May 27, 2020; The New Humanitarian
“Health for all” is the motto by which Brazilians fought for their public health system, Sistema Único de Sáude (SUS), thanks to a resilient social movement that began in 1978, while the country was still under a military dictatorship. Universal access to healthcare was officially enshrined as a human right under Brazil’s new constitution in 1988 and formally instituted as SUS in 1990. Today, it provides decentralized services, financed by the state and federal governments, to 70 percent of the population in a country of 190 million people. The other 30 percent opt to use private health services.
“It is important to note that Brazil is the only country with more than 100 million inhabitants that has a universal public health system,” said Marcia C. Castro, professor from the Harvard T.H. Chan School of Public Health during this year’s Brazil Conference at Harvard & MIT, held virtually. “SUS had a very important role in reducing inequalities in access to health, in the reducing preventable deaths, in creating the world’s largest vaccination program, the world’s largest organ transplant program, and was extremely significant in the expansion of prenatal care.”
Yet Brazil’s COVID-19 cases are surging, at 772,416 as of this writing, the second highest in the world only after the United States. Experts at the conference, which included ex-Minister of Health Luiz Henrique Mandetta and the general manager of the Sociedade Beneficente Israelita Brasileira Albert Einstein, Dr. Henrique Neves, agree that the lack of political will and concrete action at the federal level has placed Brazil in an unnecessarily dire situation.
“Imagine what it would have been like in Brazil if it weren’t for the existence of a universal health care system. I think SUS has demonstrated at key moments the ability to react quickly to specific challenges,” said Dr. Neves.
The occupancy rate of ICU beds in most states are reaching their maximum capacity, at 80 percent in Rio de Janeiro and 69 percent in São Paulo, for example. However, the rate of deaths is surprisingly low for a country with marked economic inequalities. According to John Hopkins COVID-19 world tracking system, there have been 39,680 deaths reported so far for the entire country of Brazil. Compare this to the 30,542 deaths just in the city of New York.
“Brazil is many Brazils,” said Mandetta. “We can’t talk about coronavirus in Brazil as if it were the only phenomenon. There are several phenomena with different responses that vary from state to state.”
Mandetta, who was fired by President Jair Bolsonaro back in April, believes that the politization of the coronavirus response is the leading cause for a surge of cases. Bolsonaro has repeatedly downplayed the seriousness of the pandemic, calling it “the little flu,” and has refused to implement the World Health Organization’s recommendations for social distancing, pushing instead an early relaxation of lockdown measures. His second Minister of Health, Nelson Teich, also resigned after a month at his job for refusing to promote the use of chloroquine as a cure-all for coronavirus cases. The interim health minister, a military official with no medical training, agreed to censor the official pandemic data from the government’s website, only to reinstate it two days later thanks to a speedy ruling from the Supreme Court.
Much like in the US, the responsibility of containment and prevention in Brazil has fallen squarely on local governments, the advocacy of nonprofits, private donors, and a self-organized mutual-aid community response. Paraisópolis, a favela in São Paulo, for example, trained emergency first responders to monitor “blocks” of 50 families each and created their own self-isolation quarantine centers in retrofitted public schools. It did so thanks to a public-private partnership with public health workers and Albert Einstein Medical School.
“Insufficient funding and lingering geographical inequalities” plague Brazil’s public health system, according to research published in The Lancet journal, but today the Sistema Único de Sáude is carrying most of the country’s pandemic burden, albeit more or less successfully, despite the political environment. More importantly, it has ingrained in Brazilians the understanding that access to health care is a basic human right, a legacy achieved by social movements after untold suffering under a 20-year dictatorship.
“You have to understand what we had before the SUS: two types of Brazilians, those who could pay [for healthcare services] and the indigent,” said Mandetta, “What I see in these 32 years of SUS is a story of citizenship achievements.”—Sofia Jarrin-Thomas