The PNAD 2008 Health Supplement, conducted by IBGE in partnership with the Ministry of Health, shows that 77.3% of the population evaluated their own health conditions as “very good or good” and that health centers remain as the places most often visited for health assistance. More than 95% of the persons who sought health care services (either private or public) were seen in the first attempt, and more than 85% of them considered the service “good or very good”. The survey also shows that, in 2008, 27.5 million Brazilian households were participating in the Family Health Program.

 

Between 1998, when the first edition of PNAD Health Supplement was released, and 2008, the population covered by health insurance increased from 24.5% to 26.3%. In the same period, the percentage of persons who had had a dentist’s appointment at least once changed from 81.2% to 88.5%. In the section on smoking habits, a topic investigated for the first time, the survey shows that, in 2008, Brazil had 15.7 million ex-daily smokers.

 

Compared to figures in 2003, the number of women who had already undergone a clinical breast exam and a mammogram increased by 28.5% and 48.8%, respectively. In the same period, there was a 25 percent rise of the number of women who had undergone a Papanicolaou test to prevent cervical uterine cancer. There was also an investigation of the incidence of restrictions to daily activities, such as using the toilet without help, performing simple domestic repairs or walking a one-hundred meter distance. Difficulty in walking was mentioned by about 11.2 million persons aged 14 years of age or older, and by 27.0% of the elderly population.

 

In 2008, about 75.1 million persons reported watching TV for over three hours daily, and more than 55 million reported using a computer or videogame for over three hours daily. In 2008, about 3.7 million persons declared to have been victims of some kind of violence, and 660 thousand sought health care for this reason. According to the PNAD Health Supplement, 73.2% of the persons driving or occupying the front seat of a car wore a seat belt and 4.8 million persons were involved in traffic accidents in 2008. See below the main pieces of information presented by the survey:

 

In 2008, 27.5 million Brazilian households were registered in the Family Health Program

 

In 2008, among the 57.6 million households in the country, 27.5 million (47.7%) declared to be registered in the Family Health Care Program (PSF)¹. The Northeast Region (9.7 million) concentrated 35.4% of the national overall number of households participating in the program, being followed by the Southeast (9.1 million, or 33.1%), South (4.5 million or 16.5%), Central West (2.1 million or 7.6%) and North (2.0 million or 7.4%).

 

In the 27.5 million households registered in the PSF, there were a total 96.5 million residents, or 50.9% of the country’s population. In the Northeast Region, 67.7% of the population (or 36.2 million persons) lived in registered households. The Southeast (with 38.5%, or 30.7 million persons) was the only region to have less than half of the population residing in PSF-registered households.

 

In the Northeast Region, 64.8% of the households were registered in the program, and that represented the largest proportion among all the five Major Regions. More than 4/5 of the population lived in registered households in the following states: Tocantins (94.0%), Paraíba (86.4%) and Piauí (85.5%). On the other hand, in Rio de Janeiro (19.2%) and Amapá (19.4%) less than 1/5 of the population lived in registered households.

 

Three Federation Units had less than 1/3 of their population living in registered households: Amapá (20.2%), Rio de Janeiro (17.4%) and the Federal District (11.2%), whereas other seven had more than 2/3 of the population in the same situation. Paraíba (83.7%) and Tocantins (93.2%) had the largest percentages.

 

In 2008, 3.8% of the population evaluated their own health conditions as “bad or very bad”

 

According to PNAD 2008, 77.3% of the resident population of Brazil evaluated their own health conditions as “good or very good”; 18.9% as “regular” and 3.8% as “bad or very bad”.

 

In 1998, 79.1% of the residents declared that they considered themselves to be in “good or very good” health conditions. In 2003, this group made up 78.6% of the total 175.9 million and, in 2008, 77.3% of the total 186.9 million. In the three years, the percentage of men in “good or very good” health conditions was bigger than that of women: the rates in 2008 were 79.5% and 75.2%, respectively.

 

The Southeast had the largest percentage of persons who considered their health conditions as “good or very good” (80.1%). In the South and Central West, respectively, 77.5% and 77.8% of the persons shared the same opinion. In the North Region, 75.5% also did. In the Northeast the percentage was smaller (73.4%) and 4.6% of the persons ranked their health conditions as “bad or very bad”, the highest rate among the Major Regions.

