Health in Brazil

Last updated

The fundaments of the Brazilian Unified Health System (SUS) were established in the Brazilian Constitution of 1988, under the principles of universality, integrality and equity. It has a decentralized operational and management system, and social participation is present in all administrative levels. [1] The Brazilian health system is a complex composition of public sector (SUS), private health institutions and private insurances . Since the creation of SUS, Brazil has significantly improved in many health indicators, but a lot needs to be done in order to achieve Universal Health Coverage (UHC).

Contents

The Human Rights Measurement Initiative [2] finds that Brazil is doing 93.3% of what should be possible at its level of income for the right to health. [3]

Social and Health Indicators [4]
Life expectancy (2019) [5] 76.6
Infant mortality(2019) [6] 1.24%
Fertility rate (2019) [7] 1.71
Basic Sanitation(2019) [8] 88%
Smoking rates (2018) [9] 9.3%
Obesity female (2019) [10] 30.2%
Obesity male (2019) [10] 22.8%
Undernutrition (2018) [11] 2.5%
HIV prevalence (2017) [12] 0.6%

Health situation in Brazil

Source: [13]

Health indicators and relative change over time in Brazil
Health Indicators19902019 (or latest data available)Relative Change
Life expectancy at birth [5] 66.376.616%
Child mortality rate (newborns who die before reaching 5 years) [12] 6.29%1.39%-78%
Maternal Mortality Ratio (pregnancy related deaths per 100,000 live births/year) [12] 10444 (2015)-58%
Death rates from suicide (suicide deaths per 100,000 individuals/year) [12] 7.166.09 (2017)-15%
Death rates from cancer (deaths from all cancers per 100,000 individuals/year) [12] 121.63109.58 (2017)-10%
Share of premature deaths attributed to tobacco smoking [12] 15.92 %12.43% (2017)-22%
Share of deaths caused by interpersonal violence [14] 4.45%4.67%5%
Share of adults who are obese [12] 10.20%22.10% (2016)117%
Number of new HIV cases [12] 25.95483.333 (2017)221%
Death rates from malaria ( per 100,000 individuals/year) [12] 0.430.03 (2017)-94%
Total disease burden by cause and relative change over time in Brazil
Total disease burden by cause (in million DALYs lost/year)19902017Relative Change
Injuries7.839.0616%
Communicable, maternal, neonatal, and nutritional diseases20.458.4-58%
Non-communicable diseases (NCDs)29.1140.0337%
Source: Our World in Data, [12] cited 2021 Sep 15.

Brazil has reduced the malaria incidence by over 56%in the past decade compared to the year 2000, but yet it is the country in the region of the americas with the highest number of cases.[ citation needed ]

Dengue is found in all the states of the country, with 4 viral stereotypes. Reported cases: 1.649.008 (2014).

In 2014 occurred the introduction of the Chikungunya fever virus in the country, and in 2015 the Zika virus, which are transmitted by Aedes aegypti. The vector is being faced with the strategy of Integrated Management vector and community awareness approach. [15]

In September, 30th 2020 the country has recorded more than 142.000 deaths linked to COVID-19 and more than 4.745.464 confirmed cases. It is one of the worst affected country just behind The US and India. [16]

Life expectancy

Development of life expectancy Life expectancy in Brazil.svg
Development of life expectancy

The life expectancy of the Brazilian population increased from 71.16 years in 1998 to 76.76 years in 2018, according to the Brazilian Institute of Geography and Statistics (IBGE), [17] and currently 76.76 years in 2018. [4] Life expectancy was 59.50 years in 1940.

Demographic projections foresee the continuation of this process, estimating a life expectancy in Brazil around 77.39 years in 2020. [18] According to the IBGE, Brazil will need some time to catch up with Japan, Hong Kong (China), Switzerland, Iceland, Australia, France and Italy, where the average life expectancy is already over 82. Although, research has shown that Brazil could achieve an expectancy of around 80.12 years by 2030 and pass 82 by 2040 and 2050 will be over 85 years. [18]

The decline in mortality at young ages and the increase in longevity, combined with the decline of fecundity and the accentuated increase of degenerative chronic diseases, caused a rapid process of demographic and epidemiological transition, imposing a new public health agenda in the face of the complexity of the new morbidity pattern. [19]

Infant mortality

Candido Fontoura Children's Hospital, Sao Paulo. Hospital Infantil Candido Fontoura.jpg
Cândido Fontoura Children's Hospital, São Paulo.

