Category Archives: health

Summary of the Brazilian National Household Sample Survey (PNAD) 2011: income growth was higher in the lower income classes

The Brazilian National Household Sample Survey (PNAD) studies on an annual and permanent basis the general characteristics of the population, education, employment, income, housing and other, with variable periodicity, according to the information needs of Brazil, such as migration, fecundity, marriage status, health, food security, among other themes. The PNAD 2011 shows that from 2009 to 2011, the real average monthly income grew 8.3%. By income brackets, the largest increase in income (29.2%) was seen in the 10% with lower incomes. Overall, there was a reduction in income growth as its value increased.
PNAD 2011 shows the Gini coefficient in Brazil decreased from 0.518 in 2009 to 0.501 in 2011. Regionally, only the North saw an increase, from 0.488 in 2009 to 0.496 in 2011. In other regions the increase in income was higher for the poorest, and lower for the 10% with the highest incomes. A more significant reduction was seen in the South (from 0.482 to 0.461).
The real average monthly income of permanent households was estimated at R$ 2,419.00 in 2011, representing a real gain of 3.3% compared to 2009 (R$ 2,341.00). There was an increase of household income in all major regions. The Northeast had the lowest variation (2.0%) compared to 2009, as well as the lowest value (R$ 1,607.00).
Women’s income amounted to 70.4% of men’s income. In 2011, the real average monthly income of men was R$ 1,417.00 and of women was R$ 997.00. Proportionally, women received 70.4%. In 2009, the proportion was 67.1%. In addition, there were proportionally more women employed without income or only receiving benefits (10.0%) than men (5.8%).
Formal jobs increased 11.8% from 2009 to 2011. From 2009 to 2011, there was an increase of 3.6 million employees with a formal contract in the private sector. 74.6% employees in the private sector had a formal contract. The income of employed people grew from R$ 1,242.00 to R$ 1,345.00, from 2009 to 2011. From 2009 to 2011, income of domestic workers without a formal contract increased 15.2%.
There are an increased number of workers with high school and university diplomas. From 2009 to 2011, the employed population increased the percentage of workers with at least secondary education (43.7% to 46.8%) and workers with at least a university degree (from 11.3% to 12.5%), while the percentage of workers with incomplete primary education fell from 31.8% to 25.5%.
There is an increased number of employed people in the sectors of services, trade and construction. The number rose 5.2% in the service sector (41.5 million people), 1.9% in trade and repair (16.5 million) and 13.6% in construction (7.8 million), 2009 to 2011, while falls were recorded from -7.3% in the agricultural sector (14.1 million) and -8.0% in manufacturing (12.4 million).
The increase of employed people in 2011, associated with the reduction of unemployed, brought as a result a significant drop in the unemployment rate, which fell from 8.2% in 2009 to 6.7% in 2011. In the South, PNAD saw the lowest unemployment rate (4.3%) and the highest in the Northeast (7.9%). In 2011, approximately 6.6 million people were unemployed. Despite the significant drop in the unemployment rate in Brazil, a greater difficulty in entering the labor market still persists, for some groups. Of the unemployed, 59.0% were women, 35.1% had never worked; 33.9% were between 18 and 24 years old, 57.6% were black or brown and 53.6% of them had not completed school. PNAD also confirmed the downward trend in child labor (5-17 years) in 2011. In two years, there was a reduction of 14%. However, child labor reaches 3.7 million.
It was observed that the illiteracy rate among people aged 15 or older in Brazil in 2011 was 8.6% (12.9 million illiterates), 1.1 percentage points less than in 2009 (9,7%, 14.1 million illiterates). 96.1% of the illiterate had 25 years or older. Of this group, over 60% were 50 years or older (8.2 million).
Women are more educated than men, especially between 20 and 24 years of age.  In 2011, the population aged 10 years or older had an average of 7.3 years of study. Women, in general, were more educated than men, with an average of 7.5 years of schooling, while men had 7.1 years of schooling.
From 2009 to 2011, the school enrollment rate of children between 6 and 14 years old increased by 0.6 percentage points, reaching 98.2%. As for young people between 15 and 17 years, the percentage dropped from 85.2% to 83.7%, in the same period.
In 2011, the resident population in Brazil was estimated to be at 195.2 million, an increase of 1.8% (3.5 million) compared to 2009. Women represented 51.5% (100.5 million) of the population and men 48.5% (94.7 million). People 29 years old or younger accounted for 48.6% of the population and those that are 60 years old or older, 12.1% in 2009, these values were, respectively, 50.2% and 11.3%, indicating that the population is having an aging trend.
This and other information can be viewed in full in the National Household Sample Survey (PNAD) 2011(in Portuguese)

Wellbeing Wales: Bridgend Community Weight Management Programme.

