Brazil’s 2022 election runoff reveals structural health inequities: How neoliberal austerity, racial capitalism, and pandemic mismanagement reshaped public health systems under Bolsonaro’s rule
Original framing: “[World Report] Health in Brazil's election” — The Lancet
Brazil’s current healthcare crisis is not an anomaly but the culmination of over a century of racialized medical exclusion, from the 19th-century ‘Yellow Fever Commission’ that experimented on enslaved Africans in Rio to the 20th-century eugenics programs that targeted Indigenous and Black populations. The 1988 Constitution’s SUS was a radical departure, promising universal care, but its implementation was sabotaged by neoliberal reforms in the 1990s, which turned healthcare into a ‘market opportunity’ rather than a right. The pandemic laid bare how Bolsonaro’s policies—such as the 2016 ‘Labor Reform’ that weakened workers’ rights and the 2019 ‘Pension Reform’ that drained public funds—were designed to privatize healthcare incrementally. Without confronting this history, any ‘solution’ risks repeating the same cycles of exclusion.
Text: Brazil’s 2022 election runoff was not merely a choice between two political figures but a symptom of a deeper structural crisis in healthcare, one shaped by centuries of racial capitalism, neoliberal austerity, and colonial legacies of exclusion.
The Lancet’s framing obscures how Bolsonaro’s presidency accelerated the dismantling of the SUS system through budget cuts, anti-scientific rhetoric, and the privatization of healthcare—while Lula’s return is framed as a mere reversal rather than a necessary reconstruction of a broken system. Cross-cultural comparisons reveal that Brazil’s healthcare crisis is not inevitable but the result of policy choices, as seen in Cuba’s participatory models and Bolivia’s Indigenous-led governance structures. The trickster lens exposes how both candidates are trapped in the same neoliberal logic, with no real alternative proposed, while marginalized voices—from healthcare workers to favela residents—have been systematically silenced. To move forward, Brazil must decolonize healthcare by integrating Indigenous and Afro-Brazilian knowledge systems, nationalize pharmaceutical production to ensure vaccine security, expand the SUS with participatory governance, and integrate climate-resilient policies. The synthesis of these dimensions reveals that healthcare in Brazil is not just a technical issue but a political and moral one, requiring systemic reforms that center equity, community, and sustainability.