Search

This paper evaluates health as a Sustainable Development Goal (SDG) in the context of the Post-2015 Development Agenda, between 2012 and 2014. Health was part of the debate since the Millennium Summit and the MDGs (2000), and it also appears in the documents discussing the Post-2015 Agenda, from the Rio+20 to the Open Working Group (OWG), whose report was submitted to the General Assembly of the United Nations (UNGA) 2014-2015, and in the Global Consultation on Health and the High-Level Panel of Eminent Persons reports. The Authors concluded that the treatment of health in all these documents is uniform. They point out that the scope of the health-related SDG is very comprehensive, but its targets are conceptually fragmented and reduced. They advocate their change as to include not only the idea of social determinants of health, but also targets in the field of public health, which were not included in the proposal of the OWG. They also warn that the global and national governance systems need to be reformed and advocate more participation of the civil society, which can influence diplomacy, which, in turn, will be responsible for the agreement signed at the UNGA in 2015.

The supply of medicines in response to court orders or injunctions has become a common practice in the State of São Paulo, Brazil. This 'judicialization' of the health system clashes with basic principles of the Brazilian Unified National Health System (SUS), such as equal opportunity to access health services. The aim of this paper is to analyze the legal action used to obtain medicines through the São Paulo State Health Department, from two main angles: judicialization of public policies and breach of the equity principle. This is a descriptive study of legal action taken to obtain medicines through the São State Health Department, as listed in the Electronic Court Docket System for the year 2006. Most cases were filed through private attorneys; 47% of the patients had obtained their prescriptions through private care; and 73% of the cases involved patients from the three wealthiest areas in the city of São Paulo. The data demonstrate that such legal action violates key principles of the SUS such as equity, thereby privileging individuals with higher purchasing power and more access to information.

This paper analyzes the policy model of the Brazilian Ministry of Health from 1990 to 2002. The methodology included interviews with key actors in the national health policy, document review, and analysis of the Federal budget and official databases. The Brazilian Ministry of Health underwent major changes under the influence of the health reform agenda and the liberal State reform agenda prevailing in the 1990s, shaped by two movements: institutional unification of national policy control and political/administrative decentralization. The Federal role was diminished in terms of direct services provision, and there were changes in financing and regulation. The model in the late 1990s featured strong Federal induction of States and municipalities and the adoption of market regulation strategies. There is no record of a long-term planning effort, which favors distortions in the Federal intervention model and hinders solutions to structural problems in the Brazilian health system.

Recognizing the importance of generating and disseminating innovation for the social and economic development of capitalist countries and the systemic, institutional, and historical nature of this process, this paper emphasizes the need to deal with innovation in the health sector within a framework linking economic, institutional, and policy dynamics. Analysis of the main health goods industries (manufacturers of pharmaceuticals, vaccines, and diagnostics) shows that in the developed countries there is a certain compatibility between the health system and the innovation systems in terms of requirements, and that the state is an essential player in this articulation. In Brazil, however, there is a marked disconnection between the health and innovation systems. The few initiatives aimed at this link have enhanced the competitiveness of national agents and have been essential elements in national health policy. Based on this analysis, it is argued that beyond its social dimension, health policy is a strategic means to consolidate a dynamic innovation system, with direct effects on national development.

This paper analyzes responses by welfare states to globalization in some OECD countries in the 1980s and 90s, demonstrating that the hypothesis concerning the dismantling of social welfare systems cannot be proven due to lack of evidence of substantial changes in the funding and selection of beneficiaries. The paper also focuses on the effects of internationalization of the Brazilian economy on the country's social protection system. The conclusion is that restrictions imposed on public expenditures severely limited the capacity to promote broad coverage in social policies. During the decade the option was made for targeted, selective social policies based on the adoption of a diagnosis of low effectiveness in the Brazilian social protection system. The case of health policy was an exception, due to capacity for interest mediation in the social arena.

