Health is a human right and a duty of the state. In these few words, the Brazilian Constitution of 1988 fundamentally changed the public health system in Brazil. This constitutional right led to the creation of the Unified Health System (Sistema Único de Saúde - SUS), which directly or indirectly serves 200 million Brazilians. However, obtaining the universal right to health was only possible due to decades of struggle and social movements that allowed the reform of the health system in the country.
In the 1900s and before, public health in Brazil consisted mainly of epidemic control, and it was carried out in an almost military fashion. The authoritarianism in these health campaigns, combined with the unfamiliarity of the population with prophylactic methods (such as vaccines), led to riots and social movements. Such events took place in the Vaccine Revolt in 1904, a period of riots in Rio de Janeiro caused by a compulsory smallpox vaccination campaign. Only in the 1920s would there be some efforts to create a system for health security, even if exclusionary and restrictive.
In 1920, and in some degree until the 1980s, the model for social protection in Brazil was associated with the position that a person held in the labor market. A law called Elói Chaves created the Funds of Retirement and Pensions (Caixas de Aposentadorias e pensões – CAP), organized by employers and employees operating in a system of capitalization. This was a first attempt to provide health insurance and retirement for the working class. However, the overall structure was fragile because of the reduced number of contributors and the CAP was restricted to some companies, leaving most of the working population without coverage.
The social protection system expanded during the Government of President Getúlio Dornelles Vargas (1930-1945). The CAP gave place to Institutes of Retirement and Pensions (Institutos de Aposentadorias e Pensões - IAPs). Instead of providing services for associated companies, each IAP provided different levels of coverage based on occupational categories. This allowed more people to have access to the benefits. However, the population was still not involved in the decision process and the system had large bureaucracies. An unemployed or casual employed individual had inadequate access to medical services, being dependent on philanthropic or out-of-pocket private care. According to Paim et al., “[t]he social protection system was fragmented and unequal”.
It was only in 1955, with the election of President Juscelino Kubitschek, that the social protection system adopted a more inclusive approach, with many populist projects. The President intensified the industrialization process and had an optimistic view of the future, with his motto “50 years in 5”. Indeed, there was great economic growth at that time, and his populism improved the life of the lower classes.
After the Second World War, with the discovery of antibiotics, insecticides and many...