'Vida severina', healthy family? : morbidity and mortality in two metropolitan regions of Brazil

Abstract

As in many developing countries, mortality in Brazil declined dramatically in the 1950s, as a result less of improvements in the living conditions of its population than of importation of low-cost techniques and medicines to cope with massive contagious diseases. The course of this decline was interrupted in the 1960s, when a period of intense economic growth, and lack of concern with meeting basic social needs and reducing inequalities in income and wealth, led to a deterioration in general living conditions. A new wave of mortality decline was again detected in the mid-1970s, associated with massive investment in sanitation and water supply, increasing coverage of the social security system and the implementation of some social programs by the government. Now, when the Brazilian economy is in deep crisis, mortality decline has given place to mortality increase in the historical description of trends in mortality. Sao Paulo and Belo Horizonte, two of the leading metropolitan regions of Brazil in its route to economic growth via industrialization, are perhaps the best examples of such oscillations. This thesis focuses on aspects of mortality and morbidity in the metropolitan regions of Belo Horizonte and Sao Paulo. It uses three main data sources: mortality trends and patterns during the 1975-83 period are examined on the basis of vital registration statistics, while the analysis of morbidity differentials and levels of perception is undertaken on the basis of information provided by the National Household Survey - PNAD-81, and of in-depth interviews which I carried out in slums and peripheral suburbs of Belo Horizonte. During the period of analysis dramatic improvements in expectation of life at birth were observed in the two regions, mostly due to a decline in infant mortality, and largely as a result of the drop in infant deaths caused by infectious and parasitic diseases and diseases of the respiratory system. But inequalities in mortality persist and expectation of life at birth is much higher for children bom to women with a high level of education and high family income than for children bom to women in the low strata of education and family income. The pace, not the causes, of mortality decline is different in the two regions and a process of convergence to similar levels of mortality is observed even before acceptably low levels were reached in the early industrialized and urbanized region. In levels of reported illness, such convergence is not yet apparent and the levels are considerably higher in Belo Horizonte than in Säo Paulo. Insights into the concept and perception of diseases as well as into the recognition of the necessity for and access to health services are needed not only to understand the morbidity pattern itself, but also the relationship between morbidity and mortality. This was strongly reinforced by the in-depth interviews, which revealed a segment of population with difficult access to health services, attenuated doctorpatient relationship, and a compelling willingness to describe themselves as living in a healthy family, despite living a severe life. Show more