Artikkelit

Health in Brazil - Growth in higher education and scientific production and advocacy in the global discussion, Eliana Tarnaala and Johanna Kivimäki

20.11.2024

Health in Brazil - Growth in higher education and scientific production and advocacy in the global discussion, Eliana Tarnaala and Johanna Kivimäki

Brazil’s healthcare sector is among the largest in the world. Since decades, Brazil has adopted policies to achieve universal health coverage, yet continuously tackling significant challenges around inequality, quality and sustainability. Enhancing health equality and equity has been high on Brazil´s global health agenda as well, where the country has also highlighted the importance of the nexus between climate and the One Health approach. Brazil has world-renowned higher education and research institutes in the area of health, and the country’s scientific production in medicine and health has doubled its global share in the last two decades.

Brazil’s public healthcare system is the largest in the world. Brazil’s current constitution, adopted in 1988, established the Unified Health System, SUS (Sistema Único de Saúde), which is meant to grant access to health services to the entire population of the country. The SUS is financed by taxes and the services offered by the system are free of charge. The SUS operates under a decentralized governance, with participation by all government levels from the federal to municipal governments. 

The SUS serves around 72% of the population and it has been important in reducing health inequalities, increasing access to healthcare services and improved healthcare in the country. In the last decades, Brazil has indeed improved most of the general population health indicators and reduced health inequalities. From 2000 to 2019, life expectancy at birth has increased by 5,7%, infant mortality rate has decreased by 60% and maternal mortality has decreased by 13% over the same period. However, mobilizing sufficient financing for the universal health coverage of SUS has been a persistent challenge. The extent to which services are covered and the level of financing have varied in time, and the inefficiencies of the health system continue to raise dissatisfaction. 

There is lack of personnel in the Brazilian health system. However, Brazil’s nursing workforce has increased over the past decade (8 nurses/1000 population in 2019), moving closer to the OECD average (9.1/1000). Like Finland, Brazil faces challenges to cope with future long-term needs in the context of an ageing population. For Brazil, modernizing the primary healthcare sector, upgrading the health data infrastructure to leverage digital transformation, improving efficiency and sustainability of financing, and addressing major population risk factors, such as obesity and harmful alcohol consumption, are key. There is a need to build a sustainable system for the future, able to also face major health emergencies like COVID-19. 

In terms of digitalization, Brazil has been adopting a good number of measures to allow the integration of technology more intensively in healthcare. One of the most relevant initiatives is the Brazilian National Digital Health Strategy (RNDS), a plan to be implemented for the period 2020-2028, aiming to establish a network that will connect data from public and private entities involved in healthcare.

Brazil’s healthcare market is the largest in Latin America and among the largest in the whole world. In 2019, Brazil spent on health care 9.6% of GDP, more than the OECD average (8.8%). Nevertheless, 60% of this expenditure is private and some of the world’s best private hospitals are indeed located in São Paulo, including The Albert Einstein Israelite Hospital and the Syrian-Lebanese Hospital. Brazil’s health spending is expected to increase to 12.5% of GDP by 2040, based on technological and demographic trends, rising incomes and productivity in the health sector. In 2015, Brazil passed a law allowing foreign companies to provide health services in the country, sparking great interest in foreign partners and increasing inflows of foreign investment in health into the country. 

Brazilian higher education and health research 

The number of medical schools has been growing significantly in Brazil, driven mainly by the opening of private institutions. In 2020, there were 345 medical schools, offering more than 35 000 training positions. Brazilian scientific output in the health sector has doubled its share of the global scientific output in the last two decades. For instance, between 2015-2020, 15.5% of the scientific articles in parasitology and 14.3% in tropical medicine have at least one author linked to a Brazilian Institution. In dentistry, Brazil accounts for approx. 10 % of the global scientific production and Brazilian authors participate in 12.9% of all indexed scientific articles. (Web of Science.)

Brazil has some world–renowned higher education and research institutes in the health sector. Especially the universities from the state of São Paulo stand out. In 2024, the University of São Paulo (USP) was ranked the 44th best university in the world in life sciences and medicine, including various subject areas, such as nursing, medicine, dentistry, pharmacology, etc. In dentistry, in addition to USP also other Brazilian universities are in the global top 50, including the State University of Campinas (Unicamp), the State University of São Paulo (UNESP) and the Federal University of Rio Grande do Sul (UFRGS). According to the national evaluation of the postgraduate programmes in Brazil, the best nursing schools can be found in the different campuses of the University of São Paulo (USP) and the Federal University of Ceará, and most of the best clinical medicine programmes are also in USP, the Federal University of São Paulo (UNIFESP) and Unicamp.

