It is nothing new to science that cancer incidence rates, especially in the most severe forms, are higher among lower-income, marginalized populations with little access to education and care.
For decades, studies around the world have pointed to inequality as a factor that can be decisive not only for the onset of the disease, but also for the success of the treatment and the chances of cure.
In Brazil today, however, one reality enhances this scenario even more: the dismantling of basic health care. The gateway to the SUS has been severely underfunded since the Spending Ceiling was determined by the Michel Temer (MDB) administration. In the government of Jair Bolsonaro (PL), the situation worsened.
Read more: In four years of Bolsonaro, the health area lost money, quality and capillarity
“It is worth remembering that if you add this issue to the natural scenario of the aging of the Brazilian population, the increase in risk factors and diseases, such as obesity, it becomes a very explosive solution”, warns Umane’s project coordinator, Evelin Santos.
Umane is an independent philanthropic association that articulates and promotes initiatives to support the development of the system, improvement of health conditions and health promotion. Surveys organized by the organization corroborate perceptions about the weight of inequality in the incidence of cancer.
One of the studies reveals that 48.3% of Brazilians in capitals do not do any physical activity. The habit is on the list of behaviors that can reduce the occurrence of the disease. The problem is greater among people with less education: 64.5% of those with up to eight years of education do not exercise.
Read too: Fiocruz researchers present study on challenges in Primary Health Care
“We can say that we are facing a potentially worse scenario at each period, with a great overload at all levels. The estimates of new cases of cancer that the National Cancer Institute (Inca) releases every three years only increase and corroborate this tragedy announced”, says Evelyn Santos.
Read the full interview below or listen in the audio player below the title of this article.
Brasil de Fato: What do the data collected by Umane reveal about the relationship between inequality and the incidence of cancer in Brazil?
Evelyn Santos – They indicate two very important things. The first is that we are systematically failing to prevent tumors and cancers that have long been known to be preventable. Whether through vaccination, physical activity, alcohol consumption, smoking cessation, consumption of protective foods such as fruits, vegetables, fibers, use of sunscreen, which contribute to preventing a large volume of cancers that contribute to large part for mortality in Brazil.
Another super important thing in this scenario is that we are also unable to identify, track and treat our population equally. Those with less education and income face several challenges and are probably arriving with more advanced tumors for treatment.
This causes a disproportionate and unfair increase in mortality in this group, which is consistent with national and international studies. In high-income countries, for example, 9 out of 10 women survive breast cancer, while 4 to 6 women survive in countries like South Africa and India, for example.
What is the weight that primary care exerts in this scenario?
The services that can be performed in primary care are fundamental. I’ll give you an example. In the case of cervical cancer, the preventive measure is vaccination against HPV, which is taboo. The Ministry of Health recommends vaccinating at least 90% of the target population, which are young girls and boys. It is a measure that can contribute to the eradication of this tumor in this century in the world. But we haven’t been able to move forward.
Other actions, such as screening, the very early diagnostic suspicion based on current guidelines, so that the referral to tests and specialists can be made, can also contribute to reducing the time between the appearance of tumors, diagnosis and the beginning of treatment. .
Primary care ends up depending a lot on hospitals and specialized centers after a certain point, which can complicate the situation and present bottlenecks.
We now have a reactive system. It harms those who need it most and makes the user very responsible. There are very few municipalities where the population eligible for screening tests is proactively contacted in case of non-attendance to the service. The place for this change to happen is primary care.
It is clear then that a move by the public power could prevent people with lower income from arriving with advanced cancers at the health system. Is it possible to say that the scenario that Brazil is experiencing, composed of the Spending Ceiling and the dismantling of primary care, has worsened the response to cancer cases?
Yes. It is also worth remembering that if you add this issue to the natural scenario of the aging of the Brazilian population, the increase in risk factors and diseases, such as obesity, it becomes a very explosive solution.
We can say that we are facing a potentially worse scenario each period, with a great overload at all levels. The estimates of new cases of cancer that the National Cancer Institute (Inca) launches every three years only increase and corroborate this announced tragedy.
It disproportionately affects both low- and middle-income countries and, within these countries, people with even lower incomes and education, for example. But we are hopeful in the new administrations and that the public itself, aware and demanding stronger primary care, can change this scenario a little.
What is essential to reverse this scenario?
I always give an example, it’s like we’re living in a house with leaky plumbing in every room, only we’re so busy getting the water and all the mold out of the house that we can’t stop to fix the plumbing. Another detail is that we cannot turn off registration.
What we need is for the population to have access to clear and correct information, to simple recommendations that fit into the routine and, above all, into the Brazilian pocket. Because done is better than perfect.
For this to work, we also need to minimize interference, full of conflicts of interest, from the tobacco, alcohol, and unhealthy food industries. So that the population can improve this awareness of the consequences of consumption and the real intention of marketing actions, sponsorship of events. It’s just the sale of products that are harmful to health in the greatest possible quantity.
From that, in the health unit, that is the place where you arrive welcomed promptly. By someone who knows you, where there is no shortage of inputs, equipment and professionals. Where these professionals spend less time filling out paperwork and more time understanding the patients’ life and health situation and actually talking to them.
That the health agent, who is a very important figure, have the necessary tools to register the information and organize their routine in an agile way, based on the demands. Go after the pregnant women who missed the prenatal appointment, go after the adults who need to redo glycated hemoglobin to monitor their diabetes, the girls and women who need to be vaccinated against HPV or undergo a Pap smear and mammogram.
We also need health managers to stop planning their network’s supply based on the historical series and demand and be able to look at the health situation of the population. Plan from there. If he is going to have x new cases of cancer that year in that state, according to the Inca, he has to find these cases. He doesn’t have to wait for this system to work that magic.
Information technology needs to be used to integrate this entire process and allow service professionals to spend more time assisting patients than on administrative demands, paperwork and spreadsheets. This is how we would arrive at an ideal scenario.
Editing: Nicolau Soares
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