Will the Brazilian Unified Healthcare System (SUS) survive another 30 years?

By Maria Cecília de Souza Minayo, Editor-in-chief and Luiza Gualhano, Communication Assistant, Rio de Janeiro, RJ, Brazil

As for the merits, there is concrete data and consensus on the exponential growth of the number of public services and equipment (VIACAVA, 2018), attendance (PAIM, 2018), and decrease of both infectious and chronic diseases (SOUZA, et al., 2018). It is striking observing how a universal system, although imperfect and flawed in its implementation, can provide such effective responses – which obviously should be analyzed along with other factors – in the expressive decrease in infant mortality (LEAL, et al., 2018), in the substantial increase of life expectancy (VERAS; OLIVEIRA, 2018), in the elimination or eradication of diseases (TEIXEIRA, et al., 2018), in the implementation of a series of specific policies related to human and social rights (GOMES, et al., 2018; MINAYO, et al., 2018; MINAYO-GOMEZ; VASCONCELLOS; MACHADO, 2018); and in the effective health promotion actions! (MALTA, et al., 2018)

In the 40 texts that make up this edition, the reader will also find critical and even harsh analyses on the System’s deep structural problems. Among the difficulties, there are unanimous studies that indicate the underfinancing that came with the implementation process and the implementation itself during these 30 years (SESTELO, 2018); management issues such as the excessive federal centralizing power and problems in the organization and sustainability of services in states and municipalities; (RIBEIRO, et al., 2018; VIANA, et al., 2018); the lack of an effective human resources policy (MACHADO; XIMENES NETO, 2018); the hospital-centric culture that still prevails; and the privatistic mentality that curses and plagues SUS’s attempts of growth, which was born against the international dominance of the neoliberal proposal (NORONHA, et al., 2018).

Although there is consensus about the progress made and the structural problems that undermine the immense potentialities of SUS, this edition is a sample of the plurality of diagnoses, interpretations and proposals that come from the data presented by more than 100 authors, regarding the themes that debated and compose the SUS kaleidoscope. This polysemy must at some point solve Alice’s dilemma – “all roads are open” – moving from the world of ideas and choosing one of the following paths: one that preserves universalization and contributes to the future of the SUS which, although sectoral, cannot be treated outside the destiny of the social policies necessary to the country.

References

GOMES, R., et al. Gender and sexual rights: their implications on health and healthcare. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1997-2006, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.04872018. Available from: http://ref.scielo.org/6f4wnh

LEAL, M.C., et al. Reproductive, maternal, neonatal and child health in the 30 years since the creation of the Unified Health System (SUS). Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1915-1928, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.03942018. Available from: http://ref.scielo.org/k8xv4s

MACHADO, M.H. and XIMENES NETO, F.R.G. The Management of Work and Education in Brazil’s Unified Health System: thirty years of progress and challenges. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1971-1979, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.06682018. Available from: http://ref.scielo.org/xn3vkv

MALTA, D.C., et al. O SUS e a Brazil’s Unified Health System and the National Health Promotion Policy: prospects, results, progress and challenges in times of crisis. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1799-1809, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.04782018. Available from: http://ref.scielo.org/9ykndp

MINAYO, M.C.S., et al. Institutionalizing the theme of violence within Brazil’s national health system: progress and challenges. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 2007-2016, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.04962018. Available from: http://ref.scielo.org/sgbkbj

MINAYO-GOMEZ, C., VASCONCELLOS, L.C.F. and MACHADO, J.M.H. A brief history of worker’s health in Brazil’s Unified Health System: progress and challenges. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1963-1970, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.04922018. Available from: http://ref.scielo.org/tbrj65

NORONHA, J.C., et al. The future of the Brazilian Health System: a short review of its pathways towards an uncertain and discouraging horizon. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 2051-2059, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.05732018. Available from: http://ref.scielo.org/3tzxsh

PAIM, J.S. Thirty years of the Unified Health System (SUS). Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1723-1728, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.09172018. Available from: http://ref.scielo.org/yfj7rs

RIBEIRO, J.M., et al. Federalism and health policy in Brazil: institutional features and regional inequalities. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1777-1789, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.07932018. Available from: http://ref.scielo.org/94j9sc

SESTELO, J.A.F. The dominance of finance in healthcare: political action of unlimited capital in the 21st century. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 2027-2034, ISSN: 1413-8123 DOI: 10.1590/1413-81232018236.04682018. Available from: http://ref.scielo.org/77hd58

SOUZA, M.F.M., et al. Changes in health and disease in Brazil and its States in the 30 years since the Unified Healthcare System (SUS) was created. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1737-1750, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.04822018. Available from: http://ref.scielo.org/6hd7x8

TEIXEIRA, M.G., et al. The achievements of the SUS in tackling the communicable diseases. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1819-1828, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.08402018. Available from: http://ref.scielo.org/vz2nrj

VERAS, R.P., OLIVEIRA, M. Aging in Brazil: the building of a healthcare model. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1929-1936, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.04722018. Available from: http://ref.scielo.org/phszzt

VIACAVA, F., et al. SUS: supply, access to and use of health services over the last 30 years. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1751-1762, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.06022018. Available from: http://ref.scielo.org/x695v6

VIANA, A.L.d’Á., et al. Regionalization and Health Networks. Ciênc. saúde coletiva [online]. 2018, vol. 23, no. 6, pp. 1791-1798, ISSN: 1413-8123 [viewed 17 July 2018]. DOI: 10.1590/1413-81232018236.05502018. Available from: http://ref.scielo.org/8q59m7

To read the articles, access

Ciênc. saúde coletiva vol.23 no.6 Rio de Janeiro June 2018

External link

Ciência & Saúde Coletiva – CSC: <http://www.scielo.br/csc>