Primary Care and Health Outcomes in Urban Brazil and the United States

This study examines the contribution of primary health care to select health outcomes in two urban low income regions in the city of Fortaleza, Brazil and Chicago, Illinois. The regions selected in each city are both comprised... [ view full abstract ]

This study examines the contribution of primary health care to select health outcomes in two urban low income regions in the city of Fortaleza, Brazil and Chicago, Illinois. The regions selected in each city are both comprised of neighborhoods which have a density of low income households, unemployment, and lower than average educational levels. Brazil and the United States have substantially different approaches to primary health care, and thus make an interesting comparative case when assessing the impact of health care systems on the health outcomes in poor urban neighborhoods throughout the world.

The strength of each city’s primary care system was assessed using a set of common indicators derived from secondary datasets and published literature. Health outcomes were derived from publically available data sets that each city (Fortaleza and Chicago) make available on-line.

Brazil’s primary care system is characterized by longitudinality, coordination, heavy regulation and community orientation. The United States’ primary care system is unregulated, has high primary copays and makes only limited use of patient tracking. We found higher levels of all-cause premature mortality, diabetes mortality and cancer mortality in the selected low-income urban region of Chicago, than in a similarly low-income region of Fortaleza. We conclude that strong primary care system and practice characteristics may be a way to address health care disparities in urban cities.