High Well-Being Could Salvage Healthcare in Brazil

It's well-known that Brazil is undergoing significant economic decline and social unrest. The country's healthcare system is also struggling to keep up with population needs. But adding a focus on well-being with its other preventative strategies could help the country mitigate the negative impact these current issues have on the population.

At a Crossroads

Brazil's economy boomed in the first decade of the century, lifting millions out of poverty and into the middle class with the promise of a better life. Universal healthcare -- enshrined as a constitutional right in 1988 -- plays a large role in that promise. Though far from perfect, the healthcare system has brought dramatic reductions in communicable diseases and maternal and child mortality and has lengthened average life expectancies.

Despite these gains, Gallup found in 2014 that just one in three Brazilians are satisfied with the availability of quality healthcare in the city or area where they live. Brazilians took to the streets in 2013 and 2014 to protest lavish spending ahead of the 2014 World Cup and the 2016 Olympics, which they felt came at the expense of public services like healthcare. Now, with the government engulfed in a widespread corruption scandal and the economy on the brink of recession, protesters are again on the march, with many demanding the president's impeachment.

The ongoing discontent likely reflects the public's lack of trust in the government to combat corruption and to manage the economy and public services such as healthcare. The medical system faces shortages of funding, equipment and personnel, with demand far outpacing supply. Uneven, inadequate infrastructure and unwieldy logistics in sprawling cities and remote areas prevent consistent delivery of care, often requiring Brazilians to travel great distances and endure long wait times to receive medical attention. And with Brazil's vast income inequality, health problems run the gamut from disease spread through poor sanitation in high-poverty areas to obesity and non-communicable diseases such as diabetes and heart disease in middle- and upper-income areas.

These are daunting challenges for the country's beleaguered government. But a strategy that builds on well-being could help to mitigate the system's shortfalls.

Well-being encompasses all the ways people think about and experience their lives. The Gallup-Healthways Global Well-Being Index measures people's perceptions of their well-being to determine if they are thriving, struggling or suffering in five specific elements:

• Purpose: liking what you do each day and being motivated to achieve your goals
• Social: having supportive relationships and love in your life
• Financial: managing your economic life to reduce stress and increase security
• Community: liking where you live, feeling safe and having pride in your community
• Physical: having good health and enough energy to get things done daily

In Gallup and Healthways' inaugural State of Global Well-Being report, Brazil ranked fifth globally in 2013 in thriving in three or more of the five elements of well-being. This included a strong third-place ranking in physical well-being and fourth-place rankings in purpose and social well-being out of 135 countries, including most of the developed world.

Brazil's thriving percentages surpassed regional and global averages in every category except financial well-being. Brazil ranked 78 out of 135 countries on this element, which likely reflects the public's reaction to the country's economic woes. Four in 10 (41%) Brazilians were suffering in financial well-being in 2013, while only about two in 10 (19%) were thriving.

Continuing to monitor well-being in Brazil -- as well as reforming policies, forming new partnerships with employers and communities and using big data to provide targeted responses -- can improve Brazil's public healthcare system.

Using Data to Improve Public Healthcare

Data collection and analysis play an increasingly important role in delivering and managing public services. These efforts can help governments, communities, employers and policymakers deepen their understanding of specific populations and ensure a precise design of the most appropriate, effective interventions to aid those citizens. They can also detect emerging trends in a city or area, helping to predict which issues will matter most in the future.

A World Health Organization study, for example, found that one in five (21%) Brazilian males aged 13 to 15 use tobacco. Awareness of this finding can galvanize communities and the national government to develop targeted anti-smoking campaigns for this group, and they can monitor the trend and use the data to predict future healthcare costs associated with these smokers as they age. The findings can also help in allocating resources to address the chronic conditions that originate from smoking in this group of individuals.

Interventions like this that target a specific population can aid significantly in measuring and managing a public health problem. And interventions based on well-being data can further help with the growing challenge of rising healthcare costs and demand for services. Gallup and Healthways have found that improving people's well-being can lead to a higher quality of life and reduced healthcare costs, among other vital outcomes.

Using well-being data can help leaders prioritize the most effective interventions to increase public health outcomes for individuals and communities. By accurately assessing where a population stands on each of the five elements, leaders have a starting point for designing targeted strategies to influence health outcomes and stem rising costs.

The Plight of the People

Brazil's current predicaments -- including coping with slowing growth and with corruption and inflation, among other problems -- are testing the patience of its residents. There is also a persistent division between the poor and wealthy -- those who have access to quality services, including healthcare, and those who do not. Brazilian authorities and citizens must find a way to rein in costs and expand health services if they hope to quell the unrest in their country.

"Well-being provides us with a much better and richer understanding of a population, says Nicolas Toth Jr., managing director of Healthways Brasil. "People with higher well-being are more engaged in their work, are more focused on creating value through their efforts, take on challenges with more energy, delivering results with more productivity and with lower healthcare costs. This is exactly what we need for this country for the coming years."

By including a focus on well-being with other preventative care tools, Brazilians may be able to find a more cost-effective and healthier way to deal with adverse conditions in their economy and in their broader lives.

Survey Methods

Results for the Gallup-Healthways Global Well-Being Index are based on telephone and face-to-face interviews on the Gallup World Poll, with a random sample of approximately 133,000 adults, aged 15 and older, living in 135 countries and areas in 2013. Gallup-Healthways Global Well-Being Index results for Brazil are based on face-to-face interviews conducted Sept. 18-Oct. 16, 2013, as part of the Gallup World Poll, with a random sample of 1,003 adults, aged 15 and older, living in Brazil.

For results based on the total sample of national adults, the margin of sampling error is less than ±1 percentage point at the 95% confidence level. For results based on the total sample of national adults in Brazil, the margin of sampling error is ±3.5 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

All country-level analyses use country weights. Global and regional analysis uses projection weights that account for country size. Minimum sample sizes of N=300 apply.

In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.

Each element in the Global Well-Being Index contains two questions asked of all respondents:

Purpose Well-Being:

• You like what you do every day.

• You learn or do something interesting every day.

Social Well-Being:

• Someone in your life always encourages you to be healthy.

• Your friends and family give you positive energy every day.

Financial Well-Being:

• You have enough money to do everything you want to do.

• In the last seven days, you have worried about money.

Community Well-Being:

• The city or area where you live is a perfect place for you.

• In the last 12 months, you have received recognition for helping to improve the city or area where you live.

Physical Well-Being:

• In the last seven days, you have felt active and productive every day.

• Your physical health is near-perfect.

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