Based on the authors' experience, this paper discusses a series of problems during the implementation of so-called Indigenous Health Districts (DSEI) in Brazil, related to organization of health services provision as viewed by both health professionals and anthropologists. The authors report on the Health District model's underlying concepts and present the different approaches used to implement the DSEI. The authors' experience refers to the Rio Negro area - in the northwestern Amazon, representing 10% of Brazil's total indigenous population - and the Brazilian Northeast, specifically the State of Pernambuco, with an indigenous population estimated at 20,000.

This paper is a state-of-the-art review of scientific knowledge on both the health effects of asbestos fiber inhalation and possibilities for safe and sustainable prevention, from an ethical, political, and technological point of view. The author provides scientific background and arguments from the ongoing discussion in Brazil concerning the need to redefine current asbestos policy, in order to establish a more advanced and appropriate policy whose priority is the protection of life, human health, and the environment. The first part deals with several technological and economic aspects of asbestos-chrysotile. In the second part, the author presents and discusses a bibliographic review of the construction of scientific knowledge on the health effects of asbestos fibers, first within an international perspective, and then (in the third part), from a Brazilian view. The fourth part analyzes the current debate on the fibrogenicity and carcinogenicity of asbestos-chrysotile. Some current responses from the international community towards the asbestos-chrysotile ban are also discussed. Finally, the author discusses the historical inadequacy of Brazilian asbestos policy and the urgent need to revise it to include a ban on asbestos-chrysotile in this country.

The aim of this paper is to gather elements for a discussion on health policies and services in northeast Brazil. The author begins with an analysis of the population's main health problems, the health system's limitations, and current opportunities for implementing health programs. She highlights the following research priorities: people's health situations according to their material living conditions and life styles; the private health sector's characteristics and development; the current decentralization process; and proposed innovations in services, programs, and systems. The author points out further that the policy-making process in science and technology should assure a balance between researchers' freedom and people's health needs, regional focus, and universal issues.

The Brazilian scientific literature on social and preventive dentistry from 1986 to 1993 was identified and analyzed to verify whether themes of papers referred to health policy and the national health system. Published scientific articles were used as the unit of analysis for the study. An analytical survey was conducted considering the following variables, amongst others: author's institutional affiliation; author's title; author's areas of interest; type of research; type of article; and research funding sources. Articles reviewed were published between the First and Second National Oral Health Conferences. There were 386 articles published in 19 journals, by at least 866 authors. More than 75% of the studies came from public universities. RGO was the largest publisher in this field, followed by Revista da APCD. Original articles accounted for 56.7% of the studies, while 30.3% were reviews and essays. The majority of the authors were from the State of São Paulo. Male writers predominated. A 'quantitative deficiency' was identified, since scientific production remained below 50% of its potential. Health policy was considered a specific issue in only 3 articles (0.8%) while 7 (1.8%) discussed the national health system.

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

O objetivo do texto é fazer um balanço das respostas dos Estados de bem-estar social às mudanças provocadas pelo globalização nas décadas de 1980-1990. O texto mostra que a hipótese sobre o desmantelamento dos sistemas de bem-estar social não pode ser comprovada por falta de evidências de mudanças substanciais nos mecanismos de financiamento e eleição de beneficiários. O texto focaliza também os efeitos do processo de internacionalização da economia brasileira sobre o sistema de proteção social do país. Conclui que as restrições impostas aos gastos públicos limitou severamente a capacidade em promover políticas sociais abrangentes. Verificou-se na década, a opção por políticas sociais focalizadas e seletivas pela adoção do diagnóstico da baixa efetividade do sistema de proteção social brasileiro. O caso da política de saúde foi uma exceção em razão da capacidade de intermediação de interesses na arena setorial.This paper analyzes responses by welfare states to globalization in some OECD countries in the 1980s and 90s, demonstrating that the hypothesis concerning the dismantling of social welfare systems cannot be proven due to lack of evidence of substantial changes in the funding and selection of beneficiaries. The paper also focuses on the effects of internationalization of the Brazilian economy on the country's social protection system. The conclusion is that restrictions imposed on public expenditures severely limited the capacity to promote broad coverage in social policies. During the decade the option was made for targeted, selective social policies based on the adoption of a diagnosis of low effectiveness in the Brazilian social protection system. The case of health policy was an exception, due to capacity for interest mediation in the social arena.

