Brazil’s ‘fragile’ health care gains threatened

Progress made by Brazil’s unified health system, Sistema Único de Saúde (SUS), over the past three decades is in danger of being reversed because of recent austerity measures and new policies of the Brazilian government, according to a new study led by Harvard T.H. Chan School of Public Health and the Pan American Health Organization.

The study, a collaboration among 12 institutions in the U.S., Brazil, and the U.K., was published July 11, 2019 in The Lancet.

The study noted that SUS, created in 1990, has led to reductions in inequality in access to health services, declines in avoidable deaths and hospitalizations, and near universal access to health care in Brazil. But these gains are fragile, according to the authors. And more remains to be done to address geographical inequalities, boost insufficient funding, and improve collaboration between the private and public health care sectors, they wrote.

The researchers simulated four hypothetical scenarios under varying levels of federal support, because municipalities in Brazil depend on such support to deliver health care. They predicted that, if health sector funding doesn’t increase, there will be deterioration in four key health indicators: infant mortality, prenatal care, access to primary medical care, and cardiovascular disease-related deaths. Other government policies could impact health, too—such as one that eases access to firearms.

To prevent worsening health outcomes in Brazil, the authors made a number of recommendations, including ensuring that there is sufficient public financing to sustain SUS and expanding investments in the health sector.

Lead author of the study was Marcia Castro, Andelot Professor of Demography and chair of the Department of Global Health and Population. Other Harvard Chan co-authors included senior author Rifat Atun, professor of global health systems, and visiting scientist Adriano Massuda.

Read the Lancet article: Brazil’s unified health system: the first 30 years and prospects for the future

Read an article in Piauí: Lack of funds and Bolsonaro government threaten SUS legacy