Abstract

The aim of this study was to analyze the connections between the Sendai Framework for Disaster Risk Reduction, the Sustainable Development Goals (SDGs), and the principles of Brazil’s Unified Health System (SUS) in the context of the public health emergency caused by the COVID-19 pandemic and its potential implications for population health. This qualitative, cross-sectional, exploratory study collected data from health professionals with experience in emergency and disaster risk management and treatment practices, which were then processed using the Iramuteq software for lexical analysis. The textual corpus was presented through a descending hierarchical classification that resulted in seven classes grouped into three categories: disaster response in the context of SUS; prevention of future disaster risks; and preparedness and recovery actions based on the Sendai Framework and the SDGs. The study highlighted aspects related to the direct and indirect effects of the COVID-19 pandemic and the challenges related to disaster risk reduction as advocated by the Sendai Framework, emphasizing the need to strengthen the culture of safety and sustainability within the SUS, which aligns with the ODS and social determinants of health.

Key words:
Disaster stages; Unified Health System; Public Health; Sustainable development; COVID-19

Introduction

The National Policy for Health Surveillance defines “public health emergency” (ESP) as a situation that requires urgent implementation of measures for prevention, control, and containment of risks, harms, and public health damages, which applies to the contemporary example of the COVID-19 pandemic¹1 Brasil. Ministério da Saúde (MS). Conselho Nacional de Saúde (CNS). Resolução n° 588, de 12 de julho de 2018. Política Nacional de Vigilância em Saúde. Brasília: MS; 2018.. In the Brazilian Classification and Coding of Disasters (COBRADE), this pandemic can also be classified as a natural disaster of biological typology²2 Brasil. Ministério da Integração Nacional. Classificação e Codificação Brasileira de Desastres (Cobrade) [Internet]. 2012 [acessado 2018 maio 6]. Disponível em: http://www.integracao.gov.br/documents/3958478/0/Anexo+V+-Cobrade_com+simbologia.pdf/d7d8bb0b-07f3-4572-a6ca-738daa95feb0.
http://www.integracao.gov.br/documents/3... , given that a disaster is characterized as an event that combines natural and/or technological threats, exposure, conditions of vulnerability, and insufficient response capacity³3 Narváez L, Lavell A, Ortega GP. La gestión del riesgo de desastres: un enfoque basado en procesos. Lima: Maiteé Flores Piérola - PullCreativo S.R.L; 2009..

In the Brazilian context, disasters are made worse by social determinants and health inequities, which pose greater risks for impoverished families and groups. Consequently, significant effects are often observed in the fields of health, social welfare, economics, politics, and culture. This underscores the need for the scientific community to develop better standards for prevention, preparedness, response, and recovery in the face of such events⁴4 Valencio N. Desastre como prática sociopolítica de solapamento da segurança humana. In: Carmo R, Valencio N, organizadores. Segurança humana no contexto dos desastres. São Carlos: RiMa; 2014. p. 15-44.

5 United Nations Office for Disaster Risk Reduction (UNDRR). Sendai Framework for Disaster Risk Reduction 2015-2030. Geneva: UNDRR; 2015.

6 Organização Pan-Americana da Saúde (OPAS). Agenda de saúde sustentável para as Américas 2018-2030: um chamado à ação para a saúde e o bem-estar na região. In: Anais da 29ª Conferência Sanitária Pan-Pmericana, na 69a Sessão do Comitê Regional da OMS para as Américas. Washington, D.C.; 2017 set 25-29.^-77 Almeida LS, Cota ALS, Rodrigues DF. Saneamento, arboviroses e determinantes ambientais: impactos na saúde urbana. Cien Saude Colet 2020; 25(10):3857-3868..

