Moreover, many students from disadvantaged families could not afford to study full-time. They had to work to earn money and therefore became part-time students at less prestigious institutions, where they had to pay tuition. Career opportunities, however, depend on the prestige of the institution one graduated from. The brutal irony was that rich families could afford to send their children to the expensive high schools which best prepared them for the university admissions process. Once they studied there, they benefited massively from government spending on higher learning. Though that system is basically still in place, the scenario has kept changing and has become more inclusive in recent years.
Important reasons are:. In both the public and private sector, a significant number of entrants now report to be the first in their families to study at university level. Meaningful progress has thus been made, though current political circumstances may yet reverse the trends of recent years. It is too early to tell what impact the administration of Jair Bolsonaro, the new, right-wing president will have. It is also too early to assess the results of the broad range of new initiatives in regard to social inclusion and the overall performance of higher education in Brazil.
Some imbalances and quality issues remain to be addressed, but the experience of recent decades allows for some preliminary conclusions:. Recent experience in Brazil shows that the right policies, strongly supported by the leading actors in the system and perceived as legitimate by society, can lead both the public and the private sector to build less segregated and more inclusive educational institutions.
Inequalities and extreme poverty in Brazil
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Socioeconomic differences in health expectancy in Denmark. Identifying which determinant contributes to a larger share of wealth-related inequalities in disability is important as socioenomic inequalities are avoidable 14 , Despite the differences in the prevalence of disability by age and sex, we found that demographic factors explain only a small percentage of BADL disparities.
These findings reinforce the importance of examining the various determinants of health inequalities in old age, as each determinant can carry unique contributions The fact that SES determinants explain most of the inequalities in disability highlights the need for changes in policies related to improving educational levels, reducing economic inequalities, and improving health care access.
Evidence from longitudinal data shows that individuals with no schooling not only have higher rates of disability onset, but they also have lower rates of recovery Given that educational levels are typically established by early adulthood and are relatively constant among older persons 22 , investiments in education during early years are needed. Improving the economic conditions of individuals at the bottom of the social gradient can also improve disability inequalities. Persons economically worse off tend to have less opportunities to obtain higher education levels, because of factors such as workload, difficulty in paying for private school 6 , and overall lower prestige, status, and control Nonetheless, current socioeconomic circumstances matter as well Persons with lower SES may have a higher likelihood of a health condition resulting in activity limitation.
Poor health conditions and disability may lead to additional expenditures such as health care, transportation, assistive devices, personal assistance, and house adaptation 6 that can overwhealm families and individuals at the bottom of the social gradient. Persons who are wealthier in old age can afford a wider range of facilities to either improve or keep good physical functioning. Under these circumstances, a possible way to reduce inequalities in disability at older ages may be providing more equitable, universal, and better care to those who cannot afford it.
There is some evidence that access to health care and doctor visits have been increasing in Brazil 25 , which in turn may be reducing the gap in health levels between SES groups. Therefore, expanding public health care and rehabilitation services 6 and improving accessibility 26 and home care are important ways to reduce the inequalities 3. Even though chronic conditions contributed to a small share of the inequality, they were more concentrated among the wealthiest individuals.
However, information on chronic conditions is based on self-reported data, in which knowledge and reporting can differ across SES groups. Wealthier individuals are more likely to have a diagnosed chronic condition as they have more access to healthcare Often, healthier lifestyles such as engaging in physical activity are also concentrated among wealthier individuals. As a result, wealthier individuals can live longer with diseases and may be less likely to experience disability.
This study has important strengths. First, the findings of this study are based on data from a nationally representative sample of older adults in the largest country in Latin America. Second, the data also included several socioeconomic indicators that were used to examine their contribution to wealth-related inequalities in disability. Finally, to the best of our knowledge, this was the first study to measure wealth-related inequality using CI and to decompose the contribution of its determinants. Nonetheless, the study is based on cross-sectional data that prevents us from analyzing how changes in socioeconomic conditions influence disability trends.
In addition, the socioeconomic ranking was derived from a measure of wealth that was based on an index of household assets and characteristics, which does not include other wealth domains, such as savings, that can be associated with living standards. Moreover, the data were collected from community-dwelling individuals, thus excluding the ones in institutions who are more likely to be disabled.argo-karaganda.kz/scripts/cugowaras/744.php
Entangled Inequalities, State, and Social Policies in Contemporary Brazil | SpringerLink
This in turn has the potential to increase the prevalence of BADL disability. This study showed that avoidable wealth-related inequities persist in BADL disability.
The strong contribution of SES factors highlights the need for improvements in public health policies that promote equity, universality, and integrality, such as the Family Health Strategy, and improve home nursing public services. To increase the effectiveness of preventive and rehabilitation strategies, which reduce activity limitations, it is necessary to go beyond the determinants of disability, fostering health-related behaviors and promoting mental health.
It is necessary to combine those actions with interventions focused on social determinants, particularly among the poorest individuals in the country. Global health and aging. Bethesda: NIH; [cited Jun 7]. NIH Publication, Informal and paid care for Brazilian older adults National Health Survey, Rev Saude Publica. Socioeconomic inequalities in activities of daily living limitations and in the provision of informal and formal care for noninstitutionalized older Brazilians: National Health Survey, Int J Equity Health.
Socioeconomic inequalities in health in older adults in Brazil and England. Am J Public Health. Socioeconomic inequality in disability among adults: a multicountry study using the World Health Survey. Disability and poverty in developing countries: a multidimensional study. World Dev. National and regional estimates of disability-adjusted life-years DALYs in Brazil, a systematic analysis. Activity limitation in the elderly people and inequalities in Brazil. Open Access Libr J. The association of health and income in the elderly: experience from a southern state of Brazil. PloS One. Analysis of socioeconomic health inequalities using the concentration index.
Int J Public Health.