Abstract

Introduction

Occupational Health (OH), a specific field of collective health knowledge and practices based on the development of surveillance, assistance, rehabilitation and health education actions, aims at protecting the workers’ health from risks and other potential injuries of work processes, and also at incorporating in care practices the work category as a component of the health-disease process ¹1. Brasil . Presidência da República . Lei nº 8.080, de 19 de Setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências . Diário Oficial da União . 20 Set 1990 . .

This is a challenging field, as it has inseparable economic, social, political, and technical dimensions, and because it is undoubtedly intersectoral and multidisciplinary. Due to its characteristics, the OH necessarily dialogues with actions conducted in the justice, social welfare, work, and health sectors ¹1. Brasil . Presidência da República . Lei nº 8.080, de 19 de Setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências . Diário Oficial da União . 20 Set 1990 .^,22. Brasil . Ministério da Saúde . Coordenação Técnica de Saúde dos Trabalhadores . Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST) . Manual de gestão e gerenciamento, 2006 . Brasília, DF : Ministério da Saúde ; 2006 . .

The actions performed in the work sphere aim to regulate the employer-employee relationship, standardize and characterize what would be safe and healthy work environments, besides monitoring rules compliance practice. On the other hand, the actions performed in the Social Welfare sphere aim to ensure that workers are economically safe when they need to temporarily or permanently leave their jobs, because of illness, disability or retirement age. Moreover, they promote professional rehabilitation actions whenever there is a partial or total loss of work ability to perform a certain function. Based on the current labor regulations, the Justice should enforce the workers’ rights, whether in the scope of the employer-employee relationship or by ensuring workers’ health protection ³3. Brasil . Presidência da República . Decreto nº 7.602/2011, de 7 de Novembro de 2011. Dispõe sobre a Política nacional de Segurança e Saúde no Trabalho- PNSST, 08 de novembro de 2011 . Brasília, DF : Casa Civil ; 2011 . .

Although being addressed in public policies since the 1980s ⁴4. Brasil . Ministério da Saúde . Relatório Final da 1ª Conferência Nacional de Saúde do Trabalhador . Brasília, DF : Ministério da Saúde ; 1986 . , the OH intersectoral character was clearly evident in 2011 with the approval of the National Occupational Safety and Health Policy (PNSST) ³3. Brasil . Presidência da República . Decreto nº 7.602/2011, de 7 de Novembro de 2011. Dispõe sobre a Política nacional de Segurança e Saúde no Trabalho- PNSST, 08 de novembro de 2011 . Brasília, DF : Casa Civil ; 2011 . , signed by the former President Dilma Rousseff and agreed by the then Ministries of Health, Labor and Social Welfare.

Despite prospective overlapping of attributions, as for example the Occupational Health surveillance, and important gaps, like going back to the work market process, there was an attempt, albeit modest, towards consolidating the intra/intersectoral networks, aiming at the implementation of an integrated and global system of workers’ care ²2. Brasil . Ministério da Saúde . Coordenação Técnica de Saúde dos Trabalhadores . Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST) . Manual de gestão e gerenciamento, 2006 . Brasília, DF : Ministério da Saúde ; 2006 .^,55. Magalhães R , Bodstein R . Avaliação de iniciativas e programas intersetoriais em saúde - desafios e aprendizados . Cienc Saude Colet . 2009 ; 14 ( 3 ): 861 - 8 .^,66. Ornelas AL , Teixeira MGC . Intersetorialidade ou diálogos setoriais? Reflexões a partir da experiência do Projeto Teias-Escola Manguinhos, Rio de Janeiro . Saude Debate . 2015 ; 39 ( 106 ): 659 - 70 . .

