Debates on Contexts, Policies, and Challenges in Health Systems between the Global and the Latin American. The Case of Brazil’s Unified Health System.

Abstract

Discussing health policies implies acknowledging shifts in modes of thought in each historical period, in order to clearly differentiate approaches, redefine what we understand by health and how it should be cared for, reconsider traditional models, and make way for more effectively inclusive approaches. These policies—like others—face a dual tension: the global, marked by increasing life expectancy, technological advances, new treatments, but also by the environmental crisis and the threat of pandemics; and, in parallel, for peripheral regions, including our subcontinent, structural inequality, political instability, and the fragmentation of health systems.
In this scenario, reforms have been grounded in diverse theoretical frameworks and carried out through a complex interaction between universalist proposals of varying degrees, with different combinations of the public sector, the private sector, and civil society, all within competing political projects in heterogeneous economic contexts that in practice generated a wide array of processes, experiences, and outcomes.
This paper analyzes the changes in the conception of the State and health institutions on a global and Latin American scale and examines a specific case: Brazil’s Unified Health System (SUS). The discussion is framed within the dispute between the radical neo-institutionalist (NI) approach—often labeled “neoliberalism”—and an intermediate interpretation between it and the previous Welfare State paradigm (referred to here as balanced neo-institutionalism), as well as the emergence in Latin America of the Collective Health perspective, from which SUS is said to have drawn certain concepts.