Increasing the effectiveness of smoking cessation policies requires greater consideration of the cultural and socioeconomic complexities of smoking. The purpose of this paper is to explore the association between socioeconomic status and "selected midpoints" linked to smoking cessation in Brazil. Data was collected from a representative sample of urban adult smokers as part of the ITC-Brazil Survey (2009, N = 1,215). After controlling for age and gender, there were no statistically significant differences quit attempts in the last six months between individuals with different socioeconomic status. However, smokers with high socioeconomic status visited a doctor 1.54 times more often than those with low socioeconomic status (p-value = 0.017), and were also 1.65 times more likely to receive advice to quit smoking (p-value = 0.025). Our results demonstrate that disparities in health and socioeconomic status are still a major challenge for policymakers to increase the population impact of tabacco control actions worldwide.

Increasing the effectiveness of smoking cessation policies requires greater consideration of the cultural and socioeconomic complexities of smoking. The purpose of this paper is to explore the association between socioeconomic status and "selected midpoints" linked to smoking cessation in Brazil. Data was collected from a representative sample of urban adult smokers as part of the ITC-Brazil Survey (2009, N = 1,215). After controlling for age and gender, there were no statistically significant differences quit attempts in the last six months between individuals with different socioeconomic status. However, smokers with high socioeconomic status visited a doctor 1.54 times more often than those with low socioeconomic status (p-value = 0.017), and were also 1.65 times more likely to receive advice to quit smoking (p-value = 0.025). Our results demonstrate that disparities in health and socioeconomic status are still a major challenge for policymakers to increase the population impact of tabacco control actions worldwide.El aumento de la efectividad de las políticas dirigidas a la prohibición del tabaco requiere un mayor entendimiento de cuestiones culturales y socioeconómicas, que forman parte del universo de los fumadores. El objetivo de este artículo es explorar la asociación entre status socioeconómico y "puntos intermedios seleccionados", relacionados con la prohibición del tabaco en Brasil. En base a la investigación ITC-Brasil, se recogió información de una muestra representativa de la población urbana adulta de fumadores (2009, N = 1.215), tras ajustarla por edad y sexo, no se encontraron diferencias estadísticamente significativas en las tentativas de dejar de fumar en los últimos 6 meses según el status socioeconómico. No obstante, los fumadores con un elevado status socioeconómico visitaron un médico 1,54 veces más que aquellos con un bajo status socioeconómico (p = 0,017) y también recibieron 1,65 veces más asesoría para dejar de fumar (p = 0,025). Los hallazgos indican que las disparidades entre salud y status socioeconómico todavía representan un desafío para los gestores con el fin de aumentar el impacto poblacional de las acciones de control del tabaco en el mundo.O aumento da efetividade das políticas voltadas para a cessação ao fumo requer um maior entendimento das questões culturais e socioeconômicas que fazem parte do universo dos fumantes. O objetivo deste artigo é explorar a associação entre status socioeconômico e "pontos intermediários selecionados" relacionados à cessação de fumar no Brasil. Com base na pesquisa ITC-Brasil, foram coletadas informações de uma amostra representativa da população urbana adulta de fumantes (2009, N = 1.215). Após ajustar por idade e sexo, não foram encontradas diferenças estatisticamente significativas nas tentativas de parar nos últimos 6 meses segundo status socioeconômico. Entretanto, fumantes com elevado status socioeconomico visitaram um médico 1,54 vez a mais do que aqueles com baixo status socioeconômico (p = 0,017) e também receberam 1,65 vez mais aconselhamento para parar de fumar (p = 0,025). Os achados indicam que disparidades entre saúde e status socioeconômico ainda representam um desafio para os gestores no sentido de aumentar o impacto populacional das ações de controle do tabaco no mundo.

