Journal of Public Health and Epidemiology
Subscribe to JPHE
Full Name*
Email Address*

Article Number - A4AAEDE47907

Vol.6(11), pp. 326-337 , November 2014
ISSN: 2141-2316

 Total Views: 0
 Downloaded: 0

Full Length Research Paper

Social determinants of health and inequity among people with disabilities: A Brazilian experience

Regina C. Fiorati*
  • Regina C. Fiorati*
  • Department of Neurosciences and Behavioral Sciences, Undergraduate Program in Occupational Therapy, University of São Paulo at Ribeirão Preto, Medical School, Ribeirão Preto, SP, Brazil
  • Google Scholar
Valeria M. C. Elui
  • Valeria M. C. Elui
  • Department of Neurosciences and Behavioral Sciences, Undergraduate Program in Occupational Therapy, University of São Paulo at Ribeirão Preto, Medical School, Ribeirão Preto, SP, Brazil
  • Google Scholar

 Received: 03 May 2014  Accepted: 12 September 2014  Published: 30 November 2014

Copyright © 2014 Author(s) retain the copyright of this article.
This article is published under the terms of the Creative Commons Attribution License 4.0

This paper presents a discussion concerning the results of research conducted between 2011 and 2012 in the city of Ribeirão Preto, SP, Brazil, in which the general objectives were to understand the socio-familial inclusion of people with disabilities and their daily living needs. The methodological approach was qualitative and the data collection techniques were open life history interviews. The research subjects were ten people with acquired or congenital disabilities who were residents of the region enrolled at Primary Health Care Service of Ribeirão Preto city. Analysis of data was based on interpretation in light of dialectical hermeneutics. Our results showed that the socio-familial inclusion of individuals depends on their socioeconomic conditions, with significant indices of socially vulnerable families who have difficulty accessing primary health care and rehabilitation services, and presented indicators of social inequity. Their daily lives were marked by social isolation and not being adequately occupied with social determinants that cause negative health impacts. Due to indices of vulnerability and social inequity presented by population studied, we conclude that the creation of social vulnerability reduction programs coordinated with primary health care services is required.


Key words: Disability/disabled persons, health care primary, rehabilitation, social determinants of health, social inequity.