Weight loss can be difficult at the best of times. Temptation and easy options lurk round every corner and keeping up an active lifestyle can be difficult when attempting to juggle the many demands of day-to-day life.

In the battle against obesity, Over half of Welsh adults are currently ranked as overweight or obese

Gastric bands, pills and restricted diets may provide a solution to the weight issue but the causes of over eating are often rooted in more than just diet. Many factors contribute to people’s behavioral patterns and eating habits are no different. Social, material, economic and environmental  factors all have a bearing on people’s ability to maintain a healthy weight and lifestyle.
The Garw valley in Bridgend, Wales is one area where service providers have really adopted the whole person approach to weight management. Their Weight Management Programme arose from one local GP’s frustration at the lack of local options to support obese patients and their desire to offer patients access to the established ‘slimming on referral’ schemes offered by the commercial weight management organisations.
From this the Weight Management Programme was born. The programme aimed to work to integrate health and leisure services as a non-clinical intervention for weight management. The programme involved shaping behaviour through group activities that maintained peer support, motivation and other social aspects.  The programme involved referral and support from primary care, the Weight Watchers scheme, the exercise referral scheme and signposting to community activities to aid sustainable health promoting behavior change.

Dafydd Thomas, Executive Director at Lles Cymru Wellbeing Wales was commissioned to pilot a wellbeing assessment process to explore the range of factors affecting the participants, their wellbeing and in turn their ability or motivation to manage their weight. 

The assessment explored the Weight Management Programme participant’s own subjective assessments of their wellbeing, grounded in the specific context of their community and experience using indicators that they themselves developed.

To read the report summery then please click here. We’d love to hear your thoughts on it so why not drop us an e-mail at 

Wellbeing Wales

7 billion human beings: Why gender equality matters more than ever!

This post by Angela Luci first appeared on Gender Debate.
The United Nations Population Division estimates that the world’s population reached 7 billion around October 31, 2011. This milestone has an important impact on the worldwide economic and social equilibrium. Gender equality represents a major factor allowing countries to bear the challenges and to benefit from the opportunities of demographic dynamics. 
The recent birth of the 7th billion human being has been registered with mixed feelings all over the world.  The exponential population growth that could have been observed over the last 50 years as well as the UN projections for the future global population size are perceived as quite frightening in most countries. Indeed, the actual population size and the future population growth represent enormous challenges for countries of all development stages.
In developing countries, and particularly in Sub-Saharan Africa, a first important challenge is to provide an adequate agricultural organization to avoid famine, to provide clean water and to protect the environment.  Improving the access to health and education is another major challenge. This is where gender equality comes into play. Especially for girls and young women,  access to family planning, to contraceptionto education and to the formal labour market is crucial not only for improving their own living conditions, but also in terms  of demographic dynamics.  Fertility and child mortality can be significantly reduced by fostering women’s economic empowerment and by containing patriarchal social norms (inheritance laws, genital mutilation, limited freedom of movement etc…). In addition, an improved access to education for girls and boys allows developing countries to exploit their enormous growth potential that comes along with the high proportion of young people at working age (demographic bonus).
In emerging countries, rapid industrialization and urbanization represent a major development challenge as these phenomena risk coming along with environmental damage, slum formation, unemployment, loose family networks, drug abuse and youth criminality. In this context, improving women’s access to the formal labour market as well as to health care and education is particularly important, as investments in these areas are likely to lead to later marriages, less teenage pregnancies and more stable family structures. This helps accelerating the trend to smaller families and boosts investments in the education and health of children. Providing economic and educational opportunities for women thus leads to a win-win situation for all of society.
In developed countries, low fertility and high life expectancy represent the major demographic challenges. Population ageing certainly is a worldwide phenomenon, but implies a particular problem for developed countries, as the current low fertility rates make it difficult to finance pay-as-you go pension systems in the next future. Providing women with possibilities to combine work and family life has been identified as an important factor to enable parents to realize their fertility intentions. Moreover, providing women with an independent income, which allows them to make adequate social security contributions and private savings, can be seen as the best instrument to battle old-age poverty in developed countries (which concerns mainly women).
Hence, women’s access to decent jobs with income and career perspectives emerges as a key factor to tackle the challenges of demographic dynamics. This holds for developed countries as much as for emerging and developing countries. 
This article was inspired by the symposium “The Seven Billionth Human: What Does This Birth Mean” on October 14, 2011, organized by the Hopkins Population Center and the Bill & Melinda Gates Institute for Population and Reproductive Health.