With respect to vulnerability as a central concept for understanding emergency and disaster phenomena, COVID-19 demonstrated certain specificities due to its syndemic characteristics. This “syndemic”, a neologism formed from the combination of the words “synergy” and “epidemic”⁸8 Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Sci Direct 2017; 389(10072):941-950., was conceived by Merrill Singer in the 1990s, and demonstrates the synergistic interaction of distinct diseases in specific populations. On the one hand, there is an infectious disease that causes severe acute respiratory syndrome, and on the other hand, a series of non-communicable diseases whose effects are magnified by the addition of social and economic disparities in the population⁹9 Horton R. Offline: COVID-19 is not a pandemic. Lancet 2020; 396(10255):874.. This situation has made the COVID-19 pandemic an atypical and complex disaster, which demands future alignment of international frameworks and agendas and collective scientific efforts to adopt better risk management measures for new pandemics.

An emblematic example is the Sendai Framework for Disaster Risk Reduction 2015-2030, adopted at the 3^rd World Conference on Disaster Risk Reduction held in Hyogo (Japan) in March 2015. At this occasion, the commitment of States to reduce potential disaster risks and increase resilience was restated in the context of eradicating poverty, a motto for sustainable development. It is known that women, children, the elderly, and people in vulnerable situations are disproportionately affected in these situations, making it necessary to reduce exposure to threats to prevent the development of new risks and to obtain accountability systems at all levels⁵5 United Nations Office for Disaster Risk Reduction (UNDRR). Sendai Framework for Disaster Risk Reduction 2015-2030. Geneva: UNDRR; 2015.. Effective disaster risk reduction management is a cost-effective investment in preventing future losses and contributing to sustainable development. This Framework continued the Hyogo Framework for Action 2005-2015, aiming to assess, review and identify gaps, lessons learned, and future challenges⁵5 United Nations Office for Disaster Risk Reduction (UNDRR). Sendai Framework for Disaster Risk Reduction 2015-2030. Geneva: UNDRR; 2015..

Furthermore, in September 2015, the 193 member countries of the United Nations approved the 2030 agenda and the Sustainable Development Goals (SDGs), aiming to enhance global development and improve people’s quality of life through 17 objectives with 169 targets to be achieved through joint local, national, and international actions by all levels of government, organizations, companies, and society. The agenda pointed out five areas of importance, known as the “5 Ps”: People, Planet, Prosperity, Peace, and Partnership. With the purpose of “leaving no one behind”, the Sustainable Health Agenda for the Americas 2018-2030 represents the health sector’s response to its member countries’ commitments. Among the 17 objectives, objectives 1 and 3 are particularly highlighted, although all others are equally relevant. Objective 1 aims to “end poverty in all its forms everywhere”, while Objective 3 aims to “ensure healthy lives and promote well-being for all at all ages”. The latter has target 3.3: to end, by 2030, “AIDS, tuberculosis, malaria, and neglected tropical diseases, and combat hepatitis, waterborne diseases, and other communicable diseases”⁶6 Organização Pan-Americana da Saúde (OPAS). Agenda de saúde sustentável para as Américas 2018-2030: um chamado à ação para a saúde e o bem-estar na região. In: Anais da 29ª Conferência Sanitária Pan-Pmericana, na 69a Sessão do Comitê Regional da OMS para as Américas. Washington, D.C.; 2017 set 25-29., a segment where COVID-19 is included.

On the other hand, the Unified Health System (SUS), which is the legal institution that organizes health actions and services in Brazil, created by the 1988 Constitution¹⁰10 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Manual de direito sanitário com enfoque na vigilância em saúde. Brasília: MS; 2006., is structured in a decentralized way, with comprehensive care, prioritizing preventive activities and society participation. SUS also performs epidemiological surveillance actions, participates in the training of human resources, formulates policies, executes basic sanitation actions, and promotes scientific and technological development in its area of activity, among other constitutional attributions¹¹11 Merhy EE, Bertussi DC, Santos MLM, Rosa NSF, Slomp Junior H, Seixas CT. Pandemia, Sistema Único de Saúde (SUS) e Saúde Coletiva: composições e aberturas para mundos outros. Interface (Botucatu) 2021; 26:e210491.. The SUS operates with doctrinal principles: universality, equity, and comprehensiveness; and with operational principles: decentralization, regionalization, hierarchy, and social participation¹²12 Gleriano JS, Fabro GCR, Tomaz WB, Goulart BF, Chaves LDP.Reflexões sobre a gestão do Sistema Único de Saúde para a coordenação no enfrentamento da COVID-19. Esc Anna Nery 2020; 24(n. esp.):e20200188..

