¿BAILÁS? SOBRE LA DAnZA Y nO COMO FORMA POLÍTICA COnTEMPORÁnEA
4. Grado cero
PNAD-81 asked questions about the utilization o f the health system during the period of one month before the interview, that is, between 15 October and 14 November 1981. Use of health services includes the following reasons:
1. Illness: for persons who sought health services because of illness or malaise;
2. Accident: for persons who sought health services because o f accident or injury;
3. Control or Prevention: for persons who sought preventive health care. This includes visit to a gynaecologist, antenatal care, children’s weight-height measurement, and periodical health tests such as blood-pressure measurement and electrocardiogram;
4. Obtaining a health card or medical certificate: for persons who sought health services only to obtain or renew health card or medical certificate to present at work, at school or at health insurance institutions;
5. Vaccination: for persons who sought health services for vaccination; 6. Other: for persons who sought health services for reasons not specified in the previous items, e.g., psychoanalysis, physiotherapy, rehabilitation, to dress a wound, to receive food supply or medicine.
In Säo Paulo 1,341,644 persons or 10.2 per cent o f the total population
reported having used the health services during the month. The figures estimated
for Belo Horizonte were 299,597 persons or 11.2 per cent. The age-specific
ratios show that the use o f health services is clearly higher among the younger and
older population, as also occurs in relation to the age-pattem o f both mortality and
morbidity in the two regions. Considering children less than one year old,
approximately one out o f four in Belo Horizonte and one out of five in Säo Paulo
were reported to have used the health services. At the other end of the age span,
around one in five in Belo Horizonte and one in eight in Säo Paulo o f persons
aged 70 years or more used the health services in the one month reference period.
At the middle ages only about one in 15 used the health services (Table 5.1).
Although the U-shape of all specific ratios is consistent with the pattern of
morbidity and mortality, the magnitude of the ratios themselves may well reflect
many other factors, such as those related to availability and access to health
to throw some light on this issue; in fact, Table 5.2 shows that the more
developed and well equipped the region is in terms of health services facilities, the
higher is the proportion of population who reported having actually used health
services. Accordingly, the metropolitan regions in the North and Northeast of
Brazil - the poorest and less developed regions of the country - present the lowest
percentages o f use of health services, whereas the ones in the Southeast and
South show much higher indices.
It is known that in the North and Northeast regions there are some of the
worst 'pockets o f poverty', which are associated with or shown through low
health indicators (high mortality rates and low expectation of life at birth).
Nevertheless, the proportion o f people who reported having used the health
services is almost three times higher in Belo Horizonte or Säo Paulo than in
Belem (North o f Brazil).
Table 5.1 Age-sex rates of utilization of health services: Belo Horizonte
and Säo Paulo, 1981
Age groups
Percentages
Belo Horizonte Säo Paulo
Males Females Total Males Females Total
0 25.9 25.1 25.5 23.2 19.6 21.3 1 - 4 17.7 17.4 17.6 16.0 15.1 15.5 5 - 1 4 7.8 7.1 7.4 8.1 7.1 7.6 1 5 -2 9 6.0 9.3 7.7 6.1 9.7 8.0 3 0 -4 9 8.2 14.7 11.5 6.7 12.6 9.7 5 0 -6 9 11.6 21.8 17.2 9.9 16.8 13.5 70 + 20.9 22.2 21.7 15.0 17.8 16.5 Total 9.5 12.8 11.2 8.6 11.7 10.2 N* 1,296.7 1,374.3 2,671.0 6,524.8 6,678.6 13,203.4 Note: * (x 1,000)
Table 5.2 Utilization of health services in the Brazilian metropolitan regions, 1981 Metropolitan
Regions
Numbers Percentages
Males Females Total Males Females Total
NORTH: Belem 14,236 18,558 32,794 3.5 4.1 3.8 NORTHEAST: Fortaleza 46,010 60,072 106,082 5.9 6.8 6.4 Recife 79,451 115,518 194,969 6.9 9.1 8.0 Salvador 60,850 85,392 146,242 6.8 8.8 7.9 SOUTHEAST: Belo Horizonte 123,115 176,482 299,597 9.5 12.8 11.2 Rio de Janeiro 406,890 609,406 1,016,296 9.0 12.8 10.9 Säo Paulo 562,403 779,241 1,341,644 8.6 11.7 10.2 SOUTH: Curitiba 67,795 96,223 164,018 9.0 12.4 10.7 Porto Alegre 130,858 103,671 334,529 11.6 17.0 14.4
Source: Funda^äo Institute Brasileiro de Geografia e Estatistica. PNAD, 1981
It can then be argued that the data collected by PNAD-81 were certainly
influenced, or conditioned, by cultural or behavioural issues, such as the concept
of illness and the actions towards its treatment, or by the availability of and access
to health services in each specific region. In this sense, one cannot discard the
hypothesis that these data may be reflecting the contrasts and inequalities among
the regions o f Brazil, in their different stages o f socioeconomic development. A
higher proportion of utilization of health services in Belo Horizonte than in Säo
Paulo is not only consistent with a higher morbidity rate in Belo Horizonte (see
Chapter 4), but also with higher bed ratio and physician ratio per 1,000
population in Belo Horizonte than in Säo Paulo.
