Espace popula ions socié és
Space popula ions socie ies
2014/2-3 | 2014
Popula ionse  e i oi esduB ésil
Regional Inequali ies in In an Mo ali y and
P ima y Heal h Ca e in he S a e o Minas Ge ais,
B azil
Les inégali és égionales de la mo ali é in an ile e des Soins de San é P imai es
dans l'É a du Minas Ge ais, au B ésil
Ri aldoMau odeFa iaandPaulaSan ana
Elec onic e sion
URL: h ps://jou nals.openedi ion.o g/eps/5852
DOI: 10.4000/eps.5852
ISSN: 2104-3752
Publishe
Uni e si é des Sciences e Technologies de Lille
B ough o you by Faculdade de Le as da Uni e sidade de Coimb a
Elec onic e e ence
Ri aldo Mau o de Fa ia and Paula San ana, “Regional Inequali ies in In an Mo ali y and P ima y
Heal h Ca e in he S a e o Minas Ge ais, B azil”, Espace popula ions socié és [Online], 2014/2-3 | 2014,
Online since 23 Ap il 2015, connec ion on 06 Oc obe 2022. URL: h p://jou nals.openedi ion.o g/eps/
5852 ; DOI: h ps://doi.o g/10.4000/eps.5852
This ex was au oma ically gene a ed on 3 Ap il 2021.
C ea i e Commons - A ibu ion-NonComme cial-NoDe i a i es 4.0 In e na ional - CC BY-NC-ND 4.0
h ps://c ea i ecommons.o g/licenses/by-nc-nd/4.0/
Regional Inequali ies in In an
Mo ali y and P ima y Heal h Ca e
in he S a e o Minas Ge ais, B azil
Les inégali és égionales de la mo ali é in an ile e des Soins de San é P imai es
dans l'É a du Minas Ge ais, au B ésil
Ri aldoMau odeFa iaandPaulaSan ana
1.In oduc ion
1The decline in in an mo ali y, and he concomi an educ ion in e i o ial
inequali ies, is one o he esul s highligh ed by he B azilian go e nmen in he sphe e
o he na ional policy o expanding access o P ima y Heal h Ca e (PHC) unde he
Family Heal h Teams (FHT) model [B azil, 2012]. In an mo ali y is known o be e y
sensi i e o PHC [F ankenbe g, 1995; Shi e al., 1999; S a ield, 1992; San ana, 2005].
Indeed, he main causes o in an mo ali y in he wo ld, such as dia hoea and
pneumonia [Lawn, Cousens & Zupan, 2005; Lopez e al., 2006], could in ac be p e en ed
wi h app op ia e medical ca e. Howe e , he e is pe haps no o he heal h indica o
ha is so dependen upon po e y- ela ed social condi ions, he eby e lec ing social
and geog aphic inequali ies [Goldani e al., 2001; Na a o & Shi, 2001; Szwa cwald,
And ade & Bas os, 2002; Ma mo , 2005; San ana, 2005]. This explains he spa ial
concen a ions o high in an mo ali y a es in egions o he wo ld whe e he
popula ions a e poo e and ha e less access o heal hca e [Lopez e al., 2006].
2PHC is de ined in B azil as a combina ion o ac ions o bo h an indi idual and collec i e
na u e, including pa icula ly he p omo ion o heal h and p e en ion o disease
[B azil, 2012]. Since he ad en o he Single Heal hca e Sys em (SHS), which was
celeb a ed in he B azilian Cons i u ion as ee and uni e sal, he igh o all and du y
o he s a e [B azil, 1989], B azil has made g ea e o s o expand access o hese
se ices, pa icula ly in iew o i s s a egic ole o he in eg a ion o he heal hca e
sys em, and in o de o imp o e heal h indica o s, pa icula ly as ega ds women and
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child en. Hence, he Family Heal h P og amme (FHP) was c ea ed in 1994 in esponse
o he need o a heal hca e model ha was less hospi al-o ien ed and mo e
decen alized, and also o ake con ol o lows in he PHC.
