Inequitable distribution of health resources in Brazil: an analysis of national priority setting


  • Fabio Ferri-de-Barros The Hospital for Sick Children. PhD student, Institute of Medical Sciences, University of Toronto
  • Andrew W. Howard Departments of Surgery and Health Policy, Management, and Evaluation, University of Toronto
  • Douglas K. Martin Department of Health Policy, Management and Evaluation and the Joint Centre for Bioethics, University of Toronto


The purpose of this paper is to describe the national priority setting process for the public health system in Brazil, evaluating the process using the ethical framework Accountability for Reasonableness, and equity considerations highlighted in the 2008 WHO Commission on Social Determinants of Health. We searched the Brazilian Ministry of Health website for documents that described priority setting within the Brazilian Universal Health Care System (SUS). The National Health Conference (CNS) has been defined by the Ministry of Health as the democratic priority setting forum for SUS. The most recent such conference (13th CNS, 2007) is the subject of this paper. 
Our analysis suggests that the process of priority setting within SUS has not yet achieved the ethical standards of legitimacy and fairness, and that inequitable distribution of decision making power under- represents users in poor areas. The unmet need for hospital care for children in Brazil, which reflects a remarkable inequality of opportunity for human development, may be a product of poor priority setting processes and inequity in representation.


priority setting, public health, inequitable distribution