ABC | Volume 113, Nº3, September 2019

Viewpoint Digital Health, Universal Right, Duty of the State? Marcelo Antônio Cartaxo Queiroga Lopes, 1 G láucia Maria Moraes de Oliveira, 2 Luciano Mariz Maia 3 Hospital Alberto Urquiza Wanderley, 1 João Pessoa, PB – Brazil Universidade Federal do Rio de Janeiro, 2 Rio de Janeiro, RJ – Brazil Centro de Ciências Jurídicas da Universidade Federal da Paraíba, 3 João Pessoa, PB – Brazil Mailing Address: Marcelo Antônio Cartaxo Queiroga Lopes • Cardiocenter – Av. Ministro José Américo de Almeida, 1450, Torre, Hospital - Alberto Urquiza Wanderley. Postal Code 58.040-300, João Pessoa, PB – Brazil E-mail: mqueiroga@cardiol.br , marcelocartaxoqueiroga@gmail.com Manuscript received June 24, 2019, revised manuscript June 26, 2019, accepted June 26, 2019. Keywords Comprehensive Health Care/legislation & jurisprudence; Personal Health Services/trends; Telemedicine; Unified Health System; Health Public Administration DOI: 10.5935/abc.20190161 Introduction The Brazilian Constitution establishes, in its art. 196, 1 that “health is a universal right and duty of the State, guaranteed by social and economic policies aimed at reducing the risk of diseases and other ailments, and universal and equal access to actions and services for their promotion and recovery”. In addition, article 198, 1 states that “public health actions and services are part of a regionalized and hierarchical network and constitute a single system, organized with the following guidelines: I – decentralization, with a single direction in each sphere of government; II – integral care, with priority for preventive actions, without loss to the care services; III – community participation”. From a systematic reading of these two constitutional provisions, it is possible to list the basic elements of the implementation of the right to health by the public authorities: universal and equal access, as well as integral care. Integral health care determines that “the duty of the State cannot be limited, mitigated or divided, since health as an individual, collective and development asset presupposes a complete approach to care” and providing integral care “means nothing more than privileging life to the detriment of the administration's budgetary interests – the so-called secondary public interest”. 2 Within this context, the Unified Health System (SUS) was designed to be the mechanism by which universal and equal access, as well as integral care, should be implemented. SUS must act according to these guidelines, not being able to impose any restrictions specifically directed to a particular group or class, nor can it privilege the administration’s budgetary interests to the detriment of the right to life. As observed by Resende ,3 “the concept of health as a fundamental right in the international normative framework has been extended over the years to include, in addition to the negative idea of absence of disease, positive content related to the improvement in quality of life and wellbeing”. According to the Bangkok Charter 4 for Health Promotion in a Globalized World, drafted at the VI Global Conference on Health Promotion in 2005, “The United Nations recognizes that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without discrimination. Health promotion is based on this critical human right and offers a positive and inclusive concept of health as a determinant of the quality of life and encompassing mental and spiritual well-being”. Access to health is a social right, guaranteed in Article 6 of the Constitution, 1 in accordance with the dignity of the human person, which is the basis of the democratic rule of law. The Constitution, said to be citizen-oriented, inaugurated a new legal order in the country that promotes the inclusion of millions of Brazilians who were excluded from any kind of healthcare. Putting it into perspective, at the beginning of the 20 th  century, only those who integrated welfare funds had access to the health system. Even with the unification of the Institutes of Social Security Assistance, the so-called IAPs, and the creation of the National Institute of Social Security (INPS), there was still the exclusion of non-participants – non‑taxpayers, a true legion of indigents. SUS, observing the federative organization of the Brazilian State, was conceptually conceived as a solution, but after three decades, chronic problems of financing and management persist, jamming the gears of the world's largest system of universal access to healthcare, hampering the achievement of its original objectives. The gigantism of Brazil and the heterogeneity of the different regions impose the need for efficient management that can be capable of promoting, within the priorities of the State, the convenient allocative justice. Only with the adoption of consequent public policies and its capillarity in the whole country will it be possible to change the panorama of public health in Brazil. In recent decades, as a consequence of the success of public policies, life expectancy has increased, and we are currently experiencing a real demographic transition. The growth in the number of elderly people is exponential, and it is estimated that this social segment will represent 25%of the Brazilian population in 20 years. The impact on social security is a challenge for the State, and requires increased attention, with the adoption of sustainable public policies, especially in the area of health. 4 Non-communicable chronic degenerative diseases (NCDs) are responsible for more than 30% of global mortality and this context will be aggravated by the aging and sickness of the current population. As a matter of fact, there is no way to ignore that offering the resources needed for the expansion of health care, especially for the growing prevalence of NCDs, mainly in remote areas of a country such as Brazil, 429