[COVID-19 in the midst of a "perfect storm" in neoliberal capitalism: critical reflections on its impacts in Brazil]

The impacts of the recent coronavirus pandemic on Brazilian society revealed a scenario that goes beyond a health crisis. This article sets out to present the causes and consequences of a systemic crisis in the neoliberal economic order based on the prominence of markets and social exclusion, while the role of the State - as the guardian of social rights - is neglected. The methodology adopted follows a critical interdisciplinary perspective from the fields of political economy and social sciences, located in socioeconomic reports referred to in this analysis. It is argued that the neoliberal rationale guiding government policies, which is deep rooted in the social environment, has contributed to the increase in structural inequalities in Brazil, thus creating favorable conditions for exacerbating the impacts caused by the pandemic in society, particularly among the most vulnerable social groups.

Trajetorias: a dataset of environmental, epidemiological, and economic indicators for the Brazilian Amazon

The Trajetorias dataset is a harmonized set of environmental, epidemiological, and poverty indicators for all municipalities of the Brazilian Legal Amazon (BLA). This dataset is the result of a scientific synthesis research initiative conducted by scientists from several natural and social sciences fields, consolidating multidisciplinary indicators into a coherent dataset for integrated and interdisciplinary studies of the Brazilian Amazon. The dataset allows the investigation of the association between the Amazonian agrarian systems and their impacts on environmental and epidemiological changes, furthermore enhancing the possibilities for understanding, in a more integrated and consistent way, the scenarios that affect the Amazonian biome and its inhabitants.

Brazilian Agro-industrial Wastes as Potential Textile and Other Raw Materials: a Sustainable Approach

The Brazilian agro-industrial chain generates about 291 million/tons/year of wastes, which, if inadequately destinated, could originate social and environmental risks. There is a growing need for the use of alternative raw materials to replace that originated from fossil resources in the Brazilian industry. Renewable materials play an important role on the sustainability of ecosystems and materials’ circularity. The issue has acquired importance in light of recent bio-based agro-fiber development potential applications. Considering sustainability guidelines, this study aimed to analyze the main Brazilian agro-industrial waste crops (temporary and permanent) as important sources of natural fibers and other raw materials. A systematic review of the literature (SRL) about Brazilian researches, based on concepts of industrial ecology, and the creation of a bibliometric analysis network were carried out. The agricultural biomass related to the main crops presents characteristics making them suitable to be applied for textiles, as natural fibers and polymers, in biosorbents for industrial effluents, and cellulose obtention and reinforcement material in composites. Thus, scientific investment in researches on materials and technology development are necessary to provide applications that could meet current and future demands and expand the scope of new materials for sustainability.

A ADMINISTRAÇÃO POLÍTICA DE ROBERTO SIMONSEN E A IDEOLOGIA DA TERCEIRA VIA NO CAPITALISMO ATRÓFICO BRASILEIRO

RESUMO O objetivo do presente artigo é apresentar a propositura de administração política de Roberto Simonsen como variante da ideologia da terceira via. Para tanto, utilizou-se os fundamentos materialistas da determinação social do pensamento que reconhece não apenas as condições concretas, como pressupostos objetivos para as formações ideais, como também sublinha a particularidade dos casos específicos. Assim, o ideário de Simonsen, extraído dos seus textos entre 1919 e 1947, foi considerado a partir dos traços semicoloniais do Brasil de então. As conclusões apontam para aspectos progressivos e regressivos na propositura de Simonsen, salientando que a ideologia da terceira via foi adaptada às condições nacionais à luz das aspirações industrialistas.

Instituciones, migración, remesas y pobreza. Los casos de Rancho Narváez y Yalvanté, Chiapas, México

El objetivo de este artículo es analizar el papel de las instituciones, formales e informales, en el envío, la recepción y el uso de remesas en dos comunidades indígenas de México con una histórica experiencia migratoria y con altos niveles de pobreza. Se exploran las dinámicas socioeconómicas de los territorios de origen de los migrantes prestando especial atención a la influencia que tienen las reglas socialmente compartidas y los acuerdos familiares y comunitarios en las decisiones de consumo, inversión o ahorro en los hogares receptores. Los resultados que se muestran se obtuvieron a partir del trabajo de campo realizado durante dos años, 2019 y 2020, en dos parajes de San Juan Chamula, donde se aplicaron 35 entrevistas y 30 encuestas a actores clave. Entre las conclusiones destaca la necesidad de fortalecer las instituciones para que se propicie un uso productivo de los ingresos foráneos, y al mismo tiempo se enfatiza la importancia que tienen estas transferencias monetarias en la contención de la pobreza.

[Growth, centralization, and financialization of Diagnostic and Therapeutic Support Services (SADT) in Brazil: a study of selected companies from 2008 to 2016]

This article discusses the dynamics of the Diagnostic and Therapeutic Support Services subsector from 2008 to 2016 in Brazil. Through an exploratory approach, the study aimed to operationalize key concepts from the literature on the pattern of accumulation characterizing contemporary capitalism. The research focused on the activity of six Brazilian diagnostic companies in three main dimensions: (1) net worth; (2) accounting-finance; and (3) policy. The results reveal a subsector experiencing vigorous growth via increases in the volume and prices of the services provided. The evidence corroborates traits of a pattern of financialized accumulation, especially aggressive strategies of mergers and acquisitions by leading companies, with centralization as a result. However, some characteristics associated with the concept of financialization appear not to be relevant. The article also discusses the prospects for competition in activities in the Diagnostic and Therapeutic Support Services subsector and the possible effects for the effort to consolidate Brazilian Unified National Health System (SUS).

[Analysis of financial statements from companies in the Brazilian health sector (2009-2015): concentration, centralization of capital, and expressions of financialization]

The Brazilian health system is characterized by major participation by the private sector. In the current decade, companies working in health-related sectors have stood out in the corporate world due to the results and size of their financial operations. The study analyzed the companies' trajectory from the perspective of financialization, defined as the dissemination of a pattern of accumulation, characteristic of contemporary capitalism. The article aimed to to analyze the expressions of financialization in the accounting-financial dimension of companies and corporate groups in the Brazilian health sector. The study describes the trajectory of accounting items and indicators from 2009 to 2015, based on an examination of financial statements from 43 companies in 5 subsectors (health plans, hospitals, retail pharmacies, pharmaceutical industry, and diagnostic and therapeutic support services). The results are analyzed in four categories: size, performance, indebtedness, and relevance of financial operations. The results were compared to the overall results for large and open-capital corporations in Brazil. The study reveals central aspects of financialization such as the sector's growth, the expansion of leading companies, and capital centralization, corroborating hypotheses concerning the concentration and centralization of capital. Other hypotheses, such as the relevant impacts of financial operations on revenues, were not confirmed. Finally, the evidence provided by a strictly accounting-based analysis suggest the need to incorporate other dimensions, especially such strategies as mergers, acquisitions, and other equity operations.

