Reaching Out to the Needy? Access to Justice and Public Attorneys’ Role in Right to Health Litigation in the City of São Paulo

Right to health litigation in Brazil raises a debate regarding its distributive effects in a resource-constrained setting. Several studies have found that a significant proportion of litigation features individual claimants who live in the most affluent states, cities and districts of Brazil and are usually represented by private lawyers, whose fees are beyond the reach of most of the poor population. For some, this is an indication that the distributive effects of litigation are very likely negative because litigation tends to benefit a privileged socio-economic group and may force health authorities to divert to them resources from comprehensive health programs that benefit the majority of the population. Others, however, argue that courts can nonetheless provide an important institutional voice for the poor and promote health equity when they manage to access them. The main problem for this "pro-litigation camp" is thus to enhance access to Justice. Our aim is to analyze lawsuits in which litigants are represented by public attorneys in right to health litigation in the city of São Paulo to inquire if at least this type of litigation is reaching out to the neediest citizens. This study analyzes three indicators: the income of litigants, the Human Development Index and the Health Need Index of the areas where they live. Our conclusion is that although public attorneys seem to represent mostly low income people, other indicators suggest that there are still important obstacles for public attorneys to reach the neediest