Preventive health and the wellness market in Brazil: legal and regulatory perspectives

Anderson Ribeiro
Souto Correa, São Paulo
Anderson.ribeiro@soutocorrea.com.br

Maria Luísa Matos
Souto Correa, São Paulo
maria.matos@soutocorrea.com.br

Across the world, people are redefining their relationship with health, and most health systems have yet to catch up. The global wellness market has surpassed US$5.6tn, driven by individuals who no longer wait for the state to act. Brazil illustrates this tension acutely: one of the world’s fastest-aging societies, it remains organised around a care model built for disease, reactive and structurally indifferent to prevention. This article argues that closing this gap is no longer a matter of political choice, but of constitutional and economic necessity.

Health, as a fundamental right enshrined in Article 196 of the Brazilian Constitution, imposes on the State the duty to guarantee not only the treatment of diseases, but the ‘reduction of the risk of disease and other health hazards’.[1] Despite this, the care model consolidated over recent decades, in both the public and private sectors, has remained guided by a reactive logic, centered on intervention after illness, procedure-based financing, and the organisation of services around disease rather than the person. This design, in addition to being poorly aligned with the constitutional mandate, is increasingly unsustainable from economic, actuarial, and demographic perspectives.

Accelerated population aging is the most compelling driver of this pressure. The Brazilian Institute of Geography and Statistics (IBGE) projects that Brazilians aged 60 and over will rise from approximately 15 per cent to around 25 per cent of the population by 2060.[2] Without investment in prevention, longevity tends to amplify demand for high-complexity care, placing pressure on models structured to respond to illness rather than prevent it. The transition to a preventive paradigm, therefore, is not a political option, but a requirement for the sustainability of the system.

In the supplementary health sector, the National Supplementary Health Agency (ANS), created by Law No 9,961/2000, has progressively incorporated the preventive dimension into its regulatory activities. Normative Resolution No 506/2022, by updating the Supplementary Health Performance Index (IDSS), began to include primary care and prevention indicators, recognising the correlation between preventive investment and reduced claims in the medium term.[3]

Despite this, adherence to population health management programs remains predominantly voluntary, and regulatory incentives are still insufficient to drive structural change in the care model. The central challenge lies in transforming prevention from an optional practice into a legally enforceable and economically advantageous obligation for sector actors.

The predominant reimbursement model in supplementary health is fee-for-service, which is structurally incompatible with preventive logic, as it pays for disease rather than health: the more the beneficiary falls ill and consumes services, the greater the provider’s revenue. Alternative models, such as pay for performance, risk-adjusted capitation, and value-based healthcare contracts, have been the subject of analysis by ANS in its regulatory modernization project.[4] In these models, the provider is compensated for the health outcomes it produces, including maintaining the patient’s health, preventing avoidable hospitalisations, and effectively managing chronic diseases, and not for the volume of procedures performed.

The transition, however, demands a profound restructuring of contractual relationships between operators and providers, with the definition of standardised quality and outcome metrics, implementation of consistent monitoring and audit systems, and, above all, the establishment of regulatory safeguards against adverse selection. In capitation regimes, the tendency to exclude clinically complex patients constitutes a significant risk to equity and the integrity of the system itself.

This movement finds a parallel in the market itself, where operators structured entirely around the care journey are already emerging, in contrast to the traditional model centred on the isolated care event. These operators organise their activities around the longitudinal follow-up of the beneficiary, integrating primary care, chronic disease management, prevention programs, and continuous health monitoring into a unified care proposition. In Brazil, initiatives in this direction already operate in different formats, including vertically integrated operators with their own health teams, digital health platforms with coordinated care models, and insurers that incorporate preventive programs as a central component of their value proposition.

Within the Unified Health System (SUS), the preventive vocation is expressed in Law No 8,080/1990, but faces its most persistent obstacle in chronic underfunding. The Family Health Strategy (ESF), the main instrument of primary care, presents consistent evidence of reduced avoidable hospitalisations and infant mortality, although its coverage and quality remain uneven, reflecting federative disparities.[5]

The National Health Promotion Policy (Ministerial Order GM/MS No 2,446/2014)[6] introduces a broader approach to social determinants, recognising factors such as food, education, income, and the environment as health-determining factors. This shifts the focus from biomedical logic to a territorial and intersectoral understanding of health production.

From a legal perspective, the right to health has both an individual and a collective dimension, the latter being central to preventive logic, as it requires the state to adopt public policies aimed at health promotion and protection.[7] Comprehensiveness, a founding principle of SUS, requires overcoming the dichotomy between curative and preventive actions, imposing on the system the obligation to organise itself around longitudinal care and care continuity, rather than isolated episodes of disease.[8] The effectiveness of the right to health depends not only on the existence of norms, but on the construction of institutional arrangements that ensure coordination among federal entities, stable financing, and social control mechanisms capable of guiding the system’s priorities.[9]

A phenomenon of growing relevance in the context of longevity, and one that directly engages with the structural limitations of the Brazilian care model, is the expansion of the global wellness market.

Valued at approximately US$5.6tn in 2022 by the Global Wellness Institute, with projections to reach US$8.5tn by 2027, this market encompasses segments such as mental health and wellbeing, functional nutrition and integrative medicine, active longevity, fitness and movement, health tourism, sleep and recovery, beauty and personal care, and self-care technologies.[10] In Brazil, the sector is experiencing significant growth, driven by urbanisation, rising middle-class income, population aging, and a profound cultural shift: health is no longer conceived merely as the absence of disease, but as a life project, a personal investment, and a dimension of identity.

It is also one of the most heavily explored segments in the digital environment, featuring as a true ‘favourite’ of influencers, who use it as a central vector for promotion and engagement. Regulatory enforcement faces operational challenges stemming from the scale of e-commerce and the diffusion of content across digital platforms. In this context, the role of influencers in promoting these products adds complexity, particularly regarding the transparency and technical qualification of their recommendations.

The fundamental right to health, as enshrined in Article 196 of the 1988 Federal Constitution, is only fully realised when the legal order ceases to treat prevention as a programmatic guideline and begins to equip it with normative instruments, adequate financing mechanisms, and regulatory structures capable of driving effective transformation of the care model. As long as prevention remains an ethical aspiration devoid of concrete legal consequences, the health system will continue to reproduce the logic of disease as a market, to the detriment of health as a right.

The longevity that Brazil is experiencing can be lived with quality or with suffering, with autonomy or with dependence, with systemic sustainability or with progressive collapse. The wellness market signals that society has already anticipated this demand and that there is growing willingness among individuals and companies to invest in health before illness strikes. It falls to the law to organise, democratise, and guide this transformation, ensuring that the benefits of preventive medicine and active longevity do not remain restricted to certain economic classes, but become the heritage of all Brazilian society.

Notes

[1]           Brazil, Federal Constitution of 1988, Art 196: ‘Health is a right of all and a duty of the State, guaranteed by means of social and economic policies aimed at reducing the risk of disease and other hazards and at the universal and equal access to actions and services for the promotion, protection and recovery thereof’.