Brazil has one of most crowded cities where people living under poverty line and not much conscious about their health and physical growth.Most of the people who lives in the urban area not much have enough space to grow up in a healthy environment.Having a good healthy body requires adequate food, healthy working conditions, decent housing, efficient sanitation, protected and well-preserved environment, the possibility of leisure, etc. But most of the time in Brazil health care problems happen for the lack of this opportunities. But there is also some major progress from our government that they are providing most advanced and technical services to fight with some dangerous disease such as AIDS, Cancer, Diabetes, Flu and recently the zika virus.
In the last decades, the health sector has undergone impressive transformations in important demographic, epidemiological, nutritional and technological aspects. There is also an exhibition on these changes that directly interfere with the health of the population. For this revolutionary changes, Brazil govt established an organization which maintaining the Brazil health issue since 1988 named The Unified Health System (Portuguese: Sistema Único de Saúde, SUS)
The Unified Health System (SUS) provides a new health care from the conception that does not understand health only as the absence of disease, but part of the understanding and quality of life. The Federal Constitution of 1988 is the starting point for the creation of this SUS, in which one of its articles states that health is the right of everyone and the duty of the State. In the SUS, health actions integrate a regionalized and hierarchical network according to the complexity of care, based on the principles of universality, integrity, and equity. This system proposes a profound change in the model of planning, organizing and managing health actions and services. The principle of wholeness is based on the understanding that people have the right to be met in all their needs, And that health services must be organized in such a way as to offer all the actions required by such integral care. In this way, the SUS must develop actions on the environment and the person destined to the promotion, protection, and recovery of health, as well as to rehabilitation.
Concern about public health in Brazil
According to the content presented and the authors studied (Brazil, 2010, 2011a, 2011b, 2011c, 2011d, 2011f, 2011g; Carvalho, 2001; IBGE, 2007, 2009a, 2009c; Machado, 2011; Paim, Travassos, Almeida, Bahia & Macinko, 2011) it is possible to focus on 5 health issues currently: chronic noncommunicable diseases (cardiovascular diseases, hypertension, diabetes, cancers, chronic kidney diseases and others); Communicable diseases (Acquired Immunodeficiency Syndrome (AIDS), tuberculosis, leprosy, influenza or influenza, dengue and others); Modifiable behavioral risk factors (smoking, dyslipidemia due to excessive intake of saturated fats of animal origin, obesity, insufficient intake of fruits and vegetables, physical inactivity and sedentary lifestyle); Chemical dependence and increasing and widespread use of licit and illicit drugs (alcohol, crack, oxy and others); External causes (accidents and violence).
Noncommunicable Diseases (NCDs)
When we talk about DNT, we have them that represent a serious Brazil health care problems, both in rich countries and in the middle and low-income countries. Estimates from WHO (World Health Organization, 2006) show that NCDs account for 58.5% of worldwide deaths and 45.9% of diseases affecting populations. In 2005, around 35 million people worldwide died of chronic diseases, which is double the number of deaths related to infectious diseases (WHO, 2006). In 2007, NCDs accounted for approximately 67.3% of the causes of death in Brazil and accounted for approximately 75% of health care expenditures. Cardiovascular diseases corresponded to the main causes, with 29.4% of all reported deaths (Machado, 2011).
And according to the Ministry of Health, it is estimated that hypertension reaches 23.3% of Brazilians or 44.7 million people. Of this amount, only 33 million are aware of their self-reported diagnosis or diagnosis. Only 19% have the pressure under control among those who are on treatment. Regarding gender, hypertension affects more women (25.5%) than men (20.7%). The diagnosis of arterial hypertension becomes more common with advancing age, reaching around 50% of people over 55 years old (Machado, 2011).