[The dynamics of financialized capitalism and the Brazilian health system: reflections in the shadows of the COVID-19 pandemic]

The COVID-19 pandemic in Brazil has highlighted the importance of the Brazilian Unified National Health System (SUS) and the limitations of the country's prevailing health system, consisting of the public and private sectors, in the context of financialized capitalism in which typical instabilities and crises are structurally determined. The article discusses the Brazilian health system under the aegis of financialized capitalism and during the COVID-19 pandemic. The article contends that financialization as a systemic pattern of wealth increases the process of commodification of socioeconomic relations which is inherent to this system, making the State's provision of health services indispensable.

[Financialization of the health sector in Brazil: theoretical and methodological challenges to the investigation of companies and business groups]

The article describes the history of the response to the theoretical and methodological challenges in research on companies and corporate groups in the Brazilian health sector that reorganized their shareholding structures, diversified their activities, and expanded their financial operations. Such movements in corporate concentration and expansion were analyzed with an approach to the frame of reference for financialization in contemporary capitalism in the analysis of selected companies and corporate groups. Corporate strategies were classified in three dimensions: shareholding, financial, and accounting structure and influence on the public agenda and the respective indicators orienting the organization of information from diverse sources for companies and corporate groups from 2008 and 2017. The study provides a profile of the intense and complex process of corporate reorganization in the health sector. Still, the study's exploratory design and difficulties in access to information and selection of companies and corporate groups mean that the observations are necessarily preliminary.

[From community pharmacies to big pharmacy chains: private provision of medicines, health system, and financialization of the Brazilian retail pharmacy market]

The provision of medicines in Brazil is marked by the predominance of private expenditures and supply in pharmacies and by the historically liberal regulation of retail drug sales. The first two decades of the 21st century witnessed the expansion and concentration of the retail pharmaceutical sector and growing financialization of the health sector. The article analyzes the characteristics of financialization of Brazilian retail pharmaceutical companies, considering the following three crosscutting dimensions: ownership structure, financial/accounting, and political. Quantitative and qualitative data from various sources were analyzed including ownsership and account informations of the ten biggest Brazilian retail pharmacies chains and political action of four business associations. The information collected was stored in the source project database. The ownership structure dimension revealed verticalization, diversification, capitalization via financial and shareholding operations, intensification of mergers and acquisitions, opening of pharmacy branches, entry of investors, and changes in internal management and organization. The financial/accounting dimension revealed an increase in size (revenues, assets, net worth) and good performance (return on equity capital, capital turnover, and third-party capital) of the networks compared to Brazilian companies and health companies. The policy arena revealed both clashes and collaborations between representative associations and government (Executive, Legislative, and Judiciary), depending on the issue, with outcomes that were generally favorable to the pharmaceutical sector and leadership by the Brazilian Association of Pharmacy and Drugstore Networks (Abrafarma). The financialization of the retail pharmaceutical companies' accumulation pattern and the strengthening of their political action proved relevant for understanding the changes in the provision of medicines and in the pharmaceutical market.

[Financialization, accumulation, and shareholding changes in companies and corporate groups in the Brazilian health sector]

This study aims to analyze the shareholding dimension of changes in companies and corporate groups in the Brazilian health sector from 2008 to 2017. The idea was to understand the strategies of accumulation in a context of financialization, defined as a systemic pattern of wealth in contemporary capitalism. The shareholding changes were submitted to descriptive and exploratory analysis based on different sources. We studied 58 companies from the subsectors of health plans, pharmacies, hospitals, diagnostics, pharmaceutical industry, and social organizations. Data were collected on the legal structure, ownership, and control, equity operations, and economic and patient care activities. Despite the heterogeneity of the companies and their strategies, the results point to an increase in the presence of domestic and international investors, changes in internal organization, capital, financing, and diversification of activities. The companies that stood out were actively pursuing capitalization via foreign investments, purchase and share of assets and shares, and mergers and acquisitions, accelerating the process of expansion, accumulation, and shareholding and financial appreciation. The result is an increase in capital flows and growing integration of economic and patient care structures in the Brazilian health sector with financial circuits, thereby linking peripheral intermediate companies to an expanded process of accumulation under financial dominance. The findings corroborate striking aspects of corporate dynamics in financialization that increasingly influence health systems in Brazil and the world.

The Use of Fluorides in Public Health: 65 Years of History and Challenges from Brazil

Untreated dental caries is the most common disease globally and fluoride use at the population level is crucial for its control. To investigate the economic and political conditions under which the trajectory of population-based fluoride use has occurred is key for a more comprehensive view on its current and future challenges. The objective was to give a brief history and summarize the information on the use of fluorides at the population level in Brazil from 1952 to 2017 and to point to current and future challenges. A critical overview was undertaken based on country-level analyses comprising political and economic conditions. The analytical approach adopted a set of premises applicable to the study of capitalist democracies. Fluoride methods of systemic and topic use began to be employed in Brazilian public health programs in the 1950s and in a combined way from 1974. Differences in political and economic contexts were highlighted for four periods: the first interventions from 1952 to 1974, when the fluoridated water law was approved; the expansion after 1974 until 1988, when a new constitution was enacted; the following time until 2010; and the final period. From the 1980s to 2008, water fluoridation coverage increased progressively, consolidating as a major strategy of systemic use in spite of inequalities among territories. Activities aimed to promote access to topical fluoride use increased and maintained stability until 2014, when they dropped sharply. Regulation of fluoride dentifrice's quality remained insufficient. It was hypothesized that the strengthening of conservative liberalism and the increase in fiscal austerity observed in recent years might produce serious constraints on public investment and limit access to fluorides. To reduce inequities and promote benefits for all, including the most vulnerable groups, policies based on egalitarian and social justice theoretical perspectives are needed more than ever.

Acquisition of food for away-from-home consumption in Brazil between 2002 and 2018

The aim of the study was to assess the evolution of food acquisition for away from home consumption in Brazil from 2002 to 2018. The trend of food purchases for out-of-home consumption in Brazil was evaluated by comparing food purchase data from the Household Budget Surveys (HBS) of 2002-2003, 2008-2009, and 2017-2018. The frequency of food acquisition was estimated according to sociodemographic variables and the mean cost. In 2002-2003, the frequency of purchase of food for out-of-home consumption was 35.2% (95%CI: 34.4-35.9), increasing to 41.2% (95%CI: 40.4-42.0) in 2008-2009, followed by a decline in 2017-2018 (32.3%; 95%CI: 31.7-32.9). A declining trend was observed in the frequency of purchases of alcoholic beverages and soft drinks and fast foods maintained the frequency between the last two surveys. Spending on this type of food increased between 2002-2003 and 2008-2009, while the mean value of this type of expenditure was maintained between 2008-2009 and 2017-2018. Brazilians increased food purchases for out-of-home consumption between 2002-2003 and 2008-2009, declining in 2017-2018. A consistent fall in the purchase of alcoholic beverages and soft drinks was observed over time, while the group of meals grew significantly.

