News Release

Chronic diseases in Brazil: Burden and current challenges

Peer-Reviewed Publication

The Lancet_DELETED

The fourth paper discusses the progress made by Brazil in combating chronic/non-communicable diseases (NCDs). While, like all other countries, the proportion of NCD deaths out of total deaths in Brazil continues to rise (72% in 2007), the country has implemented a number of policies that have seen age-standardised mortality rates fall by 1.8% per year since 1996, which is within the range of 1-3% observed from 1970 to 2000 in committed high-income countries such as Australia, Canada, Japan, the UK and the USA. Better access to primary care and much-improved tobacco control are credited as being the major causes of this improvement, composed principally of declining rates of cardiovascular and chronic respiratory disease. Yet this progress is threatened by increasing prevalence of risk factors such as obesity, hypertension and diabetes.

Neuropsychiatric disorders are the single largest contributor to the chronic disease burden in Brazil, with an estimated 10 to 20% of people having had depression at some stage. Research in ten developed and 8 developing countries revealed metropolitan Sao Paulo to have the highest levels of depression of all the locations studied. Due to the ageing population, dementia is rapidly becoming a major health problem, with estimates of prevalence similar to those in developing countries (5 to 9%) among those 65 and older.

Around a quarter of Brazilian men and one in six Brazilian women aged 20 years or over suffer high blood pressure, rising to half of men and over half of women aged 60 years or over. Despite the decline of 31% in cardiovascular disease mortality from 1996 to 2007, Brazil's cardiovascular mortality remains high, with Suriname and Guyana the only countries in South America with higher rates. Increasing obesity levels and better diagnosis are thought to be behind much of the increasing diabetes prevalence in adults, from 3% of Brazilians in 1996 to 5% in 2007.

In men, mortality rates from lung, prostate and colorectal cancer are increasing, while that of gastric cancer is decreasing. In women, rates of breast, lung, and colorectal cancers have risen, while those of cervical and gastric cancer have declined. Smoking rate variations could explain why rates of lung cancer in men younger than 60 years are now declining, yet those of younger women are increasing. Cervical cancer incidence in Brazil, although falling, is still among the highest in the world, probably due to the fact that many high risk women are still being inadequately screened. 5-year survival rates for cancers such as breast and prostate are low compared with high-income countries, suggesting difficulties and inequalities in access to services.

The authors say that to maintain progress, more action is necessary. Strategies involving augmented intersectoral discussion and planning are needed to implement and scale-up cost-effective interventions—for example, those reducing the salt content of foods and restricting advertisement of unhealthy foods to children—that can help to produce an environment conducive to healthy lifestyle choices.

Other major challenges must also be faced: resolving long hospital waiting lists for in-patient hospital care and diagnostic services, transferring most care for chronic conditions to primary care settings using a chronic care model, and amplifying access to cost-effective medications.

The authors conclude: "NCDs are quickly becoming the main public health priority in Brazil, and policies for their prevention and control have been implemented. Although formal assessment is lacking, the SUS has made major strides, among them the implementation of very cost-effective interventions such as tobacco control and the widespread delivery of drugs to those at high risk of cardiovascular diseases. However, much more can be done...A concomitant shift of resources, in relative terms, from hospital and high technology end-stage care to health promotion and prevention is needed to augment budgetary support and central coordination for chronic disease prevention and care."

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Professor Maria Inês Schmidt, Federal University of Rio Grande do Sul, Brazil. Contact by e-mail. E) maria.schmidt@ufrgs.br

Alternative author contacts: Dr Gulnar de Azevedo e Silva E) gulnar@terra.com.br / Dr Carlos Augusto Monteiro E) carlosam@usp.br


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