The 5 Excellences and Collaborative Medicine…

Those of you who have been following this blog know that we look at well-being and particularly how to measure it. Given the latest trends in Wikinomics, citizen created content and data from unofficial sources, there is a movement to encourage citizen participation in creating knowledge even in health.

I recently have discovered Cheng Man Ching who was a famous for his technique of Tai chi and also for his mastery of the 5 Excellences:
1) Poetry
2) Painting
3) Calligraphy
4) Medicine
5) Tai Chi

The Tao teaches that learning these 5 Excellences will help you to attain a balanced and fulfilled life.

Medicine is the one that I am reflecting on today especially in terms of progress. Doctors are to know about medicine. They are the experts and the authoritative sources. Why does the Tao recommend that all people should know about medicine? Of course, time and place will dictate how one determines the interpretation of this.

But, what does that mean for the health dimension of well-being? Since, I came across Chang Man Ching’s 5 Excellences, I added the Lancet to my Google reader. Every day, I am getting all the latest in medical news. These are a few of the links I found from Lancet which have to do with people being able to contribute proactively to their health and to create new knowledge around it:
Don Tapscott discusses participation by patients for a new model health care and the study of medicine:

Macrowikinomics: Collaborative Health Care from Macrowikinomics on Vimeo.

There is also Open MRS which is to improve health care delivery in resource-constrained environments by coordinating a global community that creates a robust, scalable, user-driven, open source medical record system platform.

Open MRS envision a world where:

  • Models exist to implement health IT in a way that decreases costs, increases capacity, and lessens the disparities between wealthy and resource-poor environments.
  • Open standards enable people to use health IT systems to share information and reduce effort.
  • Concepts and processes can be easily shared to enable health care professionals and patients to work together more effectively.
  • Medical software helps ease the work of health care providers and administrators to provide them with the tools to improve health outcomes all over the world.

Finally, this app looks really interesting especially in terms of data collection on life satisfaction perhaps. PsyMate  provides a “film” rather than a “snapshot” of a patient’s mental state. It monitors daily life experience and behavior over a period of time and not as a one-off. It also offers the possibility of interactivity with the patient.  While this app is made for collecting data on patients, I wonder, could this (or something like this) be used for collecting survey data on a society?

Next post…calligraphy.