Regarding diabetes, estimates point to 11 million people, and only 7.5 million are aware that they are carriers and not all are adequately treated. In 2008, according to the IARC (International Agency for Research on Cancer) and WHO (INCA, 2008), there were 12 million new cases of cancer worldwide, with 7 million deaths due to this reason. In Brazil, for the year 2011, estimates point to the occurrence of 489,270 new cases of cancer. The most incidental types, excluding skin cancer, non-melanoma (113 thousand new cases), should be, in men, prostate cancer (52 thousand), lung (18 thousand), stomach (14 thousand), colon and rectum (13 thousand), and in women, breast cancer (49 thousand), cervix (18 thousand), colon and rectum (15 thousand), lung (10 thousand). Data from the Ministry of Health indicate that since 2003, malignant neoplasias constitute the second cause of death in the population. In 2007, they accounted for about 17% of deaths from known causes in the country (INCA, 2008).
Data from the Brazilian Acquired Immunodeficiency Syndrome (AIDS) in Brazil, already reported, provided by the Ministry of Health, identified 592,914 cases registered since 1980. The extent of the epidemic remains stable. The incidence rate is around 20 AIDS cases per 100,000 inhabitants. In 2009, 38,538 new cases of the disease were reported, and in 87.5% of this amount, transmission occurred through heterosexual channels.
There are still more cases of the disease among men than among women today, but this difference has been decreasing over the years. The age range between 30 and 49 years is the one with the highest incidence of AIDS in both genders. What has awakened the attention is the age group of 13 to 19 years, in which the number of AIDS cases is higher among women. In 1989, the ratio was about 6 cases of AIDS in males for every 1 case of females. In 2009, it reached 1.6 cases in men for every 1 in women.
According to data from the AIDS Epidemiological Bulletin, there is a trend of a decrease in the incidence of cases in children under five years of age. Considering the period between 1999 and 2009, the reduction reached 44.4%. The result confirms the effectiveness of the policy of reducing mother-to-child HIV transmission and other prevention measures, such as expanding the HIV / AIDS diagnosis, as people who know their serology can be treated To prevent new infections.
We have that between 2008 and 2010; Brazil managed to reduce from 73,673 to 70,601 the number of new cases of tuberculosis, which represents about 3 thousand fewer cases in the period. With the decrease, the case rate (the number of patients per 100 thousand inhabitants) decreased from 38.82 to 37.99, but tuberculosis is still the third cause of deaths due to infectious diseases and the first among patients with AIDS. These are positive numbers, but they still prove to be tuberculosis one of the main public health problems in Brazil, requiring efforts to accelerate the decline of its occurrence.
As the United Nations Office on Drugs and Crime (UNODC, 2008) mentioned in a World Drug Report that about 5 percent of the world’s population (208 million people) have ever used drugs at least once. This survey shows that Brazil is the second largest cocaine market in the Americas, with about 870,000 adult users (ages 15-64), behind only the United States that has about 6 million drug users.
Only in South America is Brazil responsible for the largest quantity of marijuana seized, 167 tons in 2008. The consumption of marijuana and hashish in Brazil increased two and a half times: in 2001, 1% of Brazilians consumed drugs. In 2005, the number reached 2.6% of the population. According to the Ministry of Health, a crack can take the lives of at least 25,000 young people a year in Brazil. It is estimated that more than 1.2 million people are using crack cocaine in the country and around 600,000 people use drugs frequently, and the average age of onset is 13 years.
Recently, there is news that indicates the rapid spread of a new devastating drug, already seized in all regions of the country. It is oxy, a cheaper drug and of even more damaging consequences for users than the fearsome crack. Oxy is produced by the mixture of cocaine, fuel, virgin lime, cement, acetone, sulfuric acid, caustic soda, and ammonia. The Ministry of Health indicates that about one-third (33%) of oxy-users die in the first year. Chemical dependence, especially crack cocaine, has taken thousands of young people to prisons, which commit petty offenses such as shoplifting to buy drugs. In this sense, we believe in alternatives to imprisonment, such as therapeutic justice.
