This thematic issue arises from a research project on the enhancement of public policy for people with reduced functioning led by Oswaldo Cruz Foundation, in partnership with the Ministry of Social Development, and with the support of the Petrópolis School of Medicine. The articles reflect on the positive and negative aspects of a unique public policy on a worldwide scale because of its focus on functioning.

In 2001, through the International Classification of Functioning, Disability and Health (ICF), the WHO proposed an approach that includes disability as a multidimensional and universal phenomenon ranging from mild to severe levels, and which is situated not only in the individual, but depends on various factors of the physical, political and social environment. Today, 16 years later, the WHO still receives many requests for support from countries that have incorporated the ICF into their legislation but find it very difficult to implement it in public policies. A major obstacle is the development of benefits that really focus on functioning, and not simply on the usual presence of impairments and illnesses. A second, major challenge is to develop an evaluation process that effectively measures functioning in all its complexity.

With the Continuous Cash Benefit (BPC) program, Brazil set an example to the world of how it is possible to incorporate the ICF in public policies. In scientific articles of excellent quality, using qualitative and quantitative assessments, this thematic issue analyzes two persistent “myths” that continue to impede more countries from following the Brazilian example, or that may jeopardize the continuity of the policy in Brazil itself.

The first “myth”, that an evaluation based on eligibility criteria built on the basis of the ICF and in line with the UN Convention on the Rights of Persons with Disabilities increases considerably the number of concessions, is contested in the article entitled Social protection and public policy for vulnerable populations: an evaluation of the Continuous Cash Benefit (BPC) program in Brazil, using secondary data from the Ministry of Social Development.

Assessments of the profile of claimants are especially important because of the second “myth” of insufficiency of functioning as indicative of the need for social benefits. These evaluations are the theme of the articles entitled Social inequalities in the limitations caused by chronic diseases and deficiencies in Brazil: National Health Survey – 2013 and Socioeconomic position and disability: “The Belo Horizonte, Brazil Health Study”.

The thematic issue also provides accurate assessments of the current accessibility of the BPC in the articles entitled Bureaucracy and Social Policy; Continuous Cash Benefit (BPC) program for people with disabilities: barriers to access and intersectoral gaps and also in the paper Profile of demand and Continuous Cash Benefit (BPC) program for children diagnosed with microcephaly in Brazil. The article The BPC: from advances in security to the risks of Social Security reform analyzes the current rules that govern access to the BPC, as well as the changes discussed in the social security reform proposed by the government in 2016, and its possible impact in the future.

The accessibility of this stimulating thematic issue is guaranteed because the articles are accompanied by audio files in English and Portuguese, a pioneering initiative in the area of health.

Carla Sabariego
Institute for Medical Information Processing, Biometry and Epidemiology, Chair for Public Health and Health Services Research, Ludwig-Maximilians-Universität (LMU) München

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