Impact of the Social Agendas - Agenda 21 and Healthy Cities - upon Social Determinants of Health in Brazilian municipalities: measuring the effects of diffuse social policies through the dimensions of the Millennium Development Goals

Abstract

Introduction:In order to improve the quality of life and health of the population in recent years there have been several local social agendas, like Agenda 21 and Healthy Cities. Objectives: To identify how social agendas are impacting on the living conditions and health in municipalities of the five regions of Brazil. Methods: Through an ecological longitudinal study, the social agendas' effects on the Social Determinants of Health were measured in 105 municipalities, using indicators related to the eight dimensions of the Millennium Development Goals (MDGs). Indicators were also calculated for other 175 non-exposed municipalities. Descriptive statistics were calculated for each group of municipalities at three different moments: in the year of the agenda implementation, then 3 and 6 years later. The models were adjusted by the method of GEE to assess the effects of the agendas, time and their interaction. Nonparametric analysis of variance was used for the ordinal data with repeated measures. Results: Impacts of the agendas were detected for reduction of hunger and increase of universal access to education: 'percentage of children under one year with protein/caloric undernourishment' (interaction effect: p = 0.02) and ' Age-grade distortion in the 8th grade of fundamental education' (interaction effect: p < 0.001). Conclusion: The comparative discussion between model results and descriptive statistics recommends, at further research, extending the period of investigation, using compound indexes, improving the methodology for the apprehension of the impacts of the diffuse social policies for development, as well as using 'mixed methodologies', integrating quantitative and qualitative tools.

Iniquidades sociais e intersetorialidade: desafio à atenção primária à saúde

“…The results showed that, according to the variables, 40% of the studies dealt with intersectorial actions of governmental level involving initiatives of the federal government; 22,24 20% dealt only with local intersectoral actions involving civil society 23 and 40% involved actions of the two types. 25,26 Regarding the theoretical references, 40% involved actions to reduce health inequities based only on the WHO framework, 22.25 , 20%, in the Social Capital benchmark, 23 20% in the WHO reference frameworks and the Course of Life 24 and 20%, in the references of WHO and the Social Capital. 26 Regarding health outcomes, intersectoral actions at the PHC level and with a focus on SDH, described by the reviewed articles, showed the following results: increased access to health services and education; increase in prenatal visits from 49% to 61%; increased immunization and reduction of child malnutrition; reduction of infant mortality below five years; increased income for families in extreme poverty and extension of the social and financial protection network.…”

“…25,26 Regarding the theoretical references, 40% involved actions to reduce health inequities based only on the WHO framework, 22.25 , 20%, in the Social Capital benchmark, 23 20% in the WHO reference frameworks and the Course of Life 24 and 20%, in the references of WHO and the Social Capital. 26 Regarding health outcomes, intersectoral actions at the PHC level and with a focus on SDH, described by the reviewed articles, showed the following results: increased access to health services and education; increase in prenatal visits from 49% to 61%; increased immunization and reduction of child malnutrition; reduction of infant mortality below five years; increased income for families in extreme poverty and extension of the social and financial protection network. In addition, they also showed an increase in social capital and the strengthening of social support networks; control of problematic use of alcohol and other drugs; access to information; social participation and community empowerment and reduction of violence; reduction of hunger; increasing universal access to health and education; the tuberculosis prevalence ratio decreased from 32 to 26% in some cities; the percentage of the population served with running water increased; improvements in urban mobility and environmental improvements and increased accessibility to health services.…”

“…Regarding the issue of intersectoriality, although the articles show that there is a polysemy on the conceptual basis of intersectoriality, two types can be outlined that have marked a prevalence of the implemented actions: intersectoral action whose initiative, implementation and management departs and remains as government action from the federal level; and another modality that are local intersectoral actions, with initiatives of municipal or even federal governments, but involving participation and civil society organizations and are developed with local territorial base. [22][23][24][25][26] Although governmental intersectoral actions constituted a significant part of the studies (40%), there is a tendency (40% reflect the two types AIG and AIPS) to a concept that defines intersectoral work, emphasizing the interface between governments and civil society, as well as the reciprocity and crosscutting of the sectors towards co-participation and effective sharing of planning and management in the production of intersectoral projects and actions. There is also a tendency to overcome conceptual interpretations that delineate intersectoriality as a multisectoral enterprise through a serial logic, that is, a logic of summation of consecutive efforts without synergy.…”

“…Another reviewed study 26 proposes intersectorial action closely linked to network integration mechanisms and show that in all projects analyzed by the study, involving municipalities in the Southeast, Northeast and South regions, intersectoriality was present, however, with several scopes. Some projects of an analyzed municipality are realized by means of centralized forums through municipal administrative policies, being composed by secretaries.…”

Social iniquities in Primary Healthcare and intersectoral action: a descriptive study

“…Some of these actions are: the creation of programs targeted at the inclusion in the work market with a higher income, increased access to health and education services, the creation of programs targeted at the environmental fields, and the fostering of social capital in communities. All that empowers groups, increases social participation from the civil society, improves the gradient in health in the populations studied, improves the state of health of specific groups analyzed, and the ability to confront diseases that are considered poverty-related or that are neglected (6,(19)(20)(21)(22)(23)(24)(25)(26) .…”