Brazil_study - 1 HEALTH CARE IN BRAZIL equity as challenge1...

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1 HEALTH CARE IN BRAZIL: equity as challenge 1 Elizabeth Barros 2 Silvia Porto 3 Brasilia, october 2002 1 Text prepared for Global Development Network -GDN 2 Sociologist, , Health Planning and health policies adviser 3 Mathematician, Senior Researcher, Health Planning and Administration Department, National School of Public Health / Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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2 HEALTH CARE IN BRAZIL: equity as challenge 1. Introduction Serious debate about the question of access to health services in Brazil goes back to the 1980s. In the course of that decade, the Brazilian health care system began to develop basically in response to social demands fuelled by increasingly vigorous social movements, the emergence of combative trade unionism, and newly strengthened political parties. Conceived initially as a manifestation of the need for equality as far as people’s rights were concerned, the debate gradually began to acknowledge that different social sectors demanded a range of different health care requirements. Flowing from this, it became apparent that the principle of equity needed to be incorporated into health matters, in terms of heightened concern with distributive justice and positive discrimination. From this viewpoint, the central aim of public policies - particularly those with a social responsibility – needed to concentrate on reducing unnecessary "unjust inequalities." (Vianna at al.16) 4 , associated with the normal heterogenous nature of life. Although it is important to recognise that there is indeed a call for different types and levels of health care related to, for example, life cycles, gender, race, climatic and environmental circumstances, the vast majority of inequalities encountered in the health sphere can in effect be considered as falling within the above description of "unjust inequality." The latter calls for decisive interventions aimed at overcoming this kind of inequality. Medeiros 5 2 has pointed out that in the allocative decisions based upon the principle of equity, not only the needs of individuals, but also the availability of resources to satisfy these needs, have to be taken into account ”. In the present paper, our aim is to describe the inequalities existing in Brazil and, on the basis of available research, to attempt to draw attention to some of those alternatives which have so far been debated aimed at introducing an enhanced degree of equity into the health sphere – very much in accordance with the provisions set forth in the 1988 Brazilian Constitution. It is true that a great deal is being done within the Brazilian public health system, and that a range of alternative policies is being studied and 4 Vianna, Sólon; Barata, Rita; Nunes, André and Santos, J. Richard - Medindo as desigualdades em Saúde no Brasil - Uma proposta de monitoramento (Measuring Health Inequalities in Brazil: A Proposal for Monitoring) - OMS/OPAS/IPEA, Brasilia, 2001 5 Medeiros, Marcelo - Princípios de Justiça na Alocação de Recursos em Saúde . Texto para Discussão Nº 687.Rio de janeiro: IPEA, dezembro de 1999.
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Brazil_study - 1 HEALTH CARE IN BRAZIL equity as challenge1...

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