Health Inequalities: A Challenge for the Brazilian Unified Health System (SUS)
Abstract
Health inequalities represent one of the greatest challenges for public health systems worldwide, especially in countries with significant socioeconomic heterogeneity such as Brazil. These inequalities are evident in access to, quality of, and outcomes from health services, reflecting the profound social, economic, and cultural disparities that impact population health. In the context of the Brazilian Unified Health System (SUS), which is based on the principles of universality and equity, addressing these disparities is crucial to ensuring social justice and the right to health. This academic essay is based on an integrative literature review of scientific studies, official documents, and institutional reports to critically analyze the challenges and strategies for tackling health inequalities in Brazil. Emphasis is placed on the role of social determinants of health, the importance of primary care—especially through the Family Health Strategy—and the need for intersectoral policies, adequate funding, racial equity, social participation, professional training, and technological innovation. The conclusion reinforces the need for continuous efforts to ensure equitable and dignified health care for all Brazilians.
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Copyright © ISRG Publishers. All rights Reserved. DOI: 10.5281/zenodo.17528570 94 ISRG PUBLISHERS Abbreviated Key Title: ISRG J Arts Humanit Soc Sci ISSN: 2583-7672 (Online) Journal homepage: https://isrgpublishers.com/isrgjahss Volume– III Issue -VI (November - December) 2025 Frequency: Bimonthly Health Inequalities: A Challenge for the Brazilian Unified Health System (SUS) Mario Angelo Cenedesi Júnior1*, Grazielli Meneses Brito2, Keylla Taís de Amorim3, Henrique Wendling Sava4, Wagner de Aguiar Raupp5, Sebastiana Pessoa Palmeira6, Cristiane de Castro Barcelos7, Sandra Letícia Souza Soares Junqueira8, Cléria Rodrigues Ferreira9, Thaita Thaisi Zago10, Sérgio Raimundo Ernesto Machado11 Universidad de Ciencias Empresariales y Sociales, Argentina | Received: 24.06.2025 | Accepted: 30.06.2025 | Published: 05.11.2025 *Corresponding author: Mario Angelo Cenedesi Júnior Associate Professor at Universidad de Ciencias Empresariales y Sociales, Argentina Introduction Health inequalities represent one of the greatest challenges for public health systems worldwide, especially in countries with significant socioeconomic heterogeneity such as Brazil. These inequalities manifest in access to, quality of, and outcomes from health services, reflecting the profound social, economic, and cultural differences that affect population health (Paim et al., 2011). In the context of the Unified Health System (SUS), which is founded on the principles of universality and equity, addressing these disparities is crucial to ensuring social justice and the right to health. Health inequalities are determined by multiple social factors, known as social determinants of health, which influence the distribution of risks and living conditions among the population. These factors range from educational level and income to place of Abstract Health inequalities represent one of the greatest challenges for public health systems worldwide, especially in countries with significant socioeconomic heterogeneity such as Brazil. These inequalities are evident in access to, quality of, and outcomes from health services, reflecting the profound social, economic, and cultural disparities that impact population health. In the context of the Brazilian Unified Health System (SUS), which is based on the principles of universality and equity, addressing these disparities is crucial to ensuring social justice and the right to health. This academic essay is based on an integrative literature review of scientific studies, official documents, and institutional reports to critically analyze the challenges and strategies for tackling health inequalities in Brazil. Emphasis is placed on the role of social determinants of health, the importance of primary care—especially through the Family Health Strategy—and the need for intersectoral policies, adequate funding, racial equity, social participation, professional training, and technological innovation. The conclusion reinforces the need for continuous efforts to ensure equitable and dignified health care for all Brazilians. Keywords: health inequalities, social determinants, equity, Unified Health System, primary care.
