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Ciro Gomes and Public Health in Brazil

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Health in Brazil

Most Brazilians believe that giving access to a public health system is a duty of the state. However, this conception is relatively new in the country. Up to 1988, access to health divided citizens into three groups: those who could pay for private services, those with a formal contract of employment and the right to public health (INAMPS), and, in a third group, 80 % of the population that did not have any right to a public health system. The Constitution of 1988 made health a "right of all" and a "duty of the State".

In order to try to guarantee this right, inspired by the NHS, the British public health system, the SUS was created, the Unified Health System, one of the largest public health systems in the world. In theory, the SUS guarantees universal and equal access, from outpatient visits to organ transplants. Its resources come from the budgets of the Union, states and municipalities. The system consists of health posts, public hospitals, laboratories, blood banks, sanitary, epidemiological and environmental surveillance services, foundations and research institutes (such as FIOCRUZ and Vital Brazil).

The chronic lack of resources of the health system

The implantation of SUS was an immense advance for Brazil and a unique achievement in the world. It brought the number of beneficiaries by the State of 30 million (in 1987) to the current 190 million. According to the   Ministry of Health , 80% of Brazilians depend exclusively on SUS for access to health care. The SUS has 6,1 thousand accredited hospitals, 45 thousand primary care units and 30,3 thousand Family Health Teams. The system performs annually 2,8 billion ambulatory procedures, 19 thousand transplants (world record), 236 thousand cardiac surgeries, 9,7 million chemotherapy and radiotherapy procedures and 11 million hospitalizations. These are gigantic achievements, especially considering the chronic underfinancing of the system. But these numbers are still not enough.

There is a mass-mediated discourse that the state would not offer a return on services for the taxes it charges. But the reality is that the return of SUS to the resources it receives is unparalleled in any country in the world. It is clear that European public systems are better. But it is because they receive on average four times more state resources than the SUS. What SUS does in Brazil with what it receives, is incredible.
In 2017, for example, the budget provides for the allocation of 107 billion reais to the system, which is 3% of the union's budget. According to the   CFM   in 2014, union, states and municipalities spent together U $ 604 per Brazilian in health. For comparison terms, the Finnish state spent $ 5 per capita on health in the year of 2009, on the OECD average. This value simply corresponds to four times more than the Brazilian per capita with health. The Brazilian State is responsible for only 48,2% of the total that Brazil spends on health, while in the United Kingdom, whose NHS is inspired by SUS, the state's share of health spending is 83,5%.
We can not demand health services with quality European standards when we have a lower per capita income, a lower tax burden, and a lower proportion of state investment in health than the European countries cited. As long as we spend 22% of our budget on debt interest, it will be difficult to change this.

Diagnosing public health problems

There are other structural problems that hit Brazilian health in full. The country imports almost all the fine chemicals used in the manufacture of our medicines, making the treatments immensely expensive. Although we have a number of doctors correlated to that of some more developed countries, here the power of the medical corporation monopolizes all minimum health procedures through laws and regulations. At the same time, there is a great demand for professionals of the category and, as the proportion of doctors among the population does not increase, the remunerations of these professionals are nowadays disproportionate in comparison to other professions and the average level of income of our society. The autonomy of medical faculties, even federal and state, to determine the type of training offered makes many specialties (such as general practice, anesthesia, pediatrics, and ICU physicians) suffer from a chronic lack in the country.

With the current Federal Government in 2016, this situation only tends to worsen. The government approved a constitutional amendment limiting the growth of health, education and security spending for twenty years to the inflation index. In practice, this decision will reduce resources for public health per capita, as resources will be frozen but the population will continue to grow.

In 2017, some states (in fiscal disequilibrium) have already begun to emerge from professional layoffs and wage delays in the health sector. The service structures, already modest and living from the selflessness of their best professionals, begin to succumb. The reflection of the current dismantling of Brazilian health is dramatic. This is not a result of the lack of resources of the State, but of the determination of the current government to destroy the SUS, making it poorly seen by the population, scrapped by the lack of resources and then facilitating their eventual extinction.

Curing public health

The dramatic scenario described above imposes some actions of resistance, because when talking about access to health we are talking here of guarantee of survival, health or disease, a universal human right and families that can be devastated, with negative impacts also on productivity average of the Brazilian worker.
It is not possible to think of improving the Brazilian public health without increasing the resources for its financing, and we can not increase these resources without repealing the constitutional amendment of the ceiling of expenses. Revocation of this crime against health is a priority.

Another necessary action is the computerization of the system, the medical register, the appointment of consultations, the evaluation of the service to release the purchase of medicines. A telephone screening service such as the NHS would also help to streamline care. It is also necessary to increase the training of physicians in basic care specialties, particularly through public universities, ensuring the expansion of proven family health programs.

Finally, we need to guarantee the growth in Brazil of a health-care industrial complex that will manufacture a substantially larger share of the medicines and fine chemicals that are nowadays imported, reducing the costs of drugs and treatments.

Cyrus and health

Ciro Gomes knows the problems of Brazilian health in depth. Not only was he mayor of the capital, governor and minister of the farm, as he was recently secretary of state of health in Ceará. It has been the most vocal opponent of the PEC "of the ceiling of expenses" is in favor of the revocation of this amendment. He has publicly defended the orientation of public power in his own medical courses to promote the training of professionals in the specialties where we lack, since the professionals of this humanitarian work need to be more sensitized to the needs of the Brazilian population in relation to health. Ciro manifests wide awareness and knowledge of the problems of the sector that have been described here and does not appear in the national scenario another political leadership with these characteristics.


Policy of Ciro Gomes

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At 0 years old. And re-elected on 1986.


Governor of Ceará

Won UN award for reducing child mortality.



Mayor of Fortaleza

And was considered best mayor of Brazil.


Minister of Finance of Itamar Franco

Helped in the Real Plan. One of the lowest inflation in history.

The first candidacy for the Presidency

Number of Votes: 7.426.190 - 10,97


Minister of National Integration of Lula

Responsible for the transposition of the São Francisco River.


Secretary of Health of Ceará

He was then Director of Transnordestina S / A.


The second candidacy for the Presidency

Number of Votes: 10.170.882 - 11,97


Deputy Federal Ceará

With the highest proportional votes in the history of Brazil.



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