O trabalho aborda aspectos da relação entre metropolização e regionalização em saúde, tendo por base os processos de regionalização e pactuação na Região Metropolitana da Baixada Santista, São Paulo, Brasil. Trata-se de estudo de caso, realizado em dois momentos: o primeiro, no início da implementação do Pacto pela Saúde (2007) e dos Colegiados de Gestão Regional (CGR), e o segundo, em 2010. Foram entrevistados gestores municipais e regionais do SUS e a direção da Agência Metropolitana. Também foram analisadas atas de dez anos de reuniões da Comissão Intergestora Regional e do Conselho de Desenvolvimento da Baixada Santista. Emergiram quatro grandes temas: financiamento e infraestrutura; utilização de serviços; ineficiência das instâncias e instrumentos de gestão; relação entre os níveis de gestão. Permaneceu latente a questão da metropolização, que aparece de forma incipiente ou tangencial à gestão regional. Avalia-se que apesar de algumas limitações, o CGR vem se legitimando como espaço de gestão regional.This paper focuses on the relationship between metropolitan and regional health planning based on the processes of regionalization and the Pact for Health in the Baixada Santista Metropolitan Area, São Paulo State, Brazil. The method used was a case study in two stages, namely during initial implementation of the Pact for Health (2007) and the Regional Administration Committees (CGR) and in 2010. Municipal and regional health systems managers and the director of the Metropolitan Agency were interviewed, and records were analyzed from ten years of meetings of the Regional Inter-Administration Committee and the Regional Development Council. Four issues emerged: financing and infrastructure; health services utilization; inefficiency of the Regional Health Administration's instruments and decision-making levels; and the relationship between different levels in the Administration. Metropolitan health management remained as an underlying issue, appearing only incidentally or tangentially to regional management. Despite some limitations, the CGR has been legitimized as a space for regional health management.

En este trabajo se discuten las principales estrategias que se han planteado en la gestión sanitaria para mejorar la situación de las listas de espera. En primer lugar, se describen aquellas medidas que tratan de mejorar los indicadores tradicionales de las listas de espera (tiempo de espera y tamaño de la lista), distinguiendo entre aquéllas que tratan de incidir en el incremento de la oferta y las que tratan de controlar la demanda. En segundo lugar, se analizan aquellas medidas que no implican necesariamente una mejora en los indicadores tradicionales, pero sí consiguen mejoras significativas en la calidad de la espera. Para cada una de las estrategias se muestran tanto sus efectos esperados como otros efectos colaterales que alertan sobre su eficacia a la hora de mejorar la situación de las listas de espera.This paper analyzes the main policy initiatives for improving waiting lists in health care. The authors begin by describing strategies to reduce either waiting time or length of the list. They distinguish between demand-side and supply-side strategies. They proceed to discuss policies for improving the "quality" of waiting time. For each policy, they present both the expected effect and the indirect effects that can reduce its effectiveness for improving waiting list conditions.

O artigo analisa o modelo de atuação do Ministério da Saúde de 1990 a 2002, a partir de uma pesquisa que compreendeu: realização de entrevistas com atores envolvidos com a política nacional de saúde, análise documental, orçamentária e de bancos de dados oficiais. Observou-se que o Ministério da Saúde passou por mudanças expressivas, influenciadas tanto pela agenda da reforma sanitária quanto pela agenda liberal de reforma do Estado, hegemônica nos anos 90 e, moldadas por dois movimentos: a unificação nacional do comando sobre a política e a descentralização político-administrativa. Houve uma retração da prestação federal direta de serviços e mudanças no financiamento e na regulação. No final do período, configura-se um modelo caracterizado por forte indução federal sobre Estados e municípios e pela adoção de estratégias de regulação de mercados. A baixa integração com outras políticas, a fragilidade de planejamento em longo prazo e as lacunas no financiamento expressam a ausência de um projeto positivo para o Ministério da Saúde e favorecem distorções no modelo de intervenção federal que prejudicam o enfrentamento dos problemas estruturais do sistema de saúde brasileiro.This paper analyzes the policy model of the Brazilian Ministry of Health from 1990 to 2002. The methodology included interviews with key actors in the national health policy, document review, and analysis of the Federal budget and official databases. The Brazilian Ministry of Health underwent major changes under the influence of the health reform agenda and the liberal State reform agenda prevailing in the 1990s, shaped by two movements: institutional unification of national policy control and political/administrative decentralization. The Federal role was diminished in terms of direct services provision, and there were changes in financing and regulation. The model in the late 1990s featured strong Federal induction of States and municipalities and the adoption of market regulation strategies. There is no record of a long-term planning effort, which favors distortions in the Federal intervention model and hinders solutions to structural problems in the Brazilian health system.

