Fiscal austerity measures hamper noncommunicable disease control goals in Brazil

Malta, Deborah Carvalho; Duncan, Bruce Bartholow; Barros, Marilisa Berti de Azevedo; Katikireddi, Srinivasa Vittal; Souza, Fatima Marinho de; Silva, Alanna Gomes da; Machado, Daiane Borges; Barreto, Mauricio Lima

doi:10.1590/1413-812320182310.25222018

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DEBATE • Ciênc. saúde colet. 23 (10) • Oct 2018 • https://doi.org/10.1590/1413-812320182310.25222018 linkcopy

Fiscal austerity measures hamper noncommunicable disease control goals in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Given the Constitutional Amendment 95 and the economic crisis, we discussed the possible effects of austerity measures on the achievement of the goals established for the control of chronic noncommunicable diseases (NCDs) in the country. The trends of NCDs and risk factors were analyzed, according to data from epidemiological surveys and mortality data from the Global Burden of Disease study. The resultsindicate a trend of stability in mortality rates by NCD in 2015 and 2016. Brazilians with low schooling, in general, have a higher prevalence of risk factors and a lower prevalence of protective factors. In the 2015-2017 period, previously favorable trends reversed for indicators such as fruit and vegetable consumption and physical activity, tobacco trends stabilized, and alcohol intake increased. In conclusion, should these trends be maintained, it is unlikely that Brazil will achieve the goals previously agreed upon with the World Health Organization and the United Nations to curb NCDs and their risk factors.

Noncommunicable diseases; Risk factors; Mortality; Austerity; Sustainable development

Factor	Schooling years	2010	2011	2012	2013	2014	2015	2016	2017	% (2014 - 2010)*	% (2015 to 2017)*	PR** (2010)	PR** (2014)*	PR** (2017)*
Smoking	0 to 8	18.1	18.2	16.3	15	14.1	14.4	14.3	13.2	-22.1	-8.3	1.9 (1.7-2.2)	2.1 (1.7-2.5)	1.8 (1.6-2.0)
	9 to 11	12.2	10.7	10	10.3	10.3	9	9.4	9.9	-15.6	10.0	1.2(1.1-1.4)	1.5 (1.3-1.8)	1.3 (1.1-1.5)
	12 and over	10	9.8	9.1	7.4	6.8	7.2	6.9	7.4	-32.0	2.8	1	1	1
	Total	14.1	13.4	12.1	11.3	10.8	10.4	10.2	10.1	-23.4	-2.9
Obesity BMI ≥ 30 kg/m2)	0 to 8	18.8	19.7	21.7	22.3	22.7	23.6	23.5	23.3	20.7	-1.3	1.6 (1.4-1.8)	1.8 (1.6-2.1)	1.5 (1.3-1.7)
	9 to 11	13.1	14.2	15.2	15.1	17.2	17.8	18.3	17.8	31.3	0.0	1.1 (1.0-1.2)	1.4 (1.2-1.6)	1.1 (1.0-1.2)
	12 and over	11.7	13	14.4	14.3	12.3	14.6	14.9	16	5.1	9.6	1	1	1
	Total	15.1	16	17.4	17.5	17.9	18.9	18.9	18.9	18.5	0.0
Fruits and vegetables recommended	0 to 8	15.3	18.9	18.6	19.4	20.2	20.1	19.7	19.5	32.0	-3.0	0.6 (0.5-0.6)	0.6 (0.5-0.6)	0.7 (0.6-0.8)
	9 to 11	19.1	20.6	21.2	23.1	22.5	23.2	23	22.1	17.8	-4.7	0.7 (0.6-0.8)	0.7 (0.6-0.8)	0.7 (0.6-0.8)
	12 and over	27.4	28.9	31.4	30.1	31.9	34.6	30.8	29.7	16.4	-14.2	1	1	1
	Total	19.5	21.9	22.7	23.6	24.1	25.2	24.4	23.7	23.6	-6.0
Sufficient physical activity at leisure	0 to 8	19.6	21.2	21.6	22	22.9	25.4	24.5	23.3	16.8	-8.3	0.5 (0.4-0.5)	0.5 (0.4-0.5)	0.5 (0.4-0.5)
	9 to 11	34.6	35.3	37.1	37.2	38.5	40.1	40.4	39.7	11.3	-1.0	0.8 (0.8-0.9)	0.8 (0.8-0.9)	0.8 (0.8-0.9)
	12 and over	41.3	42.5	45.4	45.4	47.8	49.6	47.9	47	15.7	-5.2	1	1	1
	Total	30.1	31.6	33.5	33.8	35.3	37.6	37.6	37	17.3	-1.6
Alcohol abuse	0 to 8	14	13.4	15	12.8	12.3	13.2	14.2	13.8	-12.1	4.5	0.6 (0.6-0.7)	0.6 (0.6-0.7)	0.6 (0.6-0.7)
	9 to 11	19.6	17.5	19.4	17.5	18.4	18.1	19.2	20.2	-6.1	11.6	0.9 (0.8-0.9)	0.9 (0.8-0.9)	0.9 (0.8-0.9)
	12 and over	22.9	20	22	19.7	19.5	20.9	24	22.8	-14.8	9.1	1	1	1
	Total	18.1	16.5	18.4	16.4	16.5	17.2	19.1	19.1	-8.8	11.0
Arterial hypertension	0 to 8	36.4	36.4	37.9	38	38.1	39.9	41.8	39.7	4.7	-0.5	2.6 (2.4-2.8)	2.6 (2.4-2.9)	2.7 (2.5-2.9)
	9 to 11	17.3	17.6	17.9	17.1	19.3	18.2	20.6	19.6	11.6	7.7	1.2 (1.1-1.4)	1.3 (1.2-1.5)	1.3 (1.2-1.5)
	12 and over	13.9	15.3	14.2	14.6	14.6	15.1	15	14.8	5.0	-2.0	1	1	1
	Total	24.3	24.3	24.3	24.1	24.8	24.9	25.7	24.3	2.1	-2.4
Diabetes	0 to 8	10.4	10.6	12.1	12.2	14.2	13.5	16.5	14.8	36.5	9.6	2.6 (2.2-3.1)	3.8 (3.2-4.5)	4.4 (3.9-4.9)
	9 to 11	4.6	3.9	5.2	4.2	5.1	4.4	5.9	5.3	10.9	20.5	1.2 (1.0-1.4)	1.4 (1.1-1.6)	1.6 (1.3-1.9)
	12 and over	4	3.1	3.8	3.2	3.7	3.7	4.6	3.4	-7.5	-8.1	1	1	1
	Total	6.8	6.3	7.4	6.9	8	7.4	8.9	7.6	17.6	2.7

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[TFN1001] * Percentage difference in achieving goals between 2010 to 2014, 2015 to 2017. ** Prevalence Ratio and 95% CI, reference 12 years and over schooling, calculated by the Poisson Regression.