Report suggests increase in tobacco and alcohol taxation – 06/24/2023 – Health

Short-term vision in health planning, high turnover of leadership positions, great fragmentation of system management and little coordination between the public and private sectors are some of the factors that have generated inefficiency in SUS management and accentuated health inequalities.

At the same time, the system suffers from the loss of funding caused by fiscal austerity policies, with increased spending on parliamentary amendments, and with the growth of lawsuits that negatively affect planning and budget allocation in the SUS.

These are some of the findings of a report released last Wednesday (21), at the UK embassy in Brasília, which raised strengths and weaknesses of the Brazilian public system to assess sustainability and resilience during the Covid-19 pandemic and made 42 policy recommendations that can be implemented.

Among them is the progressive increase in financial resources applied to the SUS, from 4% to 6% of GDP in ten years, and additional taxation on products harmful to health, such as tobacco, alcohol and sugar. The report was presented to the Ministry of Health and to the councils that represent state and municipal health managers.

The work is part of an initiative present in more than 30 countries, the result of a collaboration between the London School of Economics, the World Economic Forum, the World Health Organization Foundation, and the companies AstraZeneca, Phillips and KPMG.

In Brazil, the first country in Latin America to join the project, the study was conducted by researchers from FGV-Saúde, involved analysis of more than one hundred documents and discussions with more than 20 specialists, including academics, government representatives, regulatory agencies and organizations public and private.

According to Adriano Massuda, FGV professor and main author of the study, the SUS is in a position to become more sustainable and resilient if it succeeds in strengthening governance, improving financing, allocating resources in areas of greatest need, strengthening primary care and integration with the other levels of the system, and create a network of responses to urgencies and emergencies.

For him, lessons learned in the pandemic need to be systematized and incorporated into the system. “The country hasn’t done that yet, and this study is an opportunity to do just that. How was the response to the pandemic? What went well and what didn’t?”

Massuda says that, although the population is tired of the Covid issue, the new public health emergencies are a real threat and need to be faced. “It is essential that the country has a convergent agenda. And for that you need to have governments and civil society together.”

For José Gomes Temporão, former Minister of Health and who also participated in the preparation of the document, many of the complaints related to assistance are not limited to the lack of funding from the SUS and can be faced.

“Today the patient is lost in the network. He does not know how long it will take to have an exam, be referred to a specialist or surgery. There is no transparency. This involves a management model, training, availability of specialists. “

According to him, all these challenges inserted in a context of population aging, increase of chronic diseases, sedentary lifestyle, inadequate diet, among others, will bring even more severe impacts to the SUS.

“Caring for health does not depend only on the Ministry of Health. If you don’t look at the social determinants, the results will always be fragmented.”

Massuda recalls that, although the current management of the Ministry of Health is still focused on rebuilding programs that were dismantled during the administration of Jair Bolsonaro (PL), such as Mais Médicos, and other public administration tasks, some issues are urgent.

He highlights, for example, an agenda to identify and deal with the dammed demands in the pandemic, especially those related to cancer and cardiovascular diseases, and a mobilization to recover the high rates of vaccination coverage.

“There has to be engagement by the President of the Republic, governors, mayors and civil society mobilization so that there is engagement and we resume 95% vaccination coverage. This cannot wait.”

During the event, several speeches highlighted the importance of public-private partnerships, such as those that emerged during the pandemic. “They show the potential for cross-sector collaboration to increase the resilience of the health system,” said Alistair McGuire, head of health economics and policy departments at the London School of Economics.

For Olavo Corrêa, director general of AstraZeneca Brasil, partnerships can address several points brought up in the report. “More than developing life-changing drugs, the healthcare industry has been working to seek a healthcare system that is more sustainable and resilient.”

Patricia Frossard, from Philips Brasil, highlighted the need for collaborative and people-centered approaches and the use of data to improve services.

See the report’s key recommendations in seven areas:

Governance – Integrate available health information and databases from different sources, public and private, to strengthen the resilience of the health system through permanent monitoring of a wide range of threats to public health.

Financing – Establish a progressive increase in financial resources applied to the SUS, from 4% to 6% of GDP in 10 years, aiming to give greater sustainability to the system, including considering additional taxation on products harmful to health (for example, tobacco, alcohol, sugar, etc. )

Workforce – Articulate health and education policies to align technical training, graduation, residency and post-graduation according to the needs of the health system; develop digital health skills across the health workforce and expand digital technology.

Medicines and technology – Strengthen health technology and productive development policies to ensure universal access and greater competitiveness of local production, reducing external dependence and the high trade balance deficit in high-cost products.

Provision of health services – Prioritize primary health care as the main source of access to comprehensive care, involving prevention, diagnosis, treatment and palliative care in the SUS, in addition to its integration with other levels of care, including emergency and mental health services.

Population Health and social determinants – Improve regulation of business practices that affect health, including tobacco and alcohol; strengthen intersectoral actions to address policies that influence health, such as transport, housing, urban planning, environment and education

Environmental sustainability – Foster the participation of the health sector in environmental agendas, including strategies to strengthen the SUS in the Amazon region, with local communities playing a leading role; Study strategies and commit to the transition to green energy sources in the SUS.