Created in 2015, the 2030 Agenda gathers UN targets for sustainable development. Health is a transversal target and is covered by all 17 Sustainable Development Goals (SDGs), but addressed specifically in Goal 3. The nine targets part of this SDG were analyzed on a new report of the Health System Performance Assessment Program (Proadess), from Instituto de Comunicação e Informação Científica e Tecnológica em Saúde - Icict/Fiocruz (Institute for Scientific and Technological Communication and Information on Health). The analysis was made based on a historical series of indicators proposed for monitoring.
According to the publication, "persistent inequalities among Great Regions are aspects to be considered, despite the fact these differences have been generally reduced over recent years". Mother mortality, addressed in the first target, is an example of this scenario. The Brazilian average is below the minimum recommended in SDGs. In 2016, deaths were 64.4 for every 100,000 live births, and the target is 70 per 100,000 live births. However, the value for the North region is 91% higher than that of the South region, with the North and Northeast regions of Brazil still being above the target.
Inequalities among the regions also affect other areas, like neonatal mortality and the healthcare workforce available in the country. Neonatal mortality is below 12 per 100,000 live births (target 3.2) in all Brazilian regions, except for the North region and six states (Amapá, Pará, Roraima, Piauí, Sergipe and Bahia). Early neonatal mortality ranged from 5.1 (South) to 9.5 (North) in 2016, and some regions showed an upward trend from 2014-2015. Targeting such internal and inter-group inequalities is fundamental for achieving the 2030 Agenda, whose motto is "Leaving No One Behind".
Other indicators reviewed are relative to the incidence of infectious diseases, like AIDS and tuberculosis (target 3.3); early mortality caused by non-transmissible diseases (target 3.4); alcohol abuse (target 3.5); death resulting from road traffic accidents (target 3.6); access to healthcare (3.8) and access to utility services, like water, sewage and garbage collection (target 3.9).
Although AIDS incidence rate has been stable, the number of new AIDS cases in younger than 5 years old does not follow the national reference standard of 10% annual reduction, and this is a worrying piece of information. Tuberculosis, despite having been reduced, is still a public health challenge, with treatment abandonment rates twice as higher than those indicated by the WHO. Meanwhile, syphilis spread to children under one year old has increased in all regions.
Regarding target 3.8, which addresses universal health coverage, the report explains this target is different from the Brazilian Unified Health System (SUS) in broader terms than universal coverage, which can be translated into minimum private plans subsidized by the government. SUS addresses access to healthcare, having universality, integrality and equity as principles. The publication assesses the estimated population coverage by Basic Healthcare and observes a reduction as of 2015. This trend is repeated in the percentage of population covered by the Family Health Strategy.
The last target (3.9) addresses deaths and diseases caused by contamination and pollution. This is one of the targets that more effectively explains the relationship between health and the environment. The report also assessed access to basic services interfering in these indicators, like water, sewage and garbage collection. Differences among regions are also profound. The percentage of the population with adequate water supply in 2013 ranged from 54.8 (North region) to 91.2 (Southeast region). Adequate sewage disposal in 2013 was worse in the North (56.4) and Central West (58.8) regions. Adequate disposal in this case means households being connected to a collection network and not sewage final disposal. The percentage of people who have their garbage collected at home is higher than 75% in all regions. Although the Northeast region has the worst results for this indicator, this region improved the most, going from 55.7% (1998) to 76.6 (2013).
Access the full report in Portuguese here.