PROBLEMAS DE SAÚDE PÚBLICA NO ESTADO DE SÃO PAULO

Abstract

The principal problems of public health in the State of São Paulo, Brazil, are studied in this article. The first problem is not directly connected with the activities of public health but it is of vital importance to them: "the low standard of livint..(of some groups of population. Unless the acquisitive power of certain social classes is elevated, they cannot acquire the minimum utilities necessary for the promotion and maintenance of "a complete physical, mental and social welfare". There is much to be done in relation to the "sanitation of the physical environment". In 1952 there were 138 cities (37,5/'f-) without water supply and 220 ( 59,6) without sewerage systems. From the 231 municipalities with water supply only 46 ( 19,9%) include water purification. Because of the lack of dynamics of the local services of public health in relation to rural zones, the noncreation of local units of public health by the Government becomes more useful to community for the saved amounts could he expended to build public water supplies, in the collecting and disposa of domestic and industrial wastes. In relation to curative medicine, intimately connected with public health, in the 369 existent municipalities, 174 ( 47,2%) don't have hospital assistance.The author proposes the creation of units as "emergency hospital-small health center" in those small municipalities as well as state regional hospitais interrelated with the existent private local hospitais. He also proposes to give administrative and financiai autonomy to state hospitais because this would allow them to receive instalment payments from their patients; for the State would not have to be burdened with the financiai onus provoked by an entirely free hospitalization. lt is necessary a perfect interrelation among local sanitary units and local, regional, state and privatc hospitais for a better efficiency of curative medicine.The reorganization of state services of public health is an urgent action to be taken and should be based on a polyvalent sanitary unit, a health center or a small rural health center. There is a desintegration of public health activities in specialized local units nowadays. There were, in March 1953, in the 368 state municipalities ( except those belonging to the Capital), 90 so called health centers; 271 1 PAMS, 173 pediatric health centers, 26 tuberculosis dispensaries, 204 trachoma local units, 53 of mataria, 20 of leprosy and 665 dental services in primary schools. These local units operate without coordination, and are directly subordinated to different central offices excepting the first two above mentioned. The state Oovernment included in its budget 1,140 million cruzeiros for public health activities and 400 million cruzeiros to give hospital assistance to patients in general psychiatric hospitais and for subsidies to private hospitais. This is a very great expense compared with the results obtained, however it could be utilized in bearing the financiai onus of the reorganization of public health state services. The state public health legislation ought to be revised. The Sanitary Code, for instance, dates from 1918. Specific functions for public health personnel should be created. Full-time must be instituted for sanitary officers, sanitary engineers, for hospital administrators, etc. The public health teaching deserves a detailed study. We can ohtain the improvement of primary teachers in sanitary education by the criation of Hygiene courses in normal schools. Preventive medicine should be taught from the first to the sixth years in the Schools of Medicine; so priva te physicians may cooperate more efficiently in public health. The School of Hygiene and Public Health need a larger sum to amplify its researches and create new courses for sanitary inspectors, public health nurses, dentists, public health veterinarians. Politics has done much harm to public health activities with the system of patronage - appointing and removing personnel in the reorganization of state services. The creation of functions giving the functionary right and duties - public health officer, public health engineer, hospital administrator, public health nurse, public health educator, sanitary inspector - as well as the fixing of those personnel in local units of public health according to technical needs, would avoid in part political corruption. There has been marked progress in many sectors in the fight against epifable diseases such as those transmitted hy adult vectors (malaria, Chagas disease) o r in the prevention of epidemic outhursts caused by diseases for which there are specific prophylactic methods. The fight against determined endemics has not yet attained a desirable phase. We had, for instance, in our Capital, 45 cases of smallpox and 538 of diphteria in 1953, diseases which can be easily eliminated from a community. In relation to hookworm disease prophylaxis almost nothing has been done and it continues to he the greatest cause of the decrease in the rural worker resistance. Leprosy prophylaxis was being done to a great content with admittance and isolation of contagious patients in leprosaria and for that reason there was no decrease in the prevalence of this diseasc among us. Efforts should be made in the searching and control of ali the Hansen disease foci, principally in domiciles. The author thinks that we still are in the phase of fighting infectious-contagious diseases and so the fight against other diseases of interest to public health such as cancer, diabetes, heart diseases, etc., should be clone by private institutions with adequate subsidies from the state Government. Sanitary education depends on the cultural changing to a rational collahoration of the people in the solutíon of public health prohlerns. This is a slow process, with slow evolution, but it should constitute the hasis of ali activities of public health services, either official or private, in a coordinatcd action.