Six Key Health Concerns for Brazilians
For the first time since the COVID-19 pandemic, healthcare has become the main concern of Brazilians, surpassing problems such as education, crime/violence and poverty/inequality. This is the finding of the What Worries the World? study, released by the Ipsos Institute in April 2024. This rate is undoubtedly linked to the serious dengue epidemic that hit Brazil in the first half of the year. More recently, it may be related to cases of mpox, which had passed 1,000 by September of this year, the threat of the return of diseases such as measles and polio, and respiratory diseases caused by the smoke from the forest fires that swept over 60% of the country in September 2024.
While Brazil is the only country with more than 100 million inhabitants to have a free public health system and the Unified Health System (SUS) is a global benchmark, the sector faces many problems and difficulties, ranging from a lack of technical capacity and resources to meet the enormous demand – today, more than 70% of the Brazilian population relies on SUS – to a lack of investment and management problems.
And it’s not just public health that’s at the top of the list of concerns and considered the main priority of the current Lula administration: patients in the private system are also suffering from consecutive increases in the cost of health plans and, amid the increase in cases of depression and anxiety, mental health has also started to feature.
Below we list some of the main concerns Brazilians have about the national health system:
1. Quality and Quantity of Public Hospitals, Beds and Health Centers
According to a survey by the National Confederation of Industry (CNI), also released in April, Brazilians point to public health as a critical sector. In the survey, more than 20% of respondents consider improving the conditions of the hospitals and healthcare facilities – the Basic Healthcare Units (UBS, in the Brazilian acronym) – of the SUS to be a priority.
A study carried out by the Federal Council of Medicine (CFM), based on the National Registry of Healthcare Facilities (CNES), revealed that between 2010 and 2023, the number of inpatient beds in public hospitals fell from 335,000 to 309,000, a loss of around 25,000.
The UBS suffer from the same problem. Considered the gateway to health care (primary care), many UBS are currently short of medicines and supplies for chronic diseases such as hypertension and diabetes, cascading the problem to secondary and tertiary care. Today, the ratio of health units to inhabitants is insufficient, and many of those available have structural problems. According to a survey carried out by the Institute for Health Policy Studies (IEPS) at the end of 2022, 34% of the population – more than 72 million people – do not have access to basic healthcare.
2. Long Queues for Appointments, Surgeries and Diagnostic Tests in the Public Health System
Waiting for medical care, exams and procedures is another critical problem highlighted by Brazilians in the CNI survey, related to the shortage of professionals, resources and beds. Many patients wait for months, including those who require immediate care or who need constant monitoring.
Even though the Federal Government has launched programs to reduce queues, such as the National Queue Reduction Program (PNRF), which was announced at the beginning of 2023 with a focus on elective surgeries, and the More Access to Specialists program, launched in April 2024, the situation is still critical: in the city of São Paulo alone, the largest in the country, 445,000 people were waiting for care at the beginning of this year.
3. Shortage of Doctors and Nurses
The Federal Council of Medicine estimates that there is 1 doctor for every 470 people in Brazil. While the national average is not unsatisfactory, the distribution of professionals between public and private networks and geographies is uneven, even with initiatives such as the More Doctors program. This problem was also identified as a priority by 20% of respondents to CNI’s survey.
A technical study conducted by the National Confederation of Municipalities (CNM) covering 3,385 Brazilian municipalities in 2023 found that 28.9% of these municipalities suffered from a shortage of primary care professionals. And the situation gets worse outside the state capitals: more than half of professionals (55.1%) are concentrated in major cities, where 23.8% of the population lives. This means that less than half of doctors care for around ¾ of the population.
4. Problems with Access to Mental Health Care
According to the “Global Health Service Monitor 2023” survey carried out by Ipsos, five out of ten Brazilians (52%) believe that mental health is the country’s main problem in terms of the population’s well-being. The problem has worsened since the COVID-19 pandemic: according to the 2024 Global Mind Project study of more than 420,000 people in 70 countries, the mental health of post-pandemic Brazilians is one of the worst in the world. Currently, more than 18 million Brazilians are estimated to suffer from disorders such as anxiety and depression.
In addition to the lack of access to care – according to a 2023 report by the Pan American Health Organization (PAHO), 80% of people diagnosed with anxiety and depression in the Americas have no access to treatment – the sector faces other barriers, such as prejudice and stigmatization, lack of family support and social and workplace support.
5. Consecutive Increases in the Cost of Health Insurance
Although supplementary health care is fundamental to relieving the burden on the public system and generates a greater sense of security for the population that has access to it, the constant increases in the cost of health insurance have been a cause for concern. According to a report by XP Investimentos based on data from the National Supplementary Health Agency (ANS), released in 2024, group health plans increased in cost by over 14% for the third consecutive year, with some plans increasing by more than 20%.
It is worth stressing that of the 50.9 million beneficiaries of supplementary healthcare, 88.6% are in group plans, whether corporate- or membership-based. The maximum annual adjustment for individual and family health plans is 6.91%, according to the limit set by the ANS in April this year.
6. Control of Epidemics such as Dengue, Measles and Mpox
After the peaks of the COVID-19 pandemic, controlled by immunization worldwide, Brazil continues to face other serious epidemics, such as dengue fever, with peaks in the first half of 2024. This disease, which killed over 4,000 people and infected more than 6 million up to June this year, is still in a state of alert, although it is advancing more slowly.
In addition to dengue fever, the country is on the alert for the possibility of new epidemics, including mpox, formerly known as monkeypox. In September, Brazil recorded 791 reported cases and 16 deaths from the disease. Due to the high transmissibility of mpox and the risk it poses to the most vulnerable populations, the World Health Organization (WHO) has issued an outbreak alert for the disease worldwide.
Diseases that had previously been eradicated from Brazil, such as measles and polio, once again require attention. According to data presented in September, during the 26th National Immunization Conference in Recife, at least 4,587 municipalities were classified as being at high risk for measles and 225 were categorized as being at very high risk, totaling 86% of towns and cities across the country with a high risk for the disease. Another 751 were listed as medium risk and only four as low risk. Also at the National Immunization Conference, data on polio was released: 68% of Brazil’s 5,570 municipalities are classified as being at high or very high risk of the disease. This represents a total of 3,781 towns and cities.
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In conclusion, the health landscape in Brazil is facing significant challenges that have emerged as top concerns for the population, particularly following the COVID-19 pandemic. Issues such as the quality and availability of public healthcare facilities, long waiting times for medical services, a shortage of healthcare professionals, and escalating mental health crises underscore the urgent need for reform. Additionally, rising health insurance costs and the resurgence of preventable diseases like dengue, measles, and polio further complicate the situation. Addressing these interconnected concerns will be crucial for the Brazilian government and healthcare system to improve overall health outcomes and ensure equitable access to care for all citizens.
Next Steps
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