Analysis: The prevalence of chronic diseases grows: for a change, the poor suffer more

If the Ministry of Health categorically fails to monitor an acute epidemic like that of Covid-19 that kills us in droves with the naked eye, just imagine, dear reader, how far the prevention of chronic non-communicable diseases has been in the country.

As the WHO warns, these conditions, despite evolving insidiously, are responsible for no less than 71% of global deaths, reaching 85% in non-developed countries.

Without adequate surveillance of diseases and their determinants –which involves data collection and systematic technical analysis– evidence-based preventive public policies cannot be implemented.

Our flagship nationwide study that annually monitors the prevalence of chronic conditions and their risk factors is called Vigitel (Surveillance of Risk and Protective Factors for Chronic Diseases).

As the release of the results of Vigitel 2020 was delayed (as well as the completion of the 2021 survey), researchers from the Institute of Studies for Health Policies (IEPS) pored over the available data and published a brief technical note to guide public policies. In December 2021, the Ministry of Health finally released the full report.

Based on both documents, I summarize the main results, which, I advance, are not encouraging.

In 2020, 16 capitals had a prevalence of obesity above 20%. Ten years ago, none of them surpassed the mark.

Manaus, Cuiabá and São Paulo lead the ranking, with about 25% of obese people. The proportion of people with arterial hypertension and type 2 diabetes –both associated with excess body weight– remained stable in the historical series, at around 25% and 7%, respectively.

In cities like Belo Horizonte and Rio de Janeiro, 3 out of 10 people reported being hypertensive; next to Maceió, the state capital also tops the diabetes ranking, with 11% of the population affected by the disease.

There are a small handful of risk factors that predispose to chronic disease: smoking, physical inactivity, alcohol abuse, and poor diet. And in terms of habits of life, we also walked poorly.

In the comparison between 2019 and 2020, therefore, the pre- and post-pandemic periods, with the exception of smoking, practically all behavioral risk factors deteriorated, albeit slightly.

Physical inactivity increased from 14% to 15% (considering the WHO criterion of 150 minutes a week of moderate to vigorous activities, the increase was from 45% to 47%). Excessive alcohol consumption jumped from 19% to 21%. The consumption of ultra-processed foods – fake foods – has also grown. Porto Alegre stands out, where about 2 out of 10 inhabitants reported consuming five or more groups of this type of food daily.

These data from Vigitel 2020 reinforce the conclusions of international and national studies carried out during the pandemic, such as one of our group from the University of São Paulo, which had pointed out important changes in the eating behaviors of the Brazilian family, such as the increase in the habit of “pinch” food. ultra-processed foods between meals and increased demand for fast food delivery services.

The trend towards worsening physical inactivity identified by the Brazilian survey is also global, probably as a consequence of the more frequent use of screens for work, study and leisure, as well as the necessary measures to restrict movement.

The most worrying data from the survey, as highlighted by the IEPS researchers, refers to the association between social determinants and the prevalence of diseases and risk factors. Among less educated people, the prevalence of hypertension and diabetes were more than twice as high as those observed among more educated people. The group with less education also had worse rates of obesity, physical inactivity, consumption of fruits and vegetables and smoking.

As the numbers show, the pandemic has not been easy, especially for the poor. If it were not enough to have to live with food insecurity, which reached the obscene mark of 55% of Brazilian homes in 2020, the poor also fight obesity and all its associated ills.

The scenario that unfolds is characteristic of a syndemic – the overlapping of various pandemics (Covid-19, obesity, chronic diseases, physical inactivity, etc.)

While public managers around the world are mobilizing to expand the umbrella of protection of the vulnerable against the coming storm, the National Congress approved the spending proposal submitted by the Ministry of Health, which is leaner in relation to the total budget of the last decade, which will certainly undermine the already weakened response capacity of the SUS.

As can be anticipated, the poor will suffer primarily, thus feeding the unparalleled list of inequities that only this country is capable of producing.