Are there regional inequalities in life expectancy in Brazil?

Responsible researcher: Silvio da Rosa Paula

Article title: REDUCING SOCIOECONOMIC INEQUALITIES IN LIFE EXPECTANCY

AMONG MUNICIPALITIES: THE BRAZILIAN EXPERIENCE

Article authors: Antonio Fernando Boing, SV Subramanian and Alexandra Crispim Boing

Location of intervention: Brazil

Sample size: Brazilian population in the 1991, 2000 and 2010 censuses

Big topic: Health

Type of Intervention: Assessment of the impact of socioeconomic and regional inequalities

Variable of main interest: Life expectancy at birth

Assessment method: Poisson Regression

Assessment Context

Between the 1990s and 2000s, Brazil underwent important economic and social changes. In the context of health, the 1988 constitution universalized access to health with the creation of the Unified Health System – SUS, ensuring that all Brazilians had access to health services. Currently, the SUS is the largest public and universal health system in the world, and covers even the most complex levels of health care, providing services ranging from immunizations to organ transplants (PAIM et al . 2011). The decentralization of the provision of health services to the municipal level impacted primary care coverage and generated effects on local health. Studies find evidence that the expansion of primary care promoted by the SUS is associated with a reduction in deaths from preventable causes, fewer hospitalizations, a reduction in racial inequalities in mortality, and a reduction in infant mortality (MACINKO et al . 2010; GUANAIS 2015; HONE et al . 2017a, 2017b).

In 1994, with the creation of the Real plan, Brazil managed to contain the hyperinflation process and stabilize the economy, factors that were later important for the appreciation of the minimum wage, reduction of unemployment, creation and expansion of social programs. From this perspective, in the 2000s, there was an expansion of social programs. The main program is Bolsa Família (BF), which, in general terms, aims to break the intergenerational cycle of poverty, through direct income transfer to families in situations of poverty or extreme poverty, which in return comply with certain conditions of health and education. Studies indicate BF contributed to the reduction of diseases such as tuberculosis and leprosy (Nery et al. 2014, 2017), increased children's visits to health centers for prevention services (Shei et al. 2014), and also contributed to reduce child mortality (Rasella et al. 2013).

In the field of education, advances were also observed, such as an increase in the educational level of the poorest population, as well as greater access to basic sanitation services, important factors that have a strong impact on health indicators, especially on children's health. . However, between 1985 and 1990 there was an increase of 4.1 percentage points (pp) in the Gini index, which measures income concentration. The same occurred for the period between 1998 and 2009, with an increase of 5.4 pp, indicating that there was an increase in income inequality for these periods.

Methodology

Data from demographic censuses from 1991, 2000 and 2010 were used, at municipal level. The municipalities were divided into percentiles according to the average per capita income, calculated in each of the three years analyzed. The method used to assess the impact of inequalities on life expectancy was Poisson regression. Briefly, Poisson regression is a probabilistic method, which plays an important role in the analysis of count data that assume non-negative integer values. An example of application is modeling the number of deaths due to traffic accidents. With this technique, it is possible to estimate the probability or expected number of deaths if the accident involves, for example, a motorcycle or a pedestrian.

Intervention Details

During the 20th century, there was a significant increase in life expectancy around the world. According to the OECD, it is estimated that in 1900 life expectancy was on average 30 years, and reached 71.4 years in 2015. In Brazil, life expectancy increased by almost 20 years between 1967 and 2015. However, significant inequalities in life expectancy are still observed between countries and also within each country. Studies carried out in the United States, the European Union, Japan and New Zealand find evidence of inequalities in life expectancy between their counties.

In the context of Brazil, the profound economic and social changes that occurred during the 1990s and 2000s, not only allowed the expansion of social programs, but also unequal economic growth between different regions, being stronger in developed regions than in poor areas of the country. country. It is from this perspective of accentuated inequalities that the study proposes to evaluate how the evolution of regional inequality in life expectancy occurred, as well as in the probability of living until 40 and 60 years of age, in Brazilian municipalities for the period from 1991 to 2010.

According to the Brazilian Institute of Geography and Statistics – IBGE, in 1940 the average life expectancy was 45.5 years, 42.9 for men and 48.3 years for women. Furthermore, in 1940, for every thousand people who reached the age of 65, 259 would reach the age of 80 or more. In 2017, for every thousand elderly people aged 65, 632 would turn 80. Also in 2017, life expectancy at birth showed significant differences between the federative units, as indicated in the graph provided by IBGE[1].

It is possible to observe that among the federative units Santa Catarina was the one with the highest life expectancy at 79.4 years, followed by Espírito Santo (78.5 years), Distrito Federal and São Paulo with (78.4 years), and Rio Grande do Sul (78 years old). On the other hand, the lowest life expectancy was observed in the state of Maranhão (70.6 years), followed by Piauí (71.2 years), Rondônia (71.5 years), and Roraima (71.8 years).

Finally, the most recent statistics from IBGE [2] indicate that a person born in Brazil in 2018 increased by three months and 4 days compared to 2017. Furthermore, the life expectancy of men increased by 72 .5 years in 2017, to 72.8 years in 2018, while that of women went from 79.6 to 79.9 years.

Results

The results found indicate that the average life expectancy in Brazilian municipalities increased by 8.8 years between 1991 and 2010. An increase of 6.7 percentage points (pp) in the probability of surviving until 40 years of age was also observed, and 12.2 pp in the probability of surviving until age 60.

The increase in life expectancy, as well as the probability of survival, generated a substantial drop in differences between regions and socioeconomic groups. For example, in 1991, inhabitants of municipalities that were among the richest 1% lived on average 11.6 years longer than inhabitants of municipalities that were among the poorest 1%. In 2010, this difference fell to 7.1 years. In the context of the probability of survival until the age of 40, the difference fell from 11.7 pp in 1991 to 1.2 pp in 2010. As for the probability of survival until the age of 60, this drop was from 1.3 pp in 1991 to 1.04 pp in 2010.

It is worth noting that during the period analyzed, no municipality showed a reduction in life expectancy or the probability of survival. However, while in the poorest municipalities there was a gain of around 12 years of life, among the richest municipalities this gain was around 7 years. Looking at the different periods, between 1991 and 2000, the richest municipalities benefited most, however, in the decade from 2000 to 2010, it was the poorest municipalities that saw the greatest gains in life expectancy.

Public Policy Lessons

Between 1991 and 2010, Brazil managed to significantly reduce municipal differences in life expectancy and the probability of living to 40 and 60 years of age. The reduction in inequalities was more pronounced in the 2000s and 2010s. Despite all the progress, Brazil continues to be one of the most unequal countries in the world, it is clear that there are no magical solutions or simple answers to the problem of inequality, however, there are points where we can move forward. For example, many of our public policies do not have clear objectives and were not designed to be evaluated, this implies a lot of wasted money, ineffective programs that often end up shadowed, making it difficult or even impossible to evaluate the effectiveness of a program. .

References

BOING, Antonio Fernando; SUBRAMANIAN, SV; BOING, Alexandra Crispim. Reducing socioeconomic inequalities in life expectancy among municipalities: the Brazilian experience. International journal of public health, vol. 64, no. 5, p. 713-720, 2019.

[1] See more at: https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/23200-em-2017-expectativa-de-vida-era -of-76-years-old

[2] See more at: https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/26104-em-2018-expectativa-de-vida-era -of-76-3-years-old