Health Ministry Health Surveillance Secretariat Department for the Analysis of the Health Condition General Coordination of Non-Communicable Diseases and Illnesses

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Health MinistryHealth Surveillance
SecretariatDepartment for the Analysis of the
Health ConditionGeneral Coordination of
Non-Communicable Diseases and Illnesses

• RESEARCH REPORT
• Mapping of surveillance, prevention and control
  initiatives for non-communicable chronic diseases
  in Brazil, 1999-2006 subsidies to formulate a
  national policy on integrated surveillance.

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Coordination Team of the Observatory for
Surveillance, Prevention and Control of
Non-Communicable Chronic Diseases (OPDCNT)

• Deborah de Carvalho Malta (SVS/MS)
• Denise Bomtempo Birche de Carvalho (University of
  Brasília)
• Otaliba Libânio de Moraes Neto (SVS/MS)
• Elisabeth Carmem Duarte (SVS/MS)
• Luciana Sardinha (SVS/MS)
• Lenildo de Moura (SVS/MS)
• Marília Mendonça Leão (CGPAN/MS)
• Anelise Rizzolo (CGPAN/MS)

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Specialists linked to the Brazilian Committee of
the Observatory for Surveillance, Prevention and
Control of NCCD (OPDCNT) Isabella Samico -
Health Evaluation (CGIAE-SVS), Iná Santos
Epidemiologist (UFPEL)Sonia Natal Health
Evaluation (ENSP) Aloysio Achutti Cardiologist
/ Tobacco policy (AMRIGS) Pedro Rodrigues Hallal
Phys Ed (UFPEL) Yara Carvalho PhysEd /Dr.
Collective He. (USP) Dilian Goullart - CGPAN
MS

• Assistant Researchers
• Juliana Rochet , Andréa Fucks, Tânia Maria Tosta
  da Silva

International Cooperation - PAHO Lucimar Coser
Cannon, Branka Legetic, WHO Cooperation
Center/Canada Silvie Stachenco, Ellen Voggel WHO
COORDINATION Silvie Stachenco
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BRAZILIAN CASE STUDY FIVE AXES OF ANALYSIS
TOBACCO CONTROL
DIET AND NUTRITION POLICY -
DIABETES/HYPERTENSION CARE
NCD
HEALTH PROMOTION AND PHYSICAL ACTIVITY
NCD SURVEILLANCE
The analysis comprised the decision making
process to formulate these initiatives within
the different sectors of the Ministry of Health
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Objectives of the Brazilian case study

• Analyzing the process to formulate these public
  actions initiatives aiming to promote health
• Analyzing how such initiatives may be included in
  a more global future strategy to face this
  problem and to formulate an integrated policy for
  NCD prevention and control in Brazil
• Identifying elements that facilitate or impair
  the formulation and approval of policies in this
  area
• Subsidizing the formulation of an integrated
  policy for NCD prevention and control in Brazil
• Analyzing the Brazilian results compared to the
  NCD prevention and control policies formulation
  processes in Costa Rica and Canada.

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Methodological procedures
This is a qualitative research aiming at
understanding the interpretations of the actors
on the formulation process for public policies on
health promotion, which may contribute for the
formulation of an integrated policy in NCD
surveillance, prevention and control.
Secondary data Laws that created and ruled the
actions and programs analyzed Presidential
decrees, plans, programs, bulletins, reports
issued by qualified governmental organisms
Publications of international organizations
Articles in national newspapers Speeches,
reports, opinions Minutes of inter-ministerial
and intra-ministerial meetings, work groups
Cientific event proceddings Others documents.
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Methodological procedures

• Primary data
• 29 semi-structured interviews with key informants
  were carried out, based on an interview form.
• Key informants were pointed out by the Policy
  Observatory committee using the following
  selection criteria
• Public decision makers that significantly
  participated in the 5 AXES formulation process
• Experts in scientific evidences of health
  epidemiologic basis related to DIET AND NUTRITION
  POLICY , NCD SURVEILLANCE, HEALTH PROMOTION AND
  PHYSICAL ACTIVITY, DIABETES/HYPERTENSION CARE AND
  TOBACCO CONTROL
• Experts in 5 AXES with proved experience in the
  formulation of food and nutritional programs and
  actions

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Structure to analyze the development of the
National Policies on NCCD
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Surveillance Organization

• The beginning of worry to control the smoking
  habit started with the figures showing the
  increase of mortality caused by
  chronic-degenerative diseases, including cancer,
  that began to gain international visibility in
  the 1970s when the process of epidemiological
  transition in the patterns of mortalitity in the
  population became clearer
• In 1990, the World Health Assembly convocated its
  Member States to adopt urgently comprehensive
  strategies to control the tobacco consumption
• The National Institute of Cancer, with the
  mission to consolidate a National Policy of
  Cancer has the smoking habit as its priority
  because this practice is one of the main risk
  factors associated to some types of cancer
• The conscientization of a big part of the
  population about the impact of smoking habit in
  the health
• Brazils adhesion to the Global Strategy on
  Diet, Physical Activity and Health, promoted by
  the WHO, whose main focus is the integrate
  attention to prevent and control the NCDs.