3The FHP has g adually acqui ed a s a egic dimension o heal h in B azil, pa icula ly
in ela ion o basic indica o s such as he educ ion o in an and ma e nal mo ali y,
inc ease in accina ion co e and educ ion o hospi aliza ions. To gi e an idea o i s
signi icance, 6.5% o he B azilian popula ion we e co e ed by he p og amme in 1998,
bu his igu e had gone up o 40% by 2004 and o a ound 60% by 2012 (SIAB, 2012).
The e o e, he Na ional Basic Heal hca e Policy (NBHP), which is he documen ha
de e mines he way PHC is o ganized in B azil, no longe conside ed o be a
p og amme (because a p og amme is unde s ood as a package o sho - e m solu ions),
bu a he as a s a egy o he consolida ion o PHC h ough he implan a ion o
Family Heal h Teams (FHT) [B azil, 2012].
4The e o e, he amily is he smalles geog aphical uni wi h which PHC acili ies wo k
in B azil. Bu each eam, gene ally consis ing o a doc o (gene al p ac i ione ), nu se,
echnicians, ancilla ies and communi y heal h agen s, ha e o be esponsible o he
heal h o a geog aphically de ined g oup o amilies. P oblem-sol ing is one o i s mos
impo an p inciples [B azil, 2012]. Thus, acco ding o Mendes (2009), hese eams
should be equipped o a end o and o e come mos o he popula ion’s heal h
p oblems.
5Reducing egional inequali ies in in an mo ali y was one o he B azilian
go e nmen ’s main objec i es in de eloping FHTs [B azil, 2012]. This is e y impo an
because, despi e he ac ha he in an mo ali y a e has been dec easing o e he
las wen y yea s in B azil ( om 33.9‰ in 1994 o 13.6‰ in 2011) [SIAB, 2012], he e a e
s ill eno mous egional inequali ies in his indica o , wi h e y high le els in he mo e
dep i ed a eas o he No h and No heas o he coun y [Vic o a e al., 2011; Fa ia,
2013). Bu also on he in e egional and e en in au ban scales, he e a e conside able
a ia ions in he in an mo ali y a es. Tha is he case wi h he s a e o Minas Ge ais,
whose loca ion a he in e sec ion be ween he No heas , Sou heas and Cen e-Wes
egions o he coun y, combined wi h his o ical p ocesses o occupa ion and he
di e en o ms o economic and p oduc i e li e, has eno mous social and egional
inequali ies and consequen ly eno mous a ia ions in in an mo ali y a es.
6The s a e o Minas Ge ais is he ou h la ges in B azil in e i o ial e ms, wi h almos
wen y million inhabi an s, dis ibu ed ac oss 853 municipali ies and 66 adminis a i e
mic o egions [IBGE, 2010]. This s a e also has some speci ic public heal h policies,
including in he domain o PHC. In ac , he go e nmen o Minas Ge ais, h ough he
S a e Sec e a y o Heal h, and in associa ion wi h policies al eady c ea ed by he
Minis y o Heal h, has gi en b oad echnical and inancial suppo o he expansion o
FHT co e age h oughou he s a e. Th ough i s s uc u ing p ojec “Heal h a Home”
[SESMG, 2005], which cu s ac oss o he public heal h policies, he go e nmen achie ed
an FHT co e age o almos 72% o he popula ion in 2012, which is abo e he a e age
o he coun y as a whole.
7Howe e , he e ha e been e y ew s udies ha assess he impac o his inc eased PHC
co e age on popula ion heal h indica o s, pa icula ly on in an mo ali y. I is wo h
men ioning he wo k o Raselha e al. (2013), speci ically as ega ds he ela ionship
be ween he inc eased PHC co e and he educ ion in in an mo ali y. Al hough i s
main heme is en ans e p og ammes, he au ho s show how hose p og ammes,
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associa ed o g ea e public heal h co e , a e impo an o imp o e popula ion heal h
indica o s. F om a di e en pe spec i e, hough no less impo an , Lou enço e al.
