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61 Family health strategy and health equity among older adults
  1. Marciane Kessler,
  2. Elaine Thumé,
  3. Michael Marmot,
  4. James Macinko,
  5. Luiz Augusto Facchini,
  6. Fúlvio Borges Nedel,
  7. Louriele Soares Wachs,
  8. Pâmela Moraes Volz,
  9. Cesar de Oliveira
  1. Department of Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil, Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil, Department of Epidemiology and Public Health, University College London, London, UK, Department of Community Health Sciences and Department of Health Policy and Management Departments, University of California, Los Angeles, EUA, Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil, Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil


People living in low social conditions have higher morbimortality risk and lower access of health services. Primary Health Care (PHC) has been recommended as the main strategy to achieve the goal of health for all. Since 1994 the Brazil MoH proposed a new strategy PHC called Family Health Strategy (FHS), to reorganize and restructure the universal health system. FHS was implemented first in the poorest and less assisted areas, to reduce health inequalities. FHS has been associated with improvement in health indicators; however, there is little understanding about how it affects social inequalities. Therefore, we compare the mortality among older adults living in areas covered by FHS to those not covered by them. We believe that there is no difference in mortality between these two groups, given that FHS could be able to minimize the impact of social inequalities among the poorest. These are results from ‘The Bagé Longitudinal Study of Ageing’. In Bagé, half of the population and sample was covered by FHS at the baseline study (2008), it means, the poorest areas/periphery of city. This context makes our study a natural experimental research. All interviewed at baseline (1,593) were eligible for a follow-up. 1,336 (83.9%) older adults were located in 2017; 579 deaths were confirmed (53.5% in FHS). We used X2 to compare proportions, cumulative survival curves adjusted for age-sex and Log-rank test. Results show a significant higher prevalence of participants with low wealth, skin color black/brown/yellow/indigenous and less school living in FHS areas, compared to TPHC areas, as expected. Hence, people living in FHS areas present higher prevalence of health conditions, as smoking, diabetes, depression and disabilities compared to TPHC, confirming the impact of social determinants. However, we confirm our hypothesis; no difference was found in all-cause mortality risk between FHS and TPHC during 9 years follow-up.

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