For example, mortality among indigenous infants in 2000 was more than triple that of the general population, highlighting the importance of tailored health policies to address disparities in health outcomes for Brazil's Indigenous Peoples. [20] Sanitation, education and per capita income are the most important explanatory factors of poor child health in Brazil. [21] According to De Souza et al. (2021), prenatal care is one of the most important indicators of maternal and infant health; their research demonstrated that in 2012, the number of women who began prenatal care in the first quarter of pregnancy increased from 0.34 to 0.79 in 2015 and the number of prenatal consultations, increased from 1.03 in 2012 to 3.94 in 2015. [22] Data from a study covering all live births in Porto Alegre from 2000 to 2017 revealed a correlation between fewer prenatal care consultations and higher infant mortality rates (Anele et al., 2021). The research examined infant mortality rates concerning three components of The Municipal Human Development Index (MHDI): longevity, education, and income. Children born to mothers with medium MHDI scores faced a 1.54 times higher risk of mortality compared to those born to mothers with very high MHDI scores. Additionally, offspring of mothers in macro-regions with low education levels (MHDIE) experienced a 1.66 times higher mortality rate compared to those in regions with high education levels. Medium MHDI scores and low MHDIE scores indicated a 16% increased risk of infant mortality. The study emphasized that, although higher maternal education doesn't guarantee complete protection against infant mortality in the first year, having less than 8 years of schooling increases the infant mortality rate by 37 to 40% across MHDI and its three elements. [23] It's important to highlight that in Brazil, women with lower levels of education faced limitations in accessing prenatal care, had fewer prenatal appointments, and predominantly relied on public healthcare services (Viellas et al., 2014). [24]

ethnographic findings of infant mortality rates (IMR) in northeast Brazil are not accurate because the government tends to overlook infant morality rates in rural areas. [25] These issues tend to be inaccurate due to a huge amount of underreporting and questions related to the cultural validity and the contextual soundness of these mortality statistics. There is a solution to this issue however and scientists stress that quality local-level cultural data can serve to craft as the alternative and appropriate method to measure infant death in Brazil accurately. In order to not overlook infant mortality rates it is also stressed that there needs to be a focus on an ethnography of experience, a vision that cuts to the core of human suffering as it flows from daily life and experiences. For example, one must get down to the flesh, blood and souls of infant death in the impoverished households of Brazilians in order to understand and live with those who have to suffer its consequences. Methods of gathering mortality data also need to be respectful of local death customs and must be implemented in places where death is experienced through a different cultural lens. [26]

Obesity

Portuguese Beneficent Hospital, in Manaus. Hospital Beneficente Portugues.jpg
Portuguese Beneficent Hospital, in Manaus.

Obesity in Brazil is a growing health concern. 52.6 percent of men and 44.7 percent of women in Brazil are overweight. 35% of Brazilians are obese in 2018. [27] [28] The Brazilian government has issued nutrition guidelines in 2014 [29] which have caught the attention of public health experts for their simplicity and their critical position towards the food industry. [30] In September 2020 the Ministry of Agriculture publicised a technical note saying that the Guideine " Attacks without justification " industrialized food and asked for revision of the recommendation. International scientists sent a group letter to the ministry of Agriculture criticizing the position in relation to The Brazilian food guide.

Climate change and health

Outline map of the Amazon biome (white outline) and Amazon basin (light blue outline) Amazon biome outline map.svg
Outline map of the Amazon biome (white outline) and Amazon basin (light blue outline)

The WHO Country Report on Climate and Health - 2015 [31] placed Brazil as an important and unique player in climate change for being economically and environmentally relevant. It is among the largest economies in the world and at least 60% of the Amazon rainforest is in its territory.  

