Moral distress, moral injury, and burnout: Clinicians' resilience and adaptability are not the solution.

The Brazilian health reform, in the context of the redemocratization of the 1980s, culminated in the creation of a public and universal Brazilian Unified National Health System (SUS, acronym in Portuguese). In the following decades, the implementation of the SUS, along with the expansion of social rights, led to the expansion of public services nationwide and improvements in health indicators. Key aspects of this process include consolidating primary health care (PHC), especially through the Family Health Strategy (FHS); expanding access to health services, supplies, and technologies of varying complexity; and institutionalizing comprehensive policies, such as the organization of health care networks. This path, however, was marked by persistent contradictions, such as health inequalities, insufficient public funding, and a strong private sector that expanded and diversified during the period . Despite these limitations, Brazilian democracy sustained important institutional advances in health, including increased social participation and the affirmation of the right to health as a duty of the State for more than three decades. This process, however, suffered a turning point following the political crisis of 2014-2015. The impeachment of President Dilma Rousseff in 2016 marked a rupture in the prevailing political-institutional arrangement. It paved the way for the rise of neoliberal, conservative and authoritarian federal governments. This inflection, often characterized as a “turn to the right” , imposed constraints on democracy and had a transversal impact on public policies , including health . Between 2016 and 2022, a period corresponding to the governments of Presidents Michel Temer and Jair Messias Bolsonaro, health policies were impacted by this new political-institutional context and by the COVID-19 pandemic, which hit Brazil from 2020 onwards. The magnitude of the multidimensional crisis related to the health emergency, which led to millions of deaths worldwide − more than 700,000 of them in Brazil − in addition to the worsening of economic, social, and health indicators, sparked international and national debates regarding a possible transformation of the pattern of state intervention in public policies

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