This system plays a strategic role in the daily life of the population, including emergencies and disasters, situations in which health determinants and conditions end up worsening the operational and logistical difficulties of responding to such events, such as those related to food, housing, urbanization, basic sanitation, environment, work, income, education, transportation, leisure, and access to essential goods and services⁷7 Almeida LS, Cota ALS, Rodrigues DF. Saneamento, arboviroses e determinantes ambientais: impactos na saúde urbana. Cien Saude Colet 2020; 25(10):3857-3868.^,1313 Silva AM, Xavier DR, Rocha V. Do global ao local: desafios para redução de riscos à saúde relacionados com mudanças climáticas, desastre e Emergências em Saúde Pública. Saude Debate 2020; 44(n. esp. 2):48-68..

In emergencies and disasters, the SUS requires strategic planning, interaction, dialogue, and coordination of the care network and its different levels and actors. Three measures are considered strategic for this purpose: the establishment of a situation room, articulation and interaction of actors and sectors, and an emergency strategic plan, aiming to ensure health care for the population with greater safety and effectiveness¹⁴14 Oliveira AB, Freitas CM, Barcellos C, Vater MC, Fehn AC, Silveira LTC, Dal Poz MR, Galliez RM, Medronho RA. Organização emergencial da rede de atenção à saúde no estado do Rio de Janeiro para enfrentamento da pandemia do novo coronavírus (COVID-19): nota Técnica conjunta de pesquisadores da UFRJ, Uerj e Fiocruz. Rio de Janeiro: Fiocruz; 2020.. Currently, government entities have been constantly demanded regarding risk management in the face of these events, which have been determining significant rates of morbidity and mortality, as well as environmental and societal impacts. Better preparation interferes with reducing the effects of these emergencies in the context of public health, and timely and effective response necessarily involves the integration of the three levels of management - Federal, State, and Municipal - of the SUS¹⁵15 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Plano de resposta às emergências em saúde pública. Brasília: MS; 2014..

The management of disaster risk in its different phases (prevention/mitigation, preparedness, response, recovery) is anchored in distinct fields of expertise and action, both internally at different levels and externally through international articulation and agreements³3 Narváez L, Lavell A, Ortega GP. La gestión del riesgo de desastres: un enfoque basado en procesos. Lima: Maiteé Flores Piérola - PullCreativo S.R.L; 2009.. This involves administrative, organizational, and operational decision-making, both governmental and non-governmental, in conjunction with society, with a view to public policies and strategies that can lead to impact reduction¹⁵15 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Plano de resposta às emergências em saúde pública. Brasília: MS; 2014.. The collection of these actions, being a dynamic and continuous planning process, is represented by the disaster cycle (Figure 1).

Within the development of a disaster risk management based on processes, health practices should be constructed in a transversal manner, scrutinizing social and economic determinants, in order to achieve equitable access for all citizens without fragmenting attention, which sometimes occurs in public health emergencies and disasters in the country¹⁶16 Silveira LTC, Oliveira AB. Desafios e estratégias para a organização do setor saúde frente à pandemia de COVID-19. Res Soc Develop 2020; 9(8):e543985987.. Therefore, seeking alignment with the existing instruments for the systematization of actions to address such events is timely and urgent. At the international level, the Sendai Framework for Disaster Risk Reduction and the Sustainable Development Goals stand out, while at the national level, the SUS is responsible for the complex task of organizing the health sector’s response to such situations, as in the case of the COVID-19 pandemic.

