Water fluoridation in Brazilian cities at the first decade of the 21st century.

OBJECTIVE: To assess the coverage of the fluoridation of the public water supply in Brazilian municipalities at the first decade of the 21st century, according to population size and municipal human development index (MHDI). METHODS: We have used data produced by national information agencies and the United Nations Development Programme. Population size was separated into < 10,000, 10,000-50,000, and > 50,000 inhabitants. The MHDI was classified into < 0.600, 0.600-0.699, 0.700-0.799, and > 0.799. Absolute and relative inequalities between categories were evaluated using indicators of effect and total impact. RESULTS: We have obtained information for 5,558 municipalities. The coverage rate of water fluoridation increased from 67.7% to 76.3%. Approximately 884 (15.9%) municipalities and 29,600,000 inhabitants started being benefited by the measure. We have observed a significant expansion in municipalities with < 10,000 inhabitants (increase of 21.0 percentage points) and low or very low MHDI (17.7 percentage points). CONCLUSIONS: Population coverage of the public policy has increased 8.6%, and we can also see significant reductions in absolute and relative inequality according to population size and MHDI. Regarding municipal coverage rate, there was also a reduction in inequality in all comparisons except for absolute inequality between the categories of MHDI. The public policy has operated as a factor of health protection in the context of the ongoing social protection policies in the country. OBJETIVO: Avaliar a cobertura da fluoretacao da agua de abastecimento publico em municipios brasileiros na primeira decada do seculo XXI, segundo porte demografico e nivel de desenvolvimento humano municipal (IDH-M). METODOS: Foram utilizados dados produzidos por agencias nacionais de informacao e pelo Programa das Nacoes Unidas para o Desenvolvimento. O porte demografico foi separado em < 10 mil; 10-50 mil; > 50 mil habitantes. O IDH-M foi classificado em < 0,600; 0,600-0,699; 0,700-0,799; > 0,799. As desigualdades absoluta e relativa entre as categorias foram avaliadas por meio de indicadores de efeito e de impacto total. RESULTADOS: Foram obtidas informacoes para 5.558 municipios. A taxa de cobertura da fluoretacao da agua aumentou de 67,7% para 76,3%. Passaram a ser beneficiados pela medida 884 (15,9%) municipios, e 29,6 milhoes de habitantes. Observou-se ampliacao expressiva em municipios com < 10 mil habitantes (aumento de 21,0 pontos percentuais) e com IDH-M baixo ou muito baixo (17,7 pontos percentuais). CONCLUSOES: A cobertura populacional da politica publica aumentou 8,6%, sendo expressivas as reducoes das desigualdades absoluta e relativa segundo o porte demografico e o IDH-M. Quanto a taxa de cobertura municipal, houve tambem reducao da desigualdade em todas as comparacoes com excecao da desigualdade absoluta entre as categorias de IDH-M. A politica publica operou como fator de protecao sanitaria no contexto das politicas de protecao social em curso no pais.