Health expenditures and causa mortis: an investigation on municipalities of the State of Paraná, Brazil

The Brazilian government shares the responsibility of financing public health among federal, state, and municipal levels. Health expenditures are thus uneven across the country and cannot contribute equally to health outcomes across disease categories. This study aims to identify how the health expenditures of municipalities affect the mortality rate in the state of Paraná by causa mortis. We considered years of life lost for each municipality, the chapters of the International Classification of Diseases (10th revision), and the elasticity of this measure in relation to public health expenditure. Considering the possibility of endogeneity, this study follows the instrumental variable approach in a panel of generalized method of moments - instrumental variable (GMM-IV) with fixed effects. Our results show that a 1% increase in health expenditure could decrease the average number of years lost specifically for some causes from 0.176% to 1.56% at the municipal level. These findings could elucidate policy perspective within state finance.

Sickle Cell Disease in Bahia, Brazil: The Social Production of Health Policies and Institutional Neglect

A disease is considered neglected when it is not given due priority in health policies despite the social relevance of that disease, either in terms of the number of individuals affected by it or its morbidity or mortality. Although the causes are structural, neglect in health does not occur in a vacuum. In this paper, we explore how sickle cell disease (SCD) is constructed and neglected in Brazil, based on insights from our long-term participatory qualitative research in the state of Bahia. We present five overarching themes relevant to the social production of SCD, and associated health policies in Brazil: (1) The achievements and setbacks to overcome neglect in SCD, (2) Continuity of comprehensive SCD care; (3) Social movements of people with SCD; (4) Biocultural citizenship; and (5) Academic advocacy. We conclude that it is insufficient to merely recognize the health inequities that differentiate white and black populations in Brazil; racism must be understood as both a producer and a reproducer of this process of neglect. We conclude with a set of recommendations for the main SCD stakeholder groups committed to improving the lives of people living with SCD.

The National Health Policy for People with Disabilities in Brazil: An Analysis of the Content, Context and the Performance of Social Actors

The purpose of this article is to analyse the circumstances in which the National Health Policy for Persons with Disabilities (PNSPCD) came into place in 2002 and the factors supporting or impeding its implementation from 2002 to 2018. The analysis was based on the Comprehensive Policy Analysis Model proposed by Walt and Gilson and focussed on understanding the context, process, content and actors involved in the formulation and implementation of the Policy. Data were obtained from two sources: document analysis of the key relevant documents and seven key informant interviews. Content analysis was undertaken using the Condensation of Meanings technique. The research demonstrates that the development and implementation of PNSPCD is marked by advances and retreats, determined, above all, by national and international macro-political decisions. The policy was formulated during Fernando Henrique’s governments, under pressure from social movements and the international agenda and constituted a breakthrough for the rights of persons with disabilities. However, progress on implementation only took place under subsequent centre-left governments with the establishment of a care network for people with disabilities and a defined specific budget. These developments resulted from the mobilization of social movements, the ratification of the United Nations Convention on the rights of people with disabilities and the adherence of these governments to the human rights agenda. The coming to power of ultra-right governments triggered fiscal austerity, a setback in the implementation of the care network and a weakening in the content of various social policies related to the care of people with disabilities. During this era, the political approach changed, with the attempt to evade the role of the State, and the perspective of guaranteeing social rights. Undoubtedly, the neoliberal offensive on social policies, especially the Unified Health System, is the main obstacle to the effective implementation of the PNPCD in Brazil.

Financing of health and the fiscal dependency of Brazilian municipalities between 2004 and 2019

This article describes the evolution of municipal financing of the Unified Health System, from 2004 to 2019, considering revenues and expenses from own and non-own sources, analyzes fiscal redistribution, according to population size and average household income, and compares this evolution in two periods, characterized as economic growth (2004-2014) and recession (2015-2019). The study was based on data from the Information System on Public Health Budgets. There was real growth in municipal spending on health from 2004 to 2014 (156.3%), with a drop between 2014 and 2015, followed by a recovery between 2015 and 2019. During the recession period, there was an overall increase in the fiscal dependence of municipalities, indicated by the increase in non-own revenues, even with the decrease in the Federal Government participation in transfers. The growth of own health expenses was lower among municipalities with lower household income, while for non-own expenses it was higher in municipalities with a smaller population size. In short, the results indicate a process of increasing municipal spending on health, as well as the increased fiscal dependence of municipalities to fund health, intensified after the 2015 crisis, which especially affected small and lower income municipalities.

Resource-Based Industries and CO2 Emissions Embedded in Value Chains: A Regional Analysis for Selected Countries in Latin America

This paper analyzes the relative content of CO2 emissions embedded in regional supply chains in four different countries in Latin America: Brazil, Chile, Colombia, and Mexico. We estimate both the trade in value-added (TiVA) and the CO2 content embedded in interregional and foreign exports, mapping the relative intensity of CO2 emission levels on value chains. For that, we applied an inter-regional input-output model to determine the interplay between the CO2 emission embedded in goods of resource-based industries and their linkages with other economic industries, revealing a map of CO2 emissions on trade in value-added trade from a subnational dimension. The main result reveals an interregional dependence, indicating a higher level of embedded CO2 on value-added in each regional economy for resource-based industries, usually intense in CO2 emissions. This finding has considerable implications for the sustainable development goals of these subnational areas, as the spatial concentration of production leads to an unbalanced regional capacity for promoting reductions in CO2 emissions along with value chains.

Perspectivas sobre transferências de tecnologias em Hui, Eco e Sarlo

O presente artigo foi construído sob a forma de revisão narrativa, com o objetivo de refletir acerca da transferência de tecnologias nos tempos atuais do antropoceno, era na qual os fazeres do ser humano reverberam diretamente em seus meios, com impactos indeléveis e que alteram o curso da história do planeta. O estudo estruturou-se em duas partes. Na primeira, voltou-se ao questionamento dos conceitos basilares da transferência de tecnologias por entre fronteiras de sociedades, bem como a decorrente mudança por meio desta nova perspectiva. Na segunda, mais especificamente, ilustrou-se o tema por meio das elucubrações diversas de Yuk Hui, Umberto Eco e Beatriz Sarlo sobre o ser-estar-fazer humanos. Como forma de continuação dos estudos, sugere-se a ampliação do debate sob as “vozes” de autores de outras diversidades

Revisiting the Missing Link: An Ecological Theory of Money for a Regenerative Economy

Money is critical for a regenerative future. Transforming it is an unavoidable social, political, and economic endeavor that must be a global priority if we are to prevent future financial crises, reduce economic inequality and adhere to our climate agreements and sustainability goals. For this transition to occur, we urgently need new economic and monetary paradigms that address the root causes of our current unsustainability, offer a new monetary ontology and design, and, more importantly, steer our monetary regime towards the regeneration of our social, economic and ecological landscapes. We need an ecological understanding of money grounded in Ecological Economics and an Ecological Value Theory that lays down the foundations for the conscious democratization, decentralization, and diversification of money. In this work, we revisit and update the missing link between money and sustainability by proposing new ontological avenues and reviewing the design elements and degenerative processes built into the existing system. We also contribute to the development and emergence of an Ecological Monetary Economics by systematizing the ongoing monetary transition toward sustainability and by offering a set of principles drawn from the regenerative economics literature for the conscious design of monetary ecosystems that contribute positively to solving our societal challenges of the 21st century.

