A diagnosis of public health in Brazil – Opinion

For most Brazilians, health is one of the topics that cause most concern. A recent survey carried out by Datafolha, and published by the newspaper “Folha de S.Paulo”, shows that 87% of young people between 15 and 29 years old classify health as very important, while the remaining 13% consider it important.

A topic as important as this would not be left out of the discussion of the series “Brasil, 2023”, by Rio Bravo Investimentos. And to talk about it, our guests from the fifth episode of this year’s season were: doctor Roberta Grabert, MBA in health management and associated leadership of the Livres movement; and public health specialist Gonzalo Vecina, who, in addition to the positions he has held in public and private management, is a professor at the Faculty of Public Health at the University of São Paulo.

In his first speech, Grabert wanted to make it clear that, although he participates in a movement that supports the liberal banner, he values ​​the defense of a universal health system. “When we talk about liberalism, we are talking about 2022, and we are not talking about 1900 or 1870. Nowadays, in a country like ours, with inequality at the level we have, we don’t think about social agendas. This is part of well-being. When we cherish freedom, the one that is most beautiful to cherish is the freedom of the other”. In this sense, the guest of the Rio Bravo videocast asks: “how can I want to be free, if I have a countryman of mine, a hungry neighbor?” Grabert completes emphasizing that advocating the cause of social agendas does not make it socialist or communist. “I am a human being who recognizes in another human being someone like me”.

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Provoked by Roberta Grabert to speak out, Gonzalo Vecina does not hesitate to take a stand: “I think the question of the social crisis, and the need for a present State that seeks to build equality, is fundamental. I would not qualify this question, saying if it is liberal, if it is socialist or if it is communist. But if I have to say it, I’m a communist! But I don’t think it changes much.” If this is not the order of the day, what is the most important agenda at this point? The professor at the Faculty of Public Health responds: “if the world is of any use, it is for us to live well in it. And for that to happen, we will have to have a society with a government that is a sponsor of this equality”. Vecina emphasizes that the tasks of this government are to provide health, education, employment, security, in short, that State of social welfare that delivers a condition of equality for all”.


Inequality and the example of teenage pregnancy

The reference in the paragraph above is not the only one that the guests make to the issue of inequality. In fact, Grabert and Vecina emphasize the importance of this topic to face the debate around access to health, for example. According to the leadership of Livres: “We live in an inverted reality. Even within the SUS there is inequality. The SUS of São Paulo is not the same as that of Piauí”. In Grabert’s assessment, “we have not yet reached the peak of well-executed public policies, as well as the absence of protocols and the overload of some services”.

When reflecting on this phenomenon, Gonzalo Vecina emphasizes: “It is necessary to understand that health is not just health. One of the problems in Brasilândia (a neighborhood of São Paulo) is teenage pregnancy. How do you combat this phenomenon? Actions related to sex education are not enough”. Here, Vecina brings her own experience to the debate: “Why didn’t my daughter get pregnant when she was a teenager? Because she had an agenda, that is, activities related to physical education, cultural activities, another language to learn. The poor man’s daughter doesn’t have that kind of alternative”. The sanitarian adds: “The periphery is a desert. What is left for young people to do? Not much. So, if you don’t have education, culture, sport and leisure, I don’t reduce teenage pregnancy”.

The issue of teenage pregnancy returns to the debate when Roberta Grabert cites, with indignation, the absence of adequate public policies to address this issue. “In addition to what the professor said, there is a poor quality public policy. What does science say? That we must address the strong cause of such a phenomenon. Instead, millions are spent on a policy of abstinence.” Sanitarian Gonzalo Vecina does not hide his indignation at hearing these words.

The importance of primary care


At another point in the videocast, Vecina explains why primary care deserves special attention when it comes to public health. “With the burden of diseases that we have today, there is no way to face those that are chronic-degenerative without primary care. It’s impossible”.

The professor at the Faculty of Public Health then lists the diseases that require this type of approach. “Thirty-five percent of Brazilian mortality has to do with cardiovascular diseases. What is the most important component of this burden of diseases like diabetes or hypertension? It’s not with medicine. In fact, either the person changes their way of life, or there is no way to fight them”.

The primary care physician’s role is to be an accomplice of this patient subject, and thus must design a single therapeutic plan, there is no way for these changes to happen. “There is no way to face this burden of disease without the commitment of the patient, who is the subject of their own health”, explains Vecina, who adds: “and there is no way to do that without primary care”.

Here, Roberta Grabert makes a point of mentioning, in this specific case, the role of a professional who is decisive for the success of the primary care proposal: “We end up talking a lot about doctors, but the community health agent goes to people’s homes”. For Grabert, once empowered, the agent helps not only health, but many other things. “We have a very beautiful structure, philosophically assembled, which just needs to be put to work properly”.

Vecina rebates: “We need to improve. We are covering 60% of the Brazilian population with the Family Health Strategy. We need to get to 90%. It is a task for the municipalities, but the federal government has a very large capacity for induction, as 25% of the strategy depends on its resources”.


At the end of the panel, Roberta Grabert and Gonzalo Vecina indicate what is the main element for Brazilian health in the coming year. Vecina has no doubts: “Financing. You need to put money in the equation.” And the sanitarian justifies: “Brazil spends 4.3% of GDP on public health. The average of European countries, 8%. Compared to our neighbors, in 2018 we spent US$1,600 per capita/year, Argentina US$2,000 and Chile US$1,500. We need to spend better, no doubt, but we need more resources.”

Roberta Grabert goes in the same direction, highlighting the importance of public policies. “All the money that comes in, we have to invest in this line of action”.

There is no doubt: health is a central theme in the lives of Brazilians. And the conversation with specialist Roberta Grabert and public health specialist Gonzalo Vecina shows how fundamental it is to address this issue from a more qualified perspective, without looking for easy solutions to complex problems. Instead, it is essential to raise the level of debate, with consistent proposals for the long term.


The entirety of the fifth episode of the Rio Bravo videocast can be accessed from the following link.


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