AOTA. American Occupational Therapy Association. (2008). The occupational therapy practice framework: Domain and \process (2nd ed.). Am. J. Occupational Therapy 62(6):625-683. doi:10.5014/ajot.62.6.625
Arendt H (1998). The Human Condition (2nd ed.). Chicago: University of Chicago Press.
Bampi LNS, Guilhem D, Alves ED (2010). Social Model: A New Approach of Disability Theme. Rev. Latino-Am. Enfermagem 18(4):816-823.
Barnes C, Oliver M, Barton L (2002). Disability studies today. Cambridge, UK: Policy Press in association with Blackwell Publishers.
Bauer MW, Gaskel G (2000). Qualitative Researching with Text, Image and Sound: A Practical Handbook for Social Research (1sted.). Thousand Oaks, CA: SAGE Publications.
Brasil (2006). Ministério da Saúde. Secretaria de Atenção à Saúde.
Departamento de Ações Programáticas Estratégicas. Manual de legislação em saúde da pessoa com deficiência. 2 ed. Ver. Atual. Brasília. Brasil (2008). Ministério da Saúde. Secretaria de Atenção à Saúde. Política Nacional da Pessoa Portadora de Deficiência. Brasília.
Bus PM, Pellegrini Filho A (2006). Iniqüidades em saúde no Brasil, nossa mais grave doença: comentários sobre o documento de referência e os trabalhos da Comissão Nacional sobre Determinantes Sociais da Saúde. Cad. Saúde Pública, Rio de Janeiro, 22(9):2005-2008, set.
Campos GWS (2000). Saúde Pública e Saúde Coletiva: campo e núcleo de saberes e práticas. Ciência & Saúde Coletiva, 5:219-230.
Chappell P, Johannsmeier C (2009). The impact of community based rehabilitation as implemented by community rehabilitation facilitators on people with disabilities, their families and communities within South Africa. Disability and Rehabilitation, 31(1):7–13. DOI: 10.1080/09638280802280429
Clair VA, W-St Kelse N, Smithe E (2011). Doing everyday occupations both conceals and reveals the phenomenon of being aged. Australian Occupational Therapy J. 58:88–94. doi: 10.1111/j.1440-1630.2010.00885.x.
Clapton J, Fitzgerald J (1997). The History of Disability: A History of 'Otherness'. New Renaissance: A J. Soc. Spiritual Awakening. Retrieved April 23, 2013. Available at:
Cooper RA, Cooper MA, McGinley EL, Fan X, Rosenthal JT (2012). Poverty, Wealth and Health Care Utilization: a geographic assessment. J. Urban Health, 89:828-847.doi: 10.1007/s11524-012-9689-3
CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
D'Aubin A (2003). "Nothing about us without us": CCD's struggle for the recognition of a human rights approach to disability issues. In: Enns, H. Neufeldt, A.H. (Ends), In pursuit of equal participation: Canada and disability at home and abroad. (pp. 111-136). Concord, ON: Captus Press.
Evans PJ, Zinkina P, Harphamb T, Chaudury G (2001). Evaluation of medical rehabilitation in community-based rehabilitation. Soc. Sci. Med. 53:333- 348. PII: S0277-9536(00)00321-X
Farrell J, Anderson S, Hewitt K, Livingston MH, Stewart D (2007). A Survey of Occupational Therapists in Canada about Their Knowledge and Use of the ICF. Canadian J. Occupational Therapy 74:221-232. (PMID:17844977)
Gannon B, Nolan B (2007). The impact of disability transitions on social inclusion. Soc. Sci. Med. 64:1425-1437. DOI: 10.1016/j.socscimed.2006.11.021
Gomes MA, Pereira MLD (2005). Família em situação de vulnerabilidade social: uma questão de políticas públicas. Ciência & Saúde Coletiva, 10:357-363.
Habermas J (1989). The Transformation of the Public Sphere. Cambridge: Polity Press.
Hartley S, Finkenflugel H, Kuipers P, Thomas M (2009). Community-based rehabilitation: opportunity and challenge. The Lancet 374:1803-1804.(9704)
Johnson JK, Barach P (2008). The role of qualitative methods in designing health care organizations. Environ. Behavior, 40:191-214. DOI:10.1177/0013916507311547
Junior RM, Coimbra M, Matos YAPS (2012). Direito Sanitário. São Paulo: Ministério Público, Centro de Apoio Operacional das Promotorias de Justiça Cível e de Tutela Coletiva.
Lancet The (2009). Disability: beyond the medical model. The Lancet, 374: 1793 editorial.
Larivière N (2008). Analyse du concept de la participation sociale: définitions, cas d'illustration, dimensions de l'activité et indicateurs. Canadian J. Occupational Therapy, 75: 114-127.
Lefebvre H (2002). Critique of everyday life. Foundations for a sociology of the everyday. London/New-York: Verso.
Levasseur M, Desrosiers J, St-Cyr Tribble D (2007). Comparing the Disability Creation Process and International Classification of Functioning, Disability and Health Models. Canadian J. Occupational Therapy 74:233-242. doi: 10.1177/00084174070740S303
Maclachlan M, Khasnabis C, Mannan H (2012). Inclusive health. J. Trop. Med. Int. Healthn 17:139-141. DOI: 10.1111/j.1365-3156.2011.02876.x
Marmot M (2005). Social determinants of health inequalities. Lancet; 365: 1099–104
Minayo MCS (Ed.). (2008). O desafio do conhecimento: pesquisa qualitativa em saúde (11thed.). São Paulo: Hucitec.
Moene KO, Wallerstein M (2001). Inequality, social insurance, and redistribution. Am. Political Sci. Rev. 95(4):859-74.
Organização Mundial da Saúde. (2003). Centro colaborador da Organização Mundial da Saúde para a Família de Classificações Internacionais. CIF: Classificação Internacional de funcionalidade e Saúde. EdUSP: São Paulo.
Phelan SK (2011). Constructions of Disability: A Call for Critical Reflexivity in Occupational Therapy. Canadian J. Occupational Therapy 78:164-172. doi: 10.2182/cjot.2011.78.3.4
Phillips RL, Olds T, Boshoff K, Lane AE (2013). Measuring activity and participation in children and adolescents with disabilities: A literature review of available instruments. Australian Occupational Therapy J. 60, 288–300.
Pierce D (2001).Untangling Occupational and Activity. Am. J. Occupational Therapy 50:138-146.
Prince MJ (2010). What about a Disability Rights Act for Canada?: Practice and Lessons from America, Australia and the United Kingdom. Canadian Public Policy, 36:199-214.
Starfield B (2011). The hidden inequity in health care. Int. J. for Equity Health 10(15):2-3.
Sullivan WF, Berg JM, Bradley E, Cheetan T, Denton R, Heng J, Hennen B, Joyce D, Kelly M, Korossy M, Lunsky Y, McMillan S (2011). Primary care of adults with developmental disabilities: Canadian consensus guidelines. Canadian Family Physician Médecin de Famille Canadien, 57:541-553.
Tomlinson M, Swart L, Officer A, Chan KY, Rudan I, Saxena S (2009). Research priorities for health of people with disabilities: an expert opinion exercise. The Lancet, 374:1857-1862.
Tregaskis C (2002). Social model theory: The story so far...Disability and Society 17 (4):457–470.
United Nations (2007). Convention on the Rights of Persons with Disabilities. New York.
Wood R, Fortune T, McKinstry C (2013). Perspectives of occupational therapists working in primary health promotion. Australian Occupational Therapy J. 60:161–170. doi: 10.1111/1440-1630.12031
World Health Organization (2001). International classification of functioning, disability and health. Geneva.
World Health Organization (2012)a. World report on disability. Geneva.
World Health Organization (2012)b. Social Determinanats of Health. Report by the Secretariat. 132nd session. 23 November.



APA Fiorati, R.C., & Elui, V.M.C. (2014). Social determinants of health and inequity among people with disabilities: A Brazilian experience. Journal of Public Health and Epidemiology, 6(11), 326-337.
Chicago Regina C. Fiorati  and Valeria M. C. Elui. "Social determinants of health and inequity among people with disabilities: A Brazilian experience." Journal of Public Health and Epidemiology 6, no. 11 (2014): 326-337.
MLA Regina C. Fiorati  and Valeria M. C. Elui. "Social determinants of health and inequity among people with disabilities: A Brazilian experience." Journal of Public Health and Epidemiology 6.11 (2014): 326-337.

Subscription Form