title: Assessing the relevance of indicators in tracking social determinants and progress toward equitable population health in Brazil.
abstract: BACKGROUND
  The importance of the social determinants of health (SDH) and barriers to the access and utilization of healthcare have been widely recognized but not previously studied in the context of universal healthcare coverage (UHC) in Brazil and other developing countries.
  
  
  OBJECTIVE
  To evaluate a set of proposed indicators of SDH and barriers to the access and utilization of healthcare - proposed by the SDH unit of the World Health Organization - with respect to their relevance in tracking progress in moving toward equitable population health and UHC in Brazil.
  
  
  METHODS
  This study had a mixed methodology, combining a quantitative analysis of secondary data from governmental sources with a qualitative study comprising two focus group discussions and six key informant interviews. The set of indicators tested covered a broad range of dimensions classified by three different domains: environment quality; accountability and inclusion; and livelihood and skills. Indicators were stratified according to income quintiles, urbanization, race, and geographical region.
  
  
  RESULTS
  Overall, the indicators were adequate for tracking progress in terms of the SDH, equity, gender, and human rights in Brazil. Stratifications showed inequalities. The qualitative analysis revealed that many of the indicators were well known and already used by policymakers and health sector managers, whereas others were considered less useful in the Brazilian context.
  
  
  CONCLUSIONS
  Monitoring and evaluation practices have been developed in Brazil, and the set of indicators assessed in this study could further improve these practices, especially from a health equity perspective. Socioeconomic inequalities have been reduced in Brazil in the last decade, but there is still much work to be done in relation to addressing the SDH.
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil; davide.rasella@gmail.com.|Fundação Oswaldo Cruz (Fiocruz), Brasilia, Brazil.
authors: Davide
authors: D
authors: Rasella
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Daiane Borges
authors: DB
authors: Machado
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Marcelo Eduardo Pfeirrer
authors: ME
authors: Castellanos
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Jairnilson
authors: J
authors: Paim
authors: ICICT, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.
authors: Celia Landmann
authors: CL
authors: Szwarcwald
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Diana
authors: D
authors: Lima
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Laio
authors: L
authors: Magno
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Leo
authors: L
authors: Pedrana
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors: Maria Guadalupe
authors: MG
authors: Medina
authors: Fundação Oswaldo Cruz (Fiocruz), Brasilia, Brazil.|Núcleo de Medicina Tropical, University of Brasilia, Brasilia, Brazil.
authors: Gerson Oliveira
authors: GO
authors: Penna
authors: Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.|Centro de Pesquisas Gonçalo Muniz, Fundação Oswaldo Cruz (Fiocruz), Salvador, Brazil.
authors: Mauricio Lima
authors: ML
authors: Barreto
mesh_terms: D001938:Brazil; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006305:Health Status Indicators; D054625:Healthcare Disparities; D006806:Human Rights; D006801:Humans; D008297:Male; D015397:Program Evaluation; D036301:Qualitative Research; D064890:Social Determinants of Health; D014944:World Health Organization
keywords: equity; inequality; monitoring; social determinants of health; universal healthcare coverage