HYPOTHESIS AND THEORY article
Front. Public Health
Sec. Disaster and Emergency Medicine
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1613822
This article is part of the Research TopicInnovative Strategies for Urban Public Health Resilience in Crisis SituationsView all 14 articles
Volatile Outcomes of Essential Public Health Functions: A Cross-Sectional Study of Surveillance and Equitable Access on Brazil's Unified Health System (SUS)
Provisionally accepted
- Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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Background:This study investigates the volatility in the outcomes of Essential Public Health Functions (EPHFs) and elaborates on its potential impacts on the operation of Brazil's Unified Health System (SUS). The research addresses the need to understand how performance variability in EPHFs affects health system stability, particularly during external shocks such as the COVID-19 pandemic, and its potential effects on the system's resilience. Methods: Using cross-sectional data (2000-2023) from the Department of Informatics of the SUS (DATASUS), the study analyzes key indicators linked to two EPHFs: (1) Surveillance, control, and risk management (infant mortality) and ( 2) Equitable access to comprehensive and quality services (cytopathological tests and mammography screenings). Volatility was defined as deviations from central trends exceeding one standard deviation relative to prior years. These metrics were assessed to evaluate health system performance and resilience. Results: Significant volatility was observed across indicators, particularly during the COVID-19 pandemic, which disrupted service levels and exposed systemic vulnerabilities. Infant mortality declined by 60% since 2000 but exhibited persistent fluctuations. Cytopathological tests and mammography screenings saw sharp declines during the pandemic, reflecting systemic challenges in sustaining equitable access to care. Conclusion: The study proposes a conceptual framework to analyze EPHF performance through a resilience lens, emphasizing the need to manage variability for stable, high-quality service delivery in the SUS. Recommendations include strengthening health data systems, integrating contextual factors into resilience planning, and enhancing institutional capacity. This work advances efforts to operationalize resilience assessments in universal health systems, offering actionable insights for policymakers and practitioners.
Keywords: health systems resilience, Public Health, Health Services Accessibility, health equity, surveillance
Received: 17 Apr 2025; Accepted: 27 May 2025.
Copyright: © 2025 Jatobá, Castro-Nunes and Carvalho. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alessandro Jatobá, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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