 

The higher the monthly household income per capita, the biggest the percentage of persons evaluating their own health conditions as “good or very good”: 87.9% of persons for incomes above 5 minimum wages and 76.2% for incomes of up to ¼ minimum wage (see the table below).

 

The proportion of persons whose daily activities were restricted due to health problems, in the two weeks before the date of interview, was about 8.3%, for an average of 5 days of restriction. The largest percentage occurred in the North Region (9.3%). Other results by Region were: South (8.7%), Northeast (8.6%), Central West (8.3%) and Southeast (7.9%).

 

The percentage of persons reporting restrictions to daily activities in the two weeks preceding the survey changed from 6.3% in 1998, to 6.9%, in 2003 and 8.3%, in 2008. The percentage of men with restricted daily activities changed from 5.6%, in 1998, to 7.5%, in 2008, and for women, from 7.0% to 9.1%, in the period.

 

31.3% of the population suffered from at least one chronic disease and 5.9%, from three or more

 

About 31.3% of the resident population (or 59.5 million persons) declared to suffer from at least one chronic disease, and 5.9% declared to suffer from three or more. The South (35.8%) and Southeast (34.2%) had the largest percentage s of persons suffering from at least one chronic disease, and were followed by the Central West (30.8%), Northeast (26.8%) and North (24.6%).

 

The most commonly reported chronic diseases (identified by a doctor or health professional) were: high blood pressure (14.0%), backache or spinal disease (13.5%), arthritis or rheumatism (5.7%), bronchitis or asthma (5.0%), depression (4.1%), heart diseases (4.0%) and diabetes (3.6%). In the population aged 35 years or older, 8.1% of the persons suffered from diabetes.

 

The proportion of occurrence of chronic diseases did not undergo any significant changes: in 1998, the estimated percentage of persons suffering from at least one chronic disease was 31.6%; in 2003, 29.9% (or 52.6 million persons) and, in 2008, 31.5% (which is equivalent to 58.3 million persons). The percentage of women suffering from chronic diseases (35.2%) was bigger than that of men (27.2%) and the proportion of persons facing this condition increased with the age.

 

The higher the income, the bigger the percentage of persons who declared to suffer from at least one disease. Among those with income of up to ¼ minimum wage, 20.8% suffered from at least one disease, and among those with income above 5 minimum wages, this figure reached 38.5%.

 

From 1998 to 2008, the population covered by health insurance plan changed from 24.5% to 26.3%

 

In the harmonized series, the percentage of persons covered by at least one health insurance plan increased between 1998 (24.5%), 2003 (24.6%, or 43.0 million persons) and 2008 (26.3%, or 49.1 million persons). The increase occurred mainly in the rural area: from 5.8% to 6.7% between 1998 and 2008. In the urban area, rates were 29.2% and 29.7% in these years. In the Southeast (35.6%) and South (30.0%) the percentages were almost three times bigger than in the North (13.3%) and Northeast (13.2%).

 

In 2008, 25.9% of the Brazilian population (49.2 million persons) had at least a health insurance plan. Among them, 77.5% were covered by private health insurance, and 22.5% by health insurance plans directed to civil servants. Only 2.3% of the persons in households with income per capita of up to ¼ minimum wage had health insurance, whereas 82.5% of those with income above 5 minimum wages had health insurance.

 

The percentage of women covered by health insurance plans (26.8%) was bigger than the percentage of men in the same situation (24.9%). However, 60.8% of the women were covered as health insurance dependents of the policy-holder. A total 42.5% of men covered by health insurance were in the same position. 

 

Considering only the main policy-holder of health insurance plans, it was observed that 20.5% had their insurance entirely paid by the employer; 43.2% of them paid it through the current or previous job; 28.1% paid it directly to the health insurance company and 8.2% had their insurance paid by another household member, or by non-dwellers of the household. The table below shows the percentage of health insurance policy-holders, aged 10 years or older, by categories of occupation.

 

 

Health centers remain as the places most commonly sought for health assistance

 

In 2008, about 139.9 million persons (or 73.6% of the population) would usually seek the same kind of health care service when necessary. The health center was the most commonly visited place (56.8%), followed by private doctor’s offices (19.2%) and hospital ambulatory units (12.2%).