The main vulnerabilities posed by climate change in this report were "risk of coastal flooding, reduced water availability, health risks associated with heat stress, and interference in climate sensitive vector borne diseases, such as malaria and dengue". [31]

Brazilian Amazon The Amazon Basin, Brazil.jpg
Brazilian Amazon

Another threat that could be softened by decarbonization is outdoor air pollution, which is mainly a consequence of the use of fossil fuels for energy generation and transportation. It poses a major risk for respiratory, cardiovascular, dermatological diseases and cancers, particularly for the population living in the urban areas. In Brazil, between 2010 and 2012, 4 out of the 5 most populated cities which had the information about air pollution available were above the annual mean for fine particulate matter (PM2.5) levels of 10 µg/m3 from the WHO guideline. [31]

Inland river flood risk can also be more frequent and affect broader areas in a high emission scenario, putting additional 78,600 people at risk of drowning, food insecurity, lack of access to safe water and sanitation, infectious diseases outbreaks and socio-economic changes. [31]

In 2016, Brazil developed a National Adaptation Plan to Climate Change, coordinated by the Ministry of Environment and with the participation of 26 Federal Government Institutions, among then, the Ministry of Health. Other agents from civil-society, private-sector and the state also contributed to the writing. [32]

Under the section of health and climate change, this plan focused on 4 main health-related risks associated to climate: natural disasters, air pollution, unavailability and quality of water resources and climate sensitive infectious diseases. For each risk, they analyzed vulnerabilities and potential impacts in the population and in the health system. Further on, the document provided guidance and strategies focusing on evidence and information management, awareness and education, potential alliances, and adaptation measures.

In December 2020, Brazil submitted to the UN Framework Convention on Climate Change (UNFCCC) an updated Nationally Determined Contribution (NDC) under the Paris Agreement, with the compromise of reducing greenhouse gas (GHG) emissions by 37% until 2025 and 43% until 2030, relative to 2005. [33]

Nevertheless, as for September 2021, the Climate Action Tracker (CAT) rated Brazilian response to mitigate climate change as Insufficient. The underlying reasons are challenges faced by the country to keep COVID-19 under control, increasing deforestation rate trends and unsatisfactory policies for halting emissions growth and support the energy transition to a greener and more sustainable one. [34] [35]

Even so, in May 2021, seven Brazilian-healthcare institutions (out of 43 in the world so far) joined the Race to Zero campaign, a United Nations initiative to promote leadership and ramp up the move to achieve net zero and a healthier, greener, and sustainable economy. Many Brazilian companies and cities are also committed to this initiative as a global effort to hasten Government's contributions to achieve the Paris Agreement. [36] [37]

See also

Related Research Articles

<span class="mw-page-title-main">Life expectancy</span> Measure of average lifespan in a given population

Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is life expectancy at birth. This can be defined in two ways. Cohort LEB is the mean length of life of a birth cohort and can be computed only for cohorts born so long ago that all their members have died. Period LEB is the mean length of life of a hypothetical cohort assumed to be exposed, from birth through death, to the mortality rates observed at a given year. National LEB figures reported by national agencies and international organizations for human populations are estimates of period LEB.

<span class="mw-page-title-main">Infant mortality</span> Death of children under the age of 1

Infant mortality is the death of an infant before the infant's first birthday. The occurrence of infant mortality in a population can be described by the infant mortality rate (IMR), which is the number of deaths of infants under one year of age per 1,000 live births. Similarly, the child mortality rate, also known as the under-five mortality rate, compares the death rate of children up to the age of five.

Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. In most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and mortality. Maternal health revolves around the health and wellness of pregnant women, particularly when they are pregnant, at the time they give birth, and during child-raising. WHO has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems and sometimes even die. Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and ensuring progressive check up on the health of women with children. Maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries.

<span class="mw-page-title-main">Araçuaí</span> Place in Brazil

Araçuaí is a Brazilian municipality located in the northeast of the state of Minas Gerais in the Jequitinhonha River valley. The Araçuaí River, a tributary of the Jequitinhonha, flows through it. Its population as of 2020 was estimated to be 36,712 people living in a total area of 2,235 km2. The city belongs to the mesoregion of Jequitinhonha and to the microregion of Araçuaí. The city is the seat of the Roman Catholic Diocese of Araçuaí. The elevation of the municipal seat is 307 meters. It became a municipality in 1870.

<span class="mw-page-title-main">Aricanduva, Minas Gerais</span> Municipality of Brazil

Aricanduva is a municipality in the northeast of the Brazilian state of Minas Gerais. As of 2020 the population was 5,269 in a total area of 243 km². The elevation is 682 meters. It is part of the IBGE statistical meso-region of Jequitinhonha and the micro-region of Capelinha. It became a municipality in 1995.

