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Alves LC and Arruda NM

diabetes, hypertension, and heart disease (Pesquisa Nacional de Saúde, 2013). Non-
communicable diseases were responsible for 72% of all deaths in the country in 2007
(Schmidt, Duncan, Silva et al., 2011). Prevalence of hypertension is high in Brazil,
affecting about one-fourth of all adults. The highest rates of mortality and morbidity
for these diseases are concentrated among the poorest and those with less schooling
(Beltrán-Sánchez and Andrade, 2016).
Socioeconomic status plays a key role in determining the health of individuals.
The effect of socioeconomic status on health is the result of interaction between
psychological and sociological mechanisms such as behavior, social support,
environmental factors, and access to goods and health services (House, Lepkowski,
Kinneyet et al., 1994). Some studies have showed that low socioeconomic status
is associated with poor health and high mortality risk (Arber, 1991; Marmot, Ryff,
Bumpass et al., 1997). According to Porell and Miltiades (2002), the impact of adverse
socioeconomic conditions on the health of individuals is higher in regions with high
inequality in income distribution. High income inequality as measured at the national,
state or community level is associated with poorer health (Kaplan, Pamuk, Lynch et
al., 1996).
Brazil has among the highest levels of socioeconomic inequality in the world (Lima-
Costa, Matos and Camarano, 2006). However, the past two decades have been marked
by important social changes, mainly characterized by reductions in inequality and
poverty. This reduction occurs nationally, but differs between the regions. The Gini
coefficient, which measures income inequality, fell by almost 12%, ranging from
0.61 to 0.54 between 1990 and 2009. The most pronounced changes were observed
in the poverty rates. The poverty rate declined from 41.92 to 11.60 between 1990 and
2009. Despite these reductions, significant regional differences are still present (IPEA,
2011; Andrade, Noronha, Menezes et al., 2013), reflecting continued differences in
inequalities within and between Brazilian regions (there being lower inequality in the
South and Southeast than in the North and Northeast), or by socioeconomic status
(comparing poor versus rich).
Since 1994, Brazil launched what has since become the world’s largest community-
based primary health care program. The Family Health Program has delivered a new,
more robust model of primary care services designed to provide accessible for the
whole population. This care program is coordinated with other health care services
and takes place within family and community contexts. Currently, each Family
Health Program team makes visits to every household in the community on a monthly
basis, and among their numerous duties they aim to identify individuals at risk of
cardiovascular disease, especially hypertension and diabetes, and refer them to a health
center (Macinko, Dourado, Aquino et al., 2010).
As the Brazilian population is aging and living longer, insight into health status
trends among older populations may help with assessment of health policies to control
chronic diseases in the country in recent years, as well as estimation of future health
care needs and setting priorities to improve public health. We need to know whether
increases in life expectancy experienced over the last decades are accompanied by
better or worse health at the end of life. Important indicators for health in old age are
prevalence of chronic diseases (Jagger, 2000).
Healthy life expectancy is a measure that combines morbidity and mortality
information into a single index. The concept is similar to life expectancy, but refers to
the average number of years of life that a person of a certain age can expect to live in
good health without some chronic condition, given prevailing morbidity and mortality
rates at that particular age (Jagger, Hauet and Brouard, 2001).
According to Robine et al. (2003), the development of indicators summarizing
mortality and morbidity has provided an important tool for understanding how health
status and length of life change in actual populations and whether there has been an
expansion or compression of healthy life. Studies based on the healthy life model
have been extremely important in clarifying the links between changes in mortality
and morbidity. These have played a key role in alerting governments to the potential

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