The Health in the Americas+ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.
Environmental and social determinants of health
In 2000 the total population of Brazil was 175 873 720 inhabitants; by 2023 this figure had risen to 216 422 446, representing a 23.1% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 10.2% of the total population, an increase of 4.7 percentage points compared to the year 2000. In 2023, there were 103.7 women per 100 men and 51.1 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 69.8% of the total population of the country in 2023 (151 029 364 people). When we add these figures to the potentially passive population (43 291 232 under 15 years of age and 22 101 851 over 65 years of age), the result is a dependency ratio of 43.3 potentially passive people per 100 potentially active people. This ratio was 54.7 in 2000.
Life expectancy at birth in 2023 was 76.2 years, lower than the average for the Region of the Americas and 6.4 years higher that in 2000.
Figure 1. Population pyramids of Brazil, years 2000 and 2023
Between 2004 and 2018, the average number of years of schooling in Brazil increased by 33.5%, reaching an average of 8.0 years in the latest year for which information is available. The unemployment rate in 2022 was 9.5%. Disaggregated by sex, the rate was 11.8% for women and 7.6% for men. The literacy rate was 99.4% in 2021. In men, this figure was 99.6%; in women, 99.2%. In 2020, 1.7% of the population was living in poverty, defined as living with an income of less than US$ 1.90 per day; this is below the regional average of 3%.
During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 11.0% (from a score of 0.679 to a score of 0.754); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).
Figure 2. Human Development Index in the Region of the Americas, 2021
In 2020, public expenditure on health accounted for 4.62% of gross domestic product (GDP) (Figure 3) and 10.77% of total public expenditure, while out-of-pocket spending on health accounted for 22.39% of total health expenditure.
Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2020
In 2021, 80.7% of the population had an internet connection, representing a considerable increase from 2000, when 2.9% of the population had an internet connection.
Maternal and child health
Between 2000 and 2020, infant mortality in Brazil decreased from 26.1 to 12.2 deaths per 1000 live births, a decrease of 53.3% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 8.1% to 8.6% between 2002 and 2020, while exclusive breastfeeding in the child population up to 6 months of age increased from 38.6% in 2006 to 79.6% in 2007 (the latest year for which information is available).
Regarding the immunization strategy, measles vaccination coverage was 81.0% in 2022, a decrease of 19.0 percentage points from 2000.
The maternal mortality ratio for 2020 was estimated at 72.1 deaths per 100 000 live births, a reduction of 5.5% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 1.6 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 50.9% decrease, from 86.4 live births per 1000 women aged 15 to 19 years in 2000 to 42.4 in 2023. Between 2000 and 2019 the percentage of pregnant people who had four or more consultations for antenatal care increased from 79.3% to 92.7%. In 2020, 99.0% of births were attended by skilled birth personnel.
Figure 4. Infant mortality per 1000 live births, 1995–2020
Figure 5. Maternal mortality per 100 000 live births, 2000–2020
In 2021, there were 37 new cases of tuberculosis per 100 000 population in Brazil. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 2.2 (1.3 in women and 3.1 in men).
In 2020, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 14.0 per 100 000 population. The age-adjusted mortality rate for HIV was 5.4 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 29.5%. There were two reported cases of human rabies in the country in 2020.
Noncommunicable diseases and risk factors
In Brazil in 2023, the prevalence of tobacco use among people aged 15 and older was 11.7%. In the same age group, the prevalence of overweight and obesity was 56.5% in 2016.
Also in 2019, 47% of the population reported insufficient physical activity.
In 2015, the reported prevalence of arterial hypertension among people aged 18 years or older was 23.3%, a decrease of 5.9 percentage points compared to 2000 (29.2%). The prevalence of diabetes mellitus, which stood at 6.9% in 2000, increased to 8.3% in 2014.
In 2019, the adjusted rate of potentially preventable premature mortality in Brazil was 249 deaths per 100 000 population, a decrease of 29.2% compared to the rate of 351.9 in 2000. This meant that, in 2019, the rate in the country was 9.8% higher than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 149.4 per 100 000 population in 2019, which is 9% higher than the regional average rate; and the rate for treatable causes was 99.6 per 100 000 population, above the regional average of 89.6.
The overall age-adjusted mortality rate was 5.8 per 1000 population in 2019, a decrease of 25.5% compared to 2000 (7.8 deaths per 1000 population).
When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 81.8 per 100 000 population (97.8 per 100 000 in men and 68.5 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 425.2 per 100 000 population (520.1 per 100 000 in men and 350.8 per 100 000 in women). The rate of age-adjusted mortality from external causes was 70.8 per 100 000 population (119.1 per 100 000 in men and 24.1 per 100 000 in women), including road traffic accidents (15.1 per 100 000 population), homicides (31.6 per 100 000 population), and suicides (6.4 per 100 000 population). In 2000, the percentage distribution of causes was 69.1% for noncommunicable diseases, 18% for communicable diseases, and 12.9% for external causes; in 2019, the percentages were 74.7%, 13.7%, and 11.6%, respectively (Figure 6).
Figure 6. Proportional mortality in Brazil, 2000 and 2019
Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 19.1 per 100 000 men; lung cancer, 17.6 per 100 000; and colorectal cancer, 10.8 per 100 000. In women, these values were 15.7 deaths per 100 000 for breast cancer; 12.5 per 100 000 for lung cancer; and 8.7 per 100 000 for colorectal cancer.