A morte é uma questão implícita na prática e na formação dos profissionais da saúde. Há, todavia, uma tendência dos profissionais de saúde de restringir sua discussão aos aspectos meramente técnicos, seja na assistência à saúde, seja nas ações de saúde pública. Este artigo analisa a importância da adoção do cuidado de qualidade no fim de vida como norteador das práticas assistenciais e a necessidade de que o campo da Saúde Pública tome esses cuidados como objeto de reflexão e de pesquisas. Por fim, aponta-se para aspectos relevantes para a formação de profissionais de saúde para que sejam respeitadores das diferenças e comprometidos com o diálogo.Death is an implicit subject in both health practice and health professionals' training. There is a tendency by health professionals to reduce this analysis merely to technical aspects. This paper analyzes the importance of adopting quality care at the end of life as a guide for public health care. We highlight relevant aspects for training health professionals to respect moral differences and to be prepared to discuss their own points of view.

Partindo do reconhecimento da importância da geração e da difusão de inovações para o desenvolvimento sócio-econômico nos países capitalistas e do caráter sistêmico, institucional e histórico desse processo, o trabalho procura evidenciar a necessidade de tratamento das inovações em saúde a partir de um enfoque que considere as dinâmicas econômica, das instituições e da política pública de forma articulada. Analisando as principais indústrias produtoras de bens em saúde - farmacêutica, de vacinas e de reagentes para diagnóstico -, é possível mostrar que nos países desenvolvidos há certa compatibilidade entre as necessidades do sistema de saúde e do sistema de inovação, sendo o Estado um ator essencial na promoção dessa articulação. No caso brasileiro, ao contrário, observa-se uma marcante desarticulação entre os dois sistemas. As poucas iniciativas que buscaram essa articulação redundaram em maior competitividade para os agentes nacionais, ao mesmo tempo em que foram elementos essenciais da política nacional de saúde. Com base nessa análise, o trabalho defende a idéia de que as políticas de saúde, além de sua dimensão social, também constituem mecanismos estratégicos para a consolidação de um sistema de inovação dinâmico, com efeitos diretos no desenvolvimento nacional.Recognizing the importance of generating and disseminating innovation for the social and economic development of capitalist countries and the systemic, institutional, and historical nature of this process, this paper emphasizes the need to deal with innovation in the health sector within a framework linking economic, institutional, and policy dynamics. Analysis of the main health goods industries (manufacturers of pharmaceuticals, vaccines, and diagnostics) shows that in the developed countries there is a certain compatibility between the health system and the innovation systems in terms of requirements, and that the state is an essential player in this articulation. In Brazil, however, there is a marked disconnection between the health and innovation systems. The few initiatives aimed at this link have enhanced the competitiveness of national agents and have been essential elements in national health policy. Based on this analysis, it is argued that beyond its social dimension, health policy is a strategic means to consolidate a dynamic innovation system, with direct effects on national development.