Time Trend of Overweight and Obesity in Adults from Rio Branco, Acre, Western Brazilian Amazon (2006-2020)

This study aimed to analyze overweight trend and obesity in adults from Rio Branco, Acre, Western Brazilian Amazon, from 2006 to 2020. This is a time series study, with data from Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL). To estimate annual percentage change (APC) and 95% confidence intervals, the software Jointpoint Regression Analysis v.4.6.0.0., was used. In Rio Branco, overweight prevalence ranged from 44.0% in 2006 to 58.9% in 2020, with a bigger frequency among men than that among women. Obesity prevalence has increased from 12.5% in 2006 to 21.4% in 2020, similar between both sexes. From 2006 to 2020, overweight APC was 5.2% (95% CI: 1.4; 9.1) by 2010, and decreased to 1.3% by 2020. Public policies to control obesity and its risks must be both, implemented as strengthened.

Crise econômica e disparidades no gasto, oferta e utilização de serviços públicos e privados de saúde no Brasil no período entre 2011 e 2019

Buscou-se analisar as repercussões da crise econômica sobre os setores público e privado do sistema de saúde brasileiro e realizar uma análise de tendência de indicadores econômicos e assistenciais, elaborados a partir de dados secundários de fontes públicas oficiais, relacionados ao gasto, ao desempenho econômico de planos e seguros de saúde, à oferta e utilização de serviços. Os resultados demonstraram estagnação do gasto público em saúde, redução do gasto público per capita e do acesso aos serviços públicos de saúde. Contrariamente, em um contexto de queda da renda e do emprego, os planos de saúde mantiveram clientes, ampliaram as receitas, os lucros e a produção assistencial. O desempenho positivo das empresas, antes e a partir da crise, pode ser explicado pela tendência de manutenção de subsídios públicos para o setor privado e pelas estratégias empresariais financeirizadas. Conclui-se que a atuação do Estado brasileiro durante a crise aprofundou a restrição de recursos ao setor público e favoreceu a expansão dos serviços privados, o que contribuiu para aumentar a discrepância no acesso a serviços públicos e privados de saúde no país.

Financiamento de Longo Prazo: Explorando o Avanço Recente do Mercado de Debêntures Brasileiro

ABSTRACT Context: in Brazil, there was an expansion of private funding via bond issuances, especially since 2017. Before that period, the sources of long-term financing were concentrated on public funding. Objective: this study aims to explore the main factors that could have positively affect Brazilian bond market and if it would be possible to improve project financing through this debt instruments. Methods: using mixed methods with econometric tests and qualitative interview analysis, this study assesses which were the factors that supported this growth and if there is any difference across industries. Results: we found that a change in the market trend has indeed happened around 2017, and it was more pronounced in specific industries such as electricity. Interviewees suggested that increases in demand (possibly triggered by the reduction of public sources of funding and the fall in local interest rates) could be the main factors that supported this change in trend. Conclusions: therefore, this study reinforces the importance of local market conditions and government policies affecting the relative attractiveness of private versus public sources of corporate investment.

O novo açúcar: a rota da cocaína na perspectiva de gênero

Resumo: A rota da cocaína não nasceu nos anos de 1970, via Colômbia, e sim no final do século XIX, em 1860, mais precisamente na relação comercial entre Peru e Alemanha. É sobre o surgimento dessa rota que trataremos no presente artigo, cujo fito é o de mostrar como a relação de centro e periferia do mercado de drogas constituiu-se. Fruto de uma pesquisa documental de doutorado, a investigação partiu do mercado de drogas nos países periféricos, em decorrência dos valores bilionários operados pelas instituições financeiras mundiais (bancos) para tornar esse dinheiro ilícito em lícito e do aprisionamento das mulheres na condição laboral de mulas, na última década (2006-2016). O mercado de drogas é, atualmente, uma das fontes empregadoras de mulheres pobres, negras, jovens e não jovens, com filhos, solteiras, com baixa escolarização, moradoras da periferia e com precário acesso à cidadania.

Analysis of financial resources for public health in Brazilian capitals: a time trend ecological study

This study aimed to analyze part of the financial resources used to fund public health actions in the 26-Brazilian capitals, from 2008 to 2018. This is a time-trend ecological study involving revenue and expenditure indicators provided by the Information System on Public Budget for Health (SIOPS). The values were deflated based on the Extended National Consumer Price Index of 2018 in Brazil to allow the comparison over the years. The mean annual variation of health investments, in Brazilian Reais (BRL) was assessed using linear regressions. Pearson’s correlation coefficients were estimated between federal revenues and expenditures with the capitals’ resources. All capitals presented statistically significant positive correlations for the origin of the budget resource invested in health. The lowest coefficient was found in the capital city of Macapá (Amapá State) (r = 0.860) and the highest, in Fortaleza (Ceará State) (r = 0.997). Belo Horizonte (Minas Gerais State) was the capital with the highest annual increase in federal transfers (about BRL 67.91 per year) and Teresina (Piauí State) presented the highest annual increase in health expenditures among the capitals (about BRL 55.42 per year). We found a increase in the transfers of the Brazilian Unified National Health System (SUS) and municipal resources in almost all capitals, but there are still inequalities in the distribution of financial resources among Brazilian capitals from different regions. Health funding is affected by the municipalization of SUS and it is not the single factor affecting the access and quality of health services.

Long-term Financing: Exploring the Recent Advances in the Brazilian Bond Market

ABSTRACT Context: in Brazil, there was an expansion of private funding via bond issuances, especially since 2017. Before that period, the sources of long-term financing were concentrated on public funding. Objective: this study aims to explore the main factors that could have positively affect Brazilian bond market and if it would be possible to improve project financing through this debt instruments. Methods: using mixed methods with econometric tests and qualitative interview analysis, this study assesses which were the factors that supported this growth and if there is any difference across industries. Results: we found that a change in the market trend has indeed happened around 2017, and it was more pronounced in specific industries such as electricity. Interviewees suggested that increases in demand (possibly triggered by the reduction of public sources of funding and the fall in local interest rates) could be the main factors that supported this change in trend. Conclusions: therefore, this study reinforces the importance of local market conditions and government policies affecting the relative attractiveness of private versus public sources of corporate investment.