Thus, this study aims to analyze the connections between the Sendai Framework for Disaster Risk Reduction, the Sustainable Development Goals, and the principles of the SUS, in the context of the public health emergency of the COVID-19 pandemic, and their potential implications for population health.

Methodology

This is a qualitative, cross-sectional, exploratory study, whose data were collected in the first semester of 2021 from healthcare professionals enrolled in the elective course “Seminar on Emerging Themes of Professional Practice: emphasis on Health in Emergencies and Disasters (risk management in the face of COVID-19)” from the Graduate Program Stricto Sensu of the Anna Nery School of Nursing (EEAN), Federal University of Rio de Janeiro. The study was approved by the ethics and research committee (Resolution No. 3.653.634; CAE: 18207019.0.0000.5238). Data collection was conducted by members of the Health in Emergencies and Disasters Teaching, Research, and Extension Group (GEPESED), through forms applied to the 16 professionals enrolled in the course, who had experience in emergency and disaster risk management and assistance.

A portion of the course was delivered online under the title “Lessons Learned from Disasters: The Case of COVID-19” and is available on the GEPESED-UFRJ YouTube channel¹⁷17 Grupo de Ensino, Pesquisa e Extensão de Saúde em Emergências e Desastres (GEPESED-UFRJ). Curso online lições aprendidas em desastres: o caso da COVID-19 [Internet]. [acessado 2022 mar 3]. Disponível em: https://www.youtube.com/c/GEPESEDUFRJ/videos.
https://www.youtube.com/c/GEPESEDUFRJ/vi... .

The textual data obtained from complementary activities carried out so as to achieve the stated objective were processed using Iramuteq®. This is a free software licensed under GNU GPL (v2), which is anchored in R software for statistical calculations¹⁸18 The R Project for Statistical Computing. Software R para os cálculos estatísticos [programa de computador]. [acessado 2022 mar 3]. Disponível em: www.r-project.org.
www.r-project.org... , and uses the Python¹⁹19 Python [programa de computador]. [acessado 2022 mar 3]. Disponível em: www.python.org.
www.python.org.... language as an interface for multidimensional analyses of texts and questionnaires. The name of the software comes from the French phrase Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires²⁰20 Souza MAR, Wall ML, Thuler ACMC, Lowen IMV, Peres AM. O uso do software Iramuteq na análise de dados em pesquisas qualitativas. Rev Esc Enferm USP 2018; 52:1-7..

The use of this computational technology allowed for greater methodological rigor and increased credibility in textual analysis, by integrating statistical analyses, graphs, and visual elements, thereby advancing beyond a mere analysis of discourse²¹21 Silva S, Ribeiro EAW. O software Iramuteq como ferramenta metodológica para análise qualitativa nas pesquisas em educação profissional e tecnológica. Braz J Edu Technol Soc2021; 14(2):275-284..

For lexical analysis, the resultant content from the discursiveness of the 16 professionals constituted the corpus, where each participant was encoded by the letter “E” followed by a sequential number (E_1 to E_16). The corpus was compressed into a single file saved as a text document, using the Unicode Transformation Format 8-bit code units (UTF-8). Acronyms were standardized, such as Disaster Risk Reduction for DRR and Intensive Care Unit for ICU. Separated words that together have the meaning of a single term were joined using a subscript hyphen, such as post_disaster and mechanical_ventilator, in order to ensure greater utilization of the text²⁰20 Souza MAR, Wall ML, Thuler ACMC, Lowen IMV, Peres AM. O uso do software Iramuteq na análise de dados em pesquisas qualitativas. Rev Esc Enferm USP 2018; 52:1-7..