(2014) also show signi ican posi i e co ela ions be ween he inc ease in PHC and he
educ ion in in an mo ali y in he s a e o São Paulo. Al hough hese s udies ha e
made an eno mous con ibu ion, he e a e s ill nume ous ques ions o be discussed on
he subjec , as ega ds bo h se ices and social inequali ies. Hence, his s udy aims o
analyse he egional impac s o PHC on he in an mo ali y a es (IMRs) in he s a e o
Minas Ge ais, aking in o accoun speci ic socioeconomic con ex s. In an mo ali y was
analysed o he pe iods 2002-2006 and 2007-2011 in he 66 mic o egions o he s a e,
wi h ela ion o h ee ope a i e dimensions:
he indices o amilies ecei ing PHC assis ance;
indexes o p ena al ca e;
he Index o Socioma e ial Dep i a ion (ISD).
2.Ma e ialsandme hods
8The s udy was implemen ed on he le el o he 66 adminis a i e mic o egions o Minas
Ge ais o he yea s 2002 o 2011, g ouped in o wo pe iods (2002-2006 and 2007-2011)
in he case o in an mo ali y and p ena al ca e, and a in e als in he case o he FHT
co e age and social dep i a ion indica o s (2002 and 2011). The da a we e collec ed
om seconda y o icial sou ces, namely he B azilian Ins i u e o Geog aphy and
S a is ics (IBGE), Li e Bi hs In o ma ion Sys em (SINASC), he Mo ali y In o ma ion
Sys em (SIM) and he Basic Heal hca e In o ma ion Sys em (SIAB). The ollowing
indica o s we e cons uc ed om he da abase in he ligh o he desi ed aims:
in an mo ali y a e (IMR), clus e ed o he yea s 2002-2006 and 2007-2011;
index o popula ion egis e ed wi h he FHTs, calcula ed o he yea s 2002, 2006 and 2011;
index o women ha did no ha e p ena al ca e du ing p egnancy;
Index o Socioma e ial Dep i a ion (ISD) in 2002 and 2011.
9The ISD was cons uc ed in acco dance wi h he me hodology sugges ed by Ca a s &
Mo is (1991) (ci ed by San ana, 2005), in ol ing he s a egic selec ion o h ee social
indica o s:
illi e acy amongs women o ep oduc i e age;
domiciles wi hou indoo ba h ooms;
low-wage amilies (i.e. hose ea ning less han hal he minimum wage).
10Following San ana (2005), hose a iables we e s anda dized using he z-sco e me hod
so each would ha e he same in luence on he inal esul o he index. The ISD hus
ep esen s he sum o hose s anda dized a iables.
11Pea son’s co ela ion coe icien was also used o calcula e he in e dependence o he
a iables o he s udy and hei a ios, pa icula ly as ega ds egional dynamics.
12A e he cons uc ion and modelling o he indica o s in acco dance wi h he
p e iously de ined spa ial and empo al scales, a hema ic ca og aphy was cons uc ed
using he Geog aphic In o ma ion Sys em (GIS). Fo his, he IBGE ca og aphic base
was used a a scale o 1:50,000, and he A cGis P og amme om he company Es i.
i.
ii.
iii.
i.
ii.
iii.
i .
i.
ii.
iii.
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3.Resul s
3.1.In an mo ali y: empo al a ia ionandspa ialdis ibu ion
13As in he es o he B azil, he s a e o Minas Ge ais, in luenced by he policies o he
coun y, has seen a educ ion in in an mo ali y. In 2002-2006 he a e was 18.0‰
which declined o 13.1‰ in 2007-2011. I is, he e o e, lowe han he B azilian a e age
(13.6‰ in 2011). The e was also a d op in in an mo ali y in he mic o egions
gene ally (Figu e 1) o e he pe iod, hough his did no occu in all mic o egions.
The e a e s ill eno mous spa ial inequali ies in in an mo ali y in Minas Ge ais, as
some mic o egions ha e low a es while o he s a e highe han he Millennium
De elopmen Goal o in an heal h [WHO, 2005] ( he 4 h MDG de e mines he
educ ion o he IMR in B azil o 15.7‰ by 2015).
14Figu e 1 shows he spa ial concen a ions o high IMR in he mic o egions in he
No heas , and also, hough wi h lowe alues, in he mic o egions o he “Fo es Zone”
and Cen e. In con as , he mic o egions loca ed be ween he No hwes and he
“Mining T iangle”, and be ween Belo Ho izon e and Sou h ha e lowe IMRs in he wo
pe iods, hough mo e ma kedly be ween 2007-2011. Special a en ion should be gi en
o he mic o egions loca ed in he ex eme No heas : ou mic o egions had a e y
high IMR, and o hose, wo ac ually wo sened, while he o he wo expe ienced only a
e y sligh educ ion.
