ELIANA CLAUDIA RIBEIRO
LUIZ ANTONIO SANTINI
The largest country in Latin America and fourth in territorial area in the world, Brazil has an estimated population of 147.5 million. It consists of 26 states and a federal district and is divided into five macro-regions (North, Northeast, Midwest, Southeast, and South) that vary in social, economic, cultural and climatic features.
With diversified industrial production and, until recently, one of the major economies in the world, the country faces the contradictions of an economic development model that generates and perpetuates social inequalities. An increased concentration of income in the 1980s was associated with a higher poverty rate. Marked differences also persist among the country's different macro-regions with respect to standards of development.
A significant increase in the urban population, primarily because of migration, has occurred during the last three decades. Urbanization, along with modernization and industrialization, intensified during this period and was associated with a rapid drop in birthrate, a reduction in population growth (today estimated at less than 2 percent), and an increase in the percentage of elderly in the general population. Brazil's health status reflects the heterogeneity of the country's epidemiological profile, with disease and death rates (e.g., heart disease, cancer, and diabetes) typical of developed countries coexisting with a high incidence of infectious and parasitic diseases typical of developing countries. This complex situation reveals the diversity and dimension of the problems faced by the health care system.
The organization of the Brazilian health care system could be described, until the mid-1980s, as too centralized, having too many uncoordinated service institutions at federal, state and county levels, with priority placed on hospital care and an unequal provision of, and access to, care for different social groups. The