies; and c) monitor inequalities in access to and quality of health services among different population groups in brazil. the methodology developed here is based on australian and canadian and paho proposals that use a "dashboard" approach, allowing one to examine and evaluate simultaneously multiple dimensions of health system performance. this article describes the experience of adapting and developing the methodology and provides suggestions on how such a system might be employed to improve health policy-making in brazil.
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