Martins, Flavio Pinheiro;
Vigurs, Carol;
Veras, Mariana Matera;
Morhayim, Lusi;
Lakhanpaul, Monica;
Parikh, Priti;
(2025)
Infrastructure-health nexus in Brazil: a scoping review.
Global Health Research and Policy
, 10
(1)
, Article 42. 10.1186/s41256-025-00441-x.
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Abstract
Background: Health system development requires robust infrastructure systems support, particularly in countries with significant regional and socioeconomic disparities. Brazil’s experience with its Unified Health System offers important insights into how the infrastructure and built environment is linked to health outcomes especially in underserved populations. This scoping review examines how different infrastructure systems such as sanitation, transportation, educational facilities, housing, influence population health in Brazil through two key pathways: (1) their role in shaping environmental conditions that affect health, and (2) their impact on healthcare service delivery among vulnerable populations. Methods: Following PRISMA-ScR checklist, we conducted a systematic search of studies published between 2013-2024 across Scopus, Web of Science, and PubMed databases. Search terms included infrastructure systems (sanitation, transportation, housing, educational facilities), health outcomes (universal health coverage, infectious diseases, maternal health), and population descriptors (vulnerable, indigenous, underserved) combined with Brazil-specific terms. Inclusion criteria focused on studies examining physical infrastructure's impact on health outcomes in underserved Brazilian communities, published in English or Portuguese. After applying exclusion criteria including publication year restrictions, language filters, geographic limitations, duplicate removal, and non-article format exclusions, 68 studies met inclusion criteria following screening and quality assessment using the Critical Appraisal Skills Programme (CASP) checklist. Our analysis applied an infrastructure framework examining institutional, personal, and material infrastructure dimensions. Data extraction captured infrastructure systems, healthcare service tiers (primary, secondary, tertiary), and specific health outcomes. Synthesis involved thematic analysis to identify patterns in infrastructure-health relationships, revealing three interconnected dimensions that form the Infrastructure-Health Nexus framework. Results: The study revealed three interconnected dimensions of infrastructure impact: Supporting Health & Wellbeing, Service Access and Delivery, and Community Engagement. This framework shows how sanitation, transportation, educational, housing, and waste management systems affect health outcomes, with underserved populations facing particular challenges. Healthcare workforce programs serve as interim solutions, with educational facilities simultaneously functioning as health hubs for service delivery and community engagement. The study highlights misalignment between infrastructure investment and UHC objectives. Conclusions: The Infrastructure-Health Nexus framework, building on Buhr’s complementarity concept, shows how infrastructure shapes health outcomes through pathways requiring integrated planning. While current research focuses predominantly on primary care aspects, Brazil’s epidemiological transition calls for broader health system considerations, suggesting reconceptualization of infrastructure systems planning as integral to health system development.
| Type: | Article |
|---|---|
| Title: | Infrastructure-health nexus in Brazil: a scoping review |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1186/s41256-025-00441-x |
| Publisher version: | https://doi.org/10.1186/s41256-025-00441-x |
| Language: | English |
| Additional information: | Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
| Keywords: | Health infrastructure Population health Scoping review, Brazil, Health system, SUS, Public health policy, Healthcare access |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of the Built Environment |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10213115 |
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