Brazil health policies: historical trends, contradictions and advances

Abstract

In this work we describe the historical trajectory of health policies in Brazil. In particular, we discuss the 'SUS' (Unified Health System); we present an analysis of its meanings, contradictions and scope. This analysis is worked out having in mind the theoretical formulations developed by Offe, Lenhardt and Ronge, especially those concerning political policies in the Capitalist State. Our goal here is to understand the existing dynamics in the health area, as a result both of the historical and current trends of the related political institutions, including those of a juridical nature, now in vigor, and the way they were constructed. We apply the so established abstract referential to the concrete realm of health assistance policies in Brazil, searching, for instance, to determine the difference between the systematic and non-random restrictions to the spaces of possibilities of events in the health area - before and after the "abertura democrática" (a period in which the democratic order was restored) in Brazil and the 1988's Constitution. We conclude that, on one hand, the constitutional core ofSUS represents a necessary breakthrough, which is not however sufficient for the consolidation of social rights in the health area; on the other hand, it is and it has been possible - under direct pressure of popular movements and other forces or through the use of spaces now available as the result of the SUS by govemments committed to policies of individual and collective health care - to progress towards guarantccing health as a citizenship right.