El artículo expone los principales cambios en el sistema de salud de Chile desde los años 20 hasta la actualidad, señalando las contradicciones, las limitaciones y los avances en cada coyuntura política. Tomando como eje el tema de la equidad, la exposición examina las decisiones tomadas desde mediados de 1920 hasta 1973 para avanzar en dirección a la socialización de la medicina y la abrupta interrupción de ese proceso con el golpe militar de 1973. En seguida, se aborda el conjunto de medidas regresivas tomadas por el neoliberalismo autoritario para insertar la salud en la economía de mercado. Por último, se analizan los esfuerzos emprendidos por los gobiernos democráticos desde que asumieron el poder, en 1990, en el sentido de corregir las desigualdades socio-económicas heredadas, enfocando el compromiso de reconstruir el sistema médico asistencial bajo nuevas bases asentadas en los principios de equidad, solidaridad y participación.This paper examines the main changes in the Chilean health system from the 1920s to the present, identifying contradictions, limits, and successes in terms of policy outcomes. Taking equity as the central theme, the analysis focuses on decisions made from the mid-1920s until 1973 in moving toward socialized medicine, with the sudden interruption of this process by the military coup in 1973. The author then discusses the set of regressive measures taken by authoritarian neoliberalism, with the help of Pinochet, to insert health into the market economy. Finally, the article analyzes efforts made by democratic administrations since 1990 to redress the legacy of socioeconomic inequalities, focusing on the commitment to rebuild the health care system with a new basis in equity, solidarity, and people's participation.

Neste artigo, abordamos as repercussões do processo de globalização sobre a prática de saúde pública. A supremacia do neoliberalismo vem causando crescente interdependência entre os países e aumento das desigualdades, exigindo transformação da prática sanitária. A globalização de riscos e a dependência dos determinantes de saúde locais a fatores externos, impedem a busca de soluções nacionais/locais de maior eficácia frente a problemas de origem global. Neste contexto, as instituições atuais de saúde pública, historicamente piramidais e dependentes do poder político estatal, centradas na análise e ação distrital, carecem das características necessárias para estimular essa transformação. Assim, sugerimos a adoção de uma nova prática embasada no uso das novas tecnologias de informação. Uma rede internacional de profissionais de saúde, horizontalizada, mais independente frente ao poder político estatal, que possibilite a troca de informações e modelos de boa prática, socializando o conhecimento e "glocalizando" soluções. Ao favorecer o trabalho entre pares permitirá estratégias conjuntas e fortalecimento das demandas políticas, possibilitando, talvez, a construção de um mundo com mais eqüidade.This paper discusses the impact of globalization on public health practice. Neoliberal supremacy has resulted in both greater interdependence between countries and increasing inequalities. Globalization of health risks and the dependence of local health conditions on external forces precludes the use of local/national solutions for global problems. In this context, the classical organization of public health services in a hierarchical pyramid based on geographically defined areas (from the local to the regional and national levels) no longer makes sense. We thus suggest some characteristics of a different type of organization based on new information technologies: a transnational network, horizontally shaped, more independent from political power, allowing for exchange of information and good practices, promoting dissemination of knowledge and producing "glocal" solutions. Through the creation of work opportunities between health professionals, the model will permit the creation of common strategies and increase the power of their political demands, perhaps allowing for the collective development of a more equitable world.

En los últimos 17 años, la política de salud en México ha transitado de una concepción de atención integral y de extensión gradual de coberturas como responsabilidad del Estado, a través de las instituciones públicas de salud, a una activa promoción gubernamental de la mercantilización de servicios, complementada con una política de beneficencia hacia la población pobre. En esta transformación se identifican tres periodos que se corresponden con los sexenios presidenciales y que expresan tres momentos distintos de la reforma del sector salud: el primero (1982-1988) caracterizado como transicional, el segundo (1988-1994), en donde emerge con claridad la estrategia bipolar de mercantilización y beneficencia y el tercero (1994-2000), en donde las estrategias gubernamentales se orientan a fortalecer los mercados de la salud. Esta reestructuración del sector salud ha sido instrumentada en forma explícita desde 1982 y forma parte del conjunto de reformas secundarias derivadas de la adecuación subordinada del campo social a las políticas de ajuste estructural y a los megaproyectos económicos y sociales impuestos por los organismos financieros internacionales.In the last 17 years, health policy in Mexico has been shifted from a conception of integrated health care and a gradually extended coverage as a major responsability of the State and health care public institutions, to in the one hand, a very active promotion of market and private profit in health services and in the other, poverty relief programs. In this paper we identify different periods corresponding to the last three presidential terms. Each clearly represent different stages of health sector reform: transitional (1982-1988), mercantilisation and poverty relief (1988-1994) and, strengtheing of the so called health markets (1994-2000). The analised transformation is part of the set of secundary reforms subordinated to the structural adjusment and the economic and social megaprojects impossed by the international financial intitutions.