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Surveillance Agenda and the NCD prevention

• 2003 creation of the CGDANT
• Structuring of NCD Surveillance System and its
  Risk Factors (RF) and Protector Factors (PF)
• Management (Regulamentation, sponsoring, human
  resources, social control and participation,
  responsability, sustainability
• Intervention to prevent (health promotion,
  interface with assistance, intersectoriality,
  integrality)
• Evaluation and Research support

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Political, economic and social contexts

• The Brazilian redemocratization process
  triggered, in the 1980s, a progressive social
  movement towards public policies, specially the
  related to health
• The New Federal Constitution of 1988 health as
  a human right matter
• The 8th Nacional Health Conference, the most
  important event of the last decades under a
  sanitary and political point of view
• Regulamentation of SUS (Unified Health System)
• Health Organic Law, Federal Law number 8080
• The 1st Nacional Seminar on Epidemiological
  Surveillance, in 1992

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Political, economic and social contexts

• In 1999, the movement inside the Ministry of
  Health to structure the NCDs surveillance area
• In 2003, the Global Forum of NCD Surveillance and
  Control, in Rio de Janeiro
• Brazilian participation in the Global WHO
  Strategy - 2004

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Ideas and interests

• Strong social demand since the mid-1980s, when
  started an international movement to control the
  risk factors associated to smoking habit and
  obesity in many countries
• Pression of the critical mass of expertise from
  institutions especialized in collective health
  put the subject insided the debates of the
  Ministry of Health
• Intersectorial work inside the Ministry of
  Health in order to support the NCDs prevention
  initiatives is fundamental to consolidate the
  surveillance actions in the area
• Consolidation of the CGDANT-General Surveillance
  Coordination of Non-Communicable Diseases and
  Damages.

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Ideas and interests Cont.

• Surveillance actions promoted by the WHO and PAHO
  in other countries are useful to structure the
  surveillance in Brazil.

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Relevant Institutions in the process

• Internationals
• Center for Disease Control (CDC)
• World Health Organization (WHO)
• Pan-American Health Organization (PAHO)
• World Bank
• Nationals
• Ministry of Health
• Committe of the National Policy on Intersectorial
  Health Promotion (the committee is composed by
  technicians of all the Secretariats, including
  the Secretariat of Science and Technology, the
  Oswaldo Cruz Fundation and the National Cancer
  Institute)
• National Cancer Institute (INCA)
• National Agency for Sanitary Surveillance
  (ANVISA)
• Brazilian Society of Clinic Oncology
• Brazilian Society of Pneumology and Tisiology.
• Universities Collaborating Centers (UFMG,
  UFBA, FIOCRUZ, UFPEL, IMIQE, FSP/USP
• Brazilian Association of Post-Graduation in
  Collective Health ABRASCO
• CELAFISCS
• IBGE.

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Conclusions

• The silent advance of the chronic diseases in the
  work force suggested the importance of the
  establishment of actions aimed to promote health
  
• The international AGENDA indicates to Brazil the
  necessity to formulate strategies to insert the
  NCD theme in the governmental agend

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Conclusions

• The creation, in 2003, of the Health Surveillance
  Secretariat, and the General Surveillance
  Coordination of Non-Communicable Diseases and
  Damages aimed to fill an important space inside
  the Brazilian Health Service
• The regulamentation of the Health Surveillance
  Secretariat strenghtned the surveillance system
  and possibilitated the formulation of
  comprehensive and inclusive governmental
  strategies in the whole Brazilian territory
• The integration of the data base, the analyses of
  health situations, the production of studies
  about the perspectives of the health problems
  were the strenghtning basis for the NDC
  Prevention and Surveillance in Brazil.

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Conclusions

• The international agenda strengthens the
  establishment of actions aimed to promote health
  among the Brazilian population
• Beginning of the establishment of directives
  aimed to combat sedentarism, promote physical
  activity, health diet and good health
  maintenance
• Awareness about the relevance to call the
  attention of the population about the importance
  of a good diet and physical activity practice as
  a preventive factor against the NCDs
• The intersectoriality is fundamental in the
  process because the health promotion envolve many
  governmental and non-governmental actors
• The participative policy elaborating process is a
  positive factor that affects the formulation and
  approval of the National Policy on Health
  Promotion in Brazil, in 2006.

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CASE STUDY PROPOSAL FIVE AXES OF ANALYSIS
TOBACCO CONTROL
DIET AND NUTRITION POLICY -
PREVENTION and SURVEILLANCE NCD
DIABETES/HYPERTENSION CARE
ALCHOOL AND THE OTHERS DRUGS
PHYSICAL ACTIVITY
The analysis comprised the decision making
process to formulate these initiatives within
the different sectors of the Ministry of Health
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