Undermining the right to health and social equality: the role of neo-liberalism in Brazil and the UK

The UN Declaration of Human Rights identifies a range of rights which are essential to health. These social determinants of health include access to health care and necessary social services. But these rights are often not realised both in developing countries like the USA and in the emerging nations such as China, India and Brazil. Even where access to free universal health care has been secured, such as in the UK, current policy developments threaten to undermine the position. This paper examines the role of neo-liberal economic and political forces over the past twenty five years in preventing the achievement of the right to health and social services through two case studies. In Brazil, neo-liberal policies have been a barrier to the achievement of universal health and social care despite progress on some fronts. In the specific case of the Brazilian health policy, the twenty-three years following the Federal Constitution (1988) are characterized by ongoing tension between two principles: the construction of universality and cost containment. This conflict is far from resolved. The public health system (SUS) does not have a defined source of funding. It was created without the option to prioritize the public system, because this priority is incompatible with the continuation of incentives for private health care within the present tax system. To guarantee adequate resources to finance a universal public health service, as established in the Constitution of 1998, would require a new “health reform” that would redefine the SUS as the primary agent of health care. In England, but not in other countries in the UK, the principles that have underpinned the national health service (NHS) are under attack and universal comprehensive health care, free at the point of delivery, is becoming a thing of the past. Successive governments led by both major political parties have colluded in substituting a market driven health care system for the previously publicly administered service despite the absence of an electoral mandate. The medical industrial complex has lobbied ministers successfully and the global financial crisis has been used as an excuse for dismantling the NHS. By examining the role of neo-liberalism in these developments and the different forms of opposition in the two countries, this paper will draw conclusions about the impact of neo-liberal policy making on inequalities in health and the implications for social work and social development.