Health conditions and health-policy innovations in Brazil: the way forward

• Published in: The Lancet (British edition) Vol. 377; no. 9782; pp. 2042 - 2053
• Main Authors: Victora, Cesar G, Prof, Barreto, Mauricio L, Prof, do Carmo Leal, Maria, MD, Monteiro, Carlos A, Prof, Schmidt, Maria Ines, MD, Paim, Jairnilson, Prof, Bastos, Francisco I, MD, Almeida, Celia, MD, Bahia, Ligia, MD, Travassos, Claudia, MD, Reichenheim, Michael, MD, Barros, Fernando C, MD
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 11-06-2011; Elsevier
• Subjects: Biological and medical sciences; Biomedical Research; Brazil - epidemiology; General aspects; Health Care Reform; Health Policy; health status; Health Status Indicators; insurance; Insurance, Health; Internal Medicine; longevity; Medical sciences; Miscellaneous; Morbidity; people; politics; private sector; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Health Care; social environment; Social Problems; society; Socioeconomic Factors; urbanization; Brazil; South America; America; Medicine; Innovation; Health policy; Public health
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(11)60055-X

Brazil is a large complex country that is undergoing rapid economic, social, and environmental change. In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.