Development and validation of a Social Vulnerability Index applied to public policies of the Unified Health System /Desenvolvimento e validacao de um Indice de Vulnerabilidade Social aplicado a politicas publicas do SUS

• Published in: Ciência & saude coletiva 2014-09, Vol.19 (9), p.3849
• Main Authors: Drachler, Maria de Lourdes, Lobato, Marcos Antonio de Oliveira, Lermen, Jose Inacio, Fagundes, Sandra, Ferla, Alcindo Antonio, Drachler, Carlos Wietzke, Teixeira, Luciana Barcellos, Leite, Jose Carlos de Carvalho
• Format: Article
• Language: Portuguese
• ISSN: 1413-8123
• DOI: 10.1590/1413-81232014199.12012013

The article outlines the development and initial validation of a Social Vulnerability Index (SVI) including five social determinants of risk to health and demonstrates its application in the financing of primary care by the Unified Health System (SUS) in the State of Rio Grande do Sul. Municipal indicators of vulnerability relating to poverty and population dispersion were obtained from the 2010 population census of the Brazilian Institute of Geography and Statistics. Both exploratory and confirmatory factor analysis suggests that the five items can constitute a reliable and acceptable measurement scale. The SVI-5 was then generated based on the first main component, measuring municipal inequalities in social vulnerability relating to poverty and population in the territory in Z-scores. The external validity of SVI-5 was examined in relation to health outcomes using DATASUS 2007-2011 data, revealing that infant mortality and hospitalizations for conditions treatable by primary care are greater in more vulnerable municipalities The results suggest that the SVI-5 is a valid measure of inequalities in social vulnerability between municipalities, applicable to socially equitable policies in health. Key words Social vulnerability index, Allocation of resources, Health equity, Health financing, Social inequality O artigo apresenta o desenvolvimento e a validacao inicial de um Indice de Vulnerabilidade Social--IVS-5, incluindo cinco determinantes sociais de risco a saude, e exemplifica sua aplicacao no financiamento da atencao basica pelo Sistema Unico de Saude no Rio Grande do Sul. Indicadores municipais de vulnerabilidade relativa a pobreza e dispersao populacional foram obtidos do Censo do IBGE-2010. A analise fatorial exploratoria e a analise fatorial confirmatoria sugerem que os cinco itens podem constituir uma escala de medida cuja confiabilidade e aceitavel. O IVS-5 foi entao gerado a partir do primeiro componente principal, medindo, em escores Z, desigualdades municipais na vulnerabilidade social relativa a pobreza e dispersao populacional no territorio. A validade externa do IVS-5 foi examinada em relacao a desfechos de saude, usando dados do Datasus 2007-2011, mostrando que a mortalidade infantil e as hospitalizacoes por condicoes sensiveis a atencao basica sao maiores em municipios mais vulneraveis. Os resultados sugerem que o IVS-5 e medida valida de desigualdades na vulnerabilidade social entre municipios, aplicavel a politicas de equidade social e e