What is the way forward to improve health conditions in Brazil?

Responsible researcher: Viviane Pires Ribeiro

Article title: HEALTH CONDITIONS AND HEALTH-POLICY INNOVATIONS IN BRAZIL: THE WAY FORWARD

Authors of the article: Cesar G Victora, Mauricio L Barreto, Maria do Carmo Leal, Carlos A Monteiro, Maria Ines Schmidt, Jairnilson Paim, Francisco I Bastos, Celia Almeida, Ligia Bahia, Claudia Travassos, Michael Reichenheim and Fernando C Barros

Intervention Location: Brazil

Sample Size: All Brazilian territory

Sector: Healthcare

Type of Intervention: Actions to improve health conditions and service provision

Variable of Main Interest: Improvement of health conditions

Assessment method: Other

Assessment Context

In recent years, Brazil has been facing several economic, social and environmental transformations. Previous studies show considerable progress in some aspects of the health conditions of the Brazilian population and the country's health system, in stark contrast to the stagnation or even deterioration of other indicators. Socioeconomic and regional disparities are enormous, signaling that much progress is needed to improve the living conditions of a large part of the population.

With approximately 200 million inhabitants, there are striking regional differences in Brazil. Richer regions, such as the South and Southeast, coexist with poorer regions, such as the North, Northeast and the Midwest border. Even with these profound differences, research shows that the health of Brazilians has improved. Life expectancy at birth has increased by more than six months every year over the past four decades. With regard to infectious diseases, the country stands out in controlling immunization-preventable diseases and HIV/AIDS, but other diseases, such as dengue, have been little affected by control efforts.

Intervention Details

According to Victora et al. (2011), the trends observed in the health conditions of the Brazilian population over the last fifty years must be interpreted in terms of social determinants of health. The military dictatorship was characterized by rapid economic growth, increased income concentration, a fragmented health system and little social participation in all sectors. This scenario stimulated a strong social movement that advocated reform of the health sector. Thus, the return to democracy enabled the creation of the Unified Health System (SUS), in the context of the new Constitution of 1988. Throughout the period, changes occurred in other determinants of health, including urbanization, fertility and education.

In the 1990s, important changes occurred, such as the Family Health Strategy, which expanded basic health care in specific geographic areas, reaching the poorest regions of the country. Conditional income transfer programs, such as Bolsa Família, were developed in addition to the social protection system.

In addition to positive changes in the scope of social determinants of health, Brazil has advanced a vigorous reform movement in the health sector, including not only academics and policymakers and managers, but also professionals in the field at all levels, trade unionists and the organized society. However, progress in the country has been uneven. In this sense, Victora et al. (2011) discuss some of the main achievements and some of the biggest challenges to improving the health of Brazilians.

Methodology Details

The analysis carried out by Victora et al. (2011) takes place through a discussion of the main achievements and biggest challenges to improving the health of the Brazilian population. The authors analyzed the Unified Health System, social participation, human resources in health, the public-private combination, private health insurance, capacity development for health research, mass media and health promotion, regulation and medicines etc.

Based on the analyzes and the series of five previous articles, Victora et al. (2011) developed a “call to action” (Panel).

Results

Based on the analyzes carried out – on the Unified Health System, social participation, human resources in health, private health insurance, etc. – and in previous studies, Victora et al. (2011) developed a “call to action” (Panel). According to the authors, in a large and complex country with so many changes underway, a call for action to improve health conditions and the provision of services must necessarily be long. To this end, the recommendations were divided into categories aimed at the Brazilian government, the private sector, academics, health workers and civil society as a whole.

The recommendation for the government is that it should reaffirm its commitment to improving the health of the Brazilian population, in particular with regard to the principles of the 1988 Constitution and the SUS, with actions in the following areas: Health conditions; Financing of health care; Primary health care; Regulation, responsibility and quality of care; Human resources in health; Health research; and Intersectoral actions.

Although the government has a central role in the sector, other actors – health workers, the private sector, universities, training institutions, health councils, researchers and civil society – must be equally involved, in order to achieve better levels of health for the population. Brazilian population. That is, the recommended actions and their respective actors are deeply interconnected and coordinated action by society is necessary.

Public Policy Lessons

The central message of the study carried out by Victora et al. (2011) is that improvements in health conditions can be attributed both to favorable changes in the social determinants of health, and to the dynamics of a vigorous sectoral reform movement, initiated in the 1970s, which led Brazil to adopt its own approach, in relation to Latin America, by creating a national health service with the main objective of reducing inequalities. The health reform and the creation of the SUS were part of a broad movement aimed at mitigating social exclusion, integrating initiatives from different sectors.

Despite general progress, Victora et al. (2011) emphasize that social and economic disparities still remain unacceptably high, pointing out that a lot of effort will be needed to improve the basic living conditions of an important portion of the population. New issues emerge as a result of urbanization and social and environmental changes, and some long-standing health problems persist without significant improvements. The administration of a complex and decentralized public health system and the vigorous action of several private health insurers inevitably lead to conflicts and contradictions. The challenge is, ultimately, political and requires the active and continuous engagement of society, with a view to ensuring the right to health for the entire Brazilian population.

Reference
VICTORA, Cesar G. et al. Health conditions and health-policy innovations in Brazil: the way forward. The Lancet , vol. 377, no. 9782, p. 2042-2053, 2011.