One of the serious problems of Brazilian public health is dependence on alcohol. According to research from the Brazilian Center for Information on Psychotropic Drugs (CEBRID, 2010), currently, 18% of the adult population consume excess alcohol, as opposed to 16.2% in 2006. The male population is still the majority of those who drink In excess (26.8% in 2010), but it was among the women that the most significant increase in the use of the alcoholic beverage occurred. In this group, the rate went from 8.2% in 2006 to 10.6% in 2010, according to data from CEBRID (2010).
In this way, alcohol consumption and abuse are increasing in all sectors of society, regardless of color, race, religion, financial condition of users, both in large urban centers and in the most remote rural areas. The use of alcohol, as well as causing serious and irreversible damage to various organs of the body, is also related to about 60% of traffic accidents and 70% of violent deaths (Almeida, Dias, Souza, Cordeiro & Chaves, 2004; Almeida & Roazzi, in press).
With almost 3,000 delegates, the 14th National Health Conference was held in 2011, the result of a participatory process, which should increasingly consolidate itself as a body that formulates principles and guidelines for public policies in Brazil (Angelucci & Verona, 2012 ). Among the discussions, we highlight the denunciation of the small scope of the substitutive network in mental health, the inadequacy of care for people with mental disorders, whether these are due to abusive use of alcohol and other drugs or not. Users, professionals and health managers also reaffirmed their agreement with SUS principles and with psychiatric reform in Brazil.
In December 2011, the Federal Government launched a plan to combat crack cocaine, which provides that therapeutic communities and other private institutions are part of the SUS, contrary to what was decided at the aforementioned Conference and contrary to Law no. 10,216 / 01, on the Psychiatric Reform in Brazil, since it retakes the logic of isolation of the individual and establishes the risk of banalization of the practice of compulsory hospitalization.
Successful experiences of lines of care committed to the principles of anti-asylum and guaranteeing human rights have consolidated the proposals for care in Health and Social Care, according to the SUS and the Unified Social Assistance System (SUAS). The ineffectiveness of a set of policies that has not even had the possibility of effectiveness can not be affirmed. These policies have been built in the last 40 years, from principles essential to democracy such as social participation, diversity, autonomy and community insertion (Angelucci & Verona, 2012). The replacement network is not fully deployed. And let us not be naive by adhering to the financial argument, the financial decision, necessarily, is political. The health budget has not been sufficiently committed to the implementation of the substitute network.
We should repudiate arguments such as, “users are not in a position to think about their lives,” or “asylum treatment is more effective” and “compulsory hospitalization aims at social welfare.” Internment is the last of the measures after the exhaustion of many lines of care, already foreseen and recognized worldwide and, in Brazil, by Law no. 10.216 / 01, which deals with Psychiatric Reform. The effective care of users is not done without equipment such as street clinics, Psychosocial Care Center (CAPS), therapeutic residences, beds in general hospitals, Reference Center for Social Assistance (CRAS) and Specialized Referral Center for Social Assistance (CREAs ). With the current Plan, we are not taking care enough; we are promoting hygienist, punitive and, therefore, Antidemocratic. And this is not the state we want to build.
Current data from the public health system
We can understand as public health a set of discourses, practices, and knowledge that aim at the best possible health status of populations; it refers to the health of the community. The concepts applied today are distinct, and the target and field of public health practice depend on a number of factors, such as the conception of the role of the state in the economic and social fields and the conception of individual and collective responsibilities for Health and the intervening factors in the health-disease process.
It is important to emphasize that the health-disease process of a community is due to several social, political, economic, environmental and biological aspects. Emphasis is placed on the social determinants: urbanization; And increasing industrialization, as well as the conditions of housing, basic sanitation, nutrition and food, schooling, recreation and leisure, access to health services for labor, employment, and income.