Results

The textual corpus processed by the software was reconfigured into text segments, which underwent lexical analysis resulting in tables listing the vocabulary. This methodological operation resulted in the Descending Hierarchical Classification (DHC), where text segments were classified by their vocabulary, and their set partitioned according to the frequency of lemmatized forms in segments with a size of three lines generated according to the size of the corpus. After statistical analysis, in the program’s summary tab and rapport report, it was observed that the corpus was processed in 22 seconds, and that all 16 texts were processed, which is important for validating the analysis performed²¹21 Silva S, Ribeiro EAW. O software Iramuteq como ferramenta metodológica para análise qualitativa nas pesquisas em educação profissional e tecnológica. Braz J Edu Technol Soc2021; 14(2):275-284.. A total of 328 text segments, 11,927 occurrences, 1,782 forms, and 810 hapax or forms with a single incidence were obtained. With the frequency of active forms ≥3: 566, divided into seven classes with 296 classified segments, a utilization rate of 90.24% was obtained. A retention rate of at least 75% of text segments is considered a good utilization rate for DHC analysis²²22 Camargo BV, Justo AM. Tutorial para uso do software de análise textual IRAMUTEQ [Internet]. Florianópolis: Universidade Federal de Santa Catarina; 2013 [acessado 2022 mar 3]. Disponível em: http://www.iramuteq.org/documentation/fichiers/tutoriel-en-portugais..

Once the classification was performed by the Reinert method and the option for simple DHC was chosen, each text segment was analyzed according to the vocabulary contained therein. The corpus was composed of seven classes formed after six partitions, as shown in Figure 2. The first partition divided the corpus into two thematic sets, A and B, represented by the dendrogram of the classes, which includes the demonstration of the association between them. The thematic set A, after the second partition, separates classes 3 and 7. The thematic set B, with the third partition, separates classes 1 and 2 from classes 4, 5, and 6. The fourth partition separates classes 4 and 5 from class 6, while the fifth partition separates classes 4 and 5. The sixth partition separates classes 1 and 2.

Figure 3 illustrates the graphic representation of the similarity analysis of the textual database structure of the corpus, by illustrating words and their close or distant connections to each other, emphasizing and establishing links between lexicons related to health, action, disaster, risk, and development.

The dendrogram represented in Figure 4 demonstrates the most frequent words in the corpus, with the initial context unit (ICU) represented by each textual construction of the 16 professionals, giving rise to elementary context units or text segments of each class, where the vocabulary of each class is similar to each other and different from the vocabulary of the other classes. The weight of the texts in each class and the associative strength between the words and their classes are analyzed when the chi-squared test is greater than 3.84, representing p<0.0001. Thus, the lower the value of the chi-squared, the lower the relationship between the variables²⁰20 Souza MAR, Wall ML, Thuler ACMC, Lowen IMV, Peres AM. O uso do software Iramuteq na análise de dados em pesquisas qualitativas. Rev Esc Enferm USP 2018; 52:1-7.. Class 1 corresponds to 11.82% with 52 forms and three predominant texts E_16, E_13 and E_09; Class 2 corresponds to 13.18% with 62 forms and two predominant texts E_15 and E_12; Class 3 corresponds to 23.29%, with 65 forms and two predominant texts E_08 and E_03; Class 4 corresponds to 11.82%, with 48 forms and three predominant texts E_02, E_04 and E_11; Class 5 corresponds to 15.2%, with 57 forms and two predominant texts E_15 and E_01; Class 6 corresponds to 12.5%, with 42 forms and two predominant texts E_15 and E_01; and Class 7 corresponds to 15.88%, with 65 forms and three predominant texts E_06, E_09 and E_10. All the predominant texts have p<0.05 and x²>3.80.

The following are the classes defined by CHD, which were structured by categories based on the content of text segments and word frequency, taking into consideration the disaster risk management processes.