A produção científica brasileira na área de odontologia preventiva e social, no período 1986-1993, foi analisada para verificar a ocorrência de temas relacionados às políticas de saúde e ao sistema de saúde. Artigos em revistas científicas brasileiras serviram como indicadores dessa produção. Realizou-se um survey para conhecer a origem institucional dos autores, suas titulações e preocupações temáticas, os tipos de pesquisas realizadas, as modalidades de artigos delas decorrentes e as fontes de financiamento. Foram analisados 386 artigos em 19 periódicos. Mais de três quartas partes da produção tiveram origem na universidade pública. RGO foi o periódico que mais publicou. Dos textos, 56,7% eram artigos originais. Revisões de literatura e ensaios somaram 30,3%. Mais da metade dos autores atuavam em São Paulo. O sexo masculino predominou. Política de saúde foi tema específico em 3 artigos (0,8%) e sistema de saúde em 7 (1,8%). No crucial período histórico de reconquista e consolidação das liberdades democráticas, em pleno apogeu do processo da Reforma Sanitária, questões dessa ordem não despertaram significativamente o interesse dos pesquisadores científicos brasileiros da área odontológica.The Brazilian scientific literature on social and preventive dentistry from 1986 to 1993 was identified and analyzed to verify whether themes of papers referred to health policy and the national health system. Published scientific articles were used as the unit of analysis for the study. An analytical survey was conducted considering the following variables, amongst others: author's institutional affiliation; author's title; author's areas of interest; type of research; type of article; and research funding sources. Articles reviewed were published between the First and Second National Oral Health Conferences. There were 386 articles published in 19 journals, by at least 866 authors. More than 75% of the studies came from public universities. RGO was the largest publisher in this field, followed by Revista da APCD. Original articles accounted for 56.7% of the studies, while 30.3% were reviews and essays. The majority of the authors were from the State of São Paulo. Male writers predominated. A "quantitative deficiency" was identified, since scientific production remained below 50% of its potential. Health policy was considered a specific issue in only 3 articles (0.8%) while 7 (1.8%) discussed the national health system.

Integrating disease control with health care delivery increases the prospects for successful disease control. This paper examines whether current international aid policy tends to allocate disease control and curative care to different sectors, preventing such integration. Typically, disease control has been conceptualized in vertical programs. This changed with the Alma Ata vision of comprehensive care, but was soon encouraged again by the Selective Primary Health Care concept. Documents are analyzed from the most influential actors in the field, e.g. World Health Organization, World Bank, and European Union. These agencies do indeed have a doctrine on international aid policy: to allocate disease control to the public sector and curative health care to the private sector, wherever possible. We examine whether there is evidence to support such a doctrine. Arguments justifying integration are discussed, as well as those that critically analyze the consequences of non-integration. Answers are sought to the crucial question of why important stakeholders continue to insist on separating disease control from curative care. We finally make a recommendation for all international actors to address health care and disease control together, from a systems perspective.El control de enfermedades es más factible cuando se encuentra integrado con los servicios curativos de salud. Este artículo examina si la actual política de cooperación tiende a atribuir el control de enfermedades y servicios curativos a distintos sectores, impidiendo así su integración. Tradicionalmente, el control de enfermedades fue conceptualizado en programas verticales. Eso cambió mediante la visión comprensiva de Alma Ata, para luego ser reinstaurado por el enfoque de la Salud Primaria Selectiva. Analizamos documentos de los actores más influyentes, tales como la Organización Mundial de la Salud (OMS), el Banco Mundial y la Unión Europea. Estas agencias sí tienen una doctrina en cooperación: la de colocar control de enfermedades dentro del sector público y servicios curativos dentro del sector privado, donde sea posible. Examinamos si hay un respaldo científico detrás de esta doctrina. Ponderamos los argumentos en pro de integración con las consecuencias descritas de no-integración. Determinamos cuáles son los motivos de los actores claves para seguir separando el control de enfermedades de los servicios curativos. Recomendamos, finalmente, a los actores que apoyen simultáneamente el control de enfermedades, los servicios y los sistemas de salud.