15As Table 1 shows, he e was spa ial a ia ion in IMRs be ween mic o egions in
acco dance wi h popula ion size. The en mos popula ed mic o egions, whe e almos
hal he popula ion o he s a e is concen a ed and whe e he la ges ci ies a e loca ed,
including he capi al Belo Ho izon e, a e hose wi h he lowes IMR. On he o he hand,
he en leas popula ed egions, which accoun o only 3.7% o he popula ion o he
s a e and which ha e only small ci ies, ha e highe IMRs on a e age, loca ed mos ly in
he No heas o he s a e. I should be poin ed ou ha he IMRs indica ed in he Table
1 a e he a e age calcula ed be ween he en mos popula ed and he en leas
popula ed mic o egions. The o he s a e g ouped sepa a ely. I can be seen ha he en
mos popula ed mic o egions ha e IMRs ha a e close o he s a e a e age,
accompanying he gene al end owa ds educ ion seen no only in Minas Ge ais bu
also in B azil as a whole. The same canno be said o he en leas popula ed
mic o egions.
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Figu e 1. In an mo ali y a e (IMR) by egions o he S a e o Minas Ge ais, B azil, o he yea s
2002-2006 and 2007-2012.
Table1.Compa isono IMR,li ebi hswi hou p ena alca e,ISD,andFHTco e age o  he en
mos andleas popula edmic o egionsando he sin hes a eo MinasGe ais,B azil
IMR
(‰)*
LBWPC
(‰)** ISD*** FHTs
(%)***
Popula ion
(%)***
U baniza ion
Index***
10 +
popula ed 13.6 10.4 -1.7 63.0 48.9 89.9
10 –
popula ed 16.6 10.6 2.4 93.9 3.7 65.6
O he s 15.01 9.96 -0.16 80.4 47.4 77.9
*Re e ing o he agg ega e pe iod 2007-2011
** Li e bi hs wi hou an ena al ca e in he agg ega e pe iod 2007-2011
***Re e ing o he yea 2011
Sou ce: Da asus, Minis y o Heal h, 2013 (cons uc ed and adap ed by he au ho s).
16Table 1 also shows a ia ions in IMR in acco dance wi h he u baniza ion a e in he
mos and leas popula ed mic o egions. The o me a e he mos u banized as hey
include he bigges ci ies o Minas Ge ais (as men ioned abo e), including i s capi al,
Belo Ho izon e. The opposi e occu s wi h he leas popula ed mic o egions. The highes
IMRs we e ound in he leas u banized mic o egions and diminished as he
u baniza ion index inc eased. In ac , he en mos popula ed and mos u banized
mic o egions ha e IMRs simila o he s a e a e age, and some a e e en lowe han
ha a e age. Fo example, he wo mos popula ed mic o egions in he s a e, Belo
Ho izon e and Ube lândia (Mining T iangle), ha e IMRs o 11.6‰ and 11.8‰
espec i ely. The e o e, wi h ega d o he agg ega ed pe iod o 2007-2011, hei a es
a e lowe han he s a e a e age. On he o he hand, he leas popula ed and leas
u banized mic o egions ha e IMRs well abo e he s a e a e age.
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17Ne e heless, i is ele an o analyse hese a es in ela ion o o he indica o s,
pa icula ly he indica o s o PHC co e and usage. This is also impo an o cla i y a
discou se ha has al eady been p esen ed by some au ho s [e.g. Sas y, 1997; Souza e
al., 1999] acco ding o which u baniza ion is associa ed o a educ ion in in an
mo ali y.
3.2.Expansiono p ima yheal hca ep o isionuse oan ena alca e
18Wi h he FHT model, he e was an inc ease in PHC co e age h oughou all he
mic o egions o Minas Ge ais (Figu e 2). The s a e a e age, which was 50% in 2002,
wen up o 64% in 2006 and 71% in 2011. The mic o egions loca ed in he No h,
No heas , Cen e and “Fo es Zone” p esen ed highe le els o co e age in he h ee
yea s analysed, while he opposi e happened in he mic o egions loca ed in he Sou h,
“Mining T iangle”, Belo Ho izon e and No hwes , whe e he FHT co e age was lowe .
