Final Reflection Paper
I enjoyed hearing from the Graduate Students our last day at UFBA. I am an Epidemiology concentration and my area of interest is in infectious disease, specifically tropical diseases. I really enjoyed hearing about their research into dengue fever and new ideas to monitor and improve reporting. They discussed several barriers Brazil faces involving the reporting cases; such as, no cure and treatment is generic, rest and hydrate. Why would you go to a doctor when the treatment is common knowledge? In Brazil, seeing a doctor could take hours or days to wait in lines and in the US you would have to pay a co-pay with insurance or for the whole visit with no insurance. How do you successfully track a disease when the barriers to care outweigh the benefits?
Our last week in Brazil, we got to experience the thrill of a disease outbreak. Zika virus is similar to dengue fever with similar treatment options. One graduate student was absent during their presentation due to the virus and several girls in our programs had suspected cases. Unfortunately, since zika and dengue have similar treatment options, they also share similar barriers to care resulting in poor monitoring and reporting of the disease. So the next question is, how do we improve surveillance of a disease when going to a doctor is more of a hassle than a solution?
What helped me the most in understanding the difference between collective and public health was the idea that public health prevents disease while collective health promotes health and like Professor Mota said, “to be happy is to be more than healthy.” Collective health encompasses a magnitude of research and policy areas. The first possible step would be listing zika and dengue in the notifiable diseases list, requiring doctors to report cases; however, sick patients would have to go to the doctor in order for their cases to be reported. An earlier step could be developing a community-based education aimed at educating people about mosquito breading and the dangers of standing water. A far off and expensive research option would be improving treatment option by developing a cure or anti-viral drugs to help patients after infection. Taking a collective health approach to improving surveillance of infectious diseases such as dengue and zika, would involve multiple areas of practice; political, ideological, social or economic.
The United States and Brazil differ greatly in certain areas but share many similar problems. I was surprised to learn that Brazil shares similarly high rates of elective caesarian sections during childbirth, organ transplants and electronic imaging usage as the US. I expected more natural births to occur in Brazil; however, Brazil has succumbed to the same over utilization of C-sections. It is not necessarily the mothers who elect for C-sections but the doctors who prefer scheduling births during business hours. The unnecessary and over use of electronic imaging software is a big cost concern in the US and Japan but again it surprised me to learn that it is also a problem here. I think one cause of the increase in unnecessary health care expenditures here in Brazil could be that SUS provides health care coverage to everyone in Brazil and doctors are going unchecked. Doctors get rich by performing procedures and charging SUS or private insurance companies (we have similar problems in the States). In a country of roughly 200 million people, providing universal coverage requires increased monitoring of procedures and payments in order to avoid excess spending.
While Brazil and the US share many of the same cost and care concerns, a major difference in access to care between our two countries is health insurance. Brazil has national health care visiting a doctor is free, however, queues can be incredibly long. The US has private bases insurance, which can be expensive, and still a high percentage of the population is without any form of health insurance making a doctor’s visit very expensive. The collective health options mentioned above are great prevention strategies but a big problem is still visiting a doctor once infected, there is not a whole lot a doctor can do and in Brazil it could take hours to see a doctor and in the US it could cost a lot of money; and for what, the doctor to tell you to go home, rest and drink lots of fluids…that hardly seems worth all the hassle in either country.
I think the US could adapt several aspects of the Brazilian national health care system into our health system. The US is struggling to find a happy medium between public health care coverage and private insurance, while Brazil successfully utilizes both. Private insurance in Brazil is voluntary and picks up where SUS leaves off, but SUS still provides health care coverage to every person in Brazil, citizens and visitors. I personally think a hybrid national health care system is the best option for us here in the US as well. Since private insurance currently covers most Americans, developing a national health care system would provide coverage to everyone but private insurance would still be available to those who want, need and can afford it further coverage. Of course that opens up the argument that health care provided to those with private insurance is better than those under the national health care system. There lies the next step for public health practitioners in the US, making sure access and quality of care is the same between those using public health care services and those who have private insurance, everyone has coverage and those who want or require more can have it as well. I would call that a win-win.
This was my first study abroad program and it wasn’t exactly what I imagined. I knew we would be taking classes at the Federal University but what I wasn’t expecting was to learn so much about Brazils national health care system and from my understanding of their health care system get a better understanding of national history and culture. My favorite part of the trip though was taking what I was learning in classes at UFBA and turning around and asking my host family what they thought about SUS and other government programs. Living with a host family definitely added to the overall experience. It allowed us to take knowledge learned in the classroom and directly apply and question it at home. I think I gained a good understanding of Brazil national health care because in class I learned the policy and good intentions of SUS and at home I was able to get a practical and personal understanding of the pros and cons of the system. Hearing the negative opinions from my host family was surprising because everything we learned in class about SUS sounded good and promising. Sometimes good intentions and policy can be lost during implementation and utilization of a program. This realization shows me the importance of program evaluation. Just like any program or policy implemented SUS the successfulness and positive/negative feedback for a national health care system needs to be evaluated. Only through evaluations can improvements be made resulting in a better and more successful program. The voice of the people is important when it comes to national health care. Everyone has different needs and wants; it is important that the government listens and makes corrections as necessary.
Public health aims to prevent disease while collective health wants to prevent disease and promote health together. Collective health is social movement that encompasses various practices including, political and policy, theory and ideology, social and economic context. The US can learn a lot from the Brazilian national health care system.