This paper offers a critical review of the theoretical literature on the relationship between the production of scientific knowledge and its use in policy formulation and implementation. Extensive academic output, using a diversity of approaches and analytical frameworks, has sought to systematize knowledge transfer categories and strategies with a view to improving the application of scientific knowledge. A considerable part of this thinking addresses the problem from a more traditional perspective, which (explicitly or implicitly) regards research results as an "accumulable product", depicts the decision-making process simplistically and linearly, and thus restricts strategies to the suiting of research endeavors to needs. Newer approaches place greater importance on the complexity of policymaking and the knowledge production process, which are integrated into and explained in particular political and institutional settings. Although the application of knowledge transfer ideas to health policy and systems research does generate some interesting contributions, a long process of theoretical thinking lies ahead.Este texto presenta una revisión crítica de la producción teórica dedicada a la reflexión de la relación entre la producción del conocimiento científico y su utilización en el proceso de formulación e implementación de políticas. Una extensa producción académica ha procurado una sistematización de categorías y estrategias de transferencia de conocimiento con el propósito de mejorar la aplicación del conocimiento científico, desde diversas perspectivas y distintos marcos de análisis. Parte importante de esa reflexión aborda el problema desde una perspectiva más tradicional, que asume (explícita o implícitamente) una concepción de los resultados de la investigación como un "producto acumulable", mientras el proceso decisorio se presenta en forma simplista y lineal, restringiendo las estrategias a la adecuación entre necesidades y los esfuerzos de la investigación. Con nuevos abordajes, se revaloriza la complejidad de la creación de políticas y del proceso de producción del conocimiento para la acción, integrados y explicados en un marco político e institucional particular. A pesar de que la aplicación de las ideas de transferencia de conocimiento aplicada al campo de la investigación en políticas y sistemas de salud genera algunos aportes interesantes, un largo camino de reflexión teórica queda pendiente.

Abstract: This paper analyses the challenges of building the Welfare State in late democracies in Latin America. The author shows how the literature has identified different social protection patterns in the region and how recent reform models have transformed institutions, in an unfavorable socioeconomic context. The results point to the emergence of a mixture of social protection measures that have increased coverage and reduced poverty, but are unable to guarantee universal citizens’ rights and longevity.

Integrating disease control with health care delivery increases the prospects for successful disease control. This paper examines whether current international aid policy tends to allocate disease control and curative care to different sectors, preventing such integration. Typically, disease control has been conceptualized in vertical programs. This changed with the Alma Ata vision of comprehensive care, but was soon encouraged again by the Selective Primary Health Care concept. Documents are analyzed from the most influential actors in the field, e.g. World Health Organization, World Bank, and European Union. These agencies do indeed have a doctrine on international aid policy: to allocate disease control to the public sector and curative health care to the private sector, wherever possible. We examine whether there is evidence to support such a doctrine. Arguments justifying integration are discussed, as well as those that critically analyze the consequences of non-integration. Answers are sought to the crucial question of why important stakeholders continue to insist on separating disease control from curative care. We finally make a recommendation for all international actors to address health care and disease control together, from a systems perspective.