A dinâmica capitalista no setor hospitalar privado no Brasil entre 2009 e 2015

Os hospitais apresentam mudanças em seu papel nos sistemas de saúde. No Brasil, os hospitais privados sempre tiveram destaque, com os filantrópicos voltando a ganhar maior importância no século XXI. Observa-se uma tendência, em especial nos Estados Unidos, de consolidação de hospitais, concentrando grande poder de mercado, consonante com o fenômeno capitalista de financeirização. O objetivo deste estudo é descrever, no contexto brasileiro, o movimento em curso nos hospitais e grupos hospitalares privados, identificando suas principais características e tendências à luz das dinâmicas atuais do capital. Realizou-se um estudo exploratório, descritivo, que teve como eixo de análise as dimensões patrimonial, contábil-financeira e política. O estudo cobriu o período entre 2009 e 2015, analisando 10 hospitais e três grupos hospitalares selecionados de modo intencional. Foram criados bancos de dados oriundos de diversas fontes a partir dos quais foram calculados indicadores e analisadas informações sobre cada uma das dimensões de análise. Observou-se que o setor hospitalar privado no Brasil já apresentava estratégias características de processo de financeirização, inclusive nos filantrópicos, tal como a formação de oligopólios por meio de fusões e aquisições e da dinâmica de diversificação para outras áreas como ensino e gestão de unidades públicas, foco em alta renda e internacionalização, apoiada por uma agenda política própria do setor. Trata-se de movimento intrinsecamente excludente, concentrador de riqueza, incompatível com os princípios constitucionais da universalidade e do direito à saúde, que requer a adoção de políticas públicas, regulamentação e controle social para sua contenção.

Experiences of Motherhood in University Students in Brazil: A Qualitative Study

Introduction:

The women’s rise to higher education contrasts with the phenomenon of motherhood, since it instigates changes in various contexts, whether physiological or emotional, and directly affects the way of life and routine of those women, resulting in a constant conflict between motherhood and academic career. In this sense, the student has to restructure responsibilities and behaviors, as well as requires family support and laws that support her in this period.

Objectives:

To describe the experiences of motherhood in university students, and to identify the strategies developed by university students to adapt motherhood with academic routine.

Methods:

This is a descriptive, exploratory and qualitative research carried out in a private University Center in Brazil. The participants were ten Nursing undergraduate students, regularly enrolled and who experienced motherhood during the academic term. Data were collected during August and September 2019, through a recorded interview using a semi-structured form. For the treatment and analysis of the data, the Collective Subject Discourse was used. The study followed the ethical precepts and was approved by the ethics committee (opinion n. 3.419.572).

Results:

The participants’ discourses gave rise to four central ideas: Feelings experienced from the discovery of pregnancy; The discovery of pregnancy and the decision to continue the course; Support relationships as a decisive factor for the non-abandonment of the course and Strategies to reconcile motherhood with academic routine. The main key expressions identified in the discourses were: joy, fear, insecurity, anguish, concern, distress, anger, sadness, interrupting, giving up, taking time off from the course, not taking time off from the course, family support, support from friends, support from the institution, adjusting schedules, studying while my child sleeps, family help, taking the baby to college, storing milk while breastfeeding.

Conclusion:

The analysis of the discourses revealed that the experience of motherhood in the university sphere is marked by a combination of different feelings, and by an important process of adaptations to the new moment, since there is a reflection and indecision about the continuity of the academic trajectory. The reports also highlight the importance of family, institutional and friend support, such as a support network of incentive to the care with the child, as well as the use of strategies to reconcile academic routine with motherhood.

Comparison between maximum consumer prices for medicines and prices practiced on the internet in Brazil: misalignments and regulatory distortions

Since 2003, the Medicine Market Regulation Chamber (CMED, in portuguese) has been responsible for establishing the maximum consumer prices (MCP) for medicines. The aim of this study is to compare prices practiced on the internet with the MCP and identify the average price difference between them in two segments of existing drugs in Brazil, the reference and the generic ones. Drug prices were collected on websites of pharmacies and drugstores and compared with their respective MCP for the year 2019. The analysis included 68 drugs and 268 commercial presentations of generic and reference drugs related to these drugs. A different pattern was observed for the average price difference in relation to the MCP in each market segment, with most generic drugs tending to show the highest differences and the reference drugs the lowest ones. The problem of price distortion in relation to the MCP pointed out by the literature was confirmed mainly in relation to the generic drug market. It was concluded that a periodic review of the MCP would be important, considering retail prices.

Advances and setbacks in the 20 years of the Brazilian National Food and Nutrition Policy

We sought to analyze the processes of formulation, updating and implementation of the Brazilian National Food and Nutrition Policy (PNAN), from 1999 to April 2020. This is a discussion paper, using institutional documentary sources, bibliographic search in national and international databases, as well as theses and dissertations. The theory of the cycle of public policies was adopted to systematize and present the set of information. PNAN was established in 1999 and updated ten years later, in a participatory process, based on an innovative approach centered on the paradigms of healthy food practices, the human right to food and nutritional security, aligned with the Brazilian Unified National. Regarding implementation, there are advances related to the publication of Food Guides with national guidelines; to the promotion of research in food and nutrition; to collective action to build the regulatory agenda, even if with disputes, and to the decentralization of financial resources for the execution of PNAN actions. The monitoring and evaluation focused on the food and nutritional situation; we found that there were insufficient mechanisms to feed back the policy. After 20 years, PNAN maintains the challenge of effectively fulfilling its historic commitment: the universal guarantee of the human right to adequate and healthy food.

The drivers of energy-related CO2 emissions in Brazil: a regional application of the STIRPAT model

Since energy is one of the basic inputs for development, emerging economies should make an effort to investigate the environmental impacts of their fast economic growth. However, large emerging economies present significant regional heterogeneity that is usually uncounted for. This study uses the Stochastic Impacts by Regression on Population, Affluence and Technology (STIRPAT) model and regional data on the 27 Brazilian states to investigate the growth-CO₂ nexus under distinct development stages. To perform this analysis, we divided the states into three groups according to their average annual GDP (i.e., richer, intermediate, and poorer regions). The results suggest that richer and poorer regions, particularly, present economic and demographic developments that are environmentally costly. Also, population and per capita GDP have the largest influences on CO₂ emissions. The roles of the industrial sector and the ascending service sector are also subject to criticism. Moreover, Brazil arguably suffers from technological stagnation as its energy intensity is growing and boosting CO₂ emissions. We discuss the policy implications of these findings and suggest a future research agenda.

Dietary patterns of children aged 6-24 months assisted by the Bolsa Família Program

OBJECTIVE

This study aimed to verify the association between socio-economic and demographic characteristics and dietary patterns (DP) of children assisted by the Conditional Cash Transfer Program, Bolsa Família Program (BFP).

DESIGN

This is a cross-sectional study. DP were defined using a principal component analysis. The association of the predictive variables and DP was modelled using multilevel linear regression analysis.

SETTING

This study was conducted in six municipalities from the State of Alagoas, Brazil.

PARTICIPANTS

The participants were children aged 6-24 months who were assisted by the BFP.

