Preventive health in Brazil - Inconsistent policy clouds successes

Jul 21, 2017 - reading time 5 mins

By Dom Phillips

Dom Phillips is a British journalist who is based in Rio de Janeiro. He arrived in São Paulo in 2007 and stayed for four years before moving to Rio in 2012. He currently reports from Brazil for the Guardian and from 2014-2016 was a contract correspondent in Rio for the Washington Post. He has also written for the New York Times, Bloomberg, Financial Times, Observer and energy news wire Platts.

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RIO DE JANEIRO - Jacson Fressatto’s daughter was born premature, and had been in intensive care for 18 days when she caught sepsis. His daughter died 90 minutes later. Her death changed the life of the corporate systems security specialist from Curitiba, Brazil.

Doctor holding end of stethoscope with a Brazilian flag on|Doctor holding end of stethoscope with a Brazilian flag on

RIO DE JANEIRO – Jacson Fressatto’s daughter was born premature, and had been in intensive care for 18 days when she caught sepsis – “a complication caused by the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and death,” according to the US Centers for Disease Control and Prevention. It took three and a half hours to identify the problem and his daughter died 90 minutes later. Her death changed the life of the corporate systems security specialist from Curitiba, in the South of Brazil.

Necessity is the mother of invention

From then on, Jacson Fressatto dedicated his life and invested all his capital producing a risk management system to save lives. It uses cognitive computing and machine learning to make decisions, analyzing data from hospital systems, laboratories and databanks and sending alarms to hospital screens and even cell-phones of doctors if a patient is developing sepsis.

He named it Robô Laura, or Robot Laura, after his little girl. In tests in one Curitiba hospital, it cut the time between the alarm and administration of the antibiotic by 85 percent, enough to save lives. But Fressatto is not going to sell his system. He is giving it away.

“My objective is to reduce mortality from Sepsis by five percent,” he said, which would save hundreds of thousands of lives. “So I assumed all the risk to make Robot Laura available for free.”

As Robot Laura demonstrates, preventative health awareness is building in Brazil. The country has seen preventative health care successes, such as averting a potential AIDS epidemic and reducing smoking.

But Fernando Cembranelli, a specialist in Brazilian health start-ups, said few are as innovative as Robot Laura. And doctors and researchers said government policy for this continent-sized country of nearly 208 million people often lacks investment and planning.

That leaves individuals like Jacson Fressatto to fill in the gaps. He believes that what Brazil lacks in policy, it makes up for in human capital.
“We are behind in many senses,” he said, but “our professionals have a natural expertise that is better in the quality of helping the patient. Imagine if we used all this potential.”

Lincoln Ferreira, second vice-president of the Brazilian Medical Association, said that Brazil needs to start taking preventative health more seriously, because it is facing a demographic time bomb.

Ageing population

Life expectancy is projected to reach 78.6 years by 2030, from 69.8 in 2000, according to government figures. People over 65 currently make up 8.5 percent of the population, but will reach 13.4 percent by 2030.

“The population is in an accelerated process of aging,” he said.

In the last 15 years, tens of millions of Brazilians emerged from poverty thanks to economic growth and wealth transfer schemes. But the country is now stuck in a recession, struggling to control soaring public spending, and grappling with ballooning obesity, which affected 11.8 percent of Brazilians in 2006 and rose to 18.9 percent ten years later.

Obesity

“The problem of malnutrition became obesity, very quickly,” Ferreira said.

Augusto de Moraes, a post-doctorate at the Preventative Medicine Department, at University of São Paulo’s School of Medicine, said despite campaigns and a new nutrition guide, the government has not yet impacted on the obesity epidemic.

“There has been not one action in recent years that has been effective in reducing this,” he said.

Brazil needs to work harder in preventative health and education, to address problems like obesity, Ferreira said. If not, 20 years from now it will be spending as much as the United States on health care – a staggering 17.8 percent of its GDP in 2015. In 2014, Brazil spent 8.3 percent of its GDP on healthcare.

“If we do not act preventively the system runs a risk of entering in collapse,” Ferreira said.

Disease prevention

He said vaccination campaigns for diseases like polio, measles, whooping cough, tetanus, meningitis and H1N1 are effective. The government’s Family Allowance scheme, which gives a basic income to poorer families, is conditional on children being vaccinated and attending school. And he praised Brazil’s use of health agents from its public healthcare system, who visit homes and supply information about vaccines, healthy eating, and healthcare.

“This one of the most relevant things in health practice,” Ferreira said.

But policy can be patchy and inconsistent. This year, vaccination failures helped a sylvatic yellow fever outbreak spread from remote rural areas of Minas Gerais state where vaccinations were recommended but had not been done, even though Brazil sees cyclical outbreaks of the disease. Since January there have been 797 confirmed cases and 275 deaths.

An outbreak of the Zika virus in 2015-2016 was blamed for an explosion of cases of the birth defect microcephaly. A mass mobilization involving the army focused on the dangers of leaving still water around – breeding sites for the Aedes Aegypti mosquito that spreads Zika, as well as Dengue and Chikungunya. The Zika public health emergency has been officially declared over. But plans to start distributing free mosquito repellent free to pregnant women receiving the Family Allowance benefit, announced in January 2016, only began in March 2017.

“Our investment in public health in Brazil is inadequate, so the response to these problems is always less than we would hope,” Ferreira said.

Brazil faced a potential AIDS epidemic in the 1980s and 1990s, which it faced down with extensive education campaigns promoting condom use and free combination antiretroviral drugs given to all AIDS patients. The country produced generic versions of antiretroviral drugs and haggled down prices of expensive imports, an important factor, a 2006 study by the New England Journal of Medicine found.

“We have had various successes,” said Gabriel Andreuccetti, a research associate in epidemiology at the Department of Preventive Medicine at the University of Sao Paulo’s Medical School.

Smoking

He noted that Brazil reduced smoking from 15.7 percent of the population in 2006 to 10.2 percent in 2016, following extensive campaigns and restrictions on advertising. But he also highlighted preventative health failures, such as the control of traffic accidents.

In 2008 Brazil began reducing its blood alcohol concentration limit, which reached zero in 2012. But despite this and increasingly tougher fines for speeding, deaths from traffic accidents across Brazil rose from 37,000 in 2005 to 39,000 in 2015.

Research that Andreuccetti and colleagues conducted at the main trauma facility in the North eastern city of Arapiraca, which has a population of 200,000, found two traffic accidents an hour, 80 percent of which involved motorbikes. A third of patients interviewed and breathalyzed were under the influence of alcohol.

“People don’t use the helmet, they have no protection, the majority have no license. If you do not invest in the education of these drivers and their day to day conduct, you will have this result,” he said.