José Leopoldo Ferreira Antunes
Associate Editor Departamento de Epidemiologia Faculdade de Saúde Pública da Universidade de São Paulo
My reading highlights of this issue of Revista de Saúde Pública (issue 46) are two studies, one on counterfeit drugs in Brazil and the second one on dental care utilization in preschool children. I invite you to find your own highlights, get familiar with the significant issues of each topic, and acknowledge gaps to be bridged in further research.
Counterfeit drugs in Brazil
A well-known definition of public health lays out the concept of "organized efforts of society" for preventing disease, prolonging life and promoting health (The Acheson Report).1 It is a direct message: public health demands are not met by health services only. There also is a need to encourage and organize all social spheres. Taking from this view, two researchers with training in pharmaceutical sciences and biochemistry present in this issue of Revista de Saúde Pública an overview of the organized efforts of society to curb illicit counterfeit drug marketing in Brazil.3
The authors' research initiative is welcome. They examined expert reports of police seizures of inauthentic drugs from the Brazilian Federal Criminal Police database, bringing into light new information from a database underused in health research. In Brazil, between 2007 and 2010, police seizures of counterfeit drugs increased by more than 200%. Therapeutic classes and types of counterfeit drugs and the Brazilian states where most seizures occurred are reported.
The need for organized social efforts to fight counterfeit drugs has been discussed in a technical report2 published in Revista de Saúde Pública some years ago. Still, it is noteworthy the scarcity of data on this subject in Brazil. Although little studied, this subject definitely meets the different definitions of a "public health problem."5 Counterfeit drugs affect individual and collective health, have a social and economic impact, are preventable and can be controlled. The severity of this problem varies depending on several factors but, as the authors point out, it is seriously concerning in the cases of counterfeit anticancer drugs with no active ingredient.
The importance of the subject contrasts with the scarcity of literature data. This is critical: understanding a problem is the first step to solving it. The lack of studies on this subject delays its advance. The authors' initiative to study counterfeit drugs in Brazil is exemplary and their study calls for special attention in public health.
Dental care utilization according to reason for consultation
A nationwide epidemiological survey conducted by the Brazilian Ministry of Health in 2010 estimated a 56% prevalence of dental caries in children aged 12 years, which is the standard age to estimate caries rate worldwide. When all 12-year-old children are considered, including those with no caries, a mean of 2.1 decayed permanent teeth or signs of past caries is found.ª In view of these extremely high rates, dental caries is the main oral health problem during childhood, possibly the most prevalent disease in our country.
Despite its magnitude, the prevalence of dental caries has significantly declined in Brazil in recent decades. Having acknowledged this decline is one of the greatest advances in oral health epidemiology, and reduction in the prevalence of dental caries has been attributed to specific protection and health promotion.6 Yet, the integration of dental care in primary prevention strategies is hampered by low utilization of dental care services among children, especially preschool children, whose teeth are deciduous.
In a study published in this issue of Revista de Saúde Pública, Camargo et al4 reported that only 37% of children from the 2004 Pelotas Birth Cohort Study had at least one dental care visit until the age of five. Among children receiving care, 55% sought care due to a dental problem, and less than 50% sought routine care. It may be the first population-based study to estimate the prevalence of dental care utilization stratified by reason for consultation. This assessment is crucial for prevention of dental caries and oral health promotion. There is a need to determine what has actually been achieved and what remains to be done in dental care, to go beyond restoring decayed teeth and provide guidance on eating habits and oral hygiene, as well as care interventions in early stages of tooth demineralization.
The authors not only described low dental care utilization but also analyzed the factors associated. They examined predisposing factors for seeking dental care services and the negative effects of not seeking care. Children of more educated mothers from better-off families were more likely to seek treatment and routine care. This finding can help guiding health actions so that they can also promote social justice and contribute to eliminate health inequities.
Epidemiological studies using data from the Pelotas Birth Cohorts have provided outstanding knowledge in public health. This study is remarkable for its description of low dental care utilization among preschool children and analysis of the factors associated with this outcome.
1. Acheson D. Public health in England: the Report of the Committee of Inquiry into the Future Development of the Public Health Function. London: HMSO; 1988. (Command Paper, 289).
2. Agência Nacional de Vigilância Sanitária. Fórum discute estratégias de combate à falsificação de medicamentos. Rev Saude Publica. 2004;38(5):748-9. DOI:10.1590/S0034-89102004000500024
3. Ames J, Souza DZ. Falsificação de medicamentos no Brasil. Rev Saude Publica. 2012;46(1):154-59.
4. Camargo MBJ, Barros AJD, Frazão P, Matijasevich A, Santos IS, Peres MA, et al. Preditores da realização de consultas odontológicas de rotina e por problema em pré-escolares. Rev Saude Publica. 2012;46(1):87-97.
5. Costa JSD, Victora CG. O que é "um problema de saúde pública"? Rev Bras Epidemiol. 2006;9(1):144-6. DOI:10.1590/S1415-790X2006000100018
6. Narvai PC, Frazão P, Roncalli AG, Antunes JLF. Cárie dentária no Brasil: declínio, polarização, iniquidade e exclusão social. Rev Panam Salud Publica. 2006;19(6):385-93. DOI:10.1590/S1020-49892006000600004
a Ministério da Saúde (BR), Secretaria de Atenção à Saúde, Departamento de Atenção Básica, Coordenação de Saúde Bucal. Primeiros resultados do Projeto SBBrasil são anunciados pelo Ministério da Saúde [cited 2011 Dec 12]. Available from: http://dab.saude.gov.br/cnsb/sbbrasil/resultados.htm