SUS: a revolutionary reform



Author introduction to newly released book

This book was written for anyone who wants to know a little more about the Unified Health System (SUS) and understand why we need a universal health system in Brazil. It is aimed at anyone who is interested in the subject, from health professionals of any level of training, health advisers, undergraduate and graduate students, public policy managers, health secretaries, public authorities and political leaders to familiarized specialists. with dozens of topics related to health, public health and everyday problems derived from the audacity of creating and maintaining, in a country like Brazil, a public health system with the mission of ensuring the right to health for more than 212 million people .

This is a scientifically rigorous work in terms of fidelity to facts, data and sources, but it is not a strictly academic book, whose text is understandable only to initiates. Rather, it was written with the intention of being accessible to readers with different backgrounds. I hope that each reader can extract, from each of its twenty chapters, meanings and conclusions according to their own knowledge on the topics covered.

The contents can be consulted separately, by chapter, as with a manual. But I recommend that the first reading be sequential, as there is a common thread in the book that takes the reader through the text and that marks the originality of the work. This is not, therefore, just another book about the SUS, but it contains my vision of it.

At various times, since the SUS was created on that Tuesday, May 17, 1988, interlocutors have asked me about different aspects of the SUS or related to it. Something like “Why does health have to be a right guaranteed by the State? Isn't it better that everyone has a health plan and leave the State out of it?” or “Where did this idea of ​​creating a public health system in Brazil come from?” or, even, “What do you think of the SUS? Not academically, but practically? Do you really believe, for real, that SUS is viable?”.

I never stopped answering each of these people, but what perplexed me – and still does – is that, sometimes, these questions came and do come from well-informed people, who, I supposed, would understand what the SUS means and could even give good answers to the questions they asked me. However, with each experience of this type, the desire to write a book about the SUS increased in me. But writing it in colloquial language, as someone who informally talks about the different subjects related to the SUS. I never thought, I never wanted to write an academic treatise, full of quotations and with hermetic language. It is possible, I believe, to deal with apparently dry and specialist topics in an accessible but rigorous way, so that anyone can understand them. For this reason, I have deliberately avoided inserting tables, graphs, charts, photographs and illustrations in the text. Just the words remain, enough, in my opinion, to understand the value of our universal health system, its achievements, weaknesses, strengths and the challenges it faces every day.

It was from this perspective that I wrote this book, at the invitation of Autêntica publishing house, which came from Professor Ricardo Musse, my colleague at the University of São Paulo (USP) who generously guided the development of this work. I take the opportunity to convey to my audience my deep gratitude to him.

But I also wanted to serve the most demanding reader, who will find here many theoretical foundations and conceptual aspects that are in the jargon of public health professionals and the SUS and that, although widely used, are not always well understood by everyone - including by many who use them. I also present some clashes between science and common sense arising from explanations based on common sense about health and public health, showing the reader the scientific foundations underlying many decisions in this area, but which are not always accepted by people, as they contradict this sense. common.

It is likely that, for many people, a population approach rather than a high-risk approach to deciding where and how to invest public resources is not coherent. Often, the conflict between universalizing or targeting public health interventions is resolved by choosing to focus actions on high-risk individuals and groups. But this can aggravate, instead of solving, the situation that is intended to be solved. Many people, including health professionals, find it difficult to understand how and why this happens, as they are unaware of the fundamentals of some health paradoxes, such as prophylaxis, prevention and reverse care.

Others ask me, also very frequently, about the difference between basic care and primary health care, or between public health and collective health, assistance and health care, health needs and health needs, isolation and quarantine, management, health management and governance, municipalization and “prefecture” of health. What is a public health problem and how to choose public health priorities? What do the abbreviations INAMPS, CONASP, AIS, SUDS mean? There are also those who consider the SUS a revolutionary experience and are disappointed when they hear or read the expression “health reform”. What would you say about the expression “social control”? Know that there are, in the Brazilian context, different connotations for it.

What would Hippocrates say about a shaman? What were the Vaccine Revolt and the Manguinhos Massacre? How did Cortés and Pizarro use not only gunpowder and sword, but what we now call biological warfare to face and defeat the Aztecs and Incas? Between Iaras and Sacis, Anhanguera made rivers burn in flames in search of emeralds, but what did he and Borba Gato leave in the sertões for the natives besides villages and syphilis? What does the Chinese revolution have to do with the Brazilian program of community health workers? What are hygienism and campaigning? Why, forty years later, is the Declaration of Astana-2018, of the World Health Organization (WHO), a step backwards when compared to the Declaration of Alma-Ata-1978? Why wouldn't Fidel Castro and Barack Obama get along if they were invited to give their opinion on the SUS? What do capitalism and democracy have to do with health and SUS? Why is the SUS symbol hidden in SUS health units, hospitals and ambulances? What do you know about the SUS symbol? Why do the so-called “health plans” not concern plans or, much less, health?

The reader will find in this book not the “correct explanation” of these, among other topics, but my view of them. It is for this reason that this is not just another book about the SUS, when there are so many of good quality in our midst. I invite the reader to follow me through the following pages to learn about this vision – which is mine, but as I am not alone, it is also the vision of many about our SUS, this revolutionary reform that we are undertaking in this part of the world in defense of of life.

*Paulo Capel Narvai is senior professor of Public Health at USP.


Paulo Capel Narvai. SUS: a revolutionary reform – to defend life. Belo Horizonte, Autêntica, 2022, 270 pages. []

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