In ac , he i s g oup had le els o co e age ha we e highe han he s a e a e age,
while he second was gene ally lowe han he s a e a e age, despi e he inc ease in he
supply in he pe iod analysed.
19In any case, he da a indica e he eno mous ad ances in FHT co e age in Minas Ge ais.
Fo many mic o egions, pa icula ly hose o he No h and No heas o he s a e,
p o ision was uni e sal by 2011. Conside ing only he mic o egions wi h a p o ision o
o e 80%, he e is a o al o 35 mic o egions, which ep esen s o e hal . I can also be
seen ha he mos popula ed and u banized mic o egions (Table 1), whe e he majo
ci ies in Minas Ge ais a e loca ed such as Ube lândia (“Mining T iangle”), Juiz de Fo a
(“Fo es Zone”), Belo Ho izon e (Me opoli an Region), Poços de Caldas, Pouso Aleg e
and Va ginha (Sou h) and Mon es Cla os (No h), a e hose wi h he lowes le els o
co e age, a e aging 63% o he popula ion. In con as , in he less popula ed and
u banized mic o egions, whe e he small ci ies a e loca ed, he le el o co e age
exceeds 93%. I should be men ioned ha he expansion o se ices in he less
popula ed mic o egions was one o he goals o he Na ional Basic Heal hca e Policy
[B azil, 2012]. Thus, in acco dance wi h he p inciple o equi y, he mic o egions ha
a e less dense in public heal h se ices and consequen ly ha e g ea e heal h needs
should ha e a g ea e supply o se ices pe inhabi an .
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Figu e 2. Co e age o Family Heal h Teams (in pe cen age o popula ion) by egions o he S a e o
Minas Ge ais, B azil, in 2002 (A), 2006 (B) and 2011 (C)
20Howe e , i we compa e he way se ices a e dis ibu ed (pe cen ages pe popula ion),
as in Figu e 2, he e is clea ly a endency o a homogeniza ion o supply; by 2011, he e
was a p edominance o mic o egions wi h o e 61% p o ision, and a educ ion o
mic o egions wi h less han his. In ac , in 2002, he e we e 44 mic o egions
(accoun ing o 66.9% o s a e’s popula ion) wi h less han 60% p o ision, while in 2011
his igu e had d opped o 9 mic o egions (19.9% o he popula ion). Simila ly, in 2002
he e was 80% co e age in only 5 mic o egions (5.3% o he popula ion) and by 2011, i
exis ed in 35 mic o egions (o e 28%).
21Thus, i can be concluded ha he policy o expanding PHC h ough he es ablishmen
o FHTs has yielded nume ically impo an esul s, in keeping wi h he policies
p oduced o he sec o . This is despi e he ac ha he Na ional Basic Heal hca e
Policy [B azil, 2012] does no s ipula e he igu e o be achie ed, bu me ely aims o an
expansion o co e age in he leas popula ed/mos dep i ed a eas.
22I should be added, howe e , ha he exis ence o se ices, o a he he expansion o
p o ision, does no mean ha hese heal h se ices a e p ope ly accessed and used, no
does i au oma ically p oduce good heal h ou comes. I is necessa y o analyse he
impac o he se ices upon he popula ion’s li ing condi ions and heal h. In his case,
i is wo h e lec ing on he popula ion’s access o and use o se ices, and on heal h
ou comes, pa icula ly o in an mo ali y. The e a e nume ous indica o s o access/
use o p ima y heal h se ices by he popula ion. In ela ion o child heal h and
impac s upon in an mo ali y a es, p ena al ca e is impo an , gi en i s po en ial o
he p e en ion o disease and in an mo ali y h ough he p omo ion o ma e nal
heal h. The e o e i is o be hoped ha he inc eased FHT co e age in Minas Ge ais will
ha e had a posi i e impac by p o iding g ea e access o p ena al ca e, and
consequen ly helping educe in an mo ali y.
