Federal spending on social policies and the social determinants of health: where are we going?

Abstract

Ensuring the highest possible level of health for the population depends on public investments in social policies, since health is determined by factors related to the conditions in which people live and work, the so-called social determinants of health (SDH). Thus, this article aims to quantify Brazil's federal spending on social policies in the last decade, in order to analyze its recent trajectory, in a context of economic crisis and fiscal austerity, and to discuss the risks of worsening the health status of the population. To this end, data on financial execution from the federal executive branch obtained from Siga Brasil were used. The results show a reduction in spending on seven out of ten policies analyzed between 2013 and 2019. There was an increase in spending for policies linked to social security, which are related to constitutionally registered rights, with a tradition of enforcing compliance through the justice system. These findings reveal that, despite the increase in expenditure for these policies, other important policies that act on SDH have been de-financed, making it difficult to achieve progress in the health status of the population, while putting them at risk of setback.