Brazil’s Unified Health System May Promote Social Inequality: Paradox or Dialectic?

Naomar Almeida Filho, Universidade Federal da Bahia, Salvador, Brazil

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Abstract: In 1990 the Brazilian Congress approved the Unified Health System (SUS) Law, which defines health as a citizen’s right and a duty of the State. A Community and Family Health Program was designed 1992-2000 to guarantee universal primary health coverage through a network that today comprises over 30,000 Family Health Care Centers. Until 2007, steady public budget increases provided advanced care and special disease control programs (e.g., HIV/AIDS and epidemiological surveillance). Annually the SUS system provides more than 2.3 billion clinical procedures, 11.3 million hospitalizations and 15,000 organ transplants; immunization rates exceed 90% and major pandemics have been controlled or prevented. Correspondingly, life expectancy rose and child mortality plummeted with a 50% decline in 20 years. However, recent data have shown a paradoxical trend towards regional and social inequalities in access to health care and growing disparities in social health indicators. A champion builder of social equity, Brazil has recently experienced a slide in Gini coefficient indicators, from .60 in 1996 to .52 in 2009 (by comparison: for the same period in the US the Gini coefficients were .46 to .47). In ten years, thanks to economic development, cash transfer programs and public policies like the SUS, more than 30 million people stepped over the poverty line. In this presentation, I intend to tackle key questions: How to analyze the paradox of increasing social equity and health inequity? What actions are needed to guard against the SUS becoming a socially selective public service? How can we best share Brazil’s experience in delivering a universal-access, state-funded, socially-controlled Health System and the social context of inequality from which it came? 

About the Presenter: 

Naomar Almeida-Filho is a Professor of Epidemiology at the Instituto de Saúde Coletiva of the Federal University of Bahia, filho Brazil. He holds an MD and a Master’s degree in Community Health from UFBA and a Ph.D. in Epidemiology from the University of North Carolina, Chapel Hill (UNC). Dr. Almeida-Filho joined the faculty of the Medical School at UFBA in 1982, where he has taught epidemiology and research methods for twenty years. He is the founder and first dean of the Institute of Collective Health at UFBA and has been a visiting scholar in several North American universities including UNC, UC Berkeley, University of Montréal and Harvard University. In the early 1980s, Professor Almeida-Filho introduced modern psychiatric epidemiology in Brazil by conducting pioneer epidemiologic surveys of neuropsychiatric disorders in the State of Bahia. Currently, his research interest has focused on the impact of socio-cultural processes (migration, poverty, urbanization, gender) upon behavioral and psychosomatic disorders, which include the first studies (outside Europe and the United States) of mental health correlates of social inequality and race/racism. In parallel, he has written a series of scholarly books on epidemiological methods and theories of health/disease/care. Professor Almeida-Filho has been awarded, six times in a row, the highest level Senior Research Fellowship Award of the National Research Council of Brazil. In 2003, he was honored with a Doctor of Science Honoris Causa degree by McGill University. From 2002 until 2010, he served as President (Reitor) of the Federal University of Bahia. In this role, he has also published studies on higher education in health and on the social mission of the university in Brazil.

Presented on: 
April 20, 2011
Symposium 2011
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