Brazil Health Profile 2012

Social safety nets  Social welfare networks to compensate for old age, illness, unemployment and disability are somewhat developed, but do not cover all risks for all strata of the population. Over the past decade, Brazil carried out significant reforms to expand the coverage, quality and efficiency of its health system and strengthen its safety net. During this time, infant mortality fell by more than a third, maternal health improved, and mortality due to infectious diseases decreased substantially. Nevertheless, significant portions of the population still lead an existence on the margins of poverty and hunger. The infant mortality rate in Brazil is 20.4 per 1,000, the third-worst in South America, even though the rate fell by 65% in the decade between 1996 and 2006. Almost half (46%) of the country’s children and youth live in conditions of poverty, compared to an overall poverty rate of 30% (defined as a family group living on two minimum wages). During its first term in office, the Lula administration launched several high-priority social initiatives, including efforts to eradicate hunger (“Fome Zero”), create youth employment (“Primeiro Emprego”), and unify conditional cash transfer programs for greater effectiveness in reducing poverty (“Bolsa Família”). The government also implemented an ambitious reform of the social security system. By the end of 2006, the Bolsa Família program was providing cash transfers – conditioned on children’s school attendance and regular health visits – to 46 million people, covering close to 90% of the nation’s poor. These programs have helped the country make remarkable gains in reducing inequality over the last four years. The poorest Brazilians are better off and less vulnerable than they were four years ago.

Equal opportunity Brazilian society is markedly heterogeneous. Although compensation programs for those disadvantaged by extreme social disparities do exist, they are insufficient. A legal code approved in August 2001 made women equal to men under the law. But women still face a reality marked by inequality in both the domestic sphere and in professional life. Violence against women and children, forced child prostitution and child labor persist. In education, the gaps between men and women have narrowed greatly, and women on average possess higher educational qualifications, often attributed to more disciplined study habits. The visibility of women in public life, the media and politics is increasing, not least of all thanks to the activities of numerous women’s organizations. The gender gap in terms of economic opportunity is also narrowing, but women still remain at a substantial disadvantage. While racial discrimination has long been officially denied as a problem in Brazil, the reality is that Afro-Brazilians earn less than 50% of the average earnings of other Brazilians, and even Afro-Brazilian university graduates earn less than other citizens who have only high school diplomas. The Lula administration has recognized this problem and taken some measures to combat racial discrimination, such as the Racial Equality Statute. There is also some evidence that services for indigenous populations have improved, as in the context of health care outcomes. During celebrations marking Indian Day in April 2005, the justice minister apologized on behalf of the government for the death of indigenous people throughout Brazilian history. This was the first time that any Brazilian government had publicly apologized for the crimes committed against the black and indigenous populations. Today there are 488 indigenous reservations in Brazil, making up 105.7 million hectares, or 12% of the national territory. The government’s efforts have resulted in the creation of 22.3 million hectares of protected areas since 2000. According to the National Indian Foundation, 123 indigenous lands are still in the process of being demarcated.

HEALTH & DEVELOPMENT
Health condition: The nation is undergoing a progression of epidemiological transition in which no communicable diseases and external causes (acts of violence) are more and more outpacing infectious and parasitic diseases. The Brazilian health structure is made up of a multifaceted network of public and private institutions that give, finance, and manage health services; produce and distribute health inputs and research; train human resources in health; and regulate, legislate, and supervise the health system. The Unified Health System (UHS or SUS as per its acronym in Portuguese) is completely in charge for providing health coverage to 78.8% of the Brazilian inhabitants, and is the primary network of public health institutions that provide, finance, and manage health services.

The residual 21.2% of the population, which are covered by the Supplementary System, is also entitled to access the health services provided by the UHS. In addition to these functions, the UHS is also responsible for health surveillance, disease control, and regulation of the health sector. The Family Health Strategy is the country’s primary instrument for providing basic care to the population. In 2005, the Family Health Strategy covered 73 million people (40% of the population) in 4,837 cities through 22,683 multidisciplinary health teams. Facilitating access to essential pharmaceutical drugs is part of basic care, and is provided through special financing mechanisms and government-owned “people’s pharmacies” (farmácias populares).

OPPORTUNITIES

• National health development is helping to support efforts at the three levels of government (Union, state, municipal) to reduce inequalities in the health field
• Support for the political and technical processes needed to ensure the country achieves the Millennium Development Goals (MDGs)
• Recognition of PAHO/WHO response capacity through its technical expertise and technical cooperation in health, working through its programmatic agreements and orientations
• Ongoing mobilization of extrabudgetary financial resources from national, bilateral, and multilateral sources

CHALLENGES

• Reform of the health sector and creation of the UHS in response to the health movement and health system reforms in  different countries
• Basic concepts of the UHS, such as public participation and complementarity with the Supplementary System
• Ongoing development and current stage o the process of UHS definition and implementation, and its relationship the national development