Universidade de São Paulo . Faculdade de Saúde Pública . Departamento de Política, Gestão e Saúde . São Paulo , SP , Brasil.
Fundação Oswaldo Cruz . Escola Nacional de Saúde Pública Sérgio Arouca . Escola de Governo em Saúde . Rio de Janeiro , RJ , Brasil.
Rev Saude Publica. 2022 Aug 8;56:73. doi: 10.11606/s1518-8787.2022056003914. eCollection 2022.
To characterize remote rural Brazilian municipalities according to their logic of insertion into socio-spatial dynamics, discussing the implications of these characteristics for health policies.
Starting from the category of analysis - the use of the territory - a typology was elaborated, with the delimitation of six clusters. The clusters were compared using socioeconomic data and the distance in minutes to the metropolis, regional capital, and sub-regional center. Mean, standard error and standard deviation of the quantitative variables were calculated, and tests on mean differences were performed.
The six clusters identified bring together 97.2% of remote rural municipalities and were called: "Matopiba," "Norte de Minas," "Vetor Centro-Oeste," "Semiárido," "Norte Águas," and "Norte Estradas." Differences are observed between the clusters in the analyzed variables, indicating the existence of different realities. Remote rural municipalities of "Norte Águas" and "Norte Estradas" clusters are the most populous, the most extensive and are thousands of kilometers away from urban centers, while those in "Norte de Minas" and "Semiárido" clusters have smaller areas with a distance of about 200 km away from urban centers. The remote rural municipalities of the "Vetor Centro-Oeste" cluster, in turn, are distinguished by a dynamic economy, inserted into the world economic circuit due to the agribusiness. The Family Health Strategy is the predominant model in the organization of primary health care.
Remote rural municipalities are distinguished by their socio-spatial characteristics and insertion into the economic logic, demanding customized health policies. The strategy of building health regions, offering specialized regional services, tends to be more effective in remote rural municipalities closer to urban centers, as long as it is articulated with the health transportation policy. The use of information technology and expansion of the scope of telehealth activities is mandatory to face distances in such scenarios. Comprehensive primary health care with a strong cultural component is key to guaranteeing the right to health for citizens residing in such regions.
根据其融入社会空间动态的逻辑，对偏远农村的巴西城市进行特征描述，探讨这些特征对卫生政策的影响。
从分析类别 - 土地利用 - 开始，制定了一个分类法，确定了六个聚类。使用社会经济数据和与大都市、区域首府和次区域中心的分钟距离对聚类进行比较。计算了定量变量的均值、标准误差和标准差，并进行了均值差异检验。
确定的六个聚类涵盖了 97.2%的偏远农村城市，被称为：“Matopiba”、“Norte de Minas”、“Vetor Centro-Oeste”、“Semiárido”、“Norte Águas”和“Norte Estradas”。在分析变量方面，聚类之间存在差异，表明存在不同的现实情况。“Norte Águas”和“Norte Estradas”聚类的偏远农村城市人口最多、面积最大，距离城市中心数千公里；而“Norte de Minas”和“Semiárido”聚类的城市面积较小，距离城市中心约 200 公里。“Vetor Centro-Oeste”聚类的偏远农村城市以经济活跃为特色，由于农业综合企业，融入了世界经济循环。家庭健康战略是组织初级卫生保健的主要模式。
偏远农村城市因其社会空间特征和融入经济逻辑而与众不同，需要制定有针对性的卫生政策。建设卫生区域、提供专业区域服务的战略在靠近城市中心的偏远农村城市中更为有效，只要与卫生交通政策相衔接即可。在这种情况下，必须使用信息技术和扩大远程医疗活动的范围。综合初级卫生保健与强大的文化组成部分是保障居住在这些地区的公民健康权的关键。