The health situation and the COVID-19 pandemic
In Brazil in 2020, there were a total of 7 563 551 cases of COVID-19, representing 35 583.2 per million population. In 2021, there were 14 700 283 identified cases, equivalent to 68 695 per million population. In 2022, there were 13 301 946 identified cases, equivalent to 57 411 per million population. In 2020, there were 195 072 deaths directly caused by COVID-19 in people diagnosed with the disease, or 910.16 per million population; in 2021, 424 262 deaths were reported, or 1979.52 per million. In 2022, 66 316 deaths were identified, representing 66 316 deaths per million population. In 2020, Brazil ranked sixth in the Region of the Americas in terms of the number of deaths from COVID-19, third in 2021, and 24th in 2022, with a cumulative 3198 deaths per million population over the three years (Figure 7).
According to estimates by the World Health Organization, there were a total of 210 810 excess deaths in 2020, or 99 per 100 000 population. A total of 470 455 deaths were estimated in 2021, for an excess mortality rate of 220 per 100 000.
As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 84% of the country's population. As of 2 July 2022 (latest available data), 77.3% of the population had completed the vaccination schedule. The vaccination campaign began on 20 January 2021, and five types of COVID-19 vaccine have been used to date.
Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023
Measures to achieve universal health coverage
The Federal Constitution of 1988 establishes that health is a right of all and a duty of the State. The Unified Health System (SUS) was created along with the Federal Constitution of 1988, and among its guiding principles are universal and comprehensive access to health services, the promotion of equality, decentralization of management, and social participation. Brazil's health system is structured as a system providing universal access for all of the country’s inhabitants.
In this regard, the public authorities have promoted various rules and actions with the aim of enhancing the health and well-being of all inhabitants through the formulation and implementation of public health policies based on the principles of universality, comprehensiveness, and equity. These include:
- Institutional Strategic Planning 2020–2023, Ministry of Health.
- National Health Plan 2020–2023 (PNS 2020–2023).
- 16th National Health Conference (held in Brasilia by the National Health Council in August 2019).
Challenges related to population health
Among the most important challenges that the country still faces is the need to strengthen management of the SUS, in order to ensure access to equitable and quality health goods and services at the federal, state, and municipal levels. Given that the SUS is one of the largest public health systems in the world, the task of managing it is not an easy one. Although in its three decades of existence the SUS has brought about numerous advances in Brazilian society, it still needs to be improved and strengthened.
COVID-19 pandemic response
The COVID-19 pandemic response plan has included a variety of initiatives, most of which are ongoing, such as the National Plan to Operationalize COVID-19 Vaccination, which has recently been extended to a second booster dose for people over 50 years of age and for health workers; influenza and measles vaccination campaigns; implementing a more robust network of laboratories to support the health surveillance system, along with genomic surveillance in the 27 units throughout the country; putting in place actions aimed at strengthening surveillance and care for conditions identified as part of post-COVID-19 syndrome, within the scope of the Ministry of Health; and incorporation of new drugs in the SUS for the treatment of various conditions.
Lastly, it is also extremely important to extend primary health care coverage in areas where access is difficult, as well as, paradoxically, in large urban centers, where public and private health systems coexist. It is also important to strengthen specialized care and logistics to address the challenges posed by the most complex care requirements, and to be positioned to respond to emergencies similar to the one that occurred with the COVID-19 pandemic.
Measures to reduce inequalities in health
In general, and particularly during the COVID-19 pandemic, public policy efforts in this area have been supported by a set of regulations and initiatives, including the following:
- The Federal Constitution of 1988, Article 3, paragraph III, which deals with eradicating poverty and marginalization, and reducing social and regional inequalities.
- Law No. 8080 of 19 September 1990, which regulates the SUS and provides, among other things, the conditions for promotion, protection, and recovery of health, and for the organization and operation of the corresponding health services. Among the guiding principles of the SUS are universality, equity, and comprehensiveness in the area of health.
- PNS 2020–2023 and the Multi-year Plan of the Union 2020–2023 (PPA 2020–2023), two planning instruments for federal public administration policies in the area of health.
- The Bolsa Familia (Family Grant) Program, under the Ministry of Citizenship, aimed at combating poverty and inequality in the country. Created in October 2003, it has three main axes: supplementary income, access to various rights, and linkage with other initiatives aimed at promoting the development of Brazilian families.
- The Auxílio Brasil Program, of 2021, which integrates several public policies on social assistance, health, education, employment, and income. This is defined as a direct and indirect income transfer program aimed at “families in poverty and extreme poverty throughout the country.” In addition to guaranteeing a basic income, the program seeks to “simplify the basket of benefits and promote the emancipation of these families, so that they can achieve autonomy and overcome situations of social vulnerability.”
National strategy to address inequalities in health
The SUS is the main public policy for social inclusion in the country and is one of the main tools for reducing inequality among the country's inhabitants. During efforts to combat COVID-19, it clearly demonstrated the importance of having a free and universal public health system. All indications are that the response to the disease was exemplary, owing mainly to the increase in hospital beds, the creation of a guide to orient health professionals, and improvements to the surveillance system.
Another strategy specific to Brazil is the effort to strengthen participatory governance among states, municipalities, and communities, through institutions created and regulated by law, such as the National Council of Health Secretaries, the National Council of Municipal Health Secretariats, and the National Health Council, providing for a comprehensive approach to implementing public health policies.
The national plans, particularly PNS 2020–2023 and PPA 2020–2023, envisage a variety of actions to reduce health inequalities. To this end, the various initiatives have focused on increasing access to primary health care services, specialized care, medicines, strategic supplies, and new technologies; strengthening the control of preventable diseases and injuries; and fostering the protection, promotion, and recovery of the health of vulnerable populations, as well as management and organization of the health system.