The Occupational Health, being dependent on strong public policies, is directly influenced by the national, state and municipal conjuncture. The social-economic-political situation since 2015 brings new challenges to the field, in the same manner it gained relevance in the 1980s with the Brazilian redemocratization, the promulgation of the Federal Constitution ⁷7. Brasil . Constituição (1988) . Constituição da República Federativa do Brasil . Brasília : Senado Federal ; 1988 . , the creation of the Brazilian National Health System (SUS) and, more recently, with the establishment of the National Network of Comprehensive Attention to Occupational Health (RENAST) ⁸8. Brasil . Ministério da Saúde . Portaria nº 2.728, de 11 de Novembro de 2009. Dispõe sobre a Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST) e dá outras providências . Brasília, DF : Ministério da Saúde ; 2009 . (2002) and the promulgation of the National Policy for Occupational Health (2012) ⁹9. Lourenço EAS , Lacaz FAC , Goulart PM . Crise do capital e o desmonte da Previdencia Social no Brasil . Serv Soc Soc . 2017 ; 130 : 467 - 86 . doi: http://dx.doi.org/10.1590/0101-6628.119 .
http://dx.doi.org/10.1590/0101-6628.119... ^,1010. Lancman S , Daldon MTB , Jardim TA , Rocha TO , Barros JO . Intersetorialidade na saúde do trabalhador: velhas questões, novas perspectivas? Cienc Saude Colet [ Internet ]. 2019 [ citado 15 Out 2019 ]. Disponível em: http://www.cienciaesaudecoletiva.com.br/artigos/intersetorialidade-na-saude-do-trabalhador-velhas-questoes-novas-perspectivas/17117?id=17117
http://www.cienciaesaudecoletiva.com.br/... .

Among the national conjuncture changes, we highlight President Dilma Rousseff’s impeachment and removal from her presidential office, followed by the entry of the Vice President Michel Temer, who ruled the country from 31 August 2016 to 31 December 2018, when a new team took over the Brazilian government, headed by Jair Messias Bolsonaro.

This is still a period in which national policies protecting the workers in the country have been suffering setbacks. This situation is triggered by institutional imbalances, ministerial reconfigurations, ongoing policies disarticulations and disruptions, added to the establishment of new policies that have clearly diminished the workers’ rights.

The actions triggered by the former Brazilian president Temer led to a process of uncertainty and instability that continues to the present day in the deconstruction and discontinuity of Brazilian public policies. There seems to have been no concern regarding the systemic impact of changes in each sector. With ministerial rearrangements and the abolition of the Ministries of Labor and Social Welfare, it is becoming more and more clear that these areas are not a priority of the Brazilian Government ¹¹11. Brasil . Presidência da República . Medida Provisória nº 870, de 1 de Janeiro de 2019. Estabelece a organização básica dos órgãos da Presidência da República e dos Ministérios . Diário Oficial da União . 1 Jan 2019 . .

With all these changes and movements, relevant actions -- such as inspections in safety and health at work and enforcement of sanctions provided for in legal or collective norms -- were under the responsibility of the Special Secretariat of Welfare and Labor of the Ministry of Economy. The latter is not intended primarily for the labor laws and workers’ rights maintenance. To date, no details have yet been disclosed on the future of the tax auditors and of other services provided by the extinct Brazilian Ministry of Labor. In addition, there are several unanswered questions, such as those concerning the use hereafter of occupational health and safety regulatory standards^ffWikipedia [Internet]. List of Brazilian Presidents. 5 February 2019 [cited 19 Apr 2019]. Available from: https://pt.wikipedia.org/wiki/Lista_de_presidentes_do_Brasil .