The other categories (pharmacies, ambulatory units in clinics or companies, emergency rooms and community agents, among others), made up, together, 11.8% of the places sought for assistance. Health centers were usually sought by persons with low monthly household income per capita.

 

From 1998 to 2008, the percentage of persons who had had a dentist’s appointment at least once changed from 81.2% to 88.5%

 

There was increase of the proportion of persons who had had a dentist’s appointment between 1998 (81.2%), 2003 (84.1%, or 147.9 million) and 2008 (88.5% or 165.5 million). For visits in the 12 months before the interview, the percentages were: 31.1%, 38.8% and 40.4%, respectively. It is worth mentioning that, among the 11.7% of the population who had never seen a dentist, 47.9% were aged 0 to 4, that is, 77.9% of the children in this age group had never seen a dentist.

 

In 2008, although 88.3% of the population had sought dental care at least once, only 40.0% had done so up to one year before the date of interview. Whereas 98.0% of the persons with monthly household income per capita of more than five minimum wages had already been seen by a dentist, the percentage was 71.3% among those with income of up to ¼ minimum wage.

 

More than 95% of those who sought health assistance were seen in the first attempt

 

In 2008, among the 27.5 million persons who sought assistance in the two weeks preceding the date of interview, 26.5 million (96.3%) were seen in the first time. Considering the household monthly income per capita, the difference in service percentages was small: 95.4% for those with income up to ¼ of the minimum wage, and 99.4% for those with more than five minimum wages.

 

The most commonly cited reason for the search for service was “illness” (50.0%), with 99.4% of those persons being seen. The second reason was “child care, vaccination and other preventive services” (22.0%). Next came dental problems (14.0%) and “accidents and lesion” (6.0%).

 

 

More than 85% of the services were considered “very good or good”

 

The service rendered was considered “very good or good” by 86.4% of the persons, regular by 10.4% and “bad or very bad” by 3.1%. Of all services rendered, 58.6% were taken in public institutions. Persons seen because of dental problems were those who better assessed the service: 93.6% considered it “very good or good”, with 68.8% of occurrences for this reason taken in private services.

 

Persons not attended in the health service in the first time, in the two weeks preceding the interview (3.8%) informed that the main reason was the lack of availability or the impossibility to get a ticket (39.6%), or because there was no doctor in attendance (34.6%). Among those who did not look for attendance, 96.6% did so for considering it unnecessary.

 

The percentage of persons who were granted admissions one or more times during the year preceding the interview changed from 6.9% in 1998 to 7.0% in 2003 and 7.1% in 2008: 12.3 million persons in 2003 and 13.3 million in 2008 were hospitalized at least once in the reference period.

 

In 2008, 93.5% of hysterectomized women were at least 40 years old

 

For the first time, PNAD investigated the operation procedure of uterus removal (hysterectomy) for women who were 25 or older. Of the total of approximately 58 million, 7.4% underwent surgery, what corresponds to 4.3 million women. The Central-West region presented the largest proportion of hysterectomized women, 8.3%, and the Northeast, the smallest, 6.4%. In 2008, 93.5% of the women who underwent the surgery were 40 or older.

 

From 2003 to 2008, the number of women who had undergone clinical breast exam² increased

 

In 2008, among the 58.0 million 25-year-old or older women dwelling in the country, 40.7 million (70.2%) had already undergone, at least once, a clinical breast exam, performed by a doctor or health professional. Among 40-year-old or older women, the percentage was a little higher: 74.7%, and the rates of this age group were the highest in all groups of household monthly income per capita, ranging from ¼ minimum wage (51.9%) to five minimum wages (96.2%).

 

Among women living in households with monthly income per capita above five minimum wages, 94.1% had undergone a clinical breast exam. Among those with income below ¼ minimum wage, just 44.8% had.

 

Between 2003 and 2008, the number of 25-year-old or older women that had already had a clinical breast exam performed by a doctor or health professional grew 28.5%. The total changed from 31.5 million to 40.5 million. In the total feminine population, this age group grew 15.6% (from 49.6% to 57.4%) in the same period.