Copyright © ISRG Publishers. All rights Reserved. DOI: 10.5281/zenodo.17528570 95 residence, race, and gender, creating a complex scenario in which the most vulnerable accumulate greater risks and worse health outcomes (Marmot, 2005). Understanding these dynamics is essential for formulating effective public policies within SUS. The challenge of reducing health inequalities in Brazil involves not only strengthening primary care but also fostering intersectoral integration and promoting equity at all stages of care. Despite significant advances, SUS still faces structural and operational obstacles that hinder the full achievement of equity (Victora et al., 2011). Thus, the discussion on health inequalities is central to the development of a fairer and more efficient health system. Methodology This academic essay is based on an integrative review of scientific literature on health inequalities and the role of SUS in their reduction. Scientific articles published in national and international journals, official documents, and institutional reports from recognized organizations were selected to provide a critical and upto-date analysis that supports the debate on challenges and strategies to address health inequalities in Brazil. Development Equity in health is a fundamental principle of SUS and implies offering differentiated care according to the specific needs of each population group, aiming to reduce existing disparities (Paim et al., 2011). This requires policies that consider the social, economic, and cultural specificities that impact access to and quality of care. The social determinants of health play a central role in explaining inequalities. Marmot (2005) highlights that conditions such as poverty, low education, precarious housing, and racial discrimination directly translate into worse health conditions, creating a vicious cycle that perpetuates disparities. Studies indicate that primary health care, especially through the Family Health Strategy, is one of SUS’s main tools for promoting equity. Macinko, Harris, and Rocha (2017) show that the expansion of primary care is associated with improvements in the health of the most vulnerable populations and the reduction of inequalities in indicators such as infant mortality and avoidable hospitalizations. However, inadequate funding and poor resource distribution are barriers to the universalization and qualification of SUS, worsening territorial and regional disparities (Buss & Pellegrini Filho, 2007). Poorer regions face difficulties in ensuring infrastructure and qualified professionals, which negatively impacts service quality. In addition, racial inequality in access to and quality of care is a persistent problem in Brazil. Studies show that Black and Indigenous populations face greater vulnerability and less access to specialized health services, reflecting historical and structural inequalities (Cruz et al., 2019). Intersectorality is a recognized strategy to address health inequalities by integrating actions across health, education, social assistance, housing, and employment. This approach allows for more effective interventions in social determinants and improves living conditions for vulnerable populations (Solar & Irwin, 2010). The implementation of evidence-based health policies and continuous monitoring is essential to identify high-risk groups and efficiently allocate resources and interventions to promote equity (Victora et al., 2011). Social participation, guaranteed in SUS legislation, is another essential aspect for tackling inequalities. Health councils and conferences enable social control and the inclusion of community demands, strengthening democracy and social justice within the system (Santos et al., 2018). Training and valuing health professionals with a focus on equity culture are indispensable to ensure care that is sensitive to users’ differences and specific needs (Fleury, 2012). Another challenge is addressing urban-rural disparities, which result in differences in access to health services. The concentration of resources in urban areas and the difficulty of care in remote regions undermine the right to health for rural residents (Campos, 2014). The incorporation of technology and innovation in SUS can help overcome some geographic and social barriers, expanding access to specialized care and promoting continuity of care (Pinto & Araujo, 2020). Finally, strengthening health surveillance is crucial to identify emerging inequalities and ensure rapid and effective responses. Integrating socioeconomic and epidemiological data is a powerful tool for equitable planning (Oliveira et al., 2017). Conclusion Health inequalities are a persistent and multifaceted challenge for SUS, requiring continuous efforts to fully implement the principles of universality and equity. Overcoming these inequalities demands integrated policies, adequate funding, professional training, and broad social participation. Overcoming these obstacles is essential to ensure that SUS fulfills its role in promoting social justice and providing dignified and accessible health care for the entire Brazilian population, regardless of their social status, race, or place of residence. References 1. Buss, P. M., & Pellegrini Filho, A. (2007). A saúde e seus determinantes sociais. Ciência & Saúde Coletiva, 12(1), 1-7. https://doi.org/10.1590/S141381232007000100002 2. Campos, G. W. S. (2014). Saúde rural e suas especificidades. 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