Maria Paula Ferreira

Bio: Maria Paula Ferreira is an academic researcher from CEM. The author has contributed to research in topics: Population & Health policy. The author has an hindex of 9, co-authored 19 publications receiving 441 citations.

Regional health inequalities: changes observed in Brazil from 2000-2016

Abstract: Advances in reducing poverty and inequalities in the 2000s had a paradoxical effect in Brazil. This article examines how socioeconomic transformations, and the complexity of health services, are expressed in the regions established for planning purposes and the inter-governmental management of the Brazilian Unified Health System. An effort was made to identify and explain differences in the compositions of the 438 existing health regions and their spatial distribution by comparing situations observed in 2016 with those in 2000. Factor analysis and grouping techniques were used to construct a typology in the two years of the series, which was based on a diverse set of secondary data sources. It was found that there was an evolution in terms of income levels and service provision within the health regions, with a significant improvement in the socioeconomic conditions of the population. These results suggest that there was a positive impact from the combination of strategies related to social, economic and regional policies for the promotion of development, which generated more widespread well-being within the affected areas. However, limitations remain regarding the policies implemented for the universalization of the health system.

Pobreza e espaço: padrões de segregação em São Paulo

Abstract: ESTE ESTUDO busca atualizar o debate sobre a segregacao urbana no Brasil, com base nos dados do Censo Demografico de 2000 e da utilizacao de Sistemas de Informacao Geografica. Sustentamos que o modelo centro-periferia e uma simplificacao generica da forma urbana, sendo a periferia de Sao Paulo heterogenea, o que acarreta importantes consequencias para as politicas publicas.

Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brasil

Abstract: O desenvolvimento socioeconomico, a oferta e a complexidade das acoes e dos servicos de saude no contexto regional podem ser considerados condicionantes estruturais para o exito do atual processo de regionalizacao da saude no Brasil. O presente estudo tem como objetivo identificar os condicionantes estruturais do processo de regionalizacao por meio da construcao de uma tipologia das regioes de saude no Brasil. Foi construida tipologia das regioes de saude brasileiras a partir de fonte de dados secundarios disponivel. A identificacao das dimensoes e dos grupos - que compoem a tipologia - foi realizada por meio de analise fatorial e de agrupamentos/clusters. Tambem foram identificados o tipo de prestador de acoes e os servicos predominantes na regiao tanto para a producao ambulatorial quanto para a internacao. As regioes foram classificadas em cinco grupos, de forma independente, de acordo com suas caracteristicas socioeconomicas e de oferta de servicos de saude. A caracterizacao das regioes de saude brasileiras, a partir da tipologia apresentada, demonstra heterogeneidade do territorio nacional e a complexidade de organizar sistemas de saude regionais. A tipologia proposta pode auxiliar na investigacao e no melhor entendimento desse cenario contraditorio e complexo, apoiando o urgente desenvolvimento de politicas publicas regionais integradas que envolvam, concomitantemente, desenvolvimento economico e social; e o fortalecimento dos espacos de governanca regional, a fim de promover a organizacao de sistemas de saude regionais alicercados nos principios do SUS e numa gestao compartilhada e solidaria que tenha como imagem-objetivo a garantia do direito a saude.

Condicionantes estruturais da regionalização na saúde: tipologia dos colegiados de gestão regional

Abstract: An explanation is required for the delay in implementing the regionalization strategy and the fragile nature of the combined decentralization and regionalization initiatives in Brazil. The article raises some hypotheses to clarify this intricate issue and reviews the structural conditioning factors of the regionalization process ongoing in the states. A national typology of the health care regions is prepared, differentiating them according to the degree of socio-economic development and the characteristics of the health care network and of the municipalities that form the Regional Management Boards (CGR), formally implanted by January 2010. Factorial and cluster analysis models were used to build the typology. Five major socio-economic groups of CGRs were identified, described according to their regional distribution, population, health care spending, profile of services offered (including the public-private sector mix) and health service coverage. The results obtained serve as guidelines for the constitution of health care networks and new initiatives at the regional level, in order to improve the regionalization policy and favour the construction of diverse and flexible regulatory instruments that are more in tune with the regional state of affairs.