<span class="mw-page-title-main">Caraí</span> Place in Brazil

Caraí is a Brazilian municipality located in the northeast of the state of Minas Gerais. Its population as of 2020 was estimated to be 23,780 people living in a total area of 1,240 km2. The city belongs to the mesoregion of Jequitinhonha and to the microregion of Araçuaí. The elevation of the municipal seat is 750 meters. It became a municipality in 1948.

Health in the United Kingdom refers to the overall health of the population of the United Kingdom. This includes overall trends such as life expectancy and mortality rates, mental health of the population and the suicide rate, smoking rates, alcohol consumption, prevalence of diseases within the population and obesity in the United Kingdom. Three of these – smoking rates, alcohol consumption and obesity – were above the OECD average in 2015.

Australia is a high income country, and this is reflected in the good status of health of the population overall. In 2011, Australia ranked 2nd on the United Nations Development Programme's Human Development Index, indicating the level of development of a country. Despite the overall good status of health, the disparities occurring in the Australian healthcare system are a problem. The poor and those living in remote areas as well as indigenous people are, in general, less healthy than others in the population, and programs have been implemented to decrease this gap. These include increased outreach to the indigenous communities and government subsidies to provide services for people in remote or rural areas.

<span class="mw-page-title-main">Health in Syria</span> Overview of health in Syria

Although emphasized by the country's ruling Baath Party and improving significantly in recent years, health in Syria has been declining due to the ongoing civil war. The war which has left 60% of the population food insecure and saw the collapse of the Syrian economy, the surging prices of basic needs, the plummeting of the Syrian pound, the destruction of many hospitals nationwide, the deterioration in the functionality of some medical equipment due to the lack of spare parts and maintenance, and shortages of drugs and medical supplies due to sanctions and corruption.

<span class="mw-page-title-main">Berilo</span> Municipality in Minas Gerais, Brazil

Berilo is a municipality in the northeast of the Brazilian state of Minas Gerais. As of 2020 the population was 11,872 in a total area of 586 km2. The elevation is 401 meters. It is part of the IBGE statistical meso-region of Jequitinhonha and the micro-region of Capelinha. It became a municipality in 1963.

<span class="mw-page-title-main">Carbonita</span> Municipality in Minas Gerais, Brazil

Carbonita is a municipality in the northeast of the Brazilian state of Minas Gerais. As of 2020 the population was 9,414 in a total area of 1,454 km2. The elevation of the town center is 751 meters. It is part of the IBGE statistical meso-region of Jequitinhonha and the micro-region of Capelinha. It became a municipality in 1963.

<span class="mw-page-title-main">Chapada do Norte</span> Human settlement in Brazil

Chapada do Norte is a municipality in the northeast of the Brazilian state of Minas Gerais. As of 2020, the population was 15,345 in a total area of 828 km². The elevation of the town center is 751 meters. It is part of the IBGE statistical meso-region of Jequitinhonha and the micro-region of Capelinha. It became a municipality in 1963.

<span class="mw-page-title-main">Turmalina, Minas Gerais</span> Municipality in Minas Gerais, Brazil

Turmalina is a municipality in the northeast of the Brazilian state of Minas Gerais. As of 2020 the population was 20,125 in a total area of 1,153 km². The elevation of the urban area is 718 meters. It is part of the IBGE statistical meso-region of Jequitinhonha and the micro-region of Capelinha. It became a municipality in 1949.

<span class="mw-page-title-main">Health in Niger</span>

Niger is a landlocked country located in West Africa and has Libya, Chad, Nigeria, Benin, Mali, Burkina Faso, and Algeria as its neighboring countries. Niger was French territory that got its independence in 1960 and its official language is French. Niger has an area of 1.267 million square kilometres, nevertheless, 80% of its land area spreads through the Sahara Desert.

According to the World Bank income level classification, Portugal is considered to be a high income country. Its population was of 10,283,822 people, by 1 July 2019. WHO estimates that 21.7% of the population is 65 or more years of age (2018), a proportion that is higher than the estimates for the WHO European Region.