Progress and young people’s health and wellbeing

by Richard Eckersley
The widely accepted story of young people’s health in developed nations is that it is continuing to improve in line with historic trends and the progress of nations. Death rates are low and falling, and most young people say they are healthy, happy and enjoying life. For most, social conditions and opportunities have improved. Health efforts need to focus on the minorities whose wellbeing is lagging behind, especially the disadvantaged and marginalised.
There is another, very different story. It suggests young people’s health may be declining – in contrast to historic trends. Mortality rates understate the importance of non-fatal, chronic ill-health, and self-reported health and happiness do not give an accurate picture of wellbeing. Mental illness and obesity-related health problems and risks have increased. The trends are not confined to the disadvantaged. The causes stem from fundamental social and cultural changes of the past several decades.
The contrast between the old and new stories is graphically illustrated by these Australian statistics: about 40 per 100,000 young people (aged 12-24) die each year and the rate is falling; 26,000 per 100,000 (26%) (aged 16-24) suffer a mental disorder each year and the rate has probably risen, perhaps steeply. Which statistic says more about young people’s wellbeing?
Stories inform and define how governments and society as a whole address youth health issues, so which story is the more accurate matters. The usual narrative says interventions should target the minorities at risk. The new narrative argues that broader efforts to improve social conditions are also needed. The old story may still generally hold true in developing nations, but the issues raised in the new story are also of increasing importance to these countries as modernisation and globalisation impact more on the lives of their young people.
A central dimension of the changed trajectory in health over recent decades, and which underpins the new story, concerns the declining significance of material and structural determinants of health and the growing importance of existential and relational factors to do with identity, belonging, certainty and purpose in life. There is a shift in emphasis from socio-economic causes of ill-health to cultural; from material and economic deprivation to psychosocial deprivation; from a problem of material scarcity to one of excess. With this has come a shift in significance from physical health to mental health.
This argument is not to suggest sharp, categorical distinctions and clear breaks from the past. Physical and mental health are closely interwoven and interdependent. Physical illness, including infectious diseases, still matter. Disadvantage and inequality still matter. Indeed, the cultural changes of past decades may well have exacerbated their effects by making material wealth and status more important to how people see and judge themselves. Environmental problems such as climate change have serious implications, including the risk of possible catastrophic effects on human health.
The contrast between the old and new stories of young people’s health and wellbeing is part of a larger contest between the dominant narrative of material progress and a new narrative, sustainable development. Material progress sees economic growth and a rising standard of living as the foundation for a better life; sustainable development seeks a better balance and integration of economic, social and environmental goals to produce a high, equitable and enduring quality of life.
Material progress represents an outdated, industrial model of progress: pump more wealth into one end of the pipeline of progress and more welfare flows out the other. Sustainable development reflects (appropriately) an ecological model, where the components of human society interact in complex, multiple, non-linear ways. Not only does sustainable development better fit the new story of youth health, it is likely to achieve better outcomes in relation to the old story’s focus on socio-economic disadvantage and inequality because it less intent than material progress on economic growth and efficiency.
Related to this contest, the new story of youth health also challenges the orthodox story of human development, which places Western nations at its leading edge. It shows that the dominant measures of development – not just income, life expectancy or happiness, but also education, governance, freedom and human rights – are not enough. However desirable these things may be, they do not capture the more intangible cultural, moral and spiritual qualities that are so important to wellbeing. And it is in these respects that Western societies do not do so well.
The health of young people should be a focal point in the larger contest of social narratives. They should, by definition, be the main beneficiaries of progress; conversely, they will pay the greatest price of any long-term economic, social, cultural or environmental decline and degradation. If young people’s health and wellbeing are not improving, it is hard to argue that life is getting better.
This is an edited extract from:
Eckersley, R. 2011. A new narrative of young people’s health and wellbeing. Journal of Youth Studies. First published 13 April 2011 (iFirst)
An author version is available at

Health as a social dynamic

Richard Eckersley
A neglected attribute of population health is that it is an important dynamic in the functioning of societies. Typically, public-health reports express this role in terms of the direct and indirect economic costs of poor health (that is, the costs of health care and lost productivity), with some acknowledgement of the social costs to individuals, families and communities. But these effects are just one part of a bigger, more complex, picture.
Poor health, both physical and mental, affects people in many life roles – as students, workers, parents and citizens. These impacts are not only the result of clinically significant health problems (which, nonetheless, affect substantial segments of the population). High rates of illness, especially mental illness, also reflect public mood, morale and vitality. Poor population health weakens a society’s confidence and resilience, and so its capacity to deal with the challenges of the modern world. And this, in turn, further impacts on population health.
This is not widely appreciated. A false dichotomy often characterises debate and discussion about national and international affairs. On the one hand, these matters are seen as shaped by large, external forces such as economic development, technological change, environmental degradation and resource depletion, and war and conflict. Population health may be affected by these forces, but health itself is not usually seen as a contributor to larger-scale social developments. The perspectives of economics, politics and the environment dominate the discourse. On the other hand, considerations of health focus on internal, psychological and physiological processes and personal attributes, circumstances, behaviours and experiences. The dominant frame of reference is the biomedical model of health as an attribute or property of individuals, as discussed above.
This separation is misleading. The reality is that change in both social and personal, external and internal, worlds is shaped by a complex interplay between them. Understanding this interplay is important to comprehending what is happening in both realms. In other words, human ‘subjectivity’ plays an important part in the functioning of social systems; it is what most distinguishes them from other, biophysical systems. Health is not just an individual illness that requires treatment, but also an issue having national, even global, causes and consequences.
Health is a way of better understanding humanity and how people should live. Just as someone who is unwell will be less able to function effectively and withstand adversity, so too will a less healthy population make a less resilient society. Population health may be an important factor in determining whether societies respond effectively to adversity – or in ways that make the situation worse. In particular, mental health and morale could have a critical bearing on how societies cope with climate change and other 21st Century global threats.
Population health perspectives can make an important contribution to sustainable development and the quest for a high, equitable and enduring quality of life: they provide a means of integrating, balancing and reconciling different social priorities by allowing them to be measured against a common goal or benchmark: improving human health and wellbeing. Population health is, then, a key element of achieving a socially, economically and environmentally sustainable way of living – humanity’s greatest challenge.
This is an edited extract from:
Eckersley R. 2011. The science and politics of population health: giving health a greater role in public policy. WebmedCentral PUBLIC HEALTH 2011; 2(3):WMC001697
Richard’s work is available at:

