Brazil had a population of 156 million people in 1993, which is the largest in South America and the fifth largest in the world. The population growth rate during the period 1985-93 was 1.8% per annum. New data are only available for the Northeast, which has the worst nutrition problems, so nutritional results focus on this region.
Nutritional trends up to 1989 were reported by the ACC/SCN in the Second Report on the World Nutrition Situation (vol.II, p.74-79, 1993), and in "The Improvement of Child Nutritional Status in Brazil: How Did It Occur?" (Iunes and Monteiro, 1993).
Recent Trends in Nutrition
Results from nationwide nutrition surveys amongst preschool children carried out in 1975 and 1989 were previously given in the Second Report on the World Nutrition Situation. In the Northeast Region where the underweight prevalences were relatively high, two other surveys were undertaken separately-one in 1986 through the Demographic and Health Surveys and another in the period from 1989 to 1992 conducted by a group from Universidad Federal de Pelotas.
Estimated trends for the regions in Brazil from the 1975 and 1989 surveys are depicted in Figure 1. Data for the Northeast region for 1989 and 1992 are also plotted.
In 1989, the national prevalence of underweight children (<-2 s.d. weight-for-age NCHS) in Brazil was estimated at about 7.1%, which was a major reduction from 18.4% in 1975. Similarly in the Northeast region, there was a decline in the prevalence of underweight children from 27% in 1975 to 12.7% in 1986. Despite these improvements, however, the child nutrition problems in the Northeast Region are still much higher, on average, than the other regions. The prevalence of 12.7% in 1989 was more than three times the rates in the South and West Center regions of the country.
The 1989-1992 surveys in the Northeast Region had a large sample size (11,890 children) and could be disaggregated to provide a statistically meaningful sub-regional breakdown. The results by state indicate wide variations. For example, the prevalence in the states of Maranhao and Piaui (18% and 12%) are about two to three times higher than other states within the region. The better-off states had rates of about 6%, similar to the other regions of the country.
A severe drought affected the Northeast Region in 1993, the worst in 60 years. There are reports of a continuing food shortage and serious malnutrition. However, no nutrition surveys are available to verify the extent of the problem. The government authorized duty free imports of maize to the Northeast Region until the end of February 1994. An emergency assistance program has been implemented, which is targeted to 6 million people (about 1.2 million families) in the area, representing half of the affected population.
Figure 1. Brazil: Prevalence of Underweight Children, (0-59 months) by Region, 1975-1992
Sources: Monteiro et al (1992) and Victora et al (1993).Factors Affecting Trends in Nutrition
Economic Growth and Food Security. Brazil's GNP per capita in 1993 was estimated at U.S.$3,010. The growth rate in per capita GDP was negative between 1986 and 1993, declining by -1.45% per year. The overall picture of income change in the country in the period between 1989 and 1993 was strongly influenced by major macroeconomic policy changes.
In March 1990 the government introduced a bold stabilization program involving temporary confiscation of about 70% of the assets of the financial system, and an array of policies for restructuring the economy by reducing the government's role and intervention. The government also introduced significant structural reforms in trade liberalization, deregulation, and privatization. The adoption of a new constitution in 1988 also had a major impact on economic management, as it reversed the trend towards a highly centralized state favored by the military to one of decentralized activities, particularly at the municipal level.
The complicated economic and political environment depressed private consumption outlays and caused investment expenditures to drop to slightly less than 15% of real GDP. Real value added in the key manufacturing sector plummeted to 4.9%. This contraction was heavily concentrated in the metropolitan Sao Paulo area-Brazil's industrial heartland- where business failures reached record levels. At the same time, the average unemployment rate in the region jumped to an unprecedented 14.9%. Most of the increase was accounted for by low-skilled workers as enterprises attempted to cut costs. By mid-1992, industrial employment was 9% lower than in 1985; some 12.3 million workers, or about one-fifth of the economically active population, were only marginally employed, mostly in Brazil's burgeoning informal sector.
High interest rate policies were implemented to combat escalating inflation caused primarily by the nation's large fiscal imbalance. The average annual inflation rate during the period 1980-92 was 370%. It was realized that monetary policy by itself would not be sufficient to reverse inflationary expectations.
In 1987 inflation began an explosive cycle. Independent studies indicate that between 1986 and 1989, the proportion of the population below the poverty line rose from 24% to 38% nationwide, while those in the Northeast Region increased from 44% in 1985 to 60% in 1989. The latest data indicate that the rate of inflation was much lower between 1990 and 1992 compared to 1989 and 1990, but still the CPI grew at extremely high rates (1,008% in 1992).
However, inflation rates for food were generally lower than that of the non-food items in the household budget. No changes in calorie supply per capita were observed between 1986 and 1990, which was above 2700 kcals per day. These figures were about 100 kcals per day higher compared to the first half of 1980s. Calorie supply rose somewhat in 1991 and 1992 as compared with 1986-90.
Health, Education. It is likely that the resumption in improvements in nutrition between 1989 and 1992 was attained by the maintenance of the same levels of fiscal expenditures for health and education in the face of macroeconomic adjustments. Trends in absolute spending on health in fact increased from about $32 in 1986 to $76 in 1989 and $72 in 1990. These are about 7% of the total government budgetary expenditures.
Immunization of infants accelerated between 1989 and 1992, from a coverage level of about 58% to 80% for DPT and from 62% to 83% for measles. This is an important milestone given the big infant and 0-4 year old child population, estimated at 18 million. The immunization program is also one of the primary reasons for the continuing decline in infant mortality rates, estimated at 52 per 1000 live births in 1993, compared to 62 in 1986.
Conclusions
Brazil experienced major declines in the prevalence of underweight children between the mid-1970s and late 1980s. However, prevalence rates have remained relatively high in the Northeast region as a whole. Nevertheless, there is a great deal of variation in prevalence rates across states in the Northeast region; prevalence rates in some states are similar to those in the rest of the country. Although the prevalence of underweight children declined in the Northeast region from 27% in 1975 to 13% in 1989, a severe drought in 1993 may have reversed the downward trend more recently. Contributing to the general trend for nutritional improvement in the country as a whole are somewhat better calorie availability, an increased rate of immunization for children, and generally increased expenditures for health.
BRAZIL
(Estimates in 1993)
|
Population |
: 156 million |
|
Population Density |
: 18 per sq. km. |
|
Population Growth Rate |
: 1.6% per annum |
|
Urban Population |
: 77% |
|
IMR |
: 52 |
|
GNP US$ (Per Capita) |
: 3010 |
|
PPP estimates of GDP |
: 5240 |
Underweight preschool children (Percent below -2 s.d. weight for age)
Infant mortality rate (Per 1,000 live births)
ECONOMICS
GDP per capita (1987 Mkt. prices, Cruzeiros Reais / capita)
Debt service ratio (Debt service/exports)
FOOD
Food production index (Per caput, 1979-81=100)
Dietary energy supply (Kcals/caput/day)
Consumer price index (1980=100)
FPI/CPI ratio (1980=100)
HEALTH
Immunization coverage (Percent)
Access to local health care (Percent)
PUBLIC EXPENDITURES
Education and health expenditures (US $ per capita)
Education and health expenditures (Percent of government expenditures)