Still as part of this context, among the processes with significant implications for the Occupational Health (OH), there can be found the already implemented Labor Reform ¹²12. Brasil . Presidência da República . Lei nº 13.467, de 13 de Julho de 2017. Altera a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei nº 5.452, de 1 de Maio de 1943, e as Leis nº 6.019, de 3 de Janeiro de 1974, 8.036, de 11 de Maio de 1990, e 8.212, de 24 de Julho de 1991, a fim de adequar a legislação às novas relações de trabalho . Diário Oficial da União . 14 Jul 2017 . p 1 . , and the Social Welfare Reform, which is still underway ¹³13. Brasil . Câmara dos Deputados . Proposta de Emenda à Constituição nº 6-A, de 2019, do Poder Executivo, que “modifica o sistema de previdência social, estabelece regras de transição e disposições transitórias, e dá outras providências” (PEC00619) [ Internet ]. Brasília : Câmara dos Deputados ; 2019 [ citado 15 Out 2019 ]. Disponível em: https://www.camara.leg.br/proposicoesWeb/fichadetramitacao?idProposicao=2192459
https://www.camara.leg.br/proposicoesWeb... . With the speed and contemporaneity of the ongoing changes, the effective analysis of the impacts on workers’ health cannot yet be found in the scientific literature. Nevertheless, from the point of view of intersectoriality, what becomes clear, when observing this picture, is the complete disregard and lack of a systemic view of the potential implications on OH.

Immersed in this conjuncture, research funded by the São Paulo Research Support Foundation (FAPESP), entitled “The construction of intersectoriality in the health and work fields: the perspective of professionals inserted in the network service of São Paulo city”, has been conducted since 2016. Its purpose is to know, to give visibility and to analyze the actors’ work processes involved in the different instances related to health and work public policies, taking into account the proposed intersectoriality brought by the National Policy of Safety and Health at Work (PNSST), besides detecting overlaps and lacks, and developing advances for the consolidation of intra and intersectoral networks, aiming at establishing an integrated and global system of attention to the Occupational Health.

This paper specifically aims at giving visibility to the formulators and managers’ perspective of public policies directed at workers, assigned at the municipal, state, and national levels, concerning intersectoriality, notably in the period shortly preceding Michel Temer’s and Jair Bolsonaro’s governments, but also in the transition periods (i.e. from 2016 to 2018) in the three governments.

Methods (g)

Using qualitative action research ¹⁵15. Bosi MLM , Mercado FJ . Pesquisa qualitativa de serviços de saúde . Petrópolis : Editora Vozes ; 2004 .

16. Minayo MCS . Conceito de avaliação por triangulação de métodos . In: Minayo MCS , Assis SG , Souza ER . Avaliação por triangulação de métodos - Abordagem de programas sociais . Rio de Janeiro : Fiocruz ; 2005 .

17. Denzin NK , Lincoln YS . O planejamento da pesquisa qualitativa: teorias e abordagens . Porto Alegre : Artmed ; 2006 .^-1818. Flick U . Qualidade na pesquisa qualitativa . Porto Alegre : Artmed ; 2009 . , this ongoing case study, which has been conducted in São Paulo city since 2016 and is expected to be completed by early 2021, employs mixed procedures for getting closer to and understanding the Brazilian reality.

We have used an extensive research design and organized it in various steps. Firstly, using a macrostructural investigation, we conducted a documentary survey to analyze the set of public policies in the health and work fields ¹⁰10. Lancman S , Daldon MTB , Jardim TA , Rocha TO , Barros JO . Intersetorialidade na saúde do trabalhador: velhas questões, novas perspectivas? Cienc Saude Colet [ Internet ]. 2019 [ citado 15 Out 2019 ]. Disponível em: http://www.cienciaesaudecoletiva.com.br/artigos/intersetorialidade-na-saude-do-trabalhador-velhas-questoes-novas-perspectivas/17117?id=17117
http://www.cienciaesaudecoletiva.com.br/... . Next, after the project approval by the Research Ethics Committee of the School of Medicine of the University of São Paulo - FMUSP (CAAE: 58418816.1.0000.0065), we conducted interviews, among other still in progress methodological procedures, with key informants who take part in the preparation of national policies and legislations for the area, as well as with managers and other professionals responsible for their implementation, specifically with reference to the city of São Paulo. The results of this step will be the focus of this paper.

