title: Impact of the social agendas--Agenda 21 and Healthy Cities--upon Social Determinants of Health in Brazilian municipalities: measuring the effects of diffuse social policies through the dimensions of the Millennium Development Goals.
abstract: BACKGROUND
  In order to improve the quality of life and health of the population in recent years there have been several local social agendas, like Agenda 21 and Healthy Cities.
  
  
  OBJECTIVE
  To identify how social agendas are impacting on the living conditions and health in municipalities of the five regions of Brazil.
  
  
  METHODS
  Through an ecological longitudinal study, the social agendas' effects on the Social Determinants of Health were measured in 105 municipalities, using indicators related to the eight dimensions of the Millennium Development Goals (MDGs). Indicators were also calculated for other 175 non-exposed municipalities. Descriptive statistics were calculated for each group of municipalities at three different moments: in the year of the agenda implementation, then 3 and 6 years later. The models were adjusted by the method of GEE to assess the effects of the agendas, time and their interaction. Nonparametric analysis of variance was used for the ordinal data with repeated measures.
  
  
  RESULTS
  Impacts of the agendas were detected for reduction of hunger and increase of universal access to education: 'percentage of children under one year with protein/caloric undernourishment' (interaction effect: p = 0.02) and 'Age-grade distortion in the 8th grade of fundamental education' (interaction effect: p < 0.001).
  
  
  CONCLUSIONS
  The comparative discussion between model results and descriptive statistics recommends, at further research, extending the period of investigation, using compound indexes, improving the methodology for the apprehension of the impacts of the diffuse social policies for development, as well as using 'mixed methodologies', integrating quantitative and qualitative tools.
authors.affiliation: Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: do Nascimento
authors.affiliation: Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Marcia Faria
authors.initials: MF
authors.lastname: Westphal
authors.affiliation: Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brazil.
authors.forename: Rafael da Silveira
authors.initials: Rda S
authors.lastname: Moreira
authors.affiliation: Departamento de Epidemiologia e Bioestatística, Instituto de Saúde da Comunidade, Universidade Federal Fluminense, Niterói, RJ, Brazil.
authors.forename: Valéria Troncoso
authors.initials: VT
authors.lastname: Baltar
authors.affiliation: Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
authors.forename: Simone Tetu
authors.initials: ST
authors.lastname: Moysés
authors.affiliation: Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Zioni
authors.affiliation: Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Evelin
authors.initials: E
authors.lastname: Minowa
mesh_terms: D001938:Brazil; D002947:Cities; D006040:Goals; D006801:Humans; D008137:Longitudinal Studies; D011640:Public Policy; D064890:Social Determinants of Health; D014480:United Nations; D014504:Urban Health