This article focuses on the development of public health in Brazil, with the aim of analyzing the present process of decentralization of health care. The authors argue that the neoliberal or conservative position is unable to offer a reasonable solution to problems in the health care system. On the other hand, the reformist position concentrates its attention on the health system and its administration, taking as its model a positivistic approach to natural and administrative sciences. The authors further argue that only a radical change in the prevailing medical paradigm and a predominance of social over biological aspects would meet the health needs of the population.