<span class="mw-page-title-main">Nanuque</span> Municipality in Southeast, Brazil

Nanuque is a municipality in the state of Minas Gerais, in the southeastern region of Brazil, belonging to Mucuri Valley and Region Nanuque. The relief consists of inselbergs and seas of hills, and the Serra dos Aimorés as predominant characteristic. Considered the 79th most populous city in the state, the 2nd Northeast 1st miner and its region, with 40,665 inhabitants according to the 2020 estimate. According to DENATRAN its fleet is 17,782 motor vehicles. As a regional hub ten municipalities, their total area 116,545 inhabitants and a total area of 8471.872 km ². Nanuque, cut the highway Ox (BR-418), reference is to be en route to the northern coast of Espirito Santo state by state highway LMG-719 and the southern coast of Bahia state by the then federal highway BR-418, of which is 605 km to the northeast of the state capital Belo Horizonte and 1257 km east of the federal capital Brasília.

This article summarizes healthcare in Texas. In 2022, the United Healthcare Foundation ranked Texas as the 38th healthiest state in the United States. Obesity, excessive drinking, maternal mortality, infant mortality, vaccinations, mental health, and limited access to healthcare are among the major public health issues facing Texas.

<span class="mw-page-title-main">Health in Norway</span> Overview of health in Norway

Health in Norway, with its early history of poverty and infectious diseases along with famines and epidemics, was poor for most of the population at least into the 1800s. The country eventually changed from a peasant society to an industrial one and established a public health system in 1860. Due to the high life expectancy at birth, the low under five mortality rate and the fertility rate in Norway, it is fair to say that the overall health status in the country is generally good.

Montenegro is a country with an area of 13,812 square kilometres and a population of 620,029, according to the 2011 census. The country is bordered by Croatia, the Adriatic Sea, Bosnia, Herzegovina, Serbia, Kosovo and Albania. The most common health issues faced are non-communicable diseases accounting for 95% of all deaths. This is followed by 4% of mortality due to injury, and 1% due to communicable, maternal, perinatal and nutritional conditions. Other health areas of interest are alcohol consumption, which is the most prevalent disease of addiction within Montenegro and smoking. Montenegro has one of the highest tobacco usage rates across Europe. Life expectancy for men is 74 years, and life expectancy for women is 79.

<span class="mw-page-title-main">Maternal mortality in the United States</span> Overview of maternal mortality in the United States

Maternal mortality refers to the death of a woman during her pregnancy or up to a year after her pregnancy has terminated; this metric only includes causes related to the pregnancy, and does not include accidental causes. Some sources will define maternal mortality as the death of a woman up to 42 days after the pregnancy has ended, instead of one year. In 1986, the CDC began tracking pregnancy-related deaths to gather information and determine what was causing these deaths by creating the Pregnancy-Related Mortality Surveillance System. According to a 2010-2011 report although the United States was spending more on healthcare than any other country in the world, more than two women died during childbirth every day, making maternal mortality in the United States the highest when compared to 49 other countries in the developed world.