 

The number of women who had already undergone a mammogram³ increased 48.8%

 

In 2008, approximately 31.6 million women aged 25 or older (54.5) had had a mammogram at least once. Among women in the 50-69 age group, 71.1% had undergone the exam.

 

Among women living in households with monthly income per capita above five minimum wages, 81.1% had undergone a mammogram, and in the households where income was below ¼ minimum wage, Just 28.8% had. Among women aged 50-69, percentages are different: in the lowest income group, 45.9% had the exam, whereas in the highest income group, 95.6% had.

 

Between 2003 and 2008, there was an increase of 48.8% in the number of women that had already had a mammogram. In 2003, they were 42.5% of the female population aged 25 or older; in 2008, 54.8%. Among women with household monthly income per capita below ¼ minimum wage, proportions were 20.2% in 2003, and 29.1% in 2008.

 

 

From 2003 to 2008, the number of women that had already had a Papanicolaou test⁴ grew 25%

 

Whereas the female population aged 25 or older grew 15.6% in the period, the number of women in the same age group that had the Pap test grew 25%. In 2008, around 49.0 million women aged 25 or older had already had a Pap test, representing 84.6% of the female population. There was an increase of 25.0% in relation to 2003, when they were approximately 39.2 million, that is, 79.0% of women from this age group.

 

In 2008, 95.4% of women with household monthly income per capita above five minimum wages had already had the exam, against 77.0% in the households with income below ¼ minimum wage.

 

Survey investigated some restrictions to the population’s physical mobility

 

PNAD 2008 investigated seven groups of activities, among persons aged 14 or older, to identify the difficulties encountered in certain tasks⁵, thus measuring their physical limitations.

 

Approximately 6.7 million persons aged 14 or older, or 4.5% of this population, faced at least mild difficulty in feeding, bathing or using a toilet without help. In the harmonized series, percentages grew from 3.4% in 2003 to 4.6% in 2008. Among women, this total represented 5.2%, against 6.8% of men. Around 15.2% of persons aged 60 or older experienced the cited difficulty.

 

Approximately 21.8 million persons in the same age group (or 14.9%) presented at least mild difficulty in pushing the table or carrying out home repairs. In the harmonized series, the rates changed from 9.9% in 2003 to 13.2% in 2008. This difficulty was found in 18.5% of women, 10.9% of men and 46.9% of the population aged 60 or older.

 

About 27.0 million persons aged 14 or older (18.4%) faced at least mild difficulty in stooping, kneeling or bending. In the harmonized series, the rates changed from 13.7% in 2003 to 16.8% in 2008. The limitations occurred in 22.1% of women, 14.5% of men and 53.9% of the elderly.

 

Finally, around 11.2 million persons aged 14 or older (7.6%) faced at least mild difficulty in walking a one hundred meter distance. In the harmonized series, rates changed from 3.9% in 2003 to 5.8% in 2008. Restrictions occurred among 9.4% of women, 5.8% of men and 27.0% of the elderly population. 

 

 

PNAD 2008 investigated for the first time persons who are active at leisure

 

PNAD 2008 also investigated some physical activities daily performed by the population aged 14 or older. Approximately 41.4 million persons of this age group declared to participate in a physical activity or sport, and 14.9 million of them (10.2%) were considered active at leisure by the WHO criteria⁶.

 

In 2008, around 75.1 million persons used to watch TV for more than three hours daily

 

Approximately 175 million people (92.4%) in the same age group said they used to watch TV and 75.1 million people (42.9%) used to do it for more than three hours daily; 56.2 million (29.6%) declared to have used computer and videogame and 28.8% used to do it for more than three hours daily. In the age groups 10-14, 15-17 and 18-19, this percentage was above 50%; in the age group 25-29, it was 38.4%, and in the 40-49 age group, 22.5%.

More than 1/3 (30.6 million) of the 91 million workers used to walk or ride a bike to work. Around 70.8 million people (49.7%) aged 14 or older used to do the cleaning at home, without help: 25.4% of men and 72.1% of women.

 

In 2008, around 3.7 million people informed to have suffered some kind of violence

 

Approximately 2.0% (3.7 million) of the dwelling population revealed to have suffered violence in the last 12 months prior to the interview: 50.6% of them were men and 49.4%, women. The Southeast region had the largest number: 1.5 million people affected (1.9%).

