In the 1980s, during the democratization process, the debate about how to deal with health inequalities, both in the access to health care services and in the patterns of health condition distribution between social groups, gained momentum. The creation of
In the 1980s, during the democratization process, the debate about how to deal with health inequalities, both in the access to health care services and in the patterns of health condition distribution between social groups, gained momentum. The creation of the SUS, the Brazilian universal public health system, in 1988, reflected the aspirations of a national and international movement advocating ‘health for all’ and was expected to help in tackling entrenched inequalities.
However, the SUS initially lacked at least two of the institutional mechanisms needed to turn these aspirations into reality:
a model of medical care that truly supported primary care;
a legal and administrative frame defining a clear governance structure among the federal, the states and the municipal governments.
These were developed mainly in the 1990s, through:
A local innovation process prompted by crises in the earlier highly centralized and hospital-centered public health system, allowing decentralized programs in, for example, primary care and HIV/AIDS prevention, to be created by civil society, municipal or state level authorities and tested before becoming national programs.
The mobilization of Brazil’s Health Reform Movement, which advocated for the effective institutionalization of citizen participation and oversight through health policy conferences, a national health council, and subnational health councils—now established in all 27 states and in nearly all municipalities. They address c