References

  1. Lobato, Lenaura. "Reorganizing the Health Care System in Brazil". Archived from the original on 2008-02-11. Retrieved 2020-09-30.
  2. "Human Rights Measurement Initiative – The first global initiative to track the human rights performance of countries". humanrightsmeasurement.org. Retrieved 2022-02-25.
  3. "Brazil - HRMI Rights Tracker". rightstracker.org. Retrieved 2022-02-25.
  4. 1 2 3 "Brazil". Our World in Data. Retrieved 2019-09-26.
  5. 1 2 "Life expectancy of Brazilians increases 3 months and reaches 76.6 years in 2019". agenciadenoticias.ibge.gov.br. 26 November 2020. Retrieved 2021-09-15.
  6. "Brazil - infant mortality rate 2009-2019". Statista. Retrieved 2021-09-15.
  7. "Fertility rate, total (births per woman) - Brazil | Data". data.worldbank.org. Retrieved 2021-09-15.
  8. "People using at least basic sanitation services (% of population) - Brazil | Data". data.worldbank.org. Retrieved 2021-09-15.
  9. "Smoking rates in Brazil 2018". Statista. Retrieved 2021-09-15.
  10. 1 2 "One out of every four adults in Brazil were obese in 2019 and primary health care was positively evaluated". agenciadenoticias.ibge.gov.br. 21 October 2020. Retrieved 2021-09-15.
  11. "Prevalence of undernourishment (% of population) - Brazil | Data". data.worldbank.org. Retrieved 2021-09-15.
  12. 1 2 3 4 5 6 7 8 9 10 "Our World in Data". Our World in Data. Retrieved 2021-09-15.
  13. "Brazil Country Overview | World Health Organization".
  14. "GBD Compare | IHME Viz Hub". vizhub.healthdata.org. Retrieved 2021-09-15.
  15. "TDR | Dengue research in Brazil". WHO. Retrieved 2020-09-30.
  16. "Brazil: WHO Coronavirus Disease (COVID-19) Dashboard". covid19.who.int. Retrieved 2020-10-01.
  17. G1, Gabriela GasparinDo; Paulo, em São (December 2, 2013). "Com revisão na expectativa de vida, valor de novas aposentadorias cai". Seu Dinheiro.{{cite web}}: CS1 maint: numeric names: authors list (link)
  18. 1 2 "Future life expectancy projections". Our World in Data. Retrieved 2019-09-26.
  19. Romero, Dalia Elena; Leite, Iúri da Costa; Szwarcwald, Célia Landmann (2005). "Healthy life expectancy in Brazil: applying the Sullivan method". Cadernos de Saúde Pública. 21: S7–S18. doi: 10.1590/S0102-311X2005000700002 . ISSN   0102-311X. PMID   16462992.
  20. Coelho, V; Shankland, A. (2011). "Making The Right To Health A Reality For Brazil's Indigenous Peoples: Innovation, Decentralization And Equity". MEDICC Review. 13 (3): 50–53. doi: 10.37757/MR2011V13.N3.12 . PMID   21778961 . Retrieved 24 May 2012.
  21. "History - Infant Mortality - Brazil" (PDF).
  22. {{cite journal| De Souza, D. R. S., De Morais, T. N. B., Da Silva Costa, K. T., & De Andrade, F. B. (2021). Maternal health indicators in Brazil. Medicine, 100(44), e27118. https://doi.org/10.1097/md.0000000000027118
  23. {{cite journal|Anele, C. R., Hirakata, V. N., Goldani, M. Z., & Da Silva, C. H. (2021). The influence of the municipal human development index and maternal education on infant mortality: an investigation in a retrospective cohort study in the extreme south of Brazil. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10226-9
  24. {{cite journal|Viellas, E. F., Domingues, R. M. S. M., Dias, M. a. B., Da Gama, S. G. N., Filha, M. M. T., Da Costa, J. V., Bastos, M. H., & Leal, M. D. C. (2014). Assistência pré-natal no Brasil. Cadernos De Saude Publica, 30(suppl 1), S85– S100. https://doi.org/10.1590/0102-311x00126013
  25. Nations, Marilyn K.; Mara Lucia Amaral (1991). "Flesh, Blood, Souls, and Households: Cultural Validity in Mortality". Medical Anthropology Quarterly. 5 (4): 204–220. doi:10.1525/maq.1991.5.3.02a00020.
  26. Nations, Marilyn K.; Mara Lucia Amaral (1991). "Flesh, Blood, Souls, and Households: Cultural Validity in Mortality". Medical Anthropology Quarterly 5 (4): 204-220.
  27. Malafaia, Sandra (April 4, 2012). "Excesso de Peso Atinge Quase Metade da População Brasileira". ABESCO. Retrieved 25 January 2013.
  28. Glickhouse, Rachel (July 30, 2012). "Supersized Brazil: Obesity a growing health threat". Christian Science Monitor . Retrieved 25 January 2013.
  29. Ministerio de saude (2014). "Guia Alimentar Para a Populacao Brasileira" (PDF). Ministerio de saude. Retrieved 29 May 2014.
  30. Barton, Adriana (16 March 2014). "Brazil takes an unambiguous new approach to fighting fat". The Globe and Mail. Retrieved 29 May 2014.
  31. 1 2 3 4 Climate and health country profile – 2015 Brazil. WHO/FWC/PHE/EPE/15.03.13 September 2016.
  32. Plano Nacional de Adaptação à Mudança do Clima. Volume II: Estratégias Setoriais e Temáticas. Brasília, 2016. Ministerio do Meio Ambiente
  33. "Brazil submits its Nationally Determined Contribution under the Paris Agreement". Ministério das Relações Exteriores. Retrieved 2021-09-14.
  34. "Overview". World Bank. Retrieved 2021-09-14.
  35. "Brazil". climateactiontracker.org. Retrieved 2021-09-14.
  36. "Race to zero". Health Care Climate Action. Retrieved 2021-09-14.
  37. "Race to Zero Campaign".