Disaster Response in the Context of SUS

The predominant classes in this category are 3, 6, and 7, with textual content constructed through the discursiveness of professionals E_03 and E_08 in class 3, E_01, E_15, and E_06 in class 6, and E_09 and E_10 in class 7. These classes are more related to assistive response actions, and therefore, to activities of health and SUS. Class 3 contains words such as Public Health Emergency of National Interest (ESPIN), pandemic, event, interventions, health, and coping, which are more closely related to assistive management and decision-making, involving the idea of a situation room or a minimally decision-making environment. Class 6 contains words that align more with SUS-related activities, such as principle, comprehensiveness, preventive, right, universal, need, resource, equity, region, in text segments that accurately report a character of planning and health policies, precisely because it is more related to emergency and disaster response, and thus to the organization of necessary arrangements for assistive performance, including the resources pertinent to the undertaking of health practices. Class 7, on the other hand, is more related to assistive response, with interventions at the forefront, with words such as case, ICU, mask, bed, vaccination, therapy, infected, which place emphasis on health care and surveillance, as well as provide elements for decision-making regarding assistive practices directly to individuals, but which do not necessarily concern only frontline operators.

Preventing future disaster risks

Classes 4 and 5 are predominant in this category, along with textual contents related to professionals E_02, E_04, and E_11 in class 4, and E_05 and E_13 in class 5, and are specifically related to prevention/mitigation actions. Class 4 words that stand out include: group, culture, opportunity, disability, rebuild, environment, post-impact, vulnerable, disaster, while class 5 words include: environmental, culture, infrastructure, economic, company, subsistence, social, food. The content of these class text segments aligns with the issues outlined in the Sustainable Development Goals and targets, as well as the principles of disaster risk reduction in the Sendai Framework:

Preparation and recovery actions based on the Sendai Framework and the SDGs

This category is mainly composed of classes 1 and 2, with the most expressive textual content related to professionals E_09, E_13, and E_16 in class 1, and E_12 and E_15 in class 2, who are more closely related to preparation and recovery actions. In class 1, words such as global, disaster risk reduction, addressing, sustainable, goal, climate, United Nations (UN), investment, and SDGs were highlighted. In class 2, there are words such as global, regional, national, Hyogo Framework for Action (HFA), prevention, risk, cooperation, international, political, disaster, and authority, which are more closely aligned with the aspects highlighted in the Sustainable Development Goals and the Sendai Framework.

Discussion

Despite the segmentation of textual content into classes, the context forms an articulating set of the three considered documentary bases, delimiting the synergistic nature that they delineate with respect to population health, especially in emergency and disaster situations. In a way, this reinforces the necessary interdisciplinarity, transdisciplinarity, and intersectoriality when such phenomena are addressed, which also emphasizes their complexity.

A relevant aspect for the discussion about the topics is the ongoing debate and controversy around the concept of disasters²³23 Marchenzini V. As ciências sociais nos desastres: um campo de pesquisa em construção. BIB 2018; 83(1):3-72., with its technical definition still unconnected from the sociological debates about them²⁴24 Valêncio N. Desastre, ordem social e planejamento em Defesa Civil: o contexto brasileiro. Saude Soc 2010; 19(4):748-762.^,2525 Valencio N. Por um triz: ordem social, vida cotidiana e segurança ontológica na crise relacionada à pandemia de COVID-19. Soc Quest 2020; XXIII(48):53-44., which generally treat disasters as events that originate from human action²⁶26 Quarantelli EL, Perr RWA. Uma agenda de pesquisa do século 21 em ciências sociais para os desastres: questões teóricas, metodológicas e empíricas, e suas implementações no campo profissional. In: Perry RW, Quarantelli EL. What is a disaster? New answers to old question. Bloomington: Xlibris Corporation; 2005. p. 325-396.. This change in judgment about the nature of disasters is important for society, as it pertains to the social generation of events that were previously considered external and alien to it²⁷27 Mateddi M. Dilemas e perspectivas da abordagem sociológica dos desastres naturais. Tempo Soc Rev Soc USP 2017; 29(3):261-285.. In the horizon of social sciences, the processes that unfold in disasters are a temporal construct operated within social systems, which, by making social groups vulnerable during disasters, interferes with the sufficiency of response and rehabilitation. Additionally, the effects of disasters on already burdened health systems further weaken their ability to respond upstream²⁸28 Silva IVM, Freitas CM, Freitas LE. Vulnerabilidade institucional do setor saúde a desastres: perspectiva dos profissionais e gestores de Nova Friburgo. Saude Debate 2020; 44(n. esp. 2):188-201.. Given the social nature of disasters, society and governments need to be aligned in order to jointly build political and economic foundations that allow for the achievement of the SDGs and the RRD, based on the foundation of SUS and the principle of equity, which is present in both the SDGs and the Sendai Framework. Indeed, the construction of the framework for the culture of safety and sustainable development should not originate from governments, but rather from society, in order to then be expressed in governments, understanding that the government serves society and not the other way around.