In the scientific literature, one of the most frequently mentioned concepts in the field of health is the one enunciated in 1920 by Winslow (1920), in which he says that Public Health is the science and art of avoiding disease, prolonging life and promoting Physical and mental health, and efficiency through organized efforts of the community, aiming at environmental sanitation, control of community infections, education of the individual in the principles of personal hygiene, organization of medical and nursing services for diagnosis And treatment of the disease and the development of social mechanisms that will ensure each person in the community the standard of living adequate for maintaining health, organizing these benefits in such a way that each is in a position to enjoy their natural right to health And longevity. Stand out,
In 2002, the Pan American Health Organization (PAHO) stated that “Public health is the organized effort of society, especially through its public institutions, to improve, promote, protect and restore the health of the population through Of collective actions .” This definition shows the magnitude of public health action, involving health promotion, specific disease prevention, as well as measures and services to restore, care for, treat and rehabilitate people due to diseases and Your health.
Ensuring for the population the rights and resources provided for in the Federal Constitution (Brazil, 1988) on Social Security (Social Assistance, Social Security, and Health) is one of the main social challenges today. Contrary to what the Constitution provides, it is the families that spend the most healthily. Figures from IBGE (2007) show that health spending accounted for 8.4% of the country’s Gross Domestic Product (GDP) in 2007. Of the total, 58.4% (or 128.9 billion Reais) were spent By families, while 41.6% (93.4 billion reais) was paid by the public sector. Non-profit institutions spent 2.3 billion reais.
According to IBGE (2007), in rich countries, 70% of health spending is covered by the government and only 30% by households. For specialists in the area of Public Health, total health spending in 2009 was R $ 270 billion (8.5% of GDP), of which R $ 127 billion (47% of resources or 4% of GDP) Public Resources and R $ 143 billion (53% of resources or 4.5% of GDP) of private resources (Carvalho, 2011).
In 2011, the budget of the Union for Health, according to the Ministry of Health, was R $ 68.8 billion (Budget 2011, Law No. 12,381, 09/02/2011). Of this total, only R $ 12 billion was invested in basic health care, through programs of the Ministry of Health, for example, in the ESF (Family Health Strategy), through fund transfers to the PAB (Basic Care Floor ). In 2010, 9.9 billion were spent (Carvalho, 2011). In this account, the own resources invested by States and Municipalities are not included.
In 2010, Brazil estimated its population with more than 192 million inhabitants and 5,565 municipalities (IBGE, 2011). However, several municipalities, mainly in the North, Northeast, and Midwest, do not have health professionals for basic care, and in hundreds of them, there is no medical professional for the daily care of the population.
According to data from the IBGE (2009c), a survey referring to, MAS reveals that of the almost 432 thousand hospital beds in the country, 52 thousand public assistance units – MAS (Medical Health Care), 95% 152.8 thousand (35.4%) belonged to public hospitals and 279.1 thousand (64.6%) to private and philanthropic hospitals.
Advances in the Unified Health System
The Ministry of Health estimates that the Family Health Program currently reaches 100 million Brazilians. The country has reduced child mortality by more than 70% in the last 30 years; Increased the number of prenatal visits; Decreased malnutrition; Has achieved one of the largest vaccination coverage for children, pregnant women and the elderly in the world. According to the Ministry of Health, cholera transmission was discontinued in 2005. Childhood paralysis and measles in 2007 and rubella in 2009 were eliminated. Deaths from communicable diseases such as tuberculosis, leprosy, malaria and AIDS, Were reduced.
When it comes to the emergency and emergencies sector, SAMU (Mobile Emergency Care Service) emerged, which currently serves more than half of the Brazilian population, considerably reducing the demand for care in emergency and emergency care units and ensuring care Pre-hospital with quality.
The Popular Pharmacy program was also set up, offering medicines with up to 90% discount, and since March 2011, the population has been able to
purchase various drugs for the treatment of hypertension and diabetes free of charge.
Surveys carried out by the Institute of Applied Economic Research (IPEA) and establishing the System of Indicators of Social Perception (SIP) indicated, in 2010, the level of satisfaction among SUS users. When mentioning the perception of the interviewees, the survey indicated that the care provided by the Family Health Team (80.7% of the answers) and the free distribution of medications (69.6%) are the best-evaluated services. The main positive point of the SUS, according to the perception of the interviewees, is free access to the health services provided by the system (52.7%), followed by universal care (48.0%) and free distribution of medicines ( 32.8%).
