Infrastructure-health nexus in Brazil: a scoping review

Area of Science:

• Public Health
• Urban Planning
• Health Systems Research

Background:

• Health system development is critically dependent on infrastructure, particularly in nations with significant regional and socioeconomic disparities.
• Brazil's Unified Health System (SUS) provides a valuable case study on the link between infrastructure, the built environment, and health outcomes, especially for underserved populations.
• This review investigates how infrastructure systems (sanitation, transportation, education, housing) impact population health in Brazil via environmental conditions and healthcare access for vulnerable groups.

Purpose of the Study:

• To examine the influence of diverse infrastructure systems on population health in Brazil.
• To understand the pathways through which infrastructure affects health outcomes, focusing on environmental conditions and healthcare service delivery.
• To develop a framework for analyzing the complex relationship between infrastructure and health.

Main Methods:

• A systematic scoping review was conducted following PRISMA-ScR guidelines, searching Scopus, Web of Science, and PubMed (2013-2024).
• Search terms encompassed infrastructure systems, health outcomes, and population descriptors, specifically for Brazil.
• 68 studies were included after rigorous screening and quality assessment, analyzed using an infrastructure framework and thematic analysis to develop the Infrastructure-Health Nexus framework.

Main Results:

• Three interconnected dimensions of infrastructure impact were identified: Supporting Health & Wellbeing, Service Access and Delivery, and Community Engagement.
• Sanitation, transportation, educational, and housing systems significantly affect health outcomes, with particular challenges for underserved populations.
• Educational facilities serve dual roles as health hubs and community engagement centers, while healthcare workforce programs act as interim solutions. Misalignment exists between infrastructure investment and Universal Health Coverage (UHC) goals.

Conclusions:

• The developed Infrastructure-Health Nexus framework highlights the need for integrated planning to optimize infrastructure's role in shaping health outcomes.
• Current research predominantly focuses on primary care, but Brazil's epidemiological transition necessitates broader health system considerations.
• Reconceptualizing infrastructure systems planning as integral to health system development is crucial for advancing population health in Brazil.