UNIVERSAL HEALTH SYSTEMS ARE A CREATION OF WELFARE STATES and have been adopted as a strategy for strengthening democracy, promoting citizenship rights, and mitigating the dramatic effects of war on the population’s quality of life. Later on, inspired by these successful experiences, other countries have created their universal systems, such as the one in Brazil.

Contemporary scenarios are characterized by profound social, political, and economic transformations, which are both the cause and effect of the crises of capitalism, which has ensured its survival through radical changes often guided by the strengthening of the financial market and the weakening of democracies. There is consensus that there is a more or less widespread crisis of democratic systems in the world, which fuels a set of perverse situations, headed by growing social inequality, with the erosion of the welfare state and the lack of quality jobs, caused by neoliberal and austerity policies prescribed to safeguard capitalist interests. Those conditions, when combined with an economic crisis, do not seem to be easily overcome.

On the other hand, the planet lives with changes in the demographic and epidemiological profile of populations in all countries that require prospective analyses of the impacts and challenges of such phenomenon on universal health systems. Such challenges involve urgent reformulations of care models, but perhaps the greatest of them is associated with the very survival of universal health systems, which are now threatened in many nations.

Therefore, there is an urgent need to advance the debates and studies, fostering alternatives to guarantee the universal right to health. This special issue of the journal ‘Health in Debate’, conducted in partnership with the National Council of Health Secretaries (Conass), intends to address relevant issues related to the trajectory and future of universal health systems at the national and international levels. The articles and essays here published will certainly contribute to deepen reflections, prospects, analyses, and debates regarding the perspectives and the sustainability of those systems.

The partnership between the Brazilian Center for Health Studies (Cebes) and the Conass, in addition to marking the common concern of the two entities on the subject, resulted in this special issue of the journal, whose objective is to broaden the debates that both entities have been carrying out. In April 2018, the Conass promoted in Brasília an international seminar in which the future of universal health systems was discussed with national and foreign experts. It was then followed by a publication1 that gathered articles commissioned from the speakers, and is available on the institution’s website.

The debate intended, in the year that the Brazilian health system was celebrating its 30th anniversary, to seek solutions in a scenario of serious political and economic crisis which threatened not only the system itself, idealized and built to serve everyone equally and equitably, but also the very right to health conquered and established by the Federal Constitution of 1988²2 Brasil. Constituição Federal de 1988 [internet]. [acesso em 2019 dez 5]. Disponível em: http://www.planalto.gov.br/ccivil_03/constituicao/constituição.htm.
http://www.planalto.gov.br/ccivil_03/con... .

The defense of universal health systems as a patrimony of citizenship must be a constant concern of countries where the state has assumed the role of ensuring the provision of accessible health services and actions to all its inhabitants. Thus, in the diversity and thematic complexity that arises from this concern, this special issue of ‘Health in Debate’ presents elements that do not exhaust the subject, but which certainly allow us to move forward by offering arguments and evidence for the field of health, associated with the existence of universal systems.

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