EFF/PAI-PAD/USP-RP-2009 EFF/PAI-PAD/USP-RP-2009 1 INEBRIA 2009 INEBRIA 2009 Newcastle upon Tyne Newcastle upon Tyne Brazilian alcohol and Brazilian alcohol and drugs policy of the drugs policy of the Ministry of Health Ministry of Health and SBIRT and SBIRT implementation implementation Erikson F. Furtado, MD, PhD – Assist. Prof. USP – University of São Paulo FMRP – School of Medicine of Ribeirão Preto Dept. Neuroscience and Behavior
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EFF/PAI-PAD/USP-RP-2009 1 INEBRIA 2009 Newcastle upon Tyne Brazilian alcohol and drugs policy of the Ministry of Health and SBIRT implementation Erikson.
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EFF/PAI-PAD/USP-RP-2009EFF/PAI-PAD/USP-RP-2009 11
INEBRIA 2009INEBRIA 2009Newcastle upon TyneNewcastle upon Tyne
Brazilian alcohol and drugs policy Brazilian alcohol and drugs policy of the Ministry of Health and of the Ministry of Health and
SBIRT implementationSBIRT implementation
Erikson F. Furtado, MD, PhD – Assist. Prof.
USP – University of São Paulo
FMRP – School of Medicine of Ribeirão Preto
Dept. Neuroscience and Behavior
EFF/PAI-PAD/USP-RP-2009EFF/PAI-PAD/USP-RP-2009 22
ObjectiveObjective
To present an overview of the To present an overview of the
present developments of the present developments of the
Brazilian public policy for alcohol Brazilian public policy for alcohol
and drugs and its relation to and drugs and its relation to
SBIRT implementation in the SBIRT implementation in the
public health system.public health system.
EFF/PAI-PAD/USP-RP-2009EFF/PAI-PAD/USP-RP-2009 33
• Population (2009) – 191 millions (mostly urban)
• Federative Republic, 5 regions, 26 States (01 FD)
Health Policy in BrazilContext: Epidemiologic Transition - Violence
Standardized Mortality Rate by Violence (Assault and Homicide) per 100.000 habitants, Region, Brazil, 1980 - 2004
Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Saúde Brasil 2006 : uma análise da situação de saúde no Brasil. Brasília : Ministério da Saúde, 2006. 620 p. : il. – (Série G. Estatística e Informação em Saúde) http://portal.saude.gov.br/portal/arquivos/pdf/saude_brasil_2006.pdf
EFF/PAI-PAD/USP-RP-2009EFF/PAI-PAD/USP-RP-2009 88
Per Capita Alcohol ConsumptionPer Capita Alcohol Consumption
Alcohol and Car AccidentsAlcohol and Car Accidents
53% car crash victims attending the 53% car crash victims attending the emergency room – HC-Sao Paulo emergency room – HC-Sao Paulo (mostly, young 15-29 ya males)(mostly, young 15-29 ya males)
Mortality due by fatal car accidents Mortality due by fatal car accidents responds for 28% of all external responds for 28% of all external causes (about 30,000 deaths/year)causes (about 30,000 deaths/year)
High BAC found among 96.8% of High BAC found among 96.8% of necropsies of fatal victims (IML-SP)necropsies of fatal victims (IML-SP)
About 50% positive AUDIT in ERAbout 50% positive AUDIT in ERSource: Report of the Brazilian Ministry of Health - 2003
2003 – Basic Guidelines for a 2003 – Basic Guidelines for a National Public Policy for Alcohol National Public Policy for Alcohol and Drugs, Prevention, Treatment and Drugs, Prevention, Treatment and Health Promotionand Health Promotion– First insertion of Brief InterventionsFirst insertion of Brief Interventions
BRASILIA DECLARATION ON ALCOHOL BRASILIA DECLARATION ON ALCOHOL PUBLIC POLICIES, 2005 - PAHOPUBLIC POLICIES, 2005 - PAHO
RecommendationsRecommendations Preventing and reducing alcohol consumption-related Preventing and reducing alcohol consumption-related
harms be considered a public health priority for action in harms be considered a public health priority for action in all countries of the Americas.all countries of the Americas.
Regional and national strategies be developed, Regional and national strategies be developed, incorporating culturally appropriate evidence-based incorporating culturally appropriate evidence-based approaches to reduce alcohol consumption related approaches to reduce alcohol consumption related harm.harm.
These strategies are supported by improved information These strategies are supported by improved information systems and further scientific studies on the impact of systems and further scientific studies on the impact of alcohol and the effects of alcohol policies in the national alcohol and the effects of alcohol policies in the national and cultural contexts of the countries in the Americas.and cultural contexts of the countries in the Americas.
BRASILIA DECLARATION ON ALCOHOL BRASILIA DECLARATION ON ALCOHOL PUBLIC POLICIES, 2005PUBLIC POLICIES, 2005
Alcohol policies whose effectiveness has been Alcohol policies whose effectiveness has been established by scientific research are established by scientific research are implemented and evaluated in all countries of implemented and evaluated in all countries of the Americas.the Americas.
Priority areas of action need to include: heavy Priority areas of action need to include: heavy drinking occasions, overall alcohol consumption, drinking occasions, overall alcohol consumption, women (including pregnant women), indigenous women (including pregnant women), indigenous peoples, youth, other vulnerable populations, peoples, youth, other vulnerable populations, violence, intentional and unintentional injuries, violence, intentional and unintentional injuries, underage drinking and alcohol use disorders.underage drinking and alcohol use disorders.
Changing attitudes after trainingChanging attitudes after training
SBIRT SBIRT
knowledge after knowledge after
training training
correlates with correlates with
reduction of reduction of
alcohol alcohol
expectanciesexpectancies
– N = 185; N = 185;
– rr = 0.215; = 0.215;
– P < 0,005P < 0,005
Implementation processImplementation process 2008 Ministry of Health, three metropolitan 2008 Ministry of Health, three metropolitan
areas pilot project for SBIRT implementation areas pilot project for SBIRT implementation in the Family Health Program and the in the Family Health Program and the matricial support teams.matricial support teams.
2009 Annual plan, Alcohol and Drugs 2009 Annual plan, Alcohol and Drugs Coordination, State of São PauloCoordination, State of São Paulo– Extending the PAI-PAD couverture of SBIRT Extending the PAI-PAD couverture of SBIRT
training for all 17 regional health departments, training for all 17 regional health departments, reaching the total population of the state reaching the total population of the state (~41mi).(~41mi).
Brasil. Ministério da Saúde. As Causas Sociais das Iniqüidades em Saúde no Brasil. Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde (CNDSS). Brasília. 2008.
Brasil, Ministério da Saúde. Painel de Indicadores do SUS, Brasília. Ano I, No. I, agosto 2006.
Cornwall, A., Shankland, A. Engaging citizens: Lessons from building Brazil’s national health system. Social Science & Medicine 66 (2008) 2173 – 2184.
Barreto, ML, Aquino, R. Recent Positive Developments in the Brazilian Health System. American Journal of Public Health. January 2009, Vol 99, No. 1.
Camargo, KR. Celebrating the 20th Anniversary of Ulysses Guimarães’ Rebirth of Brazilian Democracy and the Creation of National Health Care System. American Journal of Public Health. January 2009, Vol 99, No. 1.