Social inequalities in health in two cities of São Paulo State: measurement, monitoring and analysis

Abstract

Surveys conducted in countries of high socioeconomic level have registered that the magnitude of the social inequalities in health has remained stable or even has increased, depending on the health indicator analyzed. This is observed even in countries with public health care systems well structured. While a significant reduction of income concentration in the world had been observed between 1920 and 1970, a reversal of this trend began to show from 1980, so that in 2010 the degree of income concentration reached heights similar to 1910/20. Also, contribute to the current relevance of the theme of social inequalities in health the economic crisis that started in 2008 and has led several countries to a deep economic depression and to the adoption of policies of fiscal austerity. Studies on the impact of the crisis and the measures taken, detected the increase in the degree of social disparities in health in several health indicators analyzed. Brazil is recognized as one of the countries with the highest rates of income concentration, which, added to the economic crisis that the country is going through and the austerity policies that have been implemented, highlights the opportunity and relevance of research on health social inequalities to qualify the knowledge about the patterns and trends of social disparities in health, in two of the most important cities of São Paulo, which are the focus of this thematic project. Considering the existence of periodic population-based health surveys with wide thematic scope, developed in the cities of São Paulo and Campinas, originated from the multicenter Project ISA-SP (Process FAPESP no. 1998/14099-7) and the existence in these municipalities, since 1990, of programs developed to improve the quality of mortality information, the researchers of this thematic project aim, supported in special in those databases, to assess the magnitude of social disparities prevalent in multiple health dimensions and to monitor the changes of these inequalities over recent years. The objectives of this thematic project include: 1) analysis of social disparities in health status, health behaviors, morbidities and use of health services based on the results of the surveys ISACapital 2015, ISACamp 2014/2015 and ISACamp 2020; 2) to monitor the differences of the social inequalities between successive surveys (2003, 2008, 2014/15 and 2020) using and comparing different techniques of analysis; 3) to develop the ISACamp 2020 to provide data for monitoring the health social inequalities; 4) analysis of current social inequalities (2015/2016) and of trends over the past 20 to 30 years in mortality rates, comparing social strata defined by area of residence; 5) analysis of social inequalities in life expectancy and of disability-free life expectancy; 6) analysis of social inequalities in incidence and mortality from neoplasms based on Populacional based Registry of Cancer of Campinas. Different conceptions and theoretical alignments were historically used to support studies on social inequalities in health. The authors of this project consider that the conceptual framework adopted by the WHO Commission on Social Determinants in health comprises the different dimensions of the determinants of the health-disease process and is adequate to support the studies proposed in this thematic project. Different compositions of social strata will be used in the studies of this thematic project in order to take account the socio-economic inequalities, but also the ethnic and gender inequalities. The historical development of indicators and techniques to measure the magnitude of social inequalities also provides a list of options that will be explored in these studies in order to identify the measures and techniques most appropriate depending on the design of the study, the proposed hypotheses and the health indicator in focus. (AU)