Martins Flavio Pinheiro, Vigurs Carol, Veras Mariana Matera, Morhayim Lusi, Lakhanpaul Monica, Parikh Priti
Engineering for International Development Centre, The Bartlett School of Sustainable Construction, UCL Faculty of the Built Environment, 1-19 Torrington Place, London, WC1E 7HB, UK.
Social Research Institute, University College, 18 Woburn Square, London, WC1H 0NR, UK.
Glob Health Res Policy. 2025 Sep 2;10(1):42. doi: 10.1186/s41256-025-00441-x.
Health system development requires robust infrastructure systems support, particularly in countries with significant regional and socioeconomic disparities. Brazil's experience with its Unified Health System offers important insights into how the infrastructure and built environment is linked to health outcomes especially in underserved populations. This scoping review examines how different infrastructure systems such as sanitation, transportation, educational facilities, housing, influence population health in Brazil through two key pathways: (1) their role in shaping environmental conditions that affect health, and (2) their impact on healthcare service delivery among vulnerable populations.
Following PRISMA-ScR checklist, we conducted a systematic search of studies published between 2013-2024 across Scopus, Web of Science, and PubMed databases. Search terms included infrastructure systems (sanitation, transportation, housing, educational facilities), health outcomes (universal health coverage, infectious diseases, maternal health), and population descriptors (vulnerable, indigenous, underserved) combined with Brazil-specific terms. Inclusion criteria focused on studies examining physical infrastructure's impact on health outcomes in underserved Brazilian communities, published in English or Portuguese. After applying exclusion criteria including publication year restrictions, language filters, geographic limitations, duplicate removal, and non-article format exclusions, 68 studies met inclusion criteria following screening and quality assessment using the Critical Appraisal Skills Programme (CASP) checklist. Our analysis applied an infrastructure framework examining institutional, personal, and material infrastructure dimensions. Data extraction captured infrastructure systems, healthcare service tiers (primary, secondary, tertiary), and specific health outcomes. Synthesis involved thematic analysis to identify patterns in infrastructure-health relationships, revealing three interconnected dimensions that form the Infrastructure-Health Nexus framework.
The study revealed three interconnected dimensions of infrastructure impact: Supporting Health & Wellbeing, Service Access and Delivery, and Community Engagement. This framework shows how sanitation, transportation, educational, housing, and waste management systems affect health outcomes, with underserved populations facing particular challenges. Healthcare workforce programs serve as interim solutions, with educational facilities simultaneously functioning as health hubs for service delivery and community engagement. The study highlights misalignment between infrastructure investment and UHC objectives.
The Infrastructure-Health Nexus framework, building on Buhr's complementarity concept, shows how infrastructure shapes health outcomes through pathways requiring integrated planning. While current research focuses predominantly on primary care aspects, Brazil's epidemiological transition calls for broader health system considerations, suggesting reconceptualization of infrastructure systems planning as integral to health system development.
卫生系统的发展需要强大的基础设施系统支持，尤其是在区域和社会经济差距显著的国家。巴西统一卫生系统的经验为基础设施和建筑环境如何与健康结果相联系提供了重要见解，特别是在服务不足的人群中。本范围审查探讨了不同的基础设施系统，如卫生设施、交通、教育设施、住房，如何通过两条关键途径影响巴西的人口健康：（1）它们在塑造影响健康的环境条件方面的作用，以及（2）它们对弱势群体医疗服务提供的影响。
按照PRISMA-ScR清单，我们对2013年至2024年间在Scopus、科学网和PubMed数据库上发表的研究进行了系统检索。检索词包括基础设施系统（卫生设施、交通、住房、教育设施）、健康结果（全民健康覆盖、传染病、孕产妇健康）以及人口描述词（弱势群体、原住民、服务不足人群），并结合了巴西特有的术语。纳入标准侧重于研究巴西服务不足社区中物质基础设施对健康结果的影响，研究需以英文或葡萄牙语发表。在应用包括出版年份限制、语言筛选、地理限制、重复删除和非文章格式排除等排除标准后，68项研究在使用批判性评估技能计划（CASP）清单进行筛选和质量评估后符合纳入标准。我们的分析应用了一个基础设施框架，考察制度、个人和物质基础设施层面。数据提取涵盖基础设施系统、医疗服务层级（初级、中级、三级）以及具体的健康结果。综合分析包括主题分析，以识别基础设施与健康关系中的模式，揭示构成基础设施-健康关系框架的三个相互关联的层面。
该研究揭示了基础设施影响的三个相互关联的层面：支持健康与福祉、服务获取与提供以及社区参与。这个框架展示了卫生设施、交通、教育、住房和废物管理系统如何影响健康结果，服务不足的人群面临着特殊挑战。医疗劳动力计划作为临时解决方案，而教育设施同时作为提供服务和社区参与的健康中心发挥作用。该研究强调了基础设施投资与全民健康覆盖目标之间的不一致。
基于布尔的互补性概念的基础设施-健康关系框架，展示了基础设施如何通过需要综合规划的途径塑造健康结果。虽然目前的研究主要集中在初级保健方面，但巴西的流行病学转变需要更广泛地考虑卫生系统，这表明应将基础设施系统规划重新概念化为卫生系统发展不可或缺的一部分。