Better health, not greater wealth, should be society’s goal

Richard Eckersley

The rise in life expectancy, which more than doubled globally last century, is a cornerstone of human development. While there are competing theories about what produced the health gains, they can be, broadly speaking, attributed to factors such as material advances, especially better nutrition; public-health interventions such as sanitation; social modernisation, including education and social welfare; and improved medical treatment and care.
Historically, then, medicine and other health professions have been part of a broad, progressive movement that has improved not only life expectancy and health, but quality of life more broadly. The connection was close; the early emphasis in public health was on how social conditions influenced health and how they might be improved.
Today the relationship has changed. Health professions are increasingly engaged in countering the growing harm to health of adverse social trends, at least in developed nations. At the same time, however, they have become part of the problem because of a scientific emphasis on, and political advocacy of, a biomedical model of health based on individual cases of disease and their associated risk factors and treatments at the expense of a social model of disease prevention and health promotion. This has contributed to a separation of population health from social conditions, to the detriment of both.
Most public-health initiatives focus on individual risk factors associated with physical health: smoking, diet, exercise, alcohol use. From a health perspective, this emphasis neglects the importance of mental health; from a prevention perspective, it under-estimates the importance of social and environmental determinants.
Furthermore, the research on social determinants focuses on socio-economic factors, notably inequality, to the neglect of cultural factors such as excessive materialism and individualism. Culture and mental health are closely linked; both concern what people think and feel. This is seen clearly in young people’s health, an important predictor of future population health. Contrary to longer historic trends and official perceptions, young people’s health has arguably declined over recent generations in developed nations because of rising obesity and mental illness.
Acknowledging the importance of culture and mental health highlights the social significance of health in two ways: by casting doubt on orthodox thinking on human development and national progress, which places Western nations at the leading edge; and by showing health is an important social dynamic, a cause not just a consequence of how well society is faring because it affects people in all their roles – as citizens, workers, students and parents.
The dominant biomedical perspective suits business and government. It is in biomedicine that profits are to be made, not in social health. This model also limits the political significance of health to the politics of healthcare services. This policy focus is challenging enough as governments struggle with rising demand and costs. However, the challenge is easy compared with trying to reconcile emerging health-based social realities with existing wealth-based political priorities. Embedded in the biomedical model is a hidden ideology that defends and promotes the status quo.
The scientific and political responses to the situation might include more research on public and mental health, especially transdisciplinary approaches that integrate epidemiological, sociological, psychological and anthropological concepts and evidence. Similarly, with health services and programs, the share of the health budget allocated to public health and mental health should be increased.
The response also needs to go beyond the health system to embrace, for example, rethinking the role and purpose of education, and greater regulation and control of business, especially advertising and marketing, the dominant promoters of an unhealthy, hyper-consumer culture.
However, the most important application of this perspective may be in the contribution it can make to a much broader political and public debate about the lives people want to lead, the societies they want to live in, and the futures they want to create. That debate is intensifying, but health plays only a limited part in it.
A broad view of population health and wellbeing and their social drivers – socio-economic, cultural and environmental – challenges the legitimacy of the dominant worldview of material progress (which gives priority to economic growth and a rising standard of living), and supports the alternative, sustainable development (which seeks to balance social, environmental and economic priorities to achieve a high, equitable and lasting quality of life).
The contest between the two models, or narratives, of progress has been framed largely in economic and environmental terms, and the social dimension has been neglected. Population-health research can help to correct this distortion.
This is an edited extract from:
Eckersley R. 2011. The science and politics of population health: giving health a greater role in public policy. WebmedCentral PUBLIC HEALTH 2011; 2(3):WMC001697.
The paper, and other papers, are available on Richard’s website: