Rapid decline in childhood undernutrition in Brazil and the role of policies reducing inequality<br />Eduardo A. F. Nilson...
Decline in childhood undernutrition according to national inquiries in Brazil (children < 5 years old)<br /><ul><li>Steady...
Major causes of the decline in child undernutrition in Brazil through the last three decades<br />1975-1989:<br /><ul><li>...
Moderate increase in family income.</li></ul>1989-1996:<br /><ul><li>Gradual improvement of maternal education: universali...
Better access to basic health care (National Health System - SUS): universalization of health care.
Expansion of public water supply.</li></ul>1996-2007:<br /><ul><li>Combination of policies, but strongly contributed by pu...
But there are still differences in undernutrition rates<br /><ul><li>Iniquities still remain.</li></ul>(for children under...
And overweight and obesity are increasing…<br />Sources: National Study on Family Expenditure (ENDEF), National Health and...
… equally<br />Sources: National Study on Family Expenditure (ENDEF), National Health and Nutrition Survey (PNSN) and Fami...
Causes ofthe decline in undernutrition in thelastdecade<br />Source: Monteiro et al, 2009. Causes for the decline in child...
Underlying determinants<br />Purchasing power of Brazilian families:<br /><ul><li>Increase in average income combined with...
Economic growth and reduction in unemployment rates.
Systematic increases in the official minimum wage.
Cash transfer programs and social security.</li></ul>Population with less than US$ PPC 1.25/day (%))<br />Source: Institut...
Underlying determinants<br />Cash transfer programs in Brazil:<br /><ul><li>Firstly sectoral programs (health, education e...
2003 - unification of CCTs – BolsaFamília Program.</li></ul>Average annual growth in household per capita income per day (...
Underlying determinants<br />BolsaFamília Program:<br /><ul><li>Well targeted, capable of reducing the percentage of extre...
2010: 12.5 million beneficiary families.
Conditionalities oriented to guarantee universal rights (health and education) – over 99% of families fulfill the health c...
Registration can also be used for intersectoral policies and to target the most vulnerable families for other complementar...
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Rapid Decline in Childhood Undernutrition in Brazil and the Role of Policies Reducing Inequality

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Eduardo A.F. Nilson
Food and Nutrition Coordination
Ministry of Health of Brazil

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Rapid Decline in Childhood Undernutrition in Brazil and the Role of Policies Reducing Inequality

  1. 1. Rapid decline in childhood undernutrition in Brazil and the role of policies reducing inequality<br />Eduardo A. F. Nilson<br />Food and Nutrition Coordination<br />Ministry of Health of Brazil<br />
  2. 2. Decline in childhood undernutrition according to national inquiries in Brazil (children < 5 years old)<br /><ul><li>Steady decline in stunting during the last 3 decades, but steeper in the last 10 years.</li></ul>Sources: National population surveys (ENDEF, PNSN and PNDS)<br />
  3. 3. Major causes of the decline in child undernutrition in Brazil through the last three decades<br />1975-1989:<br /><ul><li>Great expansion of the coverage of public services (education, sanitation and health).
  4. 4. Moderate increase in family income.</li></ul>1989-1996:<br /><ul><li>Gradual improvement of maternal education: universalization of primary education.
  5. 5. Better access to basic health care (National Health System - SUS): universalization of health care.
  6. 6. Expansion of public water supply.</li></ul>1996-2007:<br /><ul><li>Combination of policies, but strongly contributed by purchase power increase and the expansion of essential public services.</li></li></ul><li>Stunting did not decline homogeneously<br /><ul><li>Gap reducing between regions and between poor and wealthy families: decline was greater in poor and more vulnerable communities.</li></ul>(for children under 5 years old)<br />By region:<br />By socioeconomic quintile:<br />Sources: Demography and Health Surveys (PNDS)<br />
  7. 7. But there are still differences in undernutrition rates<br /><ul><li>Iniquities still remain.</li></ul>(for children under 5 years old)<br />Sources: DHS 2006 (PNDS), 1st National Inquiry of Health and Nutrition on Indigenous Populations, Nutritional Call of Quilombola Populations 2006, Food and Nutrition Surveillance System (Ministry of Health of Brazil)<br />
  8. 8. And overweight and obesity are increasing…<br />Sources: National Study on Family Expenditure (ENDEF), National Health and Nutrition Survey (PNSN) and Family Budget Survey (POF)<br />
  9. 9. … equally<br />Sources: National Study on Family Expenditure (ENDEF), National Health and Nutrition Survey (PNSN) and Family Budget Survey (POF)<br />
  10. 10. Causes ofthe decline in undernutrition in thelastdecade<br />Source: Monteiro et al, 2009. Causes for the decline in child undernutrition in Brazil, 1996-2007.<br />
  11. 11. Underlying determinants<br />Purchasing power of Brazilian families:<br /><ul><li>Increase in average income combined with better income distribution – declines in families living below the poverty line:
  12. 12. Economic growth and reduction in unemployment rates.
  13. 13. Systematic increases in the official minimum wage.
  14. 14. Cash transfer programs and social security.</li></ul>Population with less than US$ PPC 1.25/day (%))<br />Source: Institute for Applied Economic Research (IPEA)<br />
  15. 15. Underlying determinants<br />Cash transfer programs in Brazil:<br /><ul><li>Firstly sectoral programs (health, education etc.) – 2001.
  16. 16. 2003 - unification of CCTs – BolsaFamília Program.</li></ul>Average annual growth in household per capita income per day (US$ PPC) by tenths of income distribution<br />Source: Institute for Applied Economic Research (IPEA)<br />
  17. 17. Underlying determinants<br />BolsaFamília Program:<br /><ul><li>Well targeted, capable of reducing the percentage of extremely poor families, transfers are mostly used for buying food.
  18. 18. 2010: 12.5 million beneficiary families.
  19. 19. Conditionalities oriented to guarantee universal rights (health and education) – over 99% of families fulfill the health conditionalities and over 97% of children and adolescents attend at least 85% of school classes.
  20. 20. Registration can also be used for intersectoral policies and to target the most vulnerable families for other complementary programs: adult alphabetizing, school reinforcement, professional education, familiar agriculture, microcredit.</li></li></ul><li>Underlying determinants<br />Maternal education<br /><ul><li>Progress in primary school enrolment and completion (90’s).
  21. 21. Policies designed to ensure universal access to primary education and to improve the quality of schools.</li></ul>Source: Demography and Health Surveys (PNDS)<br />
  22. 22. Intermediate determinants<br />Access to health care:<br /><ul><li>Brazilian National Health System (1988)
  23. 23. Universal and integral health care: to guarantee the Constitutional right for health.
  24. 24. Decentralization of management and funding (specially primary health care): municipalization and more equity in budget distribution.
  25. 25. Social control and accountability: health councils in the municipal, state and federal levels.</li></li></ul><li>Intermediate determinants<br />Access to health care:<br /><ul><li>Family Health Strategy (1994) – reorienting and promoting equity in access to primary health care:
  26. 26. Family Health Teams and Community Health Agents.
  27. 27. Dec. 2009: 30.3 thousand Family Health Teams in 5251 municipalities (population coverage of 96 million people -50,7% of Brazil’s population) – mostly low-income families.</li></ul>Population covered by Family Health Teams, Brazil.<br />Source: Ministry of Health of Brazil<br />
  28. 28. Intermediate determinants<br />Access to health care:<br /><ul><li>National Food and Nutrition Policy (1999) – directives to organize nutrition actions and services, specially in primary health care (prevention and control nutritional disorders, nutritional surveillance), and to promote intersectoral actions (food security) from the health sector perspective:
  29. 29. Vitamin A Supplementation Program (2003)
  30. 30. Iron Supplementation Program (2006)
  31. 31. Food and Nutrition Surveillance System – computerized in 2003 and improved in 2008 (on-line system). </li></li></ul><li>Intermediate determinants<br />Decline in severe food insecurity at the family level<br /><ul><li>Parallel to income redistribution and poverty decline.
  32. 32. Intersectoral policies.</li></ul>Quality of child care:<br /><ul><li>Parallel to increase in maternal education and better access to health care:
  33. 33. Lesser children per family (1996: 4.0 / 2006: 3.4 people per family)
  34. 34. Widening birth intervals
  35. 35. Access to contraceptives
  36. 36. Breastfeeding practices</li></li></ul><li>Intermediate determinants (poorest quintile)<br />
  37. 37. Proximate determinants<br />Decline in child morbidity and mortality<br /><ul><li>Immunizations are practically universal for children.
  38. 38. 90% decrease in the mortality rate by diarrhea.
  39. 39. 60% decline in overall infant mortality (1990-2008)
  40. 40. 10% increase in Family Health coverage corresponded to a 4.6% reduction in infant mortality (1994-2002).</li></ul>Infant mortality, Brazil<br />Source: Mortality Information System, Ministry of Health of Brazil<br />
  41. 41. Conclusions<br /><ul><li>Impact of overall economic progress and equity-oriented policies.
  42. 42. Change of agenda: assistancial policies give place to universal, rights-oriented policies.
  43. 43. Critical effect of policies which promote income redistribution and policies of universal access to education, health, water supply and sanitation services.
  44. 44. If Brazil maintains the present decline rate (6.3% per year) in the next decade, stunting will no longer represent a public health problem.
  45. 45. Challenge: to target the most vulnerable (traditional and isolated communities, indigenous peoples), because iniquities still exist.</li></li></ul><li>Thank you!<br />eduardo@saude.gov.br<br />

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