 

The group of persons aged 18-39 recorded the highest incidence among victimized people: 46.7%. The group 40-59 presented the second highest incidence among victimized people (27.9%).

 

Among the 3.7 million victims of violence in the reference period, 1.2 million (33.5%) declared to have quit usual activities because of the incident. Among them, 660 thousand (53.0%) looked for a health service because of it, whereas 584 thousand (47.0%) did not.

 

Among those who drive or occupy the front seat of the cars, 73.2% wore seat belts

 

Approximately 37.9% (72.1 million) of the resident population used to drive or occupy cars or vans always or almost always; 43.1% (81.9 million) sometimes or seldom and 18.9% (35.9%) never drove or were passengers in those automotive vehicles.

 

The Southeast, 44.8% (35.7 million) and the South, 44.8% (12.3 million) wee the regions with the highest percentage of persons who used to drive or ride as passengers, whereas the Federal District had the highest percentage: 62.0% (1.6 million).

 

Approximately 73.2% of the population (95.2 million people) who used to drive or occupy the front seat of car or van always or almost always wore the seat belt. Around 37.3% of the population (50.9 million) who rode as passengers on the back seat of a car or van always or almost always wore the seat belt.

 

 

4.8 million persons were involved in traffic accidents

 

PNAD 2008 also investigated the frequency of traffic accidents among the population dwelling in the reference period. It was observed that 2.5% (4.8 million) had some involvement in traffic accidents.

 

Of the persons who had involvement in traffic accidents, 52.9% were drivers or passengers of cars or vans; 30.1% were drivers or motorcycle passengers; 6.8% , drivers or bicycle passengers; 5.6% , pedestrians; 2.9%, bus drivers or passengers, and 1.7%, others. Around 30.7% of the involved in traffic accidents quit their usual activities because of them.

 

In 2008, Brazil had 15.7 million ex-daily smokers

 

In the population aged 15 or older (143.0 million), 17.2% (24.6 million) were current smokers; 15.1% were daily smokers; 2.1% were occasional smokers; 82.5% (117.9 million) were non-smokers, and 0.3% (464 thousand) was not declared. Of the 82.5% of non-smokers, 13.3% (15.7 million) were ex-daily smokers and 69.0% were never daily smokers (65.8%) never smoked. The South region had the highest percentage of current smokers: 19.3%.

 

The incidence of smoking among men was bigger: 21.5% of them were current smokers, against 13.2% of women. As to the type of tobacco product, 17.2% used to smoke any product of smoked tobacco, 14.7%, industrialized cigarette, 4.4%. straw or hand-rolled cigarette, and 0.7%, other tobacco products. The Northeast had the highest percentage of straw or hand-rolled tobacco smokers (7.0%).

 

 

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1 The Family Health Care Program (PSF), which is part of the project Basic Attention in Brazil (http://dtr2004.saude.gov.br/dab/atencaobasica.php, accessed on 01/26/2010), is formed by multi-professional teams in basic health care units. These teams are in charge of following the precise number of families dwelling in a given geographic area, and are responsible for health promotion, prevention, recovery, rehabilitation and maintenance.

 

2 The Ministry of Health recommends breast screening by means of a clinical breast exam, for all women, starting at 40 years old, conducted annually. This procedure is part of an integral care of women’s health, and must be present in all appointments, regardless the age group.

 

3 The Ministry of Health recommends breast screening by means of a mammogram, for women aged 50-69, with an interval no longer than two years.

 

4 The Ministry of Health recommends that all women who has or had an active sexual life undergo a Papanicolaou test periodically, especially in the age group 25-59.

 

5 According to the World Health Organization, a person is active at leisure if he or she plays soccer, basketball, practices aerobic gym, jogging, or tennis for at least three days a week, during 20 minutes or more; or walks or practices another kind of physical exercise or sport during at least five days a week during 30 minutes or more.

 

6 Feeding , bathing or using the toilet without help, run, lift heavy objects, practice sports or carry out heavy activities, push a table or perform household chores, GO upstairs, stoop, kneel, Bend, walk more than 1 km, walks 10 meters. The answer to each of those tasks was given in the options: could not, faced great difficulty; faced mild difficulty; faced no difficulty.