Inflation and Healthcare in Brazil: Reflections of The Making and Unmaking of Brazilian Democracy
The latter 20th century was a turbulent period in Brazil. During the early sixties, political polarization led to a military coup, which installed a Military Dictatorship that would rule the country for over twenty years. Starting in the mid-eighties, the democratization process was equally, if not more, troubling and traumatizing. Instability was the word for Brazil’s institutions, economy, and citizens. My research developed amid this cycle of Brazilian history. Guided by professor Melissa Teixeira, I approached two main subjects: inflation and its effects on the country in the late 1960s; and the political movement that led to the creation of SUS, Brazil’s Universal Healthcare System.
Regarding inflation, my objective was to analyze, compile, and produce reports on primary – newspapers and official economic policy documents – and secondary – articles and books ranging from the 1970s until 2012 – sources. Ultimately, my task was trying to understand and logically organize the ways in which inflation – or the anxiety towards it – affected politics, the economy, and the average Brazilian. Newspapers, such as the Correio da Manhã and the Correio Braziliense, provided great insight on the action-reaction pattern between inflation, public opinion, and the political atmosphere. Policy reports and secondary sources informed on macroeconomic theory and policy around inflation, indexation, trade, and monetization.
Secondly, I moved my efforts towards understanding the context surrounding the late 1980s, during the democratization process and the writing of Brazil’s new Constitution. In a smaller scope, I was tasked with trying to understand how – and why – Universal Healthcare came to be one of the building blocks of the new Brazilian State. Academic productions on this process are still somewhat incomplete and out of focus, which, once again, led me to primary sources. Newspapers were my main sources for understanding how Health was discussed in the Constitutional Assembly and how it came to have the necessary political spotlight for a massive reform. However, the most important information on SUS came from interviews I conducted with five physicians that led part of discussion, the movement, and the construction of Universal Healthcare in Brazil.
The connection between these two subjects provide us with a loyal representation of greater scope: the unmaking and making of Brazilian democratic institutions. Each one led me to important conclusions. First, the fear – and reality – of “galloping” inflation had deep structural effects, not only on the ascension of the Military Dictatorship, but also on the rebuilding of Brazilian Democracy. Lastly, the creation of SUS demonstrates the changes in Brazilian society, the political rebirth of the power of the masses, and the rights and liberties now protected by the Brazilian Constitution.
Comments
This is an awesome project!…
This is an awesome project! I am curious if this project shed light on the country's current experiences with inflation, and am also curious if Brazil's Universal Healthcare has waned or degraded in quality since the 80s, and in particular, since the rise of a new kind of Right in Brazil that is less interested in social programs.
Reply: "This is an awesome project!"
Thank you Nancy, I really appreciate your curiosity!
Let's tackle the two points you brought up:
- As I said in the video, Brazil suffered with high inflation rates for most of the 20th century. However, in 1994, a new stabilization plan - the "Plano Real" - created a new currency and changed some aspects of Brazilian monetary policy. This plan finally solved what had haunted every Brazilian Government since the 1940s. Thus, we have not experienced annual rates much higher than 10% since the mid 90s. This year, most predictions say that our annual inflation rate is going to stay below 10%. As of the Jan/2020-Aug/2020 interval, we experienced a 2.44% inflation rate.
- As of Healthcare: Since Brazil is a huge country, different regions have very different realities regarding the quality and reach of our Universal Healthcare System. Generally speaking, there is still a lot to improve when it comes to infrastructure, equipment, decent pay for physicians and nurses, and capacity to reach the farthest villages and rural areas. With that being said, SUS is a system that does work well and that is present all over the country. It took years to organize, build, and institutionalize this colossal Universal System, which is one of the biggest in the world. With all of the official data I had access to, I can affirm that, in general, the quality of SUS is not waning, but in fact it is slowly getting better as a whole.
Lastly, Bolsonaro's Government is far from perfect. I do not agree with many of his beliefs and policies. However, I can say - both as a Brazilian citizen and as researcher of Brazilian History and Politics - that his Government has not directly acted to weaken or dismantle SUS or any other Social Policy Program that was already in place, at least when it comes to Federal and Institutionalized national policies.
If you wish to have a longer chat and dive into some of this subjects, stop by my virtual Zoom meeting on Sunday, at 6pm EST.
Have a good one!
Hi Rodrigo, This was really…
Hi Rodrigo,
This was really informative - I am relatively new to the global public health field so this gave me a lot to think about. I was wondering if there were any specific tangible places where you think the SUS could be improved on. I was also hoping to get your opinion on where the SUS lies with regard to other policies (present or anticipated) from Bolsonaro's government.
Reply: "Hi Rodrigo, This was really"
Hi Ashna! Thank you for your message, I am glad I could be a good source of info for you, it means a lot.
I will try to answer your questions with some brief overviews:
- There's a lot that could be improved on SUS, but I will cite 2 points that I think are key.
First, the remuneration for qualified staff (physicians, nurses, etc) needs to be more competitive and at least a bit closer to what the private health job market pays. Why do I say that? Well, some people say that there is a lack of doctors in Brazil to account for SUS' demands. That is a fallacy. Brazil has more Med Schools than the US and more than enough professionals for public demand. The problem is that there is a "concentration" of doctors and nurses in Brazil's biggest cities and private initiative, leaving a substancial amount of the population that lives far from the developed urban centers with the few doctors that are left.
Secondly (and this is part of the solution for the first issue), public administrators need to manage their budget in more efficient ways and, furthermore, we need to adapt our legislation to impose harsher punishment for those involved in corruption scandals and money laundering. Brazil does not need to allocate more money towards Healthcare, we need to manage it properly. According to the OECD, Brazil spends more on health (as a % of GDP) than the average of its members.
- As of your second question, SUS is (thankfully) an institutionalized and well-developed part of the Brazilian State as a whole. Its existence is guaranteed by our Constitution and a wide range of additional laws. That means that there is a strong legal web to support and maintain SUS. Thus, no administration can succeed in abolishing Universal Healthcare in Brazil. Additionally, no administration would be able to significantly defund SUS, because the % of the Federal, State, and Municipal budgets that must be spent in the maintenance of SUS is also guaranteed by law. With that in mind, the Bolsonaro Government did not focus any of its policies or reforms (some of which I think were needed) on aspects related to SUS. With that being said, I think that Bolsonaro could - and should - have developed a national and organized response to the pandemic. He should have used the managerial powers of the Health Ministry to develop clearer guidelines, instructions, and product chains through SUS and its infrastructure.
I hope I was able to answer some of your thoughts and, if you have any more questions, please let me know!
Hello Rodrigo, Very…
Hello Rodrigo,
Very interesting research indeed. I just had a quick question regarding SUS. Based on your research, do you think SUS is properly equipped to deal with the pandemic or what policies could be implemented to account for the healthcare problem going on in Brazil at the moment?