In the area of public health, the Oswaldo Cruz Foundation (FIOCRUZ), under the Brazilian Ministry of Health, is a highly recognized public and strategic institution in Brazil, and the most prominent institution of science and technology in health in Latin America. FIOCRUZ produces and shares scientific knowledge and technologies, aimed at strengthening the Unified Health System (SUS) and formulating and improving public health policies in Brazil and worldwide. FIOCRUZ is installed in 10 states in Brazil and has an office also in Maputo, Mozambique. Their 16 scientific and technical units focus on teaching, research, innovation, assistance, technological development and extension. FIOCRUZ has wide international partnerships around the globe. 
Under the Brazilian Ministry of Health, there are also other National Health Institutes that offer training and post graduate programmes and produce research, including the National Cancer Institute (INCA), National Institute of Traumatology and Orthopedy (INTO) and National Institute of Cardiology (INC). Other important national institutes in the sector include the National Institute of Technology and Health (INTS) and the Brazilian Biosciences national Laboratory (LNBio). LNBio is set in the country’s most significant research infrastructure the Brazilian Center for Research in Energy and Materials, CNPEM. LNBio has four scientific divisions: Immunity and pathogens, integrative biology, facilities and services, and advanced health technologies. All CNPEM research infrastructure and facilities are open access for free for visiting researchers globally. 

Brazil’s role in the global health discussion

The current government of Brazil has been active also in the global health discussion, highlighting especially the need to address the global health inequalities. In July 2024, led by FIOCRUZ, 10 health organizations from the Global South signed the Rio de Janeiro Declaration, a letter in defense of health sovereignty in the innovation and development of diagnostics, vaccines and medicines to face international public health emergencies in the Global South. The signatories of the declaration highlight the disparities in access between the North and the South, emphasizing an alliance for regional and local production, innovation and access. The signatories demand for information sharing, technology transfer and robust investments in research and development. The declaration also stresses that the difficulties faced by countries in the Global South are worsened by the concentration of global health supply chains in countries in the North, preventing access to health supplies such as vaccines, medicines and other consumables.

In addition to tackling global health inequality, the One Health approach has gained importance in Brazil. In August 2024, Brazil launched an Interinstitutional Technical Committee for One Health, including 20 relevant Brazilian institutions with the aim to establish a national plan for One Health, recognizing the connection between human, animal, plant and environmental health. 

Enhancing global health equality and equity, including the local medicine production, as well as the nexus between climate and One Health, have been high on Brazil’s global agenda, debated also by the G20 Health Working Group in Brazil in 2024. With Brazil’s leadership, the G20 Health working group approved a joint declaration highlighting the need for resilient health systems, equity in access, and the importance of addressing long-standing inequalities. The declaration also emphasizes the collaboration between countries to deal with global and local health challenges, including communicable diseases and climate change.

Authors: Eliana Tarnaala, EDUFI-TFK intern and Johanna Kivimäki, TFK Counsellor, Consulate of Finland in São Paulo

Photo: Infographic about structural biology in the wall of the Brazilian Biosciences National Laboratory (LNBio). Johanna Kivimäki.

Sources: 
•    Consulate of Finland, Sao Paulo (2023), The healthcare industry in Brazil – main characteristics and opportunities for Finnish companies. https://finlandabroad.fi/web/bra/ajankohtaista/-/asset_publisher/TV8iYvdcF3tq/content/the-healthcare-industry-in-brazil-main-characteristics-and-opportunities-for-finnish-companies/384951
•    Campos de Carvalho et al. (2021). The evolution of Brazilian Health Sciences and the present situation, The Lancet Regional Health – Americas, Volume 3, 100044 
•    Fundação Oswaldo Cruz (Fiocruz) Fundação Oswaldo Cruz (Fiocruz): Ciência e tecnologia em saúde para a população brasileira 
•    Fundação Oswaldo Cruz (Fiocruz). (30.07.2024). Fiocruz publishes letter in defense of health sovereignty in the Global South  https://portal.fiocruz.br/en/news/2024/07/fiocruz-publishes-letter-defense-health-sovereignty-global-south 
•    G20. (1.11.2024). G20 Health approves ministerial declaration in support of global health and international cooperation. https://www.g20.org/en/news/g20-health-approves-ministerial-declaration-in-support-of-global-health-and-international-cooperation
•    OECD/The World Bank (2020), Health at a Glance: Latin America and the Caribbean 2020, OECD Publishing, Paris, https://doi.org/10.1787/6089164f-en.
•    OECD (2021), OECD Reviews of Health Systems: Brazil 2021, OECD Reviews of Health Systems, OECD Publishing, Paris, https://doi.org/10.1787/146d0dea-en.
•    US department of Commerce, International Trade Administration (2023) Brazil - Country Commercial Guide https://www.trade.gov/country-commercial-guides/brazil-healthcare

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