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Naomar de Almeida FilhoInstituto de Sade Coletiva
Universidade Federal da Bahia
Social structure,health of vulnerablepopulations and the
equity-promotion roleof health systems
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1964-1985 Military dictatorship
US dependent foreign policy External debt (economic miracle) Political repression National security ideology
Economic & political background
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1986-2002 1988 New Constitution
Hyperinflation Economic crisis External debt explosion Political freedom Neoliberal ideology
Economic & political background
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Economic & political background
2003-present Reconstruction of the State
Sustained economic growth Technological dependency Independent foreign policy Expanded social policies
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Economic developmentPoverty reduction
Environmental challengesDilemas in the labor contextViolence and intoleranceReduction of social inequalities
Social Context
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Evolution of Social Class Profile.Brasil: 1992-2009
Fonte: FGV A Nova Classe mdia: O lado brilhante dos pobresFonte: FGV A Nova Classe mdia: O lado brilhante dos pobres
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Percentage change in Gini coefficient by country.Latin America, 2000-2006
8/3/2019 Social Structure, Vulnerable Populations and Inequalities in the Health System of Brazil
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8/3/2019 Social Structure, Vulnerable Populations and Inequalities in the Health System of Brazil
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Reconstruction of the State:Debate public vs. private
Rhetorical intersectorialityLate expansion of public policiesFight against corruption
Reforms com-promisedIdeological regression
Political Context
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Health inequalities (update)
The life expectancy of Brazilian citizens reached73.5 years in 2010, up 8.5 percent from 67 yearsin 1991, according to the Brazilian Institute of
Geography and Statistics (IBGE) Among women, life expectancy reached 77.4 years
in 2007, from 70.9 years in 1991 life expectancy of Brazilian men increased from
63.2 to 69.8 years in the same period
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Brazil's infant mortality rate dropped to 21.6 deathsfor every 1,000 live births in 2010, a 46 %decrease from the 45.1 deaths per 1,000 births
in 1991. Regional differences in infant mortality rates
remain high. The northeastern region, thepoorest in Brazil, registered an infant mortalityrate of 35.6 deaths per 1,000 living births; in thesouthern region, the rate was 16.1/1,000 births.
Health inequalities (update)
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Brief History of Brazils HealthReform (1988-2009)
1986 8th National Health Conference 1988 The New Constitution
1990 The SUS Law (Unified Health System) 1992 Community Health Agents Program 1996-2000 The Family Health Program 2000-2007 Budget increase (CPMF) 2008-present: Overcoming inequities
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Thesis 1 about responsibility of theState regarding public policies
The Brazilian Statedoes not comply with the
responsibility of providingpublic services with quality,universal access and equity
to its population
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Corollaries of Thesis 1
1.Despite advances, the persistence of socialinequalities is a serious problem thatdeserves special attention not only from
governments at all levels, but also fromthe entire society .2.Expansion of funding, participatory
governance, efficient management andaffirmative action policies can correcthistorical inequities .
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In the fields of health andeducation, in addition to not
guaranteeing high-qualitypublic services (Thesis 1),
the Brazilian state is apromoter of inequality
Thesis 2 about responsibility of theState regarding public policies
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1.In principle universalist, the public healthsystem is underfinanced, withrecognized deficiencies
2.The private sector provides care to thosewho have income big enough topurchase health plans, benefitting fromstrong tax exemptions
3.Private health plans are subsidized by theSUS in higher cost and high-complexityprocedures (not-profitable)
Corollaries of Thesis 2 for Health
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The vicious impact of social inequality onthe Brazilian National Health System
-i gh c om pl ex it y i gh c om pl ex it y ublic services of ublic services of et ter quali tyet ter quali ty ;
-or freeor free
ore access ore accessEff iciencyff iciency
oli t ical oli t icalcapi talapi tal
ocial Valueocial Value
oor majori ty oor majori ty inances the inances the
Statetate ublic ublic
ervices of ervices of ower ower
quali tyual i ty-e tt er q ua li ty e tt er q ua li ty
ervices ervices -ut -ut-f reachf reach
recarious recarious ealth Less ealth Less
accessccess ocial ocial
xclusion xclusion
Reproductionof Submission
aid private aid private ervices of ervices of
et ter qual ity et ter qual ity i th i th
ax exemptionax exemption
ich minority ich minority as as iscal iscal
incentivesncentives
Reproduction of Domination
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RegressiveRegressiveTaxTax
SystemSystem
Political modelPolitical modelreproducesreproducesdominationdomination
State of Social Iniquity
Inequalities inInequalities inHealthHealth
SocialSocialperversion inperversion inEducationEducation
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Health Policy in Brazilopen questions, open choices
Health: human right or commodity? individual health or collective health? health care or health situation? health inequalities or health inequities? social policy or public policy? health policy or health politics ? Politics of Disease or Politics for Health?