HEALTH POLICIES AND INEQUALITY – SOCIAL DETERMINANTS AND BARRIERS IN ACCESS TO SERVICES OF THE UNIFIED HEALTH SYSTEM (SUS)

Abstract

This article proposes a critical reflection on public health policies in Brazil, considering, above all, the social determinants and inequalities that hinder the population's effective access to the services of the Unified Health System (SUS). Although the SUS represents a civilizational milestone in guaranteeing the right to health as a duty of the State and a right of all, in practice, this access has been marked by profound asymmetries. This is because, in addition to economic conditions, factors such as race/color, territory, gender, and education continue to structure invisible but concrete barriers in the path of the most vulnerable population. In this context, we ask: How do the social determinants of health – notably socioeconomic, racial, territorial, gender and educational inequalities – operate as structural barriers to the Brazilian population's equal access to the public services offered by the Unified Health System (SUS)? For this, the works of McKeown (1980), Starfield (2002), Arouca (2003), Funasa (2004), Paim (2006; 2008; 2009), Merhy (2007), Farmer (2003), Scheper-Hughes (1993), Fassin (2012), Adams (2016), Giovanella (2012), Anderson (2023), Machado, Lima and Baptista (2017), Vilaça Mendes (2011), Freeman (2018), Wilkinson and Marmot (2003), Padula, Anderson and Rodrigues (2022), among others, and official documents from national and international organizations on the object of research. This scientific enterprise is configured as qualitative (Minayo, 2007), descriptive and bibliographic (Gil, 2008) and with analysis from a comprehensive perspective (Weber, 1949). The analysis revealed that access to health care in Brazil remains deeply unequal, even under the normative framework of the SUS. Factors such as institutional racism, poverty, geographic location and low education constitute structural and symbolic barriers to care. Public policies, although they advance in regulations, face operational challenges, such as underfunding and fragmentation of care. The biomedical and homogeneous model still predominates, making subjectivities and diverse social contexts invisible. Therefore, the urgency of intersectoral actions and a management committed to real equity is evident.