A seminar with health data experts, held this Monday (December 8th) by the Brazilian Institute of Geography and Statistics (IBGE), marked the publication of the “National and International Overview of the Production of Social Indicators - Health Statistics and Related Services”, organized by IBGE researchers Claudio Dutra Crespo, Clician do Couto Oliveira and Marcos Antonio Ratzsch de Andreazzi, and also the first Methodological Manual of the System of Health Accounts (SHA), developed for Brazil (SHA-BR), by the Ministry of Health.

“National and International Overview of the Production of Social Indicators - Health Statistics and Related Services” is a publication of the IBGE Directorate of Surveys, and is the 9th volume in the series “Studies and Analyses of Demographic and Socioeconomic Information”. Published in July 2025, it includes the chapters Socioeconomic and Resource Indicators and Health Accounts; Demographic Indicators and their use for health; Health indicators produced by household surveys; PeNSE: the adolescent health survey; Mental health indicators and the national and international overview of the production of statistics on installed health capacity.

“With this seminar, which aims to discuss publications, we want to give more visibility to the dissemination of our surveys, but mainly to put IBGE data up for debate with society and experts on the subject,” stated the IBGE Director of Surveys (DPE), Gustavo Junger.

Clician do Couto Oliveira, also from the DPE, highlighted the importance of the seminar held at Casa Brasil IBGE, in downtown Rio de Janeiro, which promoted “the gathering of highly qualified experts in the area of ​​national health accounts to discuss the publications.”

Pedro Buril, from the Ministry of Health, explained that the SHA-BR is a document developed based on the SHA 2011 framework, created by the Organisation for Economic Co-operation and Development (OECD), the World Health Organization (WHO), and the European Union Statistical Office (Eurostat): “The SHA is a methodology for estimating accounts that allows managers, researchers, and civil society to understand the flow of financing, production, and allocation of health goods and services in a country. This produces strategic and internationally comparable information on the financing of health systems, allowing for the monitoring of health expenditures.”

The expert stated that “today, there is no formal arrangement for the SHA-BR,” which seeks data on funding from sources such as the Unified Health System (SUS), Civil Servant Plans, and Defense Personnel Plans. “Therefore, it is important to institutionalize the System of National Health Accounts, as the SHA seeks transparency and accountability,” he argued. Even though it is still pending institutionalization, Brazil is advanced in relation to the international scenario, "because Brazil already has a methodological manual for national health accounts, which is not the case in several countries." The SHA-BR data are "consolidated from multiple databases and triangulated to perform the calculation," said Mr. Buril.

Among the information compiled in SHA-BR, and presented by Mr. Buril at the seminar, it is estimated that about 60% of public health spending in Brazil is currently on curative care, to the detriment of preventive care – this is the largest share of public health expenditure. Regarding medication costs, 91.31% of Brazilians pay out of pocket, compared to 8.68% of public expenditure. In comparison with France, for example, 82.23% of medication costs are public; 4.97% are covered by health insurance plans, and only 12.70% of the French pay out of pocket.

Next, the authors of the chapters in the “National and International Overview of the Production of Social Indicators - Health Statistics and Related Services” commented on the data from IBGE surveys. Tassia Holguin spoke about “Socioeconomic and Resource Indicators and Health Accounts.” “The health satellite account is part of the national accounts, according to the methodology of the International Monetary Fund (IMF), and collects data such as final consumption expenditure by institutional sector, exports and imports (by product), income, gross value added (by activity) and change in volume, jobs (by activity) and average worker income,” she explained.

Isabel Guimarães discussed “Demographic Indicators and their use for health,” and showed the ongoing demographic transition in Brazil, with “increasingly aging population, with increased life expectancy, and a decline in births.” Data from the Population Census indicate that the life expectancy of Brazilians, which was 45.5 years in 1940, should reach 83.9 years in 2017. "In 2025, 16.6% of the population will be 60 years or older; in 2017 this number should jump to 37.8%," said the researcher. At the same time, the fertility rate has been falling: in 1940 it was 6.16 children per woman; in 2022 it was 1.58 and the projection is that in 2070 it will be 1.50. "This trend of population aging, with increased life expectancy, indicates that health treatments will become longer and more expensive, demanding an even greater change in public health policies," assesses Ms. Guimarães.

Regarding “Health Indicators Produced by Household Surveys,” Rosa Marina Dória highlighted how some themes produce health indicators collected from household surveys, such as the Continuous National Household Sample Survey (Continuous PNAD). Questions about the occurrence of chronic and/or communicable diseases can generate indicators on the proportion of adults diagnosed with diabetes, hypertension, overweight, for example. Information is also gathered on tobacco and alcohol use, physical activity, medical examinations, among others. “The advantage of household surveys is that people report things that don't necessarily enter the health system records, because people don't always seek medical attention when they have a health problem. There are occurrences that, if simple, are resolved at home, such as headaches and gastrointestinal discomfort,” said Ms. Dória.

Marcos Andreazzi commented on “PeNSE: the adolescent health survey.” PeNSE is a national health survey of adolescents aged 13 to 17 in a school setting, conducted in 2009, 2012, 2015, 2019, and 2024 by the IBGE, in partnership with the Ministry of Health and with the support of the Ministry of Education. Its objective is to map risk factors and protective factors for health in adolescence. "It is a self-administered questionnaire for adolescents, using a Mobile Data Collection Device (DMC), with simple and objective questions," he clarifies. Although based on the methodology of the Global School-based Student Health Survey (GSHS) of the then US Centers for Disease Control and Prevention (CDC), PeNSE has developed "its own improvements, such as cognitive tests to validate the questions, greater thematic scope, a larger number of respondents, and a time series of 15 years and 5 editions," notes the researcher. “This gives Brazil the potential to exercise methodological leadership, contributing to international bodies instead of just following their guidelines,” she added.

The chapter “Mental Health Indicators and the National and International Overview on the Production of Statistics on Installed Health Capacity” was addressed by researcher Danielle Marques. She emphasized that the IBGE produces data to support national public policies on mental health that are implemented by the Ministry of Health, Fiocruz, and the Ministry of Social Security. “The IBGE conducts several surveys that collect mental health data. The National Health Survey (PNS) results in data on depression, psychoses, anxiety disorders, hospitalizations, use of medications and mental health services, and risk factors such as alcohol and tobacco. The Continuous National Household Sample Survey (Continuous PNAD) has already addressed the topic of COVID-19 and persistent conditions (insomnia, anxiety, and depression) 30 days after infection. The Population Census has data on autism diagnoses by health professionals,” she enumerated. For the researcher, however, the biggest challenge in this survey is "recognizing that mental health is more than an ICD code, cases of suicide, substance use and abuse; it's a reminder that mental health is more than the absence of mental disorder."

At the end of the seminar, Mr. Crespo spoke about the Survey of Medical-Sanitary Assistance and added that the main challenge in producing health data in Brazil lies in integration. "It's necessary to consider the SHA Accounts and the national accounts in an integral way, considering their specific characteristics and gaps, in order to improve the quality of our information and thus help in the distribution of healthcare system costs," he stated.