The most frequently reported reason given for seeking health service was
illness, which accounted for 61.1 per cent of the cases in Belo Horizonte and 66.5
per cent in Säo Paulo. The next most frequently reported reason was 'control or
prevention', which includes any kind of health preventive measure such as a visit
to a gynaecologist (including antenatal visit), routine blood pressure examination,
children's weight-height measurement and any other type o f periodical health test
Table 5.3 Age-standardized rates of utilization o f health services: Belo Horizonte and Säo Paulo, 1981
Percentages
Reasons Belo Horizonte Säo Paulo
Males Females Total Males Females Total Illness 62.4 60.7 61.1 64.6 68.5 66.5 Accident 11.5 3.2 6.5 13.8 3.5 7.6 Prevention 18.5 29.5 25.4 16.2 24.0 21.3 Health Card 2.7 1.1 1.7 2.4 0.9 1.5 Vaccination 3.6 3.8 3.7 0.8 0.4 0.6 Other 1.3 1.7 1.6 2.1 2.7 2.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 N 123,008 176,482 299,490 562,403 778,818 1,341,221 Source: Fundagäo Instituto Brasileiro de Geografia e Estatfstica. Pesquisa Nacional por Amostra
de Domicflios (PNAD), 1981.
It was shown in Chapter 4 that the reporting of illness in Säo Paulo tended
to be related to more severe ill-health than it was in Belo Horizonte. In this regard,
the higher proportion in Belo Horizonte than in Säo Paulo o f people who gave
control or preventive measures as reason to seek health services is a further
indication of such a trend. However, it is well known that medical institutions in
Säo Paulo are better equipped than in Belo Horizonte and, in this matter, PNAD-
81 collected inform ation about the place in which the health services were
performed.
In fact, the difference between the structure of the health services in Säo
Paulo and Belo Horizonte seems to become more apparent when one considers
the type o f establishment where these services were reported to have taken place.
Table 5.4 shows, for instance, that in Belo Horizonte 23 per cent o f the health
services were reported as perform ed in health posts or health centres, but this
accounted for only 11 per cent of the services in Säo Paulo. The single definition
of these two types o f establishment, given in section 5.3, may help to explain the
Table 5.4 Age-standardized rates of utilization of health services, by type of establishment: Belo Horizonte and Säo Paulo, 1981
Percentages Type of
Establishment
Belo Horizonte Säo Paulo
Males Females Total Males Females Total
Health Post 21.9 23.4 22.7 10.1 10.9 10.7 Public Hosp. 31.1 30.3 30.8 30.4 30.7 30.5 Private Hosp. 38.5 40.8 39.9 48.1 49.7 49.2 Ambulatory 6.7 4.2 5.2 7.4 4.8 5.7 Other 1.8 1.2 1.4 4.0 3.9 3.9 Total 100.0 100.0 100.0 100.0 100.0 100.0
Source: Funda^äo Instituto Brasileiro de Geografia e Estatfstica. Pesquisa Nacional por Amostra de Domicflios (PNAD), 1981.