The right to health in Brazil in
question
Ana Cristina de Souza Vieira (anac.vieira@uol.com.br)
Anita Aline Albuquerque Costa (anita @hotlink.com.br)
Universidade Federal de Pernambuco, Brasil
People living with an income until
US$35/month: 8,5% of population
Brazilian inequality
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Brazil is the 11st country in inequality in the world
There is a small decreasing of inequality measured by
the Gini index in the last ten years: between 1999 and
2010 dropped from 0,599 to 0,539
Since 1990 the Brazilians citizens have the constitutional
right to comprehensive health care, as a State
responsibility, without payment
Health care in Brazil - before 1988
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It was headed by private medical groups guided by
a market logic, that sold services to the
governments
The public health care model was based on
hospitals privileging a curative perspective,
restricted to people in formal employments.
Primary health care was limited to epidemics
Social movement at the end of seventies –
questioning dictatorship, and asking for democracy,
discussed the right to health
Movement of Sanitary Reform
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Intended to break the logic of private health care
model, to establish universal access to health care –
changing from curative to preventive care.
The concept of health was redefined from the lack of
disease to an understanding that health is the result of
social determinants, such as work, leisure, housing, food,
education, among others
1988 – A new health policy – SUS (Sistema Único de
Saúde) – Public National System of Health
SUS - a public health system
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Decentralization – local governments are responsible
for implementing health services
Health promotion, prevention, treatment and
rehabilitation.
Social participation, through health conferences and
health councils with civil society
SUS had a strong resistance, especially by the private
health sector: hospitals, private health plans and
insurance
Neo liberal paradigm proposed the cut of public
services, opening spaces to private health sector
Public health spending
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Lower compared to developed and developing
countries including our neighbors in Latin America.
Brazil: 3.45 of the Gross Domestic Product (GDP),
Argentina 5.1%, Spain, 5.4%, and France, 7.2%
(Health Organization WHO, 2007:142).
2008: small increase in public spending in health
services as a percentage of GDP – 3.60
These expenses had an irregular behavior, in terms of
the amount specifically allocated to financing public
health actions and services.
Importance of SUS
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68% of all hospitalizations and 73% of the out
patient services in health area are provided by
National Public Health System.
So, SUS is responsible for over two thirds of the
health care in the country and shows the scope of its
network caring for the health of the population of the
country(IPEA, 2007: 131).
Improvement in the indicators for child mortality and
life expectancy at birth - at Northeast, the reduction
in child mortality between 1996 and 2008 was from
60,4 to 21,7 deaths of children under one year of
age per one thousand live births.
Health care challenges: restrictions to
universalization
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SUS faces some problems:
 limits in accessing health services and adequate
health care
 difficulties in labor relations
 lack of human resources
 lack of financing: while heath sector uses 3.6 of
GDP, the payment of public debt kepts more than
40%
 Focus of Health Family Strategy on extreme
poverty – community based services
Partnership with private sector –
questioning the right to health
 Privatization
of public services, an increasing of
non-governmental participation in providing
services - use of social organizations to manage
the public system
 Pernambuco: 3 new hospital and 14 emergency
services , management by private sector
 Restrictions to people assistance – some can not be
seen by the health workers because the health
problem is not considered urgent, although there is
not another health unit to help