Saúde Única: What is the dispute?
For epidemiologist Heleno Correa Filho, Saúde Única represents a redesign of preventive medicine, ignoring the political and historical intensity of public health, which supported health reform and the formulation of the unified health system as a democratic project.
Written by Clara Fagundes, Cibis.com
One health conceptOne HealthIt is presented as a renewed milestone in the global health agenda, integrating human, animal and environmental health.
But for epidemiologist Heleno Correa Filho, a retired professor at Unicamp, ESCS-UnDF collaborator and holder of a professional master’s degree at Fiocruz University, this narrative of “innovation” lacks historical accuracy and political relevance.
“What is now traditionally called individual health is equivalent to a triad appeal Frost-Level-Clark“, Heleno stated in an interview with the Brazilian Center for Health Studies (CEPES).
The resurgence, now under the auspices of multilateral organizations, ignores the political and historical intensity of public health. By salvaging the critical tradition of Virchow and Villerme, Heleno states that socialized medicine was born as a condemnation of the inequalities generated by industrial capitalism.
In Brazil, this matrix supported health reform and shaped the unified health system as a democratic project. Therefore, he criticizes the way in which individual health is integrated today – often protected from structural conflicts.
“It’s only new for sectors that have been outside of political development in the last 50 years,” he says, referring to areas such as animals, health and border control.
He cautions that this conceptual shift is useful in international settings that avoid confronting production models that generate disease, such as agribusiness and the pesticide industry.
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Heleno warns that any attempt to change the constitutional health chapter opens the door to profound setbacks. He says: “Changing these tools today constitutes a blow and a setback for at least fifty years.”
The contemporary dispute over unified health is primarily a dispute over who sets the direction of the state and the boundaries between public interest and economic power.
1. Is the “One Health” proposal compatible with socialized medicine leading to collective health in Latin America?
Heleno Korea: Social medicine is a discursive formation that emerged from the German and French Enlightenment in the centuries following the eighteenth century. The most famous names are Louis-René Villerme (1-4) and Rudolf Virchow (5, 6). Virchow’s contribution was particularly important in putting forward the need to provide a decent life for workers, especially miners in Silesia, a region now part of Poland.
The importance of quasi-slave miners’ labor in the nineteenth century derived from the strategic position of metallurgical coal in emerging capitalism. Under current conditions, it is no less important than the generation of energy from oil and nuclear energy, as well as its transition to “clean sources” – hydraulic, wind and solar energy. Miners were the source of labor to generate accumulated wealth.
The implications of social medicine concepts in the formation of preventive and social medicine in Latin America, with the subsequent development of critical epidemiology and public health, are updated derivations of the contributions of Vermeer and Virchow, although modified and distorted by the American institutions that propagated and implemented educational and health systems reforms in Latin America in the twentieth century.
The concept of the triad of causative agent, host, and environment, introduced by Wade Hampton Frost (7) in 1928 and modified in 1976 by Hugh Rodman Leavell and Eugene Gurney Clark, has been widely disseminated in Latin America in efforts to promote so-called preventive and social medicine (8, 9).
What is now conventionally called “individual health” is equivalent to a triad appeal Frost-Level-ClarkWhich was lost to some extent from the 1990s onwards, with the emergence of distinctively new social concepts of public health.
The latter updated and integrated components that were not present in previous discursive formations, by establishing a direct and active participatory role for the population – especially the workers – through their social organizations, and intervening in the vertical executive planning of states.
In Brazil, there was a reinvention of the Nazi term “social control” – originally associated with the control of society through state propaganda.
The concept was “renovated” with a proto-social democratic and socialist bias, and began to mean exactly the opposite: in public health, “social control” is the participation of organized society in monitoring the action of the state in the field of public health (10, 11).
In this sense, the One Health concept – which has been revived and pushed forward by pressure from multilateral international organizations since 2008 – represents a belated and outdated response to political pressures for universal, inclusive and equitable national health systems with direct popular participation in controlling their actions.
2. Do you think that Saúde Única brings important and fundamental innovations to guarantee the right to health?
Heleno Korea: The application of a concept such as socialized medicine revolutionizes health systems where they are unfair, unregulated, or regulated by few rights. The emergence of the trinity of agent, host, and environment has led to a revolution in the destructive capitalist environment in countries where capitalism has advanced with the use of pesticides, intense semi-slave industrial labor, and difficult access to health services.
