The invisible evidence

social determinants and structural policies as a criterion of health justice

Authors

DOI:

https://doi.org/10.62530/rbdc25p350

Keywords:

Right to health, Social determinants of health, Epidemiology, Health equity, Health justice

Abstract

Context: The right to health in Brazil, enshrined in Article 196 of the Federal Constitution, requires the integration of scientific knowledge with distributive justice. Epidemiology and the social determinants of health (SDH) show that illness results from structural inequalities rather than merely individual biological risks. However, the design and assessment of public policies still rely on fragmented rationalities in which empirical evidence and legal norms operate separately. Problem: The dissociation between the empirical rationality of epidemiology and the deductive rationality of Law has limited the effectiveness of health policies and the realization of equity. A method capable of translating social evidence into measurable legal obligations is lacking, rendering SDH invisible in decision-making processes. Objectives: To analyze how the integration between epidemiological evidence and legal normativity can serve as a criterion for health justice and for assessing the effectiveness of the right to health, based on the Federal Constitution, Law No. 8.080/1990, and key WHO and CNDSS documents. Methods: A qualitative and descriptive approach was adopted, with bibliographic and documentary analysis of legal norms, technical reports, and national and international scientific literature produced between 1990 and 2025, including works by Krieger, Marmot, and Nunes. Results: A persistent gap between evidence and juridicity was identified. Epidemiology is legally recognized as a principle of the Brazilian Unified Health System (SUS) but rarely informs administrative or judicial decisions. SDH remain marginalized, even though they constitute indicators of non-compliance with constitutional duties. Conclusions: The effectiveness of the right to health depends on the convergence between empirical and normative reasoning. Integrating epidemiology into the legal framework of public policies is essential to transform data on inequality into parameters of equity, allowing scientific evidence to regain its ethical and political role as the foundation of health justice.

Author Biographies

  • Juliana dos Santos Tavares, Santa Cecília University

    Graduated in Medicine from the Faculty of Medical Sciences of Santos (2000–2005).
    Completed a residency in Internal Medicine at Hospital Santa Marcelina (2006–2008).
    Completed a residency in Clinical Oncology at the Arnaldo Vieira de Carvalho Institute – ICAVC (2009–2012).
    Postgraduate training in Palliative Care at Instituto Paliar in 2014.
    Received the title of Specialist in Palliative Medicine from the Brazilian Medical Association (2019).
    Has worked as a clinical oncologist at Santa Casa de Misericórdia de Santos since 2012.
    Has worked as an oncologist and palliative care physician at Hospital Guilherme Álvaro since 2013.
    Served as a professor at Fundação Lusíada, School of Medicine, from 2014 to 2020.
    Coordinator of the Academic Center for Palliative Care from 2018 to 2020.
    Supervisor of the Clinical Oncology team at Santa Casa de Misericórdia de Santos since 2020.
    Supervisor of the Internal Medicine residency at Hospital Guilherme Álvaro since 2022.
    Clinical preceptor for the 12th term of the Medicine program at Universidade de Ribeirão Preto, Guarujá campus.
    Master’s degree student in Health Law (stricto sensu) at Universidade Santa Cecília since March 2025.

  • Andrea Sander, Santa Cecília University

    Physician. Bachelor of Medicine (UNIFENAS). Residency in Clinical Oncology. Postgraduate specialization in Palliative Care. Master’s student in Health Law in the Graduate Program in Health Law at Santa Cecília University (UNISANTA).

  • Marcelo Lamy, Santa Cecilia University

    Lawyer. Bachelor’s degree in Legal Sciences (UFPR). Master’s degree in Administrative Law (USP). Ph.D. in Constitutional Law (PUC-SP). Postdoctoral Fellow in Public Health Policies (Fiocruz Brasília). Postdoctoral Fellow in Fundamental Rights and Access to Justice (UFBA). Permanent Professor and Deputy Coordinator of the Stricto Sensu Graduate Program – Master’s in Law (UNISANTA). Professor of the Master of Science in Legal Studies, Emphasis in International Law (MUST University). Professor in the Law and International Relations programs (UNISANTA). Leader of the CNPq/UNISANTA Research Group “Human Rights, Sustainable Development, and Legal Protection of Health.” General Director of the Observatory of Migrant Rights (UNISANTA). Coordinator of the Public Policy Laboratory (UNISANTA). Professor at the Faculty of Law (ESAMC-Santos).

References

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BRASIL. Ministério da Saúde. Sistema de Informações sobre Mortalidade (SIM); Sistema de Informações sobre Nascidos Vivos (SINASC). Mortalidade infantil e nascidos vivos por região – 2023. Brasília: Ministério da Saúde, 2023. Disponível em: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/inf10uf.def. Acesso em: 3 out. 2025.

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Published

2025-11-17

Data Availability Statement

No research data were made available by the authors.

Issue

Vol. 25 (2025)

Section

Artigos

How to Cite

TAVARES, Juliana dos Santos; SANDER, Andrea; LAMY , Marcelo. The invisible evidence: social determinants and structural policies as a criterion of health justice. Revista Brasileira de Direito Constitucional, [S. l.], v. 25, p. 350–364, 2025. DOI: 10.62530/rbdc25p350. Disponível em: https://rbdc.com.br/revista/article/view/422. Acesso em: 17 nov. 2025.