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23In acco dance wi h he Wo ld Heal h O ganiza ion [WHO, 2002], he e should be a leas
six p ena al consul a ions du ing p egnancy. The B azilian Minis y o Heal h has
ecommended ha hese should ake place e e y ou weeks, and e e y 15 days a e
he 36 h week o p egnancy [B azil, 2006] As his is an impo an indica o o ma e nal
and child heal h, he Minis y o Heal h i sel moni o s he numbe o p ena al
consul a ions ha ha e aken place du ing p egnancy in ela ion o he numbe s o li e
bi hs. Howe e , he o icial da a do no dis inguish be ween consul a ions ha ha e
aken place in he public and p i a e heal hca e sys ems. Thus, only da a ela i e o
li e bi hs wi hou any p ena al ca e du ing p egnancy ha e been collec ed. In o he
wo ds, wha is assessed is he ulne abili y o women and oe uses when p ena al
consul a ions do no ake place. This is shown in Figu e 3 o he yea s 2002-2006 and
2007-2011.
Figu e 3. Li e bi hs wi hou p ena al ca e (in ‰) be ween he yea s 2002-2006 and 2007-2012 by
egions o he S a e o Minas Ge ais, B azil
24Figu e 3 shows ha he e was a educ ion in he numbe o li e bi hs wi hou p ena al
ca e in almos all he mic o egions o Minas Ge ais. The s a e a e age, which was
14.4‰ in 2002-2006, d opped o 10.1‰ in 2007-2012, a educ ion o almos 30%. These
alues a e below he na ional a e age o 36.7‰ in 2002-2006 and 26.9‰ in 2007-2012 (a
educ ion o 26.5%). The e o e, no only is he a e age in he s a e o Minas Ge ais
be e han he coun y as a whole, i s pe o mance was also be e in his indica o .
Howe e , he indexes o li e bi hs wi hou p ena al ca e a e s ill high in some
mic o egions, compa ed wi h he s a e and na ional a e ages. Mo eo e , he spa ial
concen a ion o hese indices is isible in mic o egions loca ed be ween he Cen e
and No heas o he s a e. In ac , hough he e has been a educ ion, he e con inue o
be spa ial concen a ions o highe a es o li e bi hs wi hou p ena al ca e o e he
wo pe iods.
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ABSTRACTS
In an mo ali y has declined in B azil in ecen yea s, pa ly as a esul o inc eased P ima y
Heal h Ca e (PHC) co e age and be e access o i . Howe e , he e a e s ill eno mous egional
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inequali ies in hese indica o s, and he e o e spa ial a ia ions in in an mo ali y. In a coun y
like B azil ha is o con inen al p opo ions, i is impo an o analyse/assess heal h policies in
he con ex o egional inequali ies in o de o ensu e equi y. This s udy hus aims o analyse he
egional impac s o PHC and assess he impo ance o socioeconomic con ex s upon in an
mo ali y a es (IMRs) in he s a e o Minas Ge ais. This is he ou h bigges s a e in B azil, wi h
a popula ion o almos 20 million, dis ibu ed o e 66 mic o egions. The IMR was assessed o he
pe iods 2002-2006 and 2007-2011 in he 66 mic o egions, conside ing h ee ope a i e dimensions:
i. indexes o amilies aided by PHC;
ii. indexes o p ena al ca e;
iii. and he Index o Socioma e ial Dep i a ion (ISD).
The da a we e collec ed om seconda y o icial sou ces, and modelled on empo al and spa ial
scales de ined and wo ked in a Geog aphical In o ma ion Sys em. The ISD, which is a composi e
indica o used o exp ess social and egional inequali ies, was cons uc ed on he basis o h ee
indica o s: i) illi e acy; ii) wages; and iii) homes wi hou indoo ba h ooms. The esul s showed a
educ ion in IMR in almos all he mic o egions o Minas Ge ais be ween 2002-2006 and
2007-2011. Howe e , he e we e inequali ies in his dec ease, wi h a con inuing concen a ion o
mo ali y in mic o egions wi h highe ISD. The expansion o PHC is mo e ma ked in he
mic o egions wi h highe ISD, which is a posi i e sign om he B azilian Heal h Sys em.
