In 1986, the 8th National Health Conference was held in Brasília. Amid the complex backdrop of Brazil’s re-democratization, the conference brought together 4,000 people, including approximately 1,000 delegates.

At the time, Brazil was looking toward the future as it emerged from dictatorship under a civilian government. However, this was the Sarney administration, elected as vice president on Tancredo Neves’s ticket in an indirect election. Neves died before taking office, and Sarney, who had a history of involvement with the military, became president of Brazil in 1985. He led a coalition of progressive parties and individuals, among whom the health movement – comprising academics, workers, and social movements – stood out. Dr. Sergio Arouca, one of the leading representatives of the progressive coalition, coordinated the 8th National Health Conference.

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A few years earlier, the Ministry of Social Security and Social Assistance had introduced changes to outpatient service financing, creating conditions for municipalities to  lay the groundwork for hiring workers to provide primary care services without discriminating between Social Security beneficiaries and others. Although implemented in a precarious manner, without the network concept that developed after the creation of the Unified Health System (SUS), the implementation of integrated health actions (Ações Integradas de Saúde, AIS) led many young people to secure their first jobs in municipal non-hospital public services. This development – and these new actors – provided the foundation for decentralization, which was reaffirmed by the 8th National Health Conference and the Constitution.

Even though the national context already showed signs that space for progressive proposals was diminishing by 1986, and the international context indicated the rise of what would later become known as neoliberalism, the 8th National Health Conference was marked by joy, hope, and democracy.

Intended to serve as a forum for discussion and enhance the viability of a project for change, the 8th Conference focused on major themes such as the Right to Health, re-imagination of the health system, and public financing. Because they disagreed with the proposal, some medical entities and hospital representatives announced they would not attend just days before the conference began.

As expected, the private sector’s participation in establishing a health system and the resulting market access to public resources became the subject of motions and votes at the assembly. Stakeholders linked to different proposals regarding the relationship between the public and private sectors continued to debate the direction of the SUS over the following 40 years.

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In 1986 and in the years that followed, public policy debate was strongly influenced by the consolidation of neoliberalism, which focused on strategies to reduce funding for the SUS, outsourcing, and the weakening of democracy and participatory governance. During the 1990s, several elected governments paved the way for Brazil’s alignment with the neoliberal agenda. Recommendations for state counter-reform and fiscal adjustment gained prominence within the Brazilian state apparatus, with privatizations and labor contract outsourcing strategies serving as major destabilizing factors for health reform proposals.

The 8th National Health Conference demonstrated the viability of a universal, public health system, reflecting the mobilizing ideas of the Health Reform. In practice, this led to the emergence of two distinct health policy approaches. One of these projects was implemented by progressive governments, while the other aimed to reduce the scope of the SUS, access to it, and the universal right to health. These policy differences compromised the continuity of the health policy approved at the 8th National Health Conference and in the Constitution. Throughout the 21st century, while three federal governments committed to public policies and social justice, setbacks occurred due to the actions of pro-privatization, conservative governments. Thus, the history of the SUS and experiences grounded in the principles of the 8th National Health Conference are characterized by paradoxical development, with advances and setbacks. The SUS does not seem to be consolidating as much as it could, but at the same time, it demonstrates resilience and has not been destroyed, as some administrations would have wished.

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Forty years later, we have foundations stemming from decentralization, the perspective of comprehensiveness, and community participation. As SUS guidelines, these elements combine to form the blend that ensures the system’s institutional framework.

In 1986, warnings were issued about the depletion of planetary resources, global warming, and water shortages. Forty years later, these issues are part of everyday life, affecting people’s daily routines and dominating the agendas of health workers. In 1986, the Cold War was showing signs of winding down, but the Global North, over the past half-century, has continued to increase its exploitation, sustained in part by war.

In this context, it is not naive to rely on the recommendations of the 8th National Health Conference. The uncertainties arising from climate unpredictability, the looming threat of new pandemics, storms, floods, droughts, and other crises demand the opposite of neoliberalism and necropolitics’ recipes. They demand, as foreseen in 1986, policies consistent with an expanded concept of health, since health and disease are determined by complex factors in which the social dimension plays a fundamental role. Today we know that the countries and industries contributing most to climate change emergencies are those that suffer the least from them, or will be the last to suffer.

The guidelines and strategies proposed at the 8th National Health Conference and in the Brazilian Constitution remain the blueprint for ensuring the universal right to health for the people. Today, we must reaffirm the SUS as a system of universal access, as proposed by the National Health Conference 40 years ago.

Originally written by Liane Beatriz Righi and Gastão Wagner de Souza Campos and published in Portuguese on Outra Saúde. Lightly edited for length.

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