RESULTS

A total of 1604 children were evaluated. Four DP were identified (DP1, DP2, DP3 and DP4). DP1 is composed of traditional Brazilian food. DP2 is formed mostly from ultra-processed foods (UPF). DP3 consists of milk (non-breast) with added sugar, while DP4 consists of fresh and minimally processed foods. Caregivers with higher age and education (β = -0·008; (95 % CI -0·017, -0·000); β = -0·037; (95 % CI -0·056, -0·018), respectively) were negatively associated with DP2. We observed a negative association between households with food insecurity (β = -0·204; (95 % CI -0·331, -0·078)) and DP4 and a positive association between caregivers with higher age and education (β = 0·011; (95 % CI (0·003; 0·019); β = 0·043; (95 % CI 0·025, 0·061), respectively) and DP4.

CONCLUSION

This study identified the association between socio-economic inequities and DP early in life, with an early introduction of UPF, in children assisted by BFP in the State of Alagoas.

Why has the Brazilian economy stagnated in the 2010s? A Minskyan analysis of the behavior of non-financial companies in a financialized economy

The Brazilian economy entered a deep recession in 2015-2016 and since then has shown a sluggish recovery. In this paper, we offer an interpretation for the slow growth based on Minsky's financial instability hypothesis and recent literature on financialization and growth. We analyze the balance sheet of large non-financial companies over the period 2012-2019, a period that comprises the positive investment cycle-initiated during the commodities boom which lasted from the second half of the 2000s until 2014-the 2015-2016 recession, and the period preceding the shock of the COVID-19 pandemic. Based on Minsky's taxonomy of financial profiles, we map a proxy for financial instability at the firm level based on Davis et al. (2019). We also propose an aggregate financial stability index. We conclude that after the 2015-2016 recession, companies have been restructuring their debt profile and adopting a defensive behavior, increasing their liquidity preference. Our analysis supports the interpretation that, even with the sharp fall in domestic real interest rates, the degree of confidence on expectations to recover investment in productive assets is low. This corroborates with the thesis that agents' decisions do not respond only to supply stimulus, but are guided by expectations of future returns, which fundamentally depend on the performance of aggregate demand. Since 2015, Brazilian economic policy has been driven by fiscal consolidation, which has proven ineffective in increasing economic growth.

Conditional cash transfer program and child mortality: A cross-sectional analysis nested within the 100 Million Brazilian Cohort

BACKGROUND

Brazil has made great progress in reducing child mortality over the past decades, and a parcel of this achievement has been credited to the Bolsa Família program (BFP). We examined the association between being a BFP beneficiary and child mortality (1-4 years of age), also examining how this association differs by maternal race/skin color, gestational age at birth (term versus preterm), municipality income level, and index of quality of BFP management.

METHODS AND FINDINGS

This is a cross-sectional analysis nested within the 100 Million Brazilian Cohort, a population-based cohort primarily built from Brazil's Unified Registry for Social Programs (Cadastro Único). We analyzed data from 6,309,366 children under 5 years of age whose families enrolled between 2006 and 2015. Through deterministic linkage with the BFP payroll datasets, and similarity linkage with the Brazilian Mortality Information System, 4,858,253 children were identified as beneficiaries (77%) and 1,451,113 (23%) were not. Our analysis consisted of a combination of kernel matching and weighted logistic regressions. After kernel matching, 5,308,989 (84.1%) children were included in the final weighted logistic analysis, with 4,107,920 (77.4%) of those being beneficiaries and 1,201,069 (22.6%) not, with a total of 14,897 linked deaths. Overall, BFP participation was associated with a reduction in child mortality (weighted odds ratio [OR] = 0.83; 95% CI: 0.79 to 0.88; p < 0.001). This association was stronger for preterm children (weighted OR = 0.78; 95% CI: 0.68 to 0.90; p < 0.001), children of Black mothers (weighted OR = 0.74; 95% CI: 0.57 to 0.97; p < 0.001), children living in municipalities in the lowest income quintile (first quintile of municipal income: weighted OR = 0.72; 95% CI: 0.62 to 0.82; p < 0.001), and municipalities with better index of BFP management (5th quintile of the Decentralized Management Index: weighted OR = 0.76; 95% CI: 0.66 to 0.88; p < 0.001). The main limitation of our methodology is that our propensity score approach does not account for possible unmeasured confounders. Furthermore, sensitivity analysis showed that loss of nameless death records before linkage may have resulted in overestimation of the associations between BFP participation and mortality, with loss of statistical significance in municipalities with greater losses of data and change in the direction of the association in municipalities with no losses.

CONCLUSIONS

In this study, we observed a significant association between BFP participation and child mortality in children aged 1-4 years and found that this association was stronger for children living in municipalities in the lowest quintile of wealth, in municipalities with better index of program management, and also in preterm children and children of Black mothers. These findings reinforce the evidence that programs like BFP, already proven effective in poverty reduction, have a great potential to improve child health and survival. Subgroup analysis revealed heterogeneous results, useful for policy improvement and better targeting of BFP.

Association between food insecurity and cardiometabolic risk in adults and the elderly: A systematic review

Background

Food insecurity is a public health concern that affects health and quality of life, but its association with cardiometabolic risk is not well established. Thus, this systematic review evaluated the association between food insecurity and cardiometabolic risk factors in adults and the elderly.

Methods

Search was conducted according to the PRISMA protocol using Scielo, LILACS and PubMed databases. We included original articles published in Portuguese, English, and Spanish, which assessed the association between food insecurity and cardiometabolic risk factors in adults and the elderly. The search identified 877 articles but only 11 were included in the review.

Results

Food insecurity was directly associated with cardiometabolic risk (excess weight, hypertension, dyslipidemias, diabetes, and stress) after adjusting for interfering factors. A limitation of the cross-sectional study design is that the cause-effect relation between food insecurity and cardiometabolic risk cannot be established.

Conclusions

We conclude that food insecurity has a direct relationship with cardiometabolic risk factors, especially excess weight, hypertension, and dyslipidemias. The identification of food insecurity as health problems can contribute to the implementation of efficient public policies for the prevention and control of chronic diseases.

Protocol registration

This review was registered on PROSPERO-International Prospective Register of Systematic Reviews – CRD4201911549.

When Land Meets Finance in Latin America: Some Intersections between Financialization and Land Grabbing in Argentina and Brazil

Financialization is one of the most relevant processes embedded in the functioning and evolution of the contemporary capitalist model and presents differential characteristics in the peripheral economies of the world-system. In turn, land grabbing is also one of the most relevant phenomena taking place in the field of farmland and land use, with particular significance also within the Global South. After presenting an in-depth analysis of both phenomena for Latin America, we specifically study the case of the two Latin American countries (Argentina and Brazil) where land grabbing has a greater qualitative and quantitative importance. In our article, we analyze the main interrelationships between both processes and show how financialization has played a fundamental role (together with the policies designed and the de-regulations implemented by respective states, and the participation of other domestic actors) in the land grabbing process in both countries.

