The impact of health interventions on inequalities: Infant and child health in Brazil

This chapter reports on the findings of two population-based cohort studies carried out eleven years apart in the same Brazilian city. These studies provide unique data for examining health inequities in the country, which has the second worst income distribution in the world. Data shows that the coverage of preventive programmes improved, particularly for the poorest mothers and children. The gap in malnutrition prevalence also diminished. For mortality, where reductions for the wealthy were still possible, the gap persisted with the same magnitude. Good quality care is most available to those who need it the least. The proposed corollary to this law - that new interventions will tend to increase inequity since they will initially reach those who are already better off - appears to hold. Thus, inequity gaps will increase with new technologies, but may eventually decrease as these trickle down the social scale.