Departamento de Administração e Planejamento em Saúde, ENSP, Fiocruz. Rua Leopoldo .. In: Sallum Junior B. Brasil e Argentina hoje: política e economia. São estas as saídas para a péssima situação da saúde pública no Brasil, Para os dois especialistas, o SUS (Sistema Único de Saúde), criado a partir da “Hoje a falta de médicos na rede pública é resultado da baixa. de Matemática, ela se dedicou ao estudo da estatística em saúde pública e de e é chamado de “Polar Area Graph”, equivalente ao que chamamos hoje.


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For these and other reasons -even if the levels of negotiation have multiplied, making the government's decisions more complex - the CF88 is far from constituting an obstacle for the governability of the country However, beyond the CF88, the structural problems of the State and of the Brazilian capitalist development system - the economic and social inequalities observed in the country are highlighted here - have saude publica no brasil hoje be considered when one is seeking to understand the challenge of social protection and, particularly, the establishment of a health policy in the s.

The studies on the development of social policies in Brazil reveal limitations, especially due to its fragmented, stratified, unequal and ineffective character in a social perspective14, Thus, the establishment of a daring sanitary reform, conceived in the democratization context of the 's and consolidated by the acknowledgement of health as a citizen's right, demanded the confrontation of structural distortions in the health system and its main challenge was overcoming the serious inequality in the health scenario of the country.

This would only saude publica no brasil hoje viable if included in a broader project to transform the development model and Brazilian society.


However, most of the constitutional conquests were hindered by the results of a conservative slant that reached its summit with the election of Fernando Collor de Mello as President of the Republic in The s in Brazil were characterized by the coexistence of democratization and economic liberalism5, with the preponderance of a State reform agenda that emphasized currency stabilization and inflation control; downsizing public structure and officialdom; restrictions to comprehensive social saude publica no brasil hoje with restrictions in expenses and in the expansion of private offers of social services.

Therefore, the political and social protection model outlined found an unfavorable context to consolidate the constitutional principles in the s.

In health, saude publica no brasil hoje if there have been important advancements - such as the political-institutional changes related to the making of a decisive framework for SUS and the expansion of the public health actions and services in the national territory - the policies course has vigorously demonstrated the tensions between the sanitary reform project and the preponderant State reform agenda.

Such agenda, neoliberally oriented, proved to be unfavorable to the expansion of State actions and imposed restrictions to the performance of duties to guarantee health as a citizen's right.


Such restrictions were strongly demonstrated especially in five fields: The limitations were expressed in violation of rights and in the maintenance of severe inequality regarding health, giving rise to doubts regarding the possibility of a health system oriented by universality and comprehensiveness guidelines in Brazil.

The action of the Executive and Legislative Branches in the right to health The reform project contained in the CF88 presupposed a new State intervention model regarding health and the reconfiguration of the role of the three government branches.

In the scope of the federal Legislative Branch, such project meant the immediate definition of a legal basis for the organization of this system regulating laws.

In the federal Executive Branch's context, the project presupposed: However, it is saude publica no brasil hoje only the reformist health project that influenced the action of the Legislative and Executive Branches in health in the s.

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A broader set of factors, forces and political projects that influenced the State intervention standard as of that decade should be considered. Thus, it is necessary to make explicit the consolidation of the saude publica no brasil hoje policy as of and how it expressed the contradictions among different reform agendas of the State.

The period between and was to define the institutional base of Social Security and SUS Chart 1but with no consensus for the creation of a regulating law for Social Security saude publica no brasil hoje would comprise social work, health and social assistance.

Each area established its own legislation, in scenery of dispute over resources, reflecting the contradictions of the Social Security model designed in and the conflicts of interests of the three areas involved In the first years of the decade, the unfavorable scenario to consolidate protection policies was clear, with the reattachment of the Social Security to the Ministry of Labor in ; with the non-fulfillment of the CF88 temporary clauses for destination of health resources; with the linkage of Social Security to the discounts on workers salaries as of ; and with the inclusion of the Union Security Taxes EPU in the Social Security Budget OSS 16, For health, this meant the beginning of a period of financial frailty due to the non-fulfillment of the OSS17,18, the instability of sources and the amount of resources19, conflicts with the economic area, low federal20 saude publica no brasil hoje and restrictions related to the decentralization and distribution criteria of federal resources7.

Not saude publica no brasil hoje the approval of a specific financing source for health in a subsequent moment Temporary Contribution on Financial Transactions - CPMF in guaranteed a substantial increase and resource stability to the sector. After the definition of the institutional basis there was a moment of great political and economical stability.


The success of the Real Plan in controlling the currency allowed a political institutional rearrangement in the Brazilian State, reasserting a liberal perspective. As ofthe elected governors attempted to eliminate traces of the Vargas State and create new ways to regulate the market, having moderate economic liberalism5 saude publica no brasil hoje the rule.

Saúde pública e política externa brasileira - Sur - Revista Internacional de Direitos Humanos

The constitutional reforms became a central point in the government strategy and were almost completely approved by the Congress. For the consolidation of social protection and right to health, the saude publica no brasil hoje from to expressed a reconfiguration of interests, with specific demands and new problems to be faced.

The period comprises two governments of President Fernando Henrique Cardoso and reveals a certain mode of directing social and health policies in an administrative reform context that was oriented to reduce the size of the State and the changes in its role.

In the analysis of the legal production in health from to it is possible to identify at least two sub-periods Chart 1which correspond to the moments of variation in the governmental health policy: The analysis of ministerial policies and the legal production of the period22 allow us to visualize tendencies in the debate about right to health that characterized the health decision process and that remained constant in the following moment.

In general, three trends in the approach to right to health in the laws were settled in the beginning of the s, especially as ofexpressing contradictions and dilemmas to guarantee the right to health: