BRIC nations -Brazil, Russia, India, and China -represent 40% of the world's population, including a growing aging population and middle class with an increasing prevalence of chronic disease. Their healthcare systems increasingly rely on prescription drugs, but they differ from most other healthcare systems because healthcare expenditures in BRIC nations have exhibited the highest revenue growth rates for pharmaceutical multinational corporations (MNCs), Big Pharma. The response of BRIC nations to Big Pharma presents contrasting cases of how governments manage the tensions posed by rising public expectations and limited resources to satisfy them. Understanding these tensions represents an emerging area of research and an important challenge for all those who work in the field of health policy and management (HPAM).

We compare health improvements among three megacities in BRIC nations as measured by declines in amenable mortality (AM). Although there have been studies of AM in Brazil and the Russian Federation using different definitions and age cohorts, this indicator has never been used to compare these cities. During the period 2000–10, age‐adjusted rates of all leading causes of AM fell in all three cities. In São Paulo, it dropped from 1.57 to 1.19 per 1,000 population. In Moscow, it fell from 2.10 to 1.40, and in Shanghai, from 0.72 to 0.54. The rate of decrease was highest in Moscow (33 percent), followed by Shanghai (30 percent), and São Paulo (24 percent). All three cities experienced large reductions in chronic cardiovascular diseases in the form of IHD and stroke, but they remain the leading causes of premature death. Our finding of the decline of AM deaths in São Paulo, Moscow, and Shanghai suggests that all three health systems made significant improvements over the 2000–10 period. It will be important to monitor this indicator as economic growth in these countries and cities has slowed considerably since 2010.

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This article uses an ecological study design to explore intraurban health inequality in São Paulo by examining neighborhood‐level changes in mortality amenable to medical care. We use 2003–2013 data for 95 city districts of São Paulo and apply a random coefficient growth curve modeling approach. We find that improved access to health‐care services is associated with reduced amenable mortality. Despite these overall improvements, the magnitude of population health disparities, as measured by amenable mortality, did not diminish. The effects of social, economic, and health system factors on amenable mortality depend on the income level of the district. Persistent disparities in amenable mortality within São Paulo suggests that neighborhood‐level differences in social determinants of health and access to health services require further investment from the Brazilian government.

This paper documents changes in infant mortality (IM) rates in São Paulo, Brazil, between 2003 and 2013 and examines the association among neighborhood characteristics and IM. We investigate the extent to which increased use of health care services and improvements in economic and social conditions are associated with reductions in IM. Using data from the Brazilian Census and the São Paulo Secretaria Municipal da Saúde/SMS, we conducted a longitudinal analysis of panel data in all 96 districts of São Paulo for every year between 2003 and 2013. Our regression model includes district level measures that reflect economic, health care and social determinants of IM. We find that investments in health care have contributed to lower IM rates in the city, but the direct effect of increased spending is most evident for people living in São Paulo's middle- and high-income neighborhoods. Improvements in social conditions were more strongly associated with IM declines than increases in the use of health care among São Paulo's low-income neighborhoods. To reduce health inequalities, policies should target benefits to lower-income neighborhoods. Subsequent research should document the consequences of recent changes in Brazil's economic capacity and commitment to public health spending for population health.