[Knowledge and risk perception on HIV/AIDS by Brazilian population, 1998 and 2005].

Abstract: OBJECTIVE: To describe the level of knowledge and risk perception on HIV/AIDS of the Brazilian Population. METHODS: Data base from a national survey on sexual behavior and HIV/AIDS risk perception in the Brazilian population, in 1998 and 2005, were used. A synthetic indicator was used, composed by nine questions on the level of knowledge and risk perception on the forms of transmission of the virus and risk situations, according to population subgroups. RESULTS: Men increased their level of knowledge in the period, reaching the same information level of women. Among youngsters, there was no significant increase in knowledge, and the difference between sexes was absent in this dimension. Regarding risk perception, there was an increase in the proportion of those that declared they were not under risk of HIV/AIDS contamination. CONCLUSIONS: Despite the increase in the level of general knowledge, the study's results indicate the need for actions and programs of HIV/AIDS prevention in the general population and, especially, with youngsters.

The Brazilian health system at crossroads: progress, crisis and resilience.

Abstract: The Unified Health System (Sistema Unico de Saude (SUS)) has enabled substantial progress towards Universal Health Coverage (UHC) in Brazil. However, structural weakness, economic and political crises and austerity policies that have capped public expenditure growth are threatening its sustainability and outcomes. This paper analyses the Brazilian health system progress since 2000 and the current and potential effects of the coalescing economic and political crises and the subsequent austerity policies. We use literature review, policy analysis and secondary data from governmental sources in 2000–2017 to examine changes in political and economic context, health financing, health resources and healthcare service coverage in SUS. We find that, despite a favourable context, which enabled expansion of UHC from 2003 to 2014, structural problems persist in SUS, including gaps in organisation and governance, low public funding and suboptimal resource allocation. Consequently, large regional disparities exist in access to healthcare services and health outcomes, with poorer regions and lower socioeconomic population groups disadvantaged the most. These structural problems and disparities will likely worsen with the austerity measures introduced by the current government, and risk reversing the achievements of SUS in improving population health outcomes. The speed at which adverse effects of the current and political crises are manifested in the Brazilian health system underscores the importance of enhancing health system resilience to counteract external shocks (such as economic and political crises) and internal shocks (such as sector-specific austerity policies and rapid ageing leading to rise in disease burden) to protect hard-achieved progress towards UHC.

Identifying areas susceptible to desertification in the Brazilian northeast

Abstract: . Approximately 57% of the Brazilian northeast region is recognized as semi-arid land and has been undergoing intense land use processes in the last decades, which have resulted in severe degradation of its natural assets. Therefore, the objective of this study is to identify the areas that are susceptible to desertification in this region based on the 11 influencing factors of desertification (pedology, geology, geomorphology, topography data, land use and land cover change, aridity index, livestock density, rural population density, fire hot spot density, human development index, conservation units) which were simulated for two different periods: 2000 and 2010. Each indicator were assigned weights ranging from 1 to 2 (representing the best and the worst conditions), representing classes indicating low, moderate and high susceptibility to desertification. The results indicate that 94% of the Brazilian northeast region is under moderate to high susceptibility to desertification. The areas that were susceptible to soil desertification increased by approximately 4.6% (83.4 km2) from 2000 to 2010. The implementation of the methodology provides the technical basis for decision-making that involves mitigating actions and the first comprehensive national assessment within the United Nations Convention to Combat Desertification framework.

Global and local spatial indices of urban segregation

Abstract: Urban segregation has received increasing attention in the literature due to the negative impacts that it has on urban populations. Indices of urban segregation are useful instruments for understanding the problem as well as for setting up public policies. The usefulness of spatial segregation indices depends on their ability to account for the spatial arrangement of population and to show how segregation varies across the city. This paper proposes global spatial indices of segregation that capture interaction among population groups at different scales. We also decompose the global indices to obtain local spatial indices of segregation, which enable visualization and exploration of segregation patterns. We propose the use of statistical tests to determine the significance of the indices. The proposed indices are illustrated using an artificial dataset and a case study of socio-economic segregation in Sao Jose dos Campos (SP, Brazil).