Os inquéritos domiciliares e o Sistema Nacional de Informações em Saúde / The household surveys and the National Health Information System

Neste artigo apresenta-se um breve histórico dos inquéritos domiciliares em saúde de abrangência nacional, que foram desenvolvidos no Brasil ao longo dos últimos 20 anos. Discutem-se alguns problemas metodológicos importantes envolvidos na concepção e no desenho amostral dos inquéritos de base populacional e faz-se uma breve revisão dos aspectos contemplados pelos suplementos de saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD), que foram a campo em 1981, 1986, 1998 e 2003. Tendo em vista o compromisso já assumido pelo Ministério da Saúde e pelo IBGE quanto à inclusão de um novo suplemento na PNAD de 2008, abre-se um debate sobre as vantagens e as limitações da PNAD como instrumento capaz de gerar dados de base populacional sobre morbidade, acesso e utilização de serviços de saúde. Finalmente destaca-se a necessidade de formulação de política para a geração de informações a partir de inquéritos de base populacional e sua incorporação ao Sistema Nacional de Informações em Saúde. Os inquéritos devem ser realizados periodicamente e os recursos financeiros para sua realização garantidos.

In this article the authors present a brief review of the household health surveys developed in Brazil in the last 20 years. Some important methodological problems related to their conception and sample design are discussed, and a brief review of the National Household Survey Health supplements conducted in 1981, 1986, 1998 and 2003 is presented. Given the already established agreement between the Ministry of Health and the Brazilian Institute of Geography and Statistics as to inclusion of a Health supplement in the 2008 National Household Survey, the authors propose a debate on the advantages and limitations of this instrument for the collection of data on morbidity, access to and utilization of health services. Finally, the authors stress the need for a policy towards generation of population-based information and its incorporation in the National Health Information System. Surveys must be periodically conducted and their financing must be guaranteed.

Problemas éticos de la salud pública / Ethical issues in public health

Studies conducted in Colombia and Venezuela to characterize the association between the level of municipal development and the prevalent mortality due to different causes, and studies conducted in Paraguay relating to the level of poverty and wealth with Access to health services, have shown that global at country level hide social exclusion, since there are great regional differences. These differences have not been handled by governments with proper public policies according to local situations and therefore, the existing social gaps continue or even increase.

Estudios realizados en Colombia y Venezuela, caracterizando que existe entre el nivel de desarrollo municipal y la mortalidad prevalente por diversas causas; y en Paraguay, relacionado el nivel de pobreza y riqueza con indicadores de acceso a servicios de salud, evidencias que los indicadores globales, a nivel del país, esconden la exclusión social, ya que existen grandes disparidades regionales. Estas diferencias no han sido intervenidas con políticas públicas acordes a la realidad por parte de los gobiernos, lo que se traduce en el mantenimiento o profundización de las brechas sociales existentes.

Priorities for research to take forward the health equity policy agenda.

Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. Our recommendations regarding research priorities for health equity are based on an assessment of what information is required to gain an understanding of how to make substantial reductions in health inequities. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people's chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas.

Inequidades en salud: cómo estudiarlas / Health inequalities: how to study them

Discute formas útiles de medir desigualdades en salud, de acuerdo con criterios igualmente útiles, que permitan comprender sus determinaciones y por tanto, establecer su evitabilidad, no-necesidad y la injusticia de su presencia en una comunidad solidaria y que se propone crear condiciones adecuadas para el desarrollo de todos sus miembros independientemente de sus características personales de raza, etnia, ocupación, sexo, creencia religiosa, etc. Se muestran metodologías sencillas que no requieren ni grandes conocimientos de estadística y epidemiología, ni datos que sean de obtención difícil o costosa. Para la prepación del artículo han sido utilizadas dos publicaciones de la OMS no disponibles en español y de circulación limitada