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Effectiveness of primary health care evaluated by a longitudinal ecological approach
  1. Airton T Stein1,
  2. Erno Harzheim2
  1. 1Collective Health Department—Fundação Faculdade Federal de Ciências Médicas de Porto Alegre and Universidade Luterana do Brasil and Gerência de Ensino e Pesquisa do Grupo Hospitalar Conceição, Brasil
  2. 2Post-Graduation Program in Epidemiology, Departamento de Medicina Social, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Brasil
  1. Correspondence to:
 Dr E Harzheim, Rua Álvaro Guterres
 335/504 CEP: 91920-010, Porto Alegre, RS, Brazil; ernoharz{at}

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The expansion of primary health care in Brazil is shaping the agenda for health care policy in the Latin American region.

Brazil is the country with the third worst income distribution in the world and, as a consequence of the unequal distribution of its main determining factors—income, education, living conditions, sanitation, and health service1—the health indicators also present broad inequalities by regions and social classes. Child health, because of greater vulnerability to risks and also to health protective factors, is a clear example of this iniquitous situation in Brazil. In 1999, the child mortality rate in the north eastern region of Brazil was 52.4/1000, while in the southern region it was 17.2/1000 live births.2 A population based investigation performed in 1990–1991, in two cities in the north east3 found 40% of avoidable deaths among the absolute total of children who …

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