Brazilians with less education are more likely to self-report as being in poor health, according to a study using data from nationwide surveys distributed every five years from 1998 to 2013. The study also found that general subjective health did not improve over the study period, even though more people gained education throughout the study, indicating that other factors associated with poor education may need to be addressed to improve self-perceptions of health.
University of Illinois researchers Flavia Cristina Drumond Andrade, a professor of kinesiology and community health, and Jeenal Deepak Mehta, an undergraduate student, published the study in the journal PLOS ONE.
"Self-reported perceived health is an effective health indicator that has been shown to be a good predictor of mortality," Andrade said. "In social contexts such as developing countries, in which some diseases may go unnoticed or undiagnosed for a while, survey data can give a good sense of individuals' assessment of their overall health."
Andrade and Mehta used data from the 1998, 2003 and 2008 Brazilian National Household Sample Survey and the Brazil National Health Survey 2013. The surveys included many factors, such as education levels, employment, race, location and health. Participants reported themselves as being in "good" or "poor" health.
Overall, the percentage of those who reported themselves as being in poor health was fairly small—the highest being 5.9 percent in 2013. However, when the researchers separated the respondents by education level, they found that the less education a group had, the higher the percentage of self-reported poor health.
The gradient was sharp, and consistent across all years of the survey: Those with no education were seven to nine times more likely to report poor health than those with at least some college.
"Often, those with lower education experience worse employment—with lower wages, worse working conditions and less access to health care—than those with more education," Andrade said. "They may also engage in unhealthy lifestyle behaviors, in part due to lower health knowledge and in part due to economic restrictions. All these conditions put them in relative disadvantage, which could be translated as worse perceived health."
Over the course of the surveyed years, Brazil experienced a period of educational development, Andrade said. The percentage of those who had completed high school rose from 13.9 percent in 1998 to 28.6 percent in 2013, and the percentage of those with some college or more rose from 9 percent to 19.1 percent. Yet the overall percentage of self-reported poor health has not varied largely, and even rose a bit in 2013, although education levels rose.
Again, the researchers noticed a difference in health reporting over time according to education levels.
"There was a worsening of self-reported perceived health among those with primary or secondary education. This is important because most Brazilians are in this group—74.8 percent in 1998 and 68 percent in 2013. On the other hand, we do not see this pattern among those with some college or more. For them, the levels of poor self-reported health did not change."
The researchers posit that these changes may be related to the slowing of economic growth that Brazil experienced over the last two survey cycles.
"Those with less education often suffer with lower incomes and more during these economic decelerations. When relative conditions worsen, perceptions of health and well-being also tend to get worse among those at the bottom of the social scale," Andrade said.
In addition, Andrade urges those seeking to improve general health in Brazil to address not only education but also the aging of the population—the average age of the survey respondents increased from 40 to 44 years over the study period—and the prevalence of chronic conditions, such as diabetes, that were reported on the surveys.
"With increases in age, there are also increases in poor self-perceived health," Andrade said. "Along with the demographic transition, there were also increases in the prevalence of some chronic conditions, which also impacts the perception of health. Therefore, efforts to prevent and control chronic conditions are necessary to improve self-perceptions of health in Brazil."
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Flavia Cristina Drumond Andrade et al, Increasing educational inequalities in self-rated health in Brazil, 1998-2013, PLOS ONE (2018). DOI: 10.1371/journal.pone.0196494