Howe e , he expansion o hese se ices as an isola ed sec o ial policy, hough impo an , has
no on i s own been able o educe he geog aphical inequali ies in in an mo ali y in Minas
Ge ais. Hence, i is necessa y o conside he social and economic con ex s o amilies when
a emp ing o imp o e indica o s ha go beyond me e heal hca e in e en ion. In o he wo ds,
in an heal h is he esul o in eg a ed public policies (eg. housing, employmen /wages,
educa ion/ aining) and mul i-le el decisions and ac ions (local, municipal, egional, ede al).
La mo ali é in an ile a diminué au B ésil au cou s des de niè es années, g âce, en e au es, à
l'ex ension de la cou e u e e l'accès aux soins de san é p imai es (SSP). Cependan , d'éno mes
inégali és égionales pe sis en en ce qui conce ne ces deux de nie s indica eu s qui on un
impac su les a ia ions spa iales de la mo ali é in an ile. Dans les pays de la aille d’un
con inen comme le B ésil, il es pe inen d'analyse / d’é alue les poli iques de san é dans le
con ex e des inégali és égionales, dans le bu d’assu e plus d’équi é. Ceci a mo i é la p ésen e
é ude, don l'objec i es d'analyse les impac s égionaux du SSP, en incluan égalemen
l'analyse des con ex es socio-économiques, su le aux de mo ali é in an ile (TMI) dans l'É a du
Minas Ge ais, au B ésil. Ce é a es le qua ième plus g and É a du B ésil, sa popula ion s’élè e à
p ès de 20 millions d'habi an s, épa is en 66 mic o égions. L'analyse de TMI a é é éalisée pou
les pé iodes 2002-2006 e 2007-2011 dans chacune de ces mic o égions, en ela ion a ec ois
dimensions opé a ionnelles de l'analyse:
i. le aux de amilles assis ées pa SSP,
ii. les aux de cou e u e des soins p éna aux
iii. e l’indice de dé a o isa ion ma é ielle e sociale (IDMS).
Les données on é é ecueillies à pa i de sou ces secondai es o icielles, adap ées à des échelles
spa iales e empo elles dé inies e a aillées a ec un Sys ème d’In o ma ion Géog aphique.
L’indice de dé a o isa ion ma é ielle e sociale, indica eu composi e u ilisé pou exp ime les
inégali és sociales e égionales, a é é cons ui su la base de ois indica eu s i)
l'analphabé isme, ii) les e enus e iii) le nomb e de ménages sans ins alla ions sani ai es au sein
de leu oye . Les ésul a s on mon é une baisse du aux de mo ali é in an ile dans p esque
ou es les mic o égions du Minas Ge ais, en e 2002-2006 e 2007-2011. Tou e ois, on cons a e des
inégali és dans ce e baisse a ec une mo ali é plus o e dans les égions ayan un IDMS plus
éle é. L’expansion des SSP es plus impo an e dans les égions qui possèden un IDMS plus éle é,
ce qui es un signal posi i pou le Sys ème de San é b ésilien. Cependan , l’expansion des SSP en
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an que poli ique sec o ielle isolée, malg é son impo ance, n’es pas su isan e pou édui e les
inégali és spa iales de la mo ali é in an ile à l’in é ieu du Minas Ge ais. Pou cela, il es
nécessai e de p end e en comp e le con ex e social e économique des amilles quand l’objec i
es d’amélio e les indica eu s au-delà d’une simple in e en ion sani ai e. Pou le di e
au emen , la san é de l’en an es la ésul an e des poli iques publiques in ég ées (exemples :
logemen , emploi/ e enu, éduca ion/ins uc ion,) e des décisions e ac ions à di é en s ni eaux
(local, municipal, égional, édé al).
INDEX
Keywo ds: p ima y heal hca e, egional inequali y, in an mo ali y
Mo s-clés: soin de san é p imai e, inégali é égionale, mo ali é in an ile
AUTHORS
RIVALDOMAURODEFARIA
Ins i u e o Geosciences
S a e Uni e si y o Campinas
Unicamp, B azil
Uni e si y Fede al o San a Ma ia, B azil
[email p o ec ed].
PAULASANTANA
Cen e o S udies in o Geog aphy and Te i o ial Planning
Depa men o Geog aphy
Uni e si y o Coimb a, Po ugal
paulasan ana.coimb [email protected].
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