During the Brazilian military-commercial dictatorship (1964-1985), it was unacceptable to propose and talk about preventive medicine, which was largely based on the concept of the triad.
With the democratic and regulatory progress that occurred in the construction of Brazilian public health from 1990 onwards, the One Health concept represents a resumption of proposals from the years 1970-1989.
This occurs in part because the sectors that recently “discovered” so-called “One Health” were oblivious to this political and conceptual development (12-17).
These sectors worked in areas not directly related to the organization of health services – such as inheritors of ancient tropical medicine (which later turned to infectious diseases), animal health surveillance, sanitary surveillance and control of the production and use of medicines for animal and human use.
The unification of the procedures of these sectors with the unified system of control also represents a novelty in areas such as border control and quality control of food and medicine. Therefore, they are considered something “new” that has gone unnoticed in the last 50 years, with the advent of public health, and in the last 37 years of unified system organization since the 1988 Constitution (18).
3. What interests are involved in implementing One Health?
Heleno Korea: From the point of view of multilateral organizations – such as the International Organization for Animal Health (OIE/WOAH), the United Nations Development Programme, the World Health Organization/World Health Organization and the Pan American Health Organization/Pan American Health Organization – the proposal represents the resumption of concepts that allow working with countries where there is no single health system, as well as the clarification of sectors that resist integration into the unified health system, including in Brazil.
Multilateral organizations prefer to work frictionlessly with countries where privatized health systems conflict with animal health, health surveillance and drug control systems. They also prefer to avoid conflicts with multinational pesticide vendors and adopt general agroecological appeals, without changing production and land ownership models.
Documents with consolidated appeals find positive responses in different political and social systems and do not burden international organizations with the management of political crises. This becomes especially important in the twenty-first century, when major shareholders in these organizations withdraw their funds due to political disagreements.
For professionals from sectors not associated with direct health care, who have only recently discovered the One Health initiative as a great novelty, it is undeniable that this is a call similar to that which moved the good professionals of the 1940s and 1960s – and will continue to move them whenever they hear proposals to unify primary, secondary and tertiary prevention measures.
The model developed by Leavell and Clark is of real fascination to those who do not have the means to intervene politically in the health systems of a single country. For those who do not know its origins, it is natural to always regard it as a great suggestion and discovery.
Hence, the international proposal and the internal “discoveries” are identical in goals and practices, as long as they do not confront the health conditions applicable in countries such as Brazil, whose system of unified health services has integrated a public health perspective for 37 years (19).
4. Where does SUS fit into the political project of health shaped by the health movement?
Heleno Korea: When the SUS was established in 1988 under the Citizen’s Constitution (Articles 196-200), there was already coordination between sectors that had not previously been coordinated. Many subsequent modifications contributed to the improvement and dismantling of SUS.
Without going into the merits and when these changes were made, what generates the greatest political backlash is when politicians and managers attempt to circumvent or reduce the social control measures of the unified social system.
All initiatives to evade the cross-sectoral management of health boards – national, state, municipal and local – represent a retreat into the old vertical model of public health, where “those at the top decide and order, while “those at the bottom” implement.
The PAHO model dating back to the 1970s – centralized design and decentralized implementation – continues to form the basis of modern management in the 21st century in many state bodies. In this sense, “modernity” One Health – Saúde Única – Attractive to those who suffer from the political turmoil of management in countries where the social conflict between capital and labor is intense.
5. As a public health thinker, do you believe there is a need to change the constitutional chapter on health, which is currently based on the concept of social determination?
Heleno Korea: Any proposal for constitutional, legal or normative change presented today will be accompanied by the actions of truly reactionary political factions, trying to regain anti-popular control over the Brazilian state.
Changing these standard instruments today would only be a blow and a setback, at best, for at least fifty years.
6. Brazil used the G20 to guide international health cooperation. In 2025, the World Health Organization unanimously approved the first agreement to combat the pandemic. How important is this treaty for Latin America and Brazil, in particular?
Heleno Korea: In 2025, Brazil will play an international role in continental and global leadership. Because it is not automatically aligned with the neoliberal and militaristic policies of NATO and the United States, it is leading a movement that favors the organization of new multilateral decision-making systems. This honors health, trade, diplomacy and the international struggle against war and hunger.
The WHO/WHO has been weakened by the withdrawal of US funding and the increased burden on private contributors. The agreement signed within the G20 represents progress in global governance in the context of the possibility of recurring epidemics.