Basic sanitation: a new indicator for the spread of COVID-19?

Background

Basic sanitation could be a potential indicator of the spread of coronavirus disease-2019 (COVID-19) and, in this context, space-time patterns are important tools with which to elucidate the spread of disease and identify risk factors. The aim of this study was to assess a possible association between basic sanitation indices and COVID-19 rates in all the 5570 municipalities of Brazil and its spatial distribution.

Methods

Data of COVID-19 cases registered in Brazil from 28 February until 31 May 2020 and independent variables associated with basic sanitation were included.

Results

High incidence rates were significantly associated with precarious water service index (0–25% coverage) and offstandard faecal coliforms index for tap water (5–50% and 75–100% of samples tested). A significant association between high mortality rates and sewage collection (0–25% coverage)/treatment (25–50% coverage) indices was also verified. In addition, clusters with significant spatial autocorrelation were identified mainly in the North and Northeast regions for mortality and incidence rates (high-high risk areas) and for offstandard faecal coliforms index. Those regions are considered the poorest in Brazil, presenting with low incomes, human agglomerations, as well as a poor basic sanitation system, which also hinder the implementation of COVID-19-preventative measures.

Conclusions

A precarious basic sanitation infrastructure could potentially be associated with the high transmission of severe acute respiratory syndrome coronavirus-2 in Brazil.

REALIDADE ADMINISTRATIVA EM EMPRESAS DE BASE TECNOLÓGICA (EBTs): UMA PESQUISA NA CIDADE DE SANTA MARIA (RS)

O objetivo geral deste estudo foi o descrever a realidade administrativa de Empresas de Base Tecnológica (EBTs) na cidade de Santa Maria. Assim, visou diagnosticar e descrever como está estrutura a área administrativa destas empresas com o objetivo de averiguar às peculiaridades destas empresas. Para atingir a este objetivo, realizou-se um levantamento de dados por meio de entrevistas com uma amostra de empresários de EBTs da cidade de Santa Maria, quando se levantou o perfil destes empresários e destas empresas. Indagou-se sobre ferramentas de administração utilizadas pelas EBTs e levantou-se as necessidades administrativas que estas empresas possuem. Com relação aos resultados da pesquisa, foi possível perceber que as EBTs já adotam uma vasta gama de ferramentas administrativas. Verificou-se que as principais dificuldades apontas pelas empresas da amostra concentram-se em como gerenciar tarefas, processos e tempo, como gerenciar pessoas e como lidar com baixo orçamento.

[Problematization of gender relations at the first Brazilian Eugenics Conference: the status of women, determination of biological gender and reproductive control]

This article problematizes gender relations during the first Brazilian Eugenics Conference, held in Rio de Janeiro in 1929. Seen as the largest public manifestation of the eugenics movement in Brazil, the Atas e Trabalhos do Congresso (Conference Minutes and Proceedings) were analyzed in terms of gender issues expressed through the spectrum of intrinsic conceptions of hereditarianism and reproduction. The problematizations make an effort to discuss, through the works of several participants in the conference, the role and status of women in Brazilian eugenics, reproductive control in Brazil and the relationship between studies involving determination of biological gender and improvement of the human race.

Combination of conditional cash transfer program and environmental health interventions reduces child mortality: an ecological study of Brazilian municipalities

Background

This study aims to assess the interactive effects of Brazilian public interventions, environmental health programs (access to water, sanitation and solid waste collection) and a Conditional Cash Transfer Program (PBF), on the mortality reduction due to diarrhea and malnutrition among children under 5 years old.

Methods

The study design is ecological, with longitudinal analysis in a balanced panel. The period covered is 2006 to 2016, including 3467 municipalities from all regions of the country, which resulted in 38,137 observations. The generalized linear models were adjusted considering the Negative Binomial (NB) distribution for the number of deaths due to malnutrition and diarrhea, with fixed effects. NB models with and without zero-inflation were assessed. Subsequent interaction models were applied to assess the combined effects of the two public policies.

Results

In relation to the decline of mortality rates due to diarrhea in the municipalities, positive effect modification were observed in the presence of: high coverage of the target population by the PBF and access to water, 0.54 (0.28–1.04) / 0.55 (0.29–1.04); high coverage by the total population by the PBF and access to water, 0.97 (0.95–1.00) and high coverage by the total population by the PBF and access to sanitation, 0.98 (0.97–1.00). Decline on diarrhea mortality was also observed in the joint presence of high coverage of solid waste collection and access to water, categories 1 (> 60% ≤85%): 0.98 (0.96–1.00), 0.98 (0.97–1, 00) and 2 (> 85% ≤ 100%): 0.97 (0.95–0.98), 0.97 (0.95–0.99). Negative effect modification were observed for mortality due to malnutrition in the presence of simultaneous high coverage of the total population by the PBF and access to sanitation categories 1 (≥ 20 < 50%): 1.0061 (0.9991–1.0132) and 2 (≥ 50 < 100%): 1.0073 (1.0002–1.0145) and high coverage of the total population by the PBF and solid waste collection, 1.0004 (1.0002–1.0005), resulting in malnutrition mortality rates increase.

Conclusion

Implementation of environmental health services and the coverage expansion by the PBF may enhance the prevention of early deaths in children under 5 years old due to diarrhea, a poverty related disease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10649-4.

Environmental Threats over Amazonian Indigenous Lands

This study investigates the main threats related to environmental degradation that affect Amazonian Indigenous Lands (ILs). Through a cluster analysis, we group ILs according to the set of common environmental threats that occur within and outside their limits. The results show that most of the 383 ILs are affected internally by a combination of different environmental threats, namely: deforestation, forest degradation, fires, mining, croplands, pastures, and roads. However, the ILs affected by multiple and relatively severe threats are mainly located in the arc of deforestation and the Roraima state. The threats related to forest loss (deforestation, forest degradation, and fires) are more intense in the ILs’ buffer zones than within, showing that ILs effectively promote environmental preservation. In the cluster analysis, we identified seven clusters that are characterized by common environmental threats within and around their limits, and, based on these results, we have outlined four environmental policy priorities to be strengthened and applied in Amazonian ILs: protecting ILs’ buffer zones; strengthening surveillance actions, and combating illegal deforestation, forest degradation, and mining activities in ILs; preventing and fighting fires; and removing invaders from all ILs in the Amazon. In this study, we warn that the threats presented make the Indigenous peoples in the Amazon more vulnerable. To guarantee indigenous peoples’ rights, illegal actions in these territories and their surroundings must be contained, and quickly.

