Health is democracy: 50 years of struggle, reflection and public commitmentIN SEPTEMBER 2026, THE BRAZILIAN CENTER FOR HEALTH STUDIES (CEBES) will mark 50 years of existence and continuous struggle for the universalization of the right to health and the guarantee of dignified living conditions for all people. Founded in a context of confronting arbitrariness and the suppression of rights, CEBES was born and consolidated guided by the premise that health is inseparable from democracy and that there is no substantive democracy without the realization of social rights1. Health is democracy, just as democracy is health – a formulation that reaffirms health as a right inherent to the human condition and to full citizenship, rather than a commodity to be acquired in the market2.
This critical understanding deliberately distances itself from conceptions that reduce health to the logic of consumption or strict economic efficiency. On the contrary, it affirms health as a collective enterprise, common good, and public responsibility, whose guarantee depends on universal state policies, robust democratic institutions, and the active participation of society3. In this sense, the defense of the right to health necessarily implies the defense of a strong democracy, capable of translating into public policies guided by the needs of the majority of the population, without neglecting historically minority groups and specific demands that ensure equity1.
The effective achievement of the universal right to health and the construction of a social existence sustained by dignified living conditions for all, therefore, permeate the structuring of healthy and sustainable public policies, articulated in an intersectoral manner and endowed with participatory mechanisms that guarantee the exercise of social control by citizens4. This dynamic requires, on the one hand, a State capable of instituting and ensuring such mechanisms, producing a high-intensity democracy, founded on freedom, security, and social protection; on the other hand, it presupposes continuous processes of strengthening social autonomy, in order to constitute virtuous circuits of citizen participation, public deliberation, and collective co-responsibility2.
It was this normative, ethical, and political horizon that guided CEBES’ performance as a proponent and constructor, alongside other social actors, of the 8th National Health Conference (8th CNS), held in Brasília, in 1986. For the first time, a national conference was organized with broad and decisive participation of civil society – social movements, unions, residents’ associations, professional entities and organizations from different social segments5. This process indelibly marked the history of Brazilian public health and laid the foundations of the principles of universality, integrality, and equity that guided the creation of the Unified Health System (SUS)1.
The 8th CNS and the debates that followed in the constituent process that culminated in the Federal Constitution of 1988 are emblematic examples of the transformative potential of social mobilization and popular participation in the formulation of public policies4. It was from this movement – which brought together technical knowledge, social activism and ethical-political commitment to social justice – that the architecture of the SUS was designed: a public, universal and free system that, despite chronic underfunding, recurrent attempts to dismantle and privatizing pressures, remains the most comprehensive policy of social inclusion in the health area ever built in the country1,2.
The SUS is, therefore, a concrete expression of a civilizing pact that recognizes health as a right for everyone and a duty of the State4. It is the heritage of the people and an international benchmark for the public health system in a country characterized by significant social, regional, and economic inequalities, such as Brazil3. Its history shows that rights are not privileges, but historical achievements resulting from organized social struggle, citizen participation, and democratic commitment1.
Consistent with this vision – which articulates health, democracy, and citizenship – CEBES remains active in the public debate and in the political struggle in defense of life, human dignity, and social justice. In a global and national context marked by health, social, environmental, and democratic crises, CEBES reaffirms its historic commitment to call on society to close ranks against barbarism, authoritarianism, and the commodification of life2.
The commemorations of its 50th anniversary, far from being limited to institutional celebrations, are moments of critical reflection, reaffirmation of principles, and renewal of the militant commitment to the construction of a more just, solidary, and democratic society. This commitment runs through the history of the journal ‘Saúde em Debate’, which, since its foundation, also 50 years ago, has been a privileged space for critical reflection, knowledge production, and intellectual intervention in the field of collective health6.
On completing half a century, CEBES and its journal reaffirm, with renewed vigor, a conviction that remains current and unavoidable: there is no health without democracy and full democracy without the universal right to health1,2.
References
- 1 Paim J. Reforma sanitária brasileira: contribuição para a compreensão e crítica. Salvador; Rio de Janeiro: Edufba; Fiocruz; 2008.
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2 Fleury S. Democracia e saúde: a luta do Cebes [Internet]. São Paulo: Lemos Editorial; 1997 [acesso em 2026 mar 5]. Disponível em: https://cebes.org.br/saude-e-democracia-a-luta-do-cebes/100/
» https://cebes.org.br/saude-e-democracia-a-luta-do-cebes/100/ - 3 Escorel S. Reviravolta na saúde: origem e articulação do movimento sanitário. Rio de Janeiro: Fiocruz; 1998.
- 4 Presidência da República (BR). [Constituição 1988]. Constituição da República Federativa do Brasil de 1988 [Internet]. Diário Oficial [da] República Federativa do Brasil, Brasília, DF. 1988 out 5; Seção 1:1.
- 5 Ministério da Saúde (BR). Relatório Final da 8a Conferência Nacional de Saúde; 1986 mar 17-21; Brasília. Brasília, DF: Ministério da Saúde; 1986.
- 6 Centro Brasileiro de Estudos de Saúde. História do Cebes e da Revista Saúde em Debate. Rio de Janeiro: Cebes; 2024.
