GEO Brasil - UNEP

The state of health and the environment
the state of the environment in Brazil
122 The Urban/Rural and Regional Disparities
Regarding Morbidity-Mortality
According to the Panamerican Health Organisation (PHO,
1998), the average national indicators do not clearly
demonstrate the disparities between urban and rural areas,
among large regions, among states located in the same
region and among districts of the same state It is estimated
that, from 1990 to 1994, 20% of all deaths in the country
were not registered This percentage reached up to 60% in
the Northeast In most parts of the South and Southeast,
however, records are above 90%, reaching almost 100% in
the urban areas (Unified Health System Database/Banco
de Dados do Sistema Único de Saúde-SUS-DATASUS,
2002)
Almost 15% of all deaths registered in the country in 1998
were not properly defined The North and Northeast
demonstrate the highest rates of improperly defined causes,
243% and 298%, respectively (DATASUS, 2002) These
numbers indicate that health care coverage in Brazil is still
insufficient for large regions This picture is expected to
change after the national implementation of the Family
Health Assistance Program (Programa de Atenção à Saúde
da Família) and the Interiorisation of Health Assistance
Program (Programa de Interiorização da Assistência à
Saúde) However, growing attention to health does not mean
an increase in equal access to medical technologies nor to
integral health policies
Analysing all causes of death groups, from 1990 to 1998,
and excluding improperly defined causes, circulatory system
diseases (mainly ischemic heart diseases and brain-vascular
diseases) represent the number one cause of death, with an
average rate of 2759% of all occurrences in the country
Even in the poorest regions of Brazil (North and Northeast),
where contagious diseases are responsible for a high
mortality rate, this group is still the first cause of death
(DATASUS, 2002) The increase in male mortality in the 15
to 29 year old age group due to external causes involving
homicides, suicides and car accidents should be pointed
out (DATASUS, 2002) This is the second cause of death
and the result of the morbidity-mortality external causes,
which represented 15% of all deaths in Brazil in 1998
Homicides stand out in this group, assuming great
importance in all regions, but mainly in large urban areas
(DATASUS, 2002)
Over the last decades, there has been a significant decline
in the mortality levels of children under 5 years of age This
percentage in the total number of registered deaths
decreased from 24% to 78% in the subgroup of children
under one year of age between 1980 and 1998 It has also
dropped from 46% to 14% in the group made up of children
from 1 to 4 years old (DATASUS, 2002) 1999 figures (RIPSA,
2001) show that the decline in infant mortality rates is bigger
in urban than in rural populations Disparities among
regions are also evident: in the Northeast, the 524 deaths
for every thousand infants born is 35 times higher than the
Southern rate of 151 deaths for every thousand infants
born The historical drop in the five-year-old mortality rate
and the rise in the proportional mortality rate in the fiftyyear-old
group are observed The reduction in mortality in
the five-year-old group is definitely related to immunisation,
oral rehydration (in cases of diarrhoea and dehydration),
breast-feeding incentive programs and a slight increase of
10% in the sanitation sewerage system of urban regions
(National Plan of Basic Sanitation/ Plano Nacional de
Saneamento Básico-PNSB, 2000)
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