“We Are Facing The Threat Of A Social And Health Catastrophe” – Brazil Health Expert


By Fabíola Ortiz

For Brazilian pediatrician and public health expert Paulo Buss, the worst enemy of health is unemployment. And if unemployment continues to rise, the result will be a global “catastrophe”, he told Tierramérica in this exclusive interview.

Buss, coordinator of international relations at the state-run Oswaldo Cruz Foundation (Fiocruz), believes that “the global economic crisis, caused by the financial meltdown in the industrialized countries, is deepening inequalities between and within countries.”

The main reason is “unemployment, one of the leading social causes of poor health,” Buss told Tierramérica in an interview conducted during the WHO (World Health Organization) World Conference on Social Determinants of Health, which took place in Rio de Janeiro Oct. 19-21.

“We will be facing a social catastrophe if we don’t take care to protect employment in order to maintain a decent quality of life for everyone,” warned Buss.

The conference, attended by representatives of more than 100 countries, was organized with the support of Fiocruz and the Brazilian government. It served as a platform for dialogue on the recommendations made in the final report of the WHO Commission on Social Determinants of Health, created in 2005.

In the report, published in 2008, the Commission put forward three overarching recommendations: improve daily living conditions; tackle the inequitable distribution of power, money and resources; and measure and understand the problem and assess the impact of action.

TIERRAMÉRICA: What are the social determinants of health, the subject of the WHO conference?

PAULO BUSS: The conference was organized on the basis of an important report published in 2008, which alerted the global community to the absurdity of the inequalities in health, which are unjustified and preventable.

Infant mortality in Sweden, for example, is less than three deaths for every thousand live births, in Brazil it is 15, and in some countries in Africa it is over 100, in other words, 10 percent of the children born do not survive.

It is the same with life expectancy. In Sweden and Japan people live more than 80 years, in Brazil 72, and in Mozambique and Angola, less than 50 years.

There are global, national and local disparities, between countries and within countries. The conference gathered national and local experiences to combat these inequalities and address the social determinants of health, such as income distribution, educational levels, and access to resources and general public services: water, sanitation and waste collection. These are avoidable and preventable inequalities.

The conference sought to identify initiatives, policies, mechanisms and tools that countries, municipalities and communities are using to achieve more equitable results. Health is the result of social equity.

TIERRAMÉRICA: Brazil presented its successful experiences…

PB: Brazil presented many experiences, like the Bolsa Familia program (which provides an income for poor families, conditional on school attendance and health-care checkups for the children). It has been demonstrated that there has been a notable improvement in the health of beneficiary families. Infant mortality has decreased, and life expectancy has risen.

Another example is that of communities who have improved their access to clean water, sewage systems and waste collection, three dimensions of public services.

Brazil has achieved significant reductions in inequalities and improvements in health indicators, which is why it was chosen by WHO to host the world conference.

TIERRAMÉRICA: Could the Unified Health System (SUS) be considered an example of progress?

PB: Brazil began the universalization of free immunization 35 years ago and achieved an impressive impact. We did away with chicken pox, measles and polio, and drastically reduced tetanus, whooping cough and influenza. The SUS provides vaccinations for all, as well as treatment for HIV/AIDS, malaria and all infectious diseases.

But we still have a lot of inequalities in the system. Among woman who have no formal education, only 25 percent have had a mammogram for early detection of breast cancer. Among women with 15 years of schooling, over 65 percent have been tested.

TIERRAMÉRICA: What is the aim of the final declaration of the conference? Is it a binding agreement?

PB: It is called the Rio Political Declaration on Social Determinants of Health and it contains a series of elements of a political nature.

We want to demonstrate that the global economic crisis, caused by the financial meltdown in the industrialized countries, is deepening inequalities between and within countries, primarily because of unemployment, which is one of the leading social causes of poor health.

We want to call on governments, academics and civil society to assume responsibility. We will be facing a social catastrophe if we don’t take care to protect employment in order to maintain a decent quality of life for everyone.

TIERRAMÉRICA: Does it involve concrete proposals?

PB: It involves respecting the policies of different sectors. We are going to collaborate so that governments create integrated action plans in the public sector. Brazil is a model for countercyclical policies and for having created the economic conditions for the maintenance of a dynamic domestic market that has fostered more effective redistribution of income.

The declaration will be the basis of a major platform for dialogue and the sharing of successful experiences. That means the conference gives continuity to the work that began in 2005 and has not ended. The idea is to plan for a new assessment, before 2015, of what has been done and the extent to which national plans have been fulfilled.


Tierramérica is a joint project of the United Nations Environment Programme (UNEP), the United Nations Development Programme (UNDP) and The World Bank (WB), with IPS serving as the executive agency.

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