Skip to main content

Advertisement

SpringerLink
Log in

Reducing socioeconomic inequalities in life expectancy among municipalities: the Brazilian experience

  • Original article
  • Published:
International Journal of Public Health

Abstract

Objectives

This study analyzed the evolution of regional and socioeconomic inequality in life expectancy (LE) at birth and the probability of living up to 40 (LU40) and up to 60 years of age (LU60) in Brazilian municipalities between 1991 and 2010.

Methods

We analyzed data from the last three national census (1991, 2000 and 2010) computed for the 5565 Brazilian municipalities. They were divided into centiles according to the average per capita income. Poisson regression was performed to calculate the ratios between the poorest and the richest centiles.

Results

The average LE (+ 8.8 years), LU40 [6.7 percentage points (pp)] and LU60 increased (12.2 pp) between 1991 and 2010. The ratio of LE between the 1% of richest counties and the 1% of poorest counties decreased from 1.20 in 1991 to 1.09 in 2010. While in the poorest municipalities there was a gain of around 12 years of life, among the richest this increase was around 7 years.

Conclusions

There was a remarkable decrease in regional and socioeconomic inequality in LE, LU40 and LU60 in Brazil between 1991 and 2010.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Barnish M, Tørnes M, Nelson-Horne B (2018) How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review. BMJ Open. 8(10):e020886

    Article  PubMed  PubMed Central  Google Scholar 

  • Brasil (2010) Instituto Brasileiro de Geografia e Estatística. Síntese de Indicadores Sociais: uma análise das condições de vida da população brasileira 2010. IBGE, Rio de Janeiro

  • Brasil (2013) Instituto Brasileiro de Geografia e Estatística (IBGE). Tábuas abreviadas de mortalidade por sexo e faixa etária. IBGE, Brasília

  • Chetty R, Stepner M, Abraham S, Lin S, Scuderi B, Turner N, Bergeron A, Cutler D (2016) The association between income and life expectancy in the United States, 2001–2014. JAMA 315(16):1750–1766

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • dos Reis AAC (2018) What will be of Brazil and SUS? Rev Eletron Comun Inf Inov Saúde 12(2):119–124

    Article  Google Scholar 

  • Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Mackenbach JP, van Lenthe FJ, Mokdad AH, Murray CJL (2017) Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and keydrivers. JAMA Intern Med 177(7):1003–1011

    Article  PubMed  PubMed Central  Google Scholar 

  • Fukuda Y, Nakao H, Yahata Y, Imai H (2007) Are health inequalities increasing in Japan? The trends of 1955 to 2000. Biosci Trends 1(1):38–42

    PubMed  Google Scholar 

  • Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H et al (2016) Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 388(10058):2386–2402

    Article  PubMed  Google Scholar 

  • Guanais FC (2015) The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998–2010. Am J Public Health 105(Suppl 4):S593–S599

    Article  PubMed  PubMed Central  Google Scholar 

  • Hone T, Rasella D, Barreto M, Atun R, Majeed A, Millett C (2017a) Large reductions in amenable mortality associated with Brazil’s primary care expansion and strong health governance. Health Aff (Millwood) 36(1):149–158

    Article  Google Scholar 

  • Hone T, Rasella D, Barreto ML, Majeed A, Millett C (2017b) Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: a national longitudinal analysis. PLoS Med 14(5):e1002306

    Article  PubMed  PubMed Central  Google Scholar 

  • Lustig N, Lopez-Calva LF, Ortiz-Juarez E (2012) Declining inequality in Latin America in the 2000s: the cases of Argentina, Brazil, and Mexico. World Bank, Washington

    Book  Google Scholar 

  • Macinko J, Dourado I, Aquino R, Bonolo PF, Lima-Costa MF, Medina MG, Mota E, de Oliveira VB, Turci MA (2010) Major expansion of primary care in Brazil linked to decline in unnecessary hospitalization. Health Aff (Millwood) 29(12):2149–2160

    Article  Google Scholar 

  • MacIntyre S, MacIver S, Sooman A (1993) Area, class and health: should we be focusing on places or people? J Soc Psychol 22(2):213–234

    Google Scholar 

  • Martins AP, Monteiro CA (2016) Impact of the Bolsa Família program on food availability of low-income Brazilian families: a quasi experimental study. BMC Public Health 16(1):827

    Article  PubMed  PubMed Central  Google Scholar 

  • Massuda A, Hone T, Leles FAG, de Castro MC, Atun R (2018) The Brazilian health system at crossroads: progress, crisis and resilience. BMJ Glob Health 3(4):e000829

    Article  PubMed  PubMed Central  Google Scholar 

  • Melo FLB, Figueiredo A, Mineiro AS, Mendonça SEA (2012) Rescuing the minimum wage as a tool for development in Brazil. Int J Labour Res 4(1):27–44

    Google Scholar 

  • Murphy M, Bobak M, Nicholson A, Rose R, Marmot M (2006) The widening gap in mortality by educational level in the Russian Federation, 1980–2001. Am J Public Health 96(7):1293–1299

    Article  PubMed  PubMed Central  Google Scholar 

  • Neri MC (2007) Pobreza e políticas sociais na década da redução da desigualdade. Nueva Sociedade 3:53–73

    Google Scholar 

  • Nery JS, Pereira SM, Rasella D, Penna ML, Aquino R, Rodrigues LC, Barreto ML, Penna GO (2014) Effect of the Brazilian conditional cash transfer and primary health care programs on the new case detection rate of leprosy. PLoS Negl Trop Dis 8(11):e3357

    Article  PubMed  PubMed Central  Google Scholar 

  • Nery JS, Rodrigues LC, Rasella D, Aquino R, Barreira D, Torrens AW, Boccia D, Penna GO, Penna MLF, Barreto ML, Pereira SM (2017) Effect of Brazil’s conditional cash transfer programme on tuberculosis incidence. Int J Tuberc Lung Dis 21(7):790–796

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • OECD (Organization for Economic Co-operation and Development) (2018) Life expectancy at birth (indicator). https://doi.org/10.1787/27e0fc9d-en. Accessed 17 Jan 2018

  • Oeppen J, Vaupel JW (2002) Broken limits to life expectancy. Science 296:1029

    Article  CAS  PubMed  Google Scholar 

  • Östergren O, Martikainen P, Lundberg O (2018) The contribution of alcohol consumption and smoking to educational inequalities in life expectancy among Swedish men and women during 1991–2008. Int J Public Health 63(1):41–48

    Article  PubMed  Google Scholar 

  • Paim J, Travassos C, Almeida C, Bahia L, Macinko J (2011) The Brazilian health system: history, advances, and challenges. Lancet 377(9779):1778–1797

    Article  PubMed  Google Scholar 

  • Pearce J, Dorling D (2006) Increasing geographical inequalities in health in New Zealand, 1980–2001. Int J Epidemiol 35(3):597–603

    Article  PubMed  Google Scholar 

  • Pochman M (2010) Social structure in Brazil: recent changes. Serv Soc Soc 104:637–649

    Article  Google Scholar 

  • Programa das Nações Unidas para o Desenvolvimento (PNUD) (2013) Instituto de Pesquisa Econômica Aplicada (Ipea), Fundação João Pinheiro (FJP). Atlas de Desenvolvimento Humano Formosa, PNUD, Ipea, FJP

  • Rasella D, Aquino R, Santos CA, Paes-Sousa R, Barreto ML (2013) Effect of a conditional cash transfer programme on childhood mortality: a nationwide analysis of Brazilian municipalities. Lancet 382(9886):57–64

    Article  PubMed  Google Scholar 

  • Rasella D, Basu S, Hone T, Paes-Sousa R, Ocké-Reis CO, Millett C (2018) Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: a nationwide microsimulation study. PLoS Med 15(5):e1002570

    Article  PubMed  PubMed Central  Google Scholar 

  • Richardson EA, Pearce J, Mitchell R, Shortt NK, Tunstall H (2014) Have regional inequalities in life expectancy widened within the European Union between 1991 and 2008? Eur J Public Health 24(3):357–363

    Article  PubMed  Google Scholar 

  • Riley JC (2005) Estimates of regional and global life expectancy, 1800–2001. Popul Dev Rev 31(3):537–543

    Article  Google Scholar 

  • Serrano F, Summa R (2012) Macroeconomic policy, growth and income distribution in the Brazilian economy in the 2000s. Investig Econ 71(282):55–92

    Google Scholar 

  • Shei A, Costa F, Reis MG, Ko AI (2014) The impact of Brazil’s Bolsa Família conditional cash transfer program on children’s health care utilization and health outcomes. BMC Int Health Hum Rights 14:10

    Article  PubMed  PubMed Central  Google Scholar 

  • Son M, Cho Y, Oh J, Kawachi I, Yi J, Kwon S (2012) Social inequalities in life expectancy and mortality during the transition period of economic crisis (1993–2010) in Korea. Int J Equity Health 21(11):71

    Article  Google Scholar 

  • Spiteri J, von Brockdorff P (2019) Economic development and health outcomes: evidence from cardiovascular disease mortality in Europe. Soc Sci Med 30(224):37–44

    Article  Google Scholar 

  • Vaitsman J, Paes-Sousa R (2007) Avaliação de Políticas e Programas do MDS: Resultados: Bolsa Família e Assistência Social. MDS, Brasília

    Google Scholar 

  • Wiesebron M (2014) Social policies during the Lula administration: the conditional cash transfer program Bolsa Família. In: de Castro F, Koonings K, Wiesebron M (eds) Brazil under the workers’ party. Palgrave Macmillan, London

    Google Scholar 

  • World Health Organization (WHO) (2016) World health statistics: monitoring health for the SDGs, sustainable development goals. WHO, Geneva, p 2016

    Google Scholar 

  • World Health Organization (WHO) (2017) World health statistics: monitoring health for the SDGs, sustainable development goals. World Health Organization, Geneva, p 2017

    Google Scholar 

Download references

Acknowledgements

National Council of Scientific Development—CNPq—for granting financial resources (205120/2018-0).

Funding

There was no specific funding for this research.

Author information

Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, USA

    Antonio Fernando Boing, S. V. Subramanian & Alexandra Crispim Boing

  2. Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, SC, 88040-900, Brazil

    Antonio Fernando Boing & Alexandra Crispim Boing

Authors
  1. Antonio Fernando Boing
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. V. Subramanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexandra Crispim Boing
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Fernando Boing.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boing, A.F., Subramanian, S.V. & Boing, A.C. Reducing socioeconomic inequalities in life expectancy among municipalities: the Brazilian experience. Int J Public Health 64, 713–720 (2019). https://doi.org/10.1007/s00038-019-01244-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00038-019-01244-x

Keywords

Search

Navigation