Although COVID-19 has certain characteristics of Beck’s Smog²⁹29 Beck U. Sociedade de risco: rumo a uma outra modernidade. 2ª ed. 2ª reimp. São Paulo: Editora 34; 2016., “Hunger is hierarchical, Smog is democratic”(p.43), it impacts the poor more than the rich, since risks, as well as wealth, are distributed in class systems²⁹29 Beck U. Sociedade de risco: rumo a uma outra modernidade. 2ª ed. 2ª reimp. São Paulo: Editora 34; 2016.(p.41). In fact, industries where production risks are high are transferred to poor countries that accept them, which is reiterated in Beck’s expression²⁹29 Beck U. Sociedade de risco: rumo a uma outra modernidade. 2ª ed. 2ª reimp. São Paulo: Editora 34; 2016.: “the devil of hunger is fought with the Beelzebub risk potentiation”(p.51). Although the rich have more to lose than the poor, hunger affects the latter more³⁰30 Luhmann N. Sociología del riesgo. 1ª ed. México: Universidad Iberoamericana; 1992.(p.84).

It is precisely because it was designed for everyone and has a function in public health, with equity, universal and equal access, and also collaborates with environmental protection, that the SUS can be considered, beyond the field of health, as an inducer of social organization, allowing the rich and poor to not be separated and fighting hunger, as well as promoting citizenship, without the risks being potentiated. This understanding is linked to the Sendai Framework in such a way that by effectively managing disaster risk, sustainable development is also contributed. Prevention and planning applied to disaster risk reduction actions protect people, communities, countries, health, ecosystems, and socio-economic-cultural heritage, thereby increasing resilience⁵5 United Nations Office for Disaster Risk Reduction (UNDRR). Sendai Framework for Disaster Risk Reduction 2015-2030. Geneva: UNDRR; 2015.. These tasks fall within the competence of the Sendai Framework, the SDGs, and the SUS.

The Sendai Framework highlights the need for special attention to be given to the limited availability of technology, the irresponsible use of finite natural resources, and epidemics and pandemics. This is consistent with the responsibilities of the Brazilian Unified Health System (SUS), which include promoting scientific and technological development, organizing epidemiological surveillance actions, participating in the development and execution of policies and measures for basic sanitation, as well as collaborating with environmental protection efforts and the Sustainable Development Goals (SDGs) related to combating hunger, promoting sustainable agriculture, and improving health and well-being.

An additional challenge is the deepening of inequalities that the COVID-19 pandemic has brought to populations, especially in areas with the greatest social disparities, highlighting the fragilities in achieving sustainable development as outlined in the United Nations 2030 Agenda. In Brazil, the pandemic has brought to light issues related to access to social protection networks, public health services, employment, income, transportation, and housing. The pandemic has also brought to the fore other more powerful inequalities, however, the recovery prompted by this disaster brings a unique opportunity to rethink society with a focus on human rights and a better future for all, with fewer risks³¹31 Organização das Nações Unidas (ONU). Covid-19 e desenvolvimento sustentável: avaliando a crise de olho na recuperação. Brasília: UNICEF, ONU, OPAS; 2021.. The direct and indirect effects of the COVID-19 pandemic in Latin America have impacted all areas of human life, paralyzing the economy and leading to profound social changes, which have brought uncertainties. The inequalities are unsustainable and deep, and require equal and sustainable reconstruction, “aiming at creating a true welfare state, a long overdue task in the region”³²32 Naciones Unidas. Comisión Económica para América Latina y el Caribe (CEPAL). Panorama Social de América latina, 2020. Santiago: Naciones Unidas; 2021..

