Does the São Paulo population use the public health services frequently? Is it pleased with it? How much do citizens spend on doctors and medicines? Are they accustomed to taking preventative examinations? How do they live and how do they feed themselves? Are they exposed to risk factors? Do they adequately vaccinate their children? How many pregnant women are concerned with their pre-natal condition? Finally, what is the state of health of the São Paulo population in the interior and in the capital? What can be done to improve it? The development of public health policies must take into consideration the answers to these questions. Nonetheless, “policies are drawn up based on figures of dead and morbidity rate registered at the public health services”, says Chester Luiz Galvão Cesar, professor at the Department of Epidemiology of the Public Health School of USP. With the intention of changing this picture, Galvão Cesar is coordinating a wide range household survey. The project, supported by FAPESP,is being carried out jointly with researchers from USP, Unicamp and Unesp, in partnership with the State Health Secretary.
The information traced through the statistics on the sick and dead show themselves to be more and more insufficient. “This data is provided by the public health network, taking into account only those who have been attended to by the medical and ambulatory services of the State linked Unified Health System (SUS in the Portuguese Acronym)” Galvão Cesar explains. Consequently, the government does not have the slightest idea of what is happening with those who don't go through the system. They are not a small number of people: according to the Standard of Living Research carried out by the Seade Foundation between 1994 and 1998, less than half of the population of the State of São Paulo (48.9%) at that time sought public health institutions – numbers that have tended to decrease year by year with the gradual migration of the São Paulo citizens to private medical services.
Parallel to this, the development of medicine has been demanding more and more diversified knowledge about people's habits, their conditions and life styles. “The traditional data obtained by the technique of attended demand is giving way to the modern technique of a population based inquiry.” said the researcher. The household inquiries base themselves on extensive questionnaires, applied directly by a team of interviewers. In the case of this project, four large regions were selected: the district of Butantã, in the west side of São Paulo, the cities of Taboão da Serra, Embu and Itapecerica da Serra, in the metropolitan region, the city of Campinas, and the city of Botucatu in the country.
A team of 25 people carried out the field work, beginning in April of this year and that has a scheduled finishing date of March 2002. They expect to apply between 6,400 and 7,000 questionnaires that contain many innovations. “An example are the questions about eating habits, a study which is being done with the help of nutritionists from the Nutrition Department of the Public Health School of USP.” The numbers coming from the research are going to generate an Index of Adequate Feeding for the State of São Paulo, important for the development of nutritional policies.
The field work will result in a large mapping, of considerable use to research, teaching and government. “Population based inquiries are traditionally used in countries such as Britain, the United States and Canada, for the formation of policies and the improvement of health services. In Brazil this is something new”, says the researcher. In the cities of Taboão da Serra, Embu and Itapecerica da Serra, Galvão Cesar had already carried out a similar piece of research exactly ten years ago. Although it is more comprehensive than the last one, the current research will allow for a comparison of the evolution over the last decade. For example, it will be possible to know, in numbers, the impact of the building of a public hospital in Itapecerica da Serra, built years after the first evaluation of the region. In the district of Butantã, which “is becoming a health-school district, due to the partnership between USP and the city of São Paulo”, the results will be applied immediately in the formation of actionstrategies.Republish