The challenges in rebuilding a quality public health in Brazil
Authors: Cenedesi Júnior Mario Angelo , Rodrigues Dirce Pacheco Vitório , Merege Maria Cecília , Schwarz Fernanda Santos , Gomes Glaucia Sá Brandão Freitas , Vasconcelos Jocilane Lima de Almeida , Melo Juciane Lima do Nascimento , De Amorim Keylla Tais , da Silva Kenya Costa Rodrigues , Araújo Maria Aparecida de Almeida , Platon Neliane de Souza , De Moraes Regina Gabriela Caldas , Pinto Paulo Rogério Ferreira , Martins Samuel Ribeiro , Malta Arlete do Monte Massela 
Published: February 2024

In recent years, Brazil has grappled with a denialist approach to its healthcare system, the Unified Health System (SUS), especially during the COVID-19 pandemic. Influential figures, including public personalities, have cast doubt on science, leading to widespread uncertainty. Despite the challenges, Brazil boasts a strong National Immunization Plan (PNI) that has served as a global reference. The country faces the demographic transition, with an aging population requiring healthcare adaptation. Addressing chronic diseases becomes paramount, as does managing the economic implications of an older workforce supporting retirees. Inequalities in access to quality public healthcare persist due to socioeconomic disparities, a divided healthcare system, geographic disparities, ethnic and racial inequalities, education and cultural factors, and long wait times in the public healthcare system. Environmental issues, like deforestation, wildfires, climate change, water pollution, pesticide use, industrial pollution, and food security, impact public health. Sustainable policies and awareness are crucial. Health research in Brazil thrives in universities, institutions, and through international collaboration. Clinical research, epidemiology, public health research, and tropical medicine research are prevalent, but funding challenges and research misconduct persist. Combating infodemia and fake news is essential to ensure that public health decisions are based on reliable information. Fact-checking organizations, healthcare professionals, and education play a vital role. Expanding vaccination coverage is critical to protect against infectious diseases. Brazil employs campaigns, vaccination centers, home visits, school vaccination, partnerships, effective communication, vaccination records, education, and prioritizing high-risk groups. Strengthening the First Level of Health Care through the Family Health Strategy, coverage expansion, professional qualification, electronic health records, prevention programs, management strategies, specialized care, service integration, and community participation can improve healthcare access and coordination. Health education in Brazil focuses on health promotion, disease prevention, child and family health, sexual education, community engagement, school education, information accessibility, and trust in public health policies. The growth of health technology in Brazil can enhance care quality, access, resource management, disease prevention, cost savings, and innovation. However, ethical considerations, equitable access, and data privacy are vital. A democratic environment in public health promotes community participation, accountability, equity, evidence-based decision-making, individual and collective rights, anti-corruption efforts, conflict resolution, and long-term policy planning. SUS funding faces challenges of insufficient resources, budget predictability, dependence on unstable funding sources, regional inequalities, healthcare professional shortages, underfunding of complex services, lack of prevention investment, corruption, and an aging population. Addressing these challenges is vital to maintain SUS as an equitable and effective healthcare system. In conclusion, addressing these healthcare challenges and opportunities is crucial for Brazil's future. It requires ongoing investment in public policies, a multidisciplinary approach, and active community participation. Strengthening primary healthcare and combating misinformation are essential steps toward a healthier and more equitable Brazil.