Health Care Around the World: Brazil

BRAZIL A LEADER IN HEALTH CARE IN DEVELOPING WORLD: The largest Latin American country has had nationalized health care since 1988 & is known for innovate, affordable HIV treatment. Pictured: Ipanema Beach. Photo: Wikimedia Commons

Brazil—the largest Latin American country both by geographical area and population—has one of the world’s best health care systems.

In the latest installment of our Health Care Around the World series, the UMHS Endeavour looks at the nationalized medical system of Brazil and what the public and students at American and Caribbean medical schools can learn from it as the USA adapts to changes in our own health care policies due to the Affordable Care Act (Obamacare). Although a conservative Catholic nation in many respects, Brazil has some of the most progressive attitudes both in Latin America and globally toward HIV treatment and health care for lesbian, gay, bisexual and transgender (LGBT) citizens. We will look at facts from CNN, the World Health Organization (WHO), the New York Times and other sources.

‘Citizen’s Right to Health Care’

Health care is not just free in Brazil but “is recognized as a citizen’s right," a CNN article “Where in the world can you get universal health care?”
stated back in 2012.

Brazil’s Sistema Único de Saúde offers citizens a private and public health care system, the latter of which was overhauled in 1988. As CNN reports, the nationalized system offers primary health coverage and “public and contracted hospitals deliver specialist care”.

WHO says on its website that nearly three decades after establishing the Unified Health System, “more than 75% of the country's estimated 190 million people rely exclusively on it for their health care coverage.”

CNN says an estimated 80 percent of Brazilians use public care, and the remaining 20 percent are wealthy and thus can pay for private care, based on a Center for Strategic and International Studies report.

Since 1988, infant mortality decreased and life expectancy increased by 10.6 years, CNN quotes a 2011 study published in The Lancet as saying.

'Most Successful' HIV Program in Developing World

HIV has been a problem for years in Brazil, but the nation has “one of the developing world's largest, and arguably most successful, AIDS treatment programs,” says the article “AIDS Treatment In Brazil: Impacts and Challenges,” published by the National Center for Biotechnology Information, U.S. National Library of Medicine.

In 1993, Brazil lowered treatment costs for HIV by making several generic anti-retroviral drugs (ARVs) domestically.

Below are highlights from “AIDS Treatment in Brazil: Impacts and Challenges”:

• “Domestic production increased greatly in the late 1990s, as more patients sought treatment and Brazil developed infrastructure to provide treatment in clinics nationwide."
• “Brazil's threats to issue compulsory licenses also prompted steep price declines for patented ARVs.”
• ‘Since 2001, the pharmaceutical companies Roche, Gilead, Merck, Abbott, and Bristol-Myers Squibb have dropped their ARV prices in Brazil and introduced tiered pricing in many developing countries.”
• “Price negotiations saved the Brazilian health ministry $US 1.2 billion in AIDS treatment costs in recent years.”
• “Threatening to issue compulsory licenses is a unique strategy. Few developing countries have public drug production capacity or requisite political will (including political engagement at the highest levels, vocal media, and strong support from local and global civil-society organizations) to challenge drug companies about prices.”
• “Brazil's strategies are not widely replicable, but they established precedents for developing countries to challenge drug companies and pursue other novel approaches to promote affordable access to medicines—strategies other nations have since adopted.”
• “Price challenges also increased transparency about global drug prices and prompted global policy dialogue about affordable access to treatment.”

Brazil a Leader in LGBT Health Care

Despite being a predominantly Catholic country, Brazil is known as a leader in LGBT health care. According to a 2014 New York Times article by Rafael de la Dehesa, “In Brazil, AIDS Activism Led to Political Connections,” (Brazil has made many advanced steps to helps its LGBT citizens, including legalizing same-sex marriage and including access to gender reassignment surgery and hormone therapy for transgender Brazilians in the public health system, has worked to combat homophobia in religious ministries and has “led international discussions on sexual orientation, gender identity and human rights.”

Back in the 1990s. Brazil’s national STD/AIDS program “embraced civic participation, universal access, and a broad reading of health policy that encompassed combating homophobia and social stigma as a key to prevention,” Mr. de la Dehesa writes in the New York Times.

Despite all the progress, Brazilian health officials have hits snags along the way. In June 2013, Brazil gave into pressure from the evangelical caucus in the government, "pulling an AIDS prevention campaign intended to reach sex workers (merely the latest instance of such censorship), and firing the head of the national S.T.D./AIDS program,” according to the New York Times.

Brazil faces the same issues the U.S. does regarding conservative religious leaders and government and medical policies for LGBT individuals, but there is no question much can be learned from Brazil's inclusive and comprehensive health care coverage for all people regardless of race, creed, gender or sexual orientation.

(Top photo) Christ the Redeemer statue in Rio. Photo: Klaus with K/Wikimedia Commons

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