Income is by far the biggest social determinant of health. Hospital Israelita Albert Einstein serves both private and public patients and has insights into data from the pandemic to highlight the impact of income. The mortality rate in the public ICU was double that in the private, despite both having the exact same equipment, processes and resources. He said, “public patients were simply arriving in a much worse state.” Patients were arriving later and with more underlying health conditions. It is similar with Einstein’s prostate cancer patients; private patients arrive with stage 1, public with stage 4. Brazil has universal health coverage through its national health system. But that does not translate to equal access without addressing the other social determinants.