Optimal Tax Theory: Its Contributions to the Brazilian Reality

ABSTRACT Objectives: this theoretical essay aims to present classic and contemporary fundamentals of the optimal tax theory (OTT) and to problematize its presence and possibilities in the scenario of tax policy in Brazil. Context: such objectives are located in the contemporary context that discusses tax reforms aimed at efficient and socially responsible public management. Methods: after surveying the state of knowledge of optimal taxation in Brazil, and from the perspective of economics and political law, we sought to identify secondary data on tax distribution in Organization for Economic Co-operation and Development (OECD) countries in relational analysis with data from Brazil. Results: the text draws attention to the fact that OTT is able to bring social issues to the discussion of public tax management policies in a structured way, with the perspective of inclusion and social responsibility, based on the importance of different treatment of economic agents, physical and legal, based on their needs and possibilities. Conclusion: it is concluded that, like in other countries, OTT is present in the Brazilian debate expressing as possible and necessary to advance in a tax policy that responds to the needs of public collection articulated and reconciled to social well-being through responsible management, modern and transparent.

Teoria da Tributação Ótima: Contribuições para a Realidade Brasileira

ABSTRACT Objectives: this theoretical essay aims to present classic and contemporary fundamentals of the optimal tax theory (OTT) and to problematize its presence and possibilities in the scenario of tax policy in Brazil. Context: such objectives are located in the contemporary context that discusses tax reforms aimed at efficient and socially responsible public management. Methods: after surveying the state of knowledge of optimal taxation in Brazil, and from the perspective of economics and political law, we sought to identify secondary data on tax distribution in Organization for Economic Co-operation and Development (OECD) countries in relational analysis with data from Brazil. Results: the text draws attention to the fact that OTT is able to bring social issues to the discussion of public tax management policies in a structured way, with the perspective of inclusion and social responsibility, based on the importance of different treatment of economic agents, physical and legal, based on their needs and possibilities. Conclusion: it is concluded that, like in other countries, OTT is present in the Brazilian debate expressing as possible and necessary to advance in a tax policy that responds to the needs of public collection articulated and reconciled to social well-being through responsible management, modern and transparent.

Prescriptions of analgesics and anti-inflammatory drugs in municipalities from a Brazilian Southeast state

The objective of this study was to describe dental prescriptions of non-steroidal anti-inflammatory drugs (NSAID), opioids, and analgesics dispensed by the Brazilian National Health System (BNHS, SUS in Portuguese) of a Southeastern state from January to December 2017, and to analyze their association with socioeconomic and oral health care services' characteristics at municipal level. Data were collected from the Brazilian Integrated Pharmaceutical Care Management System. Medicines were grouped according to the Anatomical Therapeutic Chemical Classification System. The total number of Defined Daily Doses (DDD) and DDD per 1,000 inhabitants (inhab.) per year were presented and compared between groups of municipalities. Data analysis used the Classification and Regression Tree model performed with IBM SPSS 25.0. The total number of NSAID, opioids, and analgesics prescriptions was 70,747 and accounted for 354,221.13 DDD. The most frequently prescribed medicine was ibuprofen (n = 24,676; 34.88%). The number of dental practitioners in the BNHS per 1,000 inhab. (p < 0.001), first dental appointment coverage (p = 0.010), oral health teams per 1,000 inhab. (p=0.022), and the proportion of rural population (p = 0.014) were variables positively associated with the number of DDD of NSAID per 1,000 inhab. per year. Bolsa Família program coverage per 1,000 inhab. (p = 0.022) was negatively associated with NSAID prescription. Regarding analgesics, first dental appointment coverage (p=0.002) and Bolsa Família program coverage per 1,000 inhab. (p = 0.012) were positively associated with DDD per 1,000 inhab. per year. In conclusion, dental prescriptions of analgesics and NSAID in the BNHS were associated with socioeconomic and oral health care services' characteristics.

Spatial Modeling for Homicide Rates Estimation in Pernambuco State-Brazil

Homicide rates have been increasing worldwide, especially in Latin America, where it is considered one of the most lethal of the continents. Despite that, the occurrence of homicides are not homogeneous in time and space on the continent or in the Brazilian cities. Therefore, the main objective of this study is to present a spatial analysis of homicides in the state of Pernambuco, Brazil, between the years of 2016 and 2019, by the use of an exploratory analysis of spatial homicide data with five variables that could explain its occurrence. In addition to that, it was applied the Global and Local Moran’s Index, Ordinary Least Squares (OLS) regression, and Geographically Weighted Regression (GWR), all implemented in the Geographic Information System (GIS) software. Thus, the distribution of clusters revealed a spatial autocorrelation for homicide rates, confirming a spatial dependence. This data also showed the polarization of the rate between the coast and the interior of the state of Pernambuco.

Federal spending on social policies and the social determinants of health: where are we going?

RESUMO A garantia do mais alto nível possível de saúde à população depende de investimentos públicos em políticas sociais, uma vez que a saúde é determinada por fatores relacionados com as condições nas quais as pessoas vivem e trabalham, os chamados Determinantes Sociais da Saúde (DSS). O objetivo deste artigo foi quantificar o gasto federal do Brasil com políticas sociais setoriais de 2010 a 2019, a fim de analisar sua trajetória recente, em uma conjuntura de crise econômica e de austeridade fiscal, e de discutir o risco de piora da situação de saúde da população. Para tanto, foram utilizados dados de execução financeira do Poder Executivo federal obtidos do Siga Brasil. Os resultados mostram redução do gasto com sete das dez políticas analisadas entre 2013 e 2019. Houve aumento de gasto para as políticas vinculadas à seguridade social, as quais se relacionam com direitos constitucionalmente inscritos, com tradição de exigibilidade de seu cumprimento via sistema de Justiça. Esses achados revelam que, a despeito do aumento de despesa para essas políticas, outras políticas importantes, que atuam sobre DSS, foram desfinanciadas, dificultando a obtenção de progressos na situação de saúde da população, ao mesmo tempo que a coloca sob risco de retrocesso.

Gasto federal com políticas sociais e os determinantes sociais da saúde: para onde caminhamos?

RESUMO A garantia do mais alto nível possível de saúde à população depende de investimentos públicos em políticas sociais, uma vez que a saúde é determinada por fatores relacionados com as condições nas quais as pessoas vivem e trabalham, os chamados Determinantes Sociais da Saúde (DSS). O objetivo deste artigo foi quantificar o gasto federal do Brasil com políticas sociais setoriais de 2010 a 2019, a fim de analisar sua trajetória recente, em uma conjuntura de crise econômica e de austeridade fiscal, e de discutir o risco de piora da situação de saúde da população. Para tanto, foram utilizados dados de execução financeira do Poder Executivo federal obtidos do Siga Brasil. Os resultados mostram redução do gasto com sete das dez políticas analisadas entre 2013 e 2019. Houve aumento de gasto para as políticas vinculadas à seguridade social, as quais se relacionam com direitos constitucionalmente inscritos, com tradição de exigibilidade de seu cumprimento via sistema de Justiça. Esses achados revelam que, a despeito do aumento de despesa para essas políticas, outras políticas importantes, que atuam sobre DSS, foram desfinanciadas, dificultando a obtenção de progressos na situação de saúde da população, ao mesmo tempo que a coloca sob risco de retrocesso.