It's Carnival time in Brazil; a time of year when practical realities such as the country's health policies take a backseat to the sun, samba, and sensationalism of the Mardi Gras festival. The thousands of tourists descending on the country, flocking to the tourist capital, Rio de Janeiro, will embrace the intoxicating hedonism of the spectacle. The few who actually encounter the Brazilian health service will probably do so as a result of excess Caçhaca--an unbeleivably potent rum.

Unfortunately, postcards depicting the Cidade Maravilhosa of Rio are unrecognisable to most of the population. In stark contrast to its opulent carnival, Brazil is plagued by widespread poverty and an extreme divide between rich and poor. Brazil has the 10th largest economy in the world,1 but 30% of its 174 million inhabitants live below the poverty line.2 According to the World Bank, Brazil is a rich country full of poor people.3 This gap in income is mirrored by the quality of health care available to rich and poor.

REX/RICHARD SOWERSBY

Brazil's inequality in health has existed since colonisation by the Portuguese in 1500, which marked the onset of economic development dependent on enslaving indigenous and African populations. Few native Brazilians remain. Most of today's population is made up of descendants of European colonisation or African slaves. In a society that is 54% white and 45.3% black or mixed race,4 less than 1% of the population is made up of indigenous peoples.

In addition, during the past century income and health inequalities increased despite exponential international debt relief, after 30 years of intermittent dictatorship. October 2002, however, marked the beginning of a new era as former Workers' Party leader Luiz Inaçio Lula de Silva, known as Lula, won a landslide victory in the elections. For the first time in modern history, a left wing president leads Brazil; a real opportunity to achieve social justice.

Lula has inherited a health system that produces large discrepancies in health indicators between geographical regions and populations with low and high incomes. Life expectancy is 65.5 years in the north east compared with 70.8 in the south.4 White people receive an average of 6.6 years of schooling, compared with only 4 years for black and mixed race people. Per capita income in the richest state is seven times per capita income of the poorest state.5 In addition, the poor and non-whites are disproportionately affected by infant and maternal mortality.6 Lula would do well to address these discrepancies, as well as target health problems related to crowded living conditions, inadequate sanitation, and water supply endured by those who live in favelas. These are shanty towns with endemic tuberculosis, diarrhoea, dysentery, and intestinal parasites as well as violent crime and drug misuse.

At the time of Lula's election, many people likened the general atmosphere of Brazil to that of the carnival. Lula has been given real opportunity to prioritise the poor and improve the health of the nation.