In the final paper, Series guru Professor Cesar G Victora (Universidade Federal de Pelotas, Brazil) and colleagues summarise the progress made and the challenges ahead. Improvements in the social determinants of health—such as wealth, access to healthcare, and reduced inequality —have been the main drivers of improvements in health status and life expectancy. The approach taken by Brazil—that of creating a national health service—is unique in Latin America.
The authors say: "Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction...as does the presence of a strong private health insurance sector."
They issue a call to action* that stresses the coordinated action by the government, private sector, academics, health workers, and civil society as a whole that will be required for Brazil to continue improving on the progress already made, and address the concerns covered by the first five papers.
The authors conclude: "The challenge is ultimately political, requiring continuous engagement by Brazilian society as a whole to secure the right to health for all Brazilian people."
Professor Cesar G Victora, Universidade Federal de Pelotas, Brazil. In USA until May 6 so contact by e-mail only until then, from May 6 can be contacted by phone also. T) +55 53 9982 6676 E) cvictora@gmail.com
Journal
The Lancet