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. 2018 Mar 5;27(1):e000100017.
doi: 10.5123/S1679-49742018000100017.

Measurement of social inequalities in health: concepts and methodological approaches in the Brazilian context

[Article in English, Portuguese]
Inácio Crochemore Mohnsam da Silva  1 , Maria Clara Restrepo-Mendez  1 , Janaína Calu Costa  1 , Fernanda Ewerling  1 , Franciele Hellwig  1 , Leonardo Zanini Ferreira  1 , Luis Paulo Vidaletti Ruas  1 , Gary Joseph  1 , Aluísio J D Barros  1
Affiliations

Measurement of social inequalities in health: concepts and methodological approaches in the Brazilian context

[Article in English, Portuguese]
Inácio Crochemore Mohnsam da Silva et al. Epidemiol Serv Saude. .

Abstract
in English, Portuguese, Spanish

This study aims to describe methodological approaches to measure and monitor health inequalities and to illustrate their applicability. The measures most frequently used in the literature were reviewed. Data on coverage and quality of pre-natal care in Brazil, from the Demographic and Maternal and Child Health Survey (PNDS-2006) and the National Health Survey (PNS-2013) were used to illustrate their applicability. Absolute and relative measures of inequalities were presented, highlighting their complementary character. Despite the progress achieved in the national indicators of pre-natal care, important inequalities were still identified between population subgroups, with no change in the magnitude of the differences throughout the studied period. Brazil has important social inequalities, whose consequences still lead to health inequalities. Their description and monitoring are highly relevant to support polices focused on those vulnerable population groups who have been left behind.

O objetivo deste artigo é apresentar os principais métodos de mensuração e monitoramento das desigualdades sociais em saúde e ilustrar suas aplicações. Foram revisadas as medidas mais frequentemente empregadas na literatura. Dados de cobertura e qualidade do cuidado pré-natal no Brasil, provenientes da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) e da Pesquisa Nacional de Saúde (PNS-2013), foram utilizados para exemplificar as aplicações. Medidas de desigualdade absoluta e relativa foram apresentadas, destacando-se sua complementaridade. Apesar dos avanços evidenciados nos indicadores nacionais de pré-natal, importantes desigualdades foram identificadas entre subgrupos da população, sem que houvesse redução da magnitude dessas diferenças no período estudado. O Brasil apresenta importantes desigualdades sociais, que ainda se refletem em persistentes desigualdades em saúde. A descrição e monitoramento dessas desigualdades são fundamentais para o direcionamento de políticas de saúde, com foco em grupos mais vulneráveis que vêm sendo deixados para trás.

El objetivo de este artículo es presentar los principales métodos de medición y monitoreo de las desigualdades sociales en salud, y demostrar sus aplicaciones prácticas. Se realizó una revisión de los métodos más frecuentemente utilizados en la literatura. Datos sobre cobertura y calidad de la atención prenatal en Brasil, provenientes de la Encuesta Nacional de Demografía y Salud del Niño y la Mujer (PNDS-2006) y de la Encuesta Nacional de Salud (PNS-2013) fueran usados como ejemplo. Fueron presentadas medidas de desigualdad absoluta y relativa, destacando su complementariedad. A pesar de los avances evidenciados en los indicadores de atención prenatal en Brasil, fueron identificadas desigualdades importantes, sin que hubiese una reducción de la magnitud de esas diferencias en el periodo estudiado. Brasil presenta desigualdades sociales importantes, que aún se ven reflejadas en las persistentes desigualdades en salud. Su descripción y seguimiento son fundamentales para el direccionamiento de políticas en salud, focalizadas en grupos más vulnerables que han sido relegados.

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Figures

Figure 1
Figure 1
– Coverage of at least six antenatal care visits and adequate quality of antenatal care, according to area of residence, Brazil, 2006 and 2013
Figure 2
Figure 2
– Coverage of at least six antenatal care visits and adequate quality of antenatal care, according to household wealth quintiles, Brazil, 2006 and 2013
Figure 3
Figure 3
– (A) Slope Index of Inequality (SII), of at least six antenatal care visits, Brazil, 2013; (B) Concentration Index (CIX), of at least six antenatal care visits, Brazil, 2013
See this image and copyright information in PMC

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