Assessment of the association between the Brazilian family health strategy and adult mortality

• Published in: Health policy and planning Vol. 37; no. 4; pp. 461 - 471
• Main Authors: Diaz, Maria Dolores Montoya, Teixeira, Adriano Dutra, Postali, Fernando Antonio Slaibe, Ferreira-Batista, Natalia Nunes, Moreno-Serra, Rodrigo
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 12.04.2022; Oxford Publishing Limited (England)
• Subjects: Adult; Adults; Asthma; Brazil - epidemiology; Cerebrovascular disease; Cerebrovascular diseases; Complications; Congestive heart failure; Coronary artery disease; Diabetes; Diabetes mellitus; Disease; Effects; Families & family life; Family Health; Gastroenteritis; Health; Health care; Health problems; Heart diseases; Heart failure; Humans; Hypertension; Mortality; Primary care; Public policy; Teams; Ulcers; Vascular diseases; Brazil; Family Health Strategy (ESF); adult mortality; impact evaluation; datasus database
• ISSN: 1460-2237; 0268-1080; 1460-2237
• DOI: 10.1093/heapol/czac011

Abstract This study aimed to analyse a wide range of related health problems that respond favourably to efficient primary care treatment among adults. We evaluate the direct impact of the Family Health Strategy (ESF) in Brazil on mortality of adults aged 25–64 years related to conditions for which access to effective primary care can reduce the likelihood of more severe outcomes. Additionally, we discuss heterogeneous effects associated with different intensities of the programme. To address these issues, we estimated a model with variation at the municipal level of the ESF expansion, including municipal-fixed effects, municipal specific trends and year-fixed effects. Our results show that a higher intensity of ESF is associated with reduced mortality by all conditions sensitive to primary care and for some diseases, especially after some years: avoidable conditions, asthma, heart failure, cerebrovascular diseases and gastrointestinal ulcer, infectious gastroenteritis and complications, diseases of the lower airways, hypertension and diabetes. As a public policy view, these results help understand how a nationwide primary care strategy can help mitigate mortality and emphasize the role of having sufficient health teams to attend to the population.