Social inequalities lead to asymmetry in access to available care technologies, asymmetries that exist in all countries, regardless of their level of development, including gender, social and economic status, race, and ethnicity³³33 Barreto LM. Desigualdade em saúde: uma perspectiva global. Cien Saude Colet 2017; 22(7):2097-2108.. In Brazil, neoliberal policies exacerbate the impacts of the pandemic³⁴34 Sanhueza-Sanzana C, Aguiar IWO, Almeida RLF, Kendall C, Mendes A, Kerr LRFS. Desigualdades sociais associadas com a letalidade por COVID-19 na cidade de Fortaleza, Ceará, 2020. Epidemiol Serv Saude 2021; 30(3):1-12.. Neoliberalism and individualism place the weight of responsibility for what happens on individuals rather than the social system³⁵35 Giddens A. As consequências da modernidade. São Paulo: Fundação Editora da UNESP; 1991.. However, in the world of decision-making, multiple individuals are making decisions at the same time, but not all individuals are necessarily decision-makers, and thus, affected individuals emerge, those who do not participate in the decisions, i.e., deciding is the opposite of being affected. “The affected individual suffers the threats of what they have no power to control”³⁰30 Luhmann N. Sociología del riesgo. 1ª ed. México: Universidad Iberoamericana; 1992.(p.84-90).

According to Giddens³⁵35 Giddens A. As consequências da modernidade. São Paulo: Fundação Editora da UNESP; 1991., “risk is not an individual issue; there are risks, such as ecological disasters and nuclear wars, that create risk environments that affect a large number of individuals”³⁵35 Giddens A. As consequências da modernidade. São Paulo: Fundação Editora da UNESP; 1991.(p.46). Furthermore, due to social inequalities, health inequalities are also intertwined with them, making it strategic to develop actions related to social issues, which require coordinated interventions on various aspects of social life. This implies multilateral government actions, which are not simple in technical and political terms. When social inequalities are overcome by political initiatives, the concept of “health in all policies” arises, where health is incorporated into the management actions of different political sectors³⁴34 Sanhueza-Sanzana C, Aguiar IWO, Almeida RLF, Kendall C, Mendes A, Kerr LRFS. Desigualdades sociais associadas com a letalidade por COVID-19 na cidade de Fortaleza, Ceará, 2020. Epidemiol Serv Saude 2021; 30(3):1-12.. All these issues related to social inequalities have a different impact on symmetry, intensity, and depth, where the precepts of the Sendai Framework, the SDGs, and the SUS are applicable.

Concluding remarks

The analyzed texts highlighted aspects regarding the direct and indirect effects of the COVID-19 pandemic, concerning the challenges of disaster risk reduction, the urgency of implementing what the Sendai Framework lists in terms of objectives, goals, and governance efforts, recognizing that sustainable development also comes from effective disaster risk management³¹31 Organização das Nações Unidas (ONU). Covid-19 e desenvolvimento sustentável: avaliando a crise de olho na recuperação. Brasília: UNICEF, ONU, OPAS; 2021.. Additionally, the Unified Health System (SUS) plays a fundamental role in all actions by working with inclusive and egalitarian principles and with health in the context of its social determinants.

The COVID-19 pandemic and its social, economic, and structural implications are embedded in the context of social inequalities and, consequently, social determinants of health. The main challenge is to learn from it and try to better respond to future biological disasters and public health emergencies within the scope of the SUS. Public authorities and policymakers must recognize that disaster risk reduction strategies are only effective when worked on by distinct capabilities, such as: political skills, construction and adoption of specific regulations and legislation, social participation of different actors, knowledge management from an interdisciplinary perspective, development of innovation and technologies, progress monitoring and deviation correction, and risk communication and information. In this context, health works with the comprehensiveness of collective health and transcends health public policy in a broad sense.

References

Publication Dates

History