“Health is everyone’s right”

August 2016

Professor José Paranaguá is a reference in Brazil and Latin America in terms of community health, international health and bioethics.

He is currently the coordinator of the Center for Studies on Bioethics and Diplomacy in Health (Nethis) and he is also the advisor on international health at Fiocruz (Brasília).

Paranaguá believes that the Brazilian public health has made important advances in relation to 30 years ago. However, according to him these advances are still not enough, due to the delay in social policies.

The professor thinks that it’s time to revive those ideals and strengthen the search for strategies and tools to continue on the path of health reform.

In this interview to our blog, Paranaguá talks about the creation of SUS, its main difficulties and the challenges to maintain an universal health policy in a country the size of a continent.

How was the creation of the Unified Health System (SUS) conceived? 

All of this formed part of the even wider process of the historical construction of the federal republic of Brazil. Thus, the SUS is a concrete expression of a proposal that emanated from numerous experiences of constructing alternative solutions to overcome the social ills of a nation, within the specific field of health.

I wish to emphasize that when I refer to a specific field I do not mean a sector that is isolated from other social areas.On the contrary, it is immanent in the idea of health reform that was enshrined in Article 198 of the 1988 Brazilian Constitution: “Health is everyone’s right and it is the duty of the state to guarantee it through social and economic policies aimed at reducing the risk of disease and other health problems, as well as universal and equal access to actions and services to promote, protect and recover health”.

What are the challenges in relation to maintaining a universal health policy in a country the size of a continent?

There are many challenges. The main one was a result of the point I discussed earlier, i.e. a health sector reform project within the context of a federal republic project that remains centralized and directed by various interests in relation to the social demands of the majority of the citizens of this federation.

Another important point to mention regarding a specific aspect of the institutional organization of healthcare in Brazil is the importance of the private sector in relation to the public sector. Apart from a history of atrophy, the public health sector was previously fragmented in many institutions, especially in terms of care.

This scenario started to change with the unification of social security health services in the 1970s, and a few years later the new constitution began the consolidation of a unified system at the federal level, with the integration of the National Institute of Social Security Medical Assistance into the Ministry of Health during the 1990s.

In keeping with the constitutional dictum in the midst of a federal republic like Brazil, the decentralization of the SUS presents difficulties which highlight the fragility of the capacity of government of these units of the country. Finally, and without exhausting the list of these challenges, I should mention the well-known difficulties regarding securing qualified personnel to perform good healthcare for most of this vast country.

What has changed regarding theory and practice? What are the main obstacles and difficulties?

There have been significant changes, considering the situation three or four decades ago. However, those changes do not justify the long-term delays in relation to overdue reforms to social policies in Brazil, including health. Encouragement can be found in the fact that, although we are still far from achieving an ideal situation, we have made significant progress over this period.

In my view, the important thing for the future is that the efforts that have been made thus far are allowed to continue unabated so that the achievements made by my generation of health workers continue in terms of seeking to consolidate the practice and theory of our health reforms.

What are the main challenges for the SUS in the future?

I have already referred to the structural challenges. Currently, we have concerns about the immediate future, which is not limited to the health sector, in relation to the whole of the political and economic situation. However, as someone who started their professional experience in the public health sector in the mid-1970s it’s time to revive those ideals and strengthen the search for strategies and tools to continue on the path of health reform.

Read in HCS-Manguinhos:

Paiva, Carlos Henrique Assunção and Santana, José Paranaguá de Presentation. Hist. cienc. saude-Manguinhos, Mar 2015, vol.22, no.1, p.18-20. ISSN 0104-5970

See the full issue of the dossier Bioethics and diplomacy in health, organized by José Paranaguá and Carlos Henrique Paiva.