The achievements of SUS in 2010, based on data from DATASUS, revealed that 535 million prevention and promotion actions were carried out, 634 million medicines were made available; 495 million examinations were carried out; There were 239 million oral health visits; 40 million physical therapies were done; 11.1 million hospitalizations occurred. Every year, there are 3.5 million orthotics and prosthetics and more than 20,000 transplants.
We also have the results of the 1998 Ibope Research, commissioned by the National Council of State Secretaries of Health (CONASS) and the National Health Foundation (FNS), recent evaluations by the Ministry of Health and Health Secretariats show that despite problems in the quality of care, more than half of the people served by SUS were satisfied. Negative responses are related to waiting time in queues, anxiety, or tension to be attended to. It is a known problem of the difficulty of access to health services, reception, and care in the appropriate time.
Challenges of the Unified Health System
In the short, medium and long term, the SUS has several challenges, mainly because it needs more resources and optimization of the use of public money. Currently, twice as many resources are invested in the disease (hospitalizations, surgeries, transplants) as in basic health actions (vaccines and consultations) that prevent the disease. According to IPEA (Brazil, 2011g), the most frequent problems are the lack of doctors (58.1%), the delay in attendance at health centers or hospitals (35.4%) and the delay in obtaining a Consultation with specialists (33.8%). In fact, these are chronic public health problems in Brazil, due, in large part, to a logic that experts define as immediate and “hospital-centric.” It should replace a system that prioritizes primary care, early diagnosis and prevention work.
Continuing with the IPEA survey (Brazil, 2011g), the improvements most suggested by the interviewees were: increase in the number of physicians and reduction of waiting time. Based on reports, disclosures in the media and situations experienced by SUS users, some opportunities for improvement and some general challenges to improve the provision of SUS services are listed below. Access:
- Lack of recognition and appreciation of basic care, disarticulation of its programs between itself and with society.
- Overcrowding of emergency and emergency units (ready-to-use).
- Precarious access with long queues for appointment appointments, procedures (such as surgeries) and examinations.
- Lack of hospital beds and unequal distribution across regions of the country, as well as the lack of ICU beds.
- Insufficient pharmaceutical assistance to the population.
- Lack of adequate humanization and reception in health facilities.
- Disregard for mental health, even in the face of the indiscriminate increase of chemical dependents in the country, especially in the youngest population.
- A tendency towards judicialization in health, provoking excessive and ordinary demands to the judiciary and the public prosecutor.
We now see that the right to health is being transformed into ‘business’ in a market! There needs to be the empowerment of the poor in terms of claiming (citizenship) and doing something concrete and enforcing the basic right to health, and other rights such as education, housing, and security. This right is guaranteed in the constitutions of many countries (social control of the State by civil society), but it is still far from becoming a reality for the populations of most countries of Latin America and the Caribbean. The change, which we all expect and are seeking, will not happen from the top down, but from awareness and education to citizenship and social control.
In this way, health councils are an important mechanism for popular participation in the deliberation, monitoring, and monitoring of public health policies. Articulated between the three spheres of government, they are composed of representatives of entities and social movements of users, as well as workers, managers and service providers. It is up to the councils to approve the health budget and monitor its implementation. It is the responsibility of the national council to approve the National Health Plan (PNS) every four years.
It is also important to emphasize that in the field of health we must deepen and put into practice the so-called ‘bioethics of the 4 Ps’: health promotion; prevention of diseases; Protection of vulnerable prey easy to manipulate; Precaution against biotechnological development. This means protecting the population against the potential risks of morally unacceptable harm, whether they pose a threat to human health or life threatened with serious and irreversible harm, unjust to present and future generations. Public responsibility for health drives us to act and also to reflect that society, based on values of justice, equity and solidarity among human beings, must not accept the avoidable, avoidable and inequitable injustices of social inequalities, especially in the context of Cheers.