Methodological trajectory for conducting the interviews and characterization of the interviewed population

We conducted 16 individual and group interviews with actors linked to the Occupational Health from the following sectors: Health, Labor, Social Welfare, and Justice, in the period ranging from the second semester of 2016 to the end of 2018. We have not named the positions held by the respondents at the time of data collection for respecting their anonymity -- an important ethical aspect to ensure the subjects’ participation in this study and which is protected by the signature of the Free and Informed Consent Form (ICF).

With reference to the health sphere, the following items were contemplated: Primary Care, Technical Area of Occupational Health and Surveillance in Occupational Health. In relation to the social welfare sector, we interviewed the subjects linked to the Occupational Health theme. With regard to the Justice, some Public Ministry of Labor representatives agreed to participate in this study. Finally, we interviewed some representatives linked to the training/professional development processes in the workplace (former Ministry of Labor - ML).

The interviews were conducted in private places and at pre-arranged times, according to each interviewee’s availability. The interviews were fully recorded and transcribed, and they had an average duration time of 90 minutes each. They were performed according to the following guiding script: professional career description in the public network; details of the responsibilities of the agency under its responsibility; possibilities, difficulties and strategies faced to carry out the specificities related to the scope of the service it represents regarding other institutions; impacts of model changes and network reorganization on the development of their professional practice; expectations, suggestions and difficulties experienced; strategies found in everyday work; perspectives on intersectoriality in the health and work fields.

Data analysis

The purpose of the data analysis is to know and find out new elements that answer the research questions, and then confront them with the other outcomes, therefore expanding the possibilities of understanding the studied phenomena ¹⁹19. Gibbs G . Analise de dados qualitativos . Porto Alegre : Artmed ; 2009 .^,2020. Minayo MCS . O desafio do conhecimento. Pesquisa qualitativa em saúde . São Paulo, Rio de Janeiro : Hucitec, ABRASCO ; 2010 . .

For data analysis of the collected interview material, we used the Thematic Content Analysis Technique ²⁰20. Minayo MCS . O desafio do conhecimento. Pesquisa qualitativa em saúde . São Paulo, Rio de Janeiro : Hucitec, ABRASCO ; 2010 . . Throughout the planned steps (i.e. pre-analysis, categorization and reconstruction of the research content), the research team found reports that indicated perspectives for the set of public policies in this field, in addition to referring to the interviewees’ experience. We consider such portrayal of this historical moment of the Brazilian reality relevant to be shared with the scientific community.

As previously mentioned, it should be noted that the interviews were sometimes performed individually and sometimes in pairs/groups. Therefore, the reference at the end of each one of them points to the “unit” interview, rather than to a particular interviewee.

Results

The information gathered was organized into two broad categories: macrostructural aspects that render it difficult the realization of intersectoriality, and everyday challenges for the attainment of intersectoriality. In the end, there was a consensus among the respondents regarding the global difficulties to implement this practice.

In their opinion, it is theoretically insufficient to have guiding documents for the interviewees, since intersectoriality needs to be built every day from the emphasis on the common aspects that surpass the corporatism of each category or sector. They also underlined the fact that there is some isolation and emptying of practices, and also duplicity of actions and conflicts of attributions.

Macro-structural aspects that hinder intersectoriality accomplishment

Some respondents highlighted that the different sectors sometimes do not know each other’s roles, leading to the lack of visibility of developed actions and shared experiences. Resources and information are missing, thus compromising the construction of joint strategies to address the difficulties.

This scenario leads to a dynamic that emphasizes the specificities of each sector and neglects the confluence of common and transversal aspects that would otherwise favor unity and collaboration. The information produced by each sector is not shared, hardening even more the exposure of problems, and thereby the development of projects, actions and coordinated solutions. In this respect, the interviewees feel powerless when facing crystallized, hierarchical and disjointed structures.

Intersectoriality was underlined as a never achieved utopia. In order to have it built, changes in the way of thinking the Occupational Health would be required. In a number of instances, intersectoriality happened more due to passion, militancy and personal and small-group initiatives than as a result of institutional and programmatic actions with State support.

According to the opinion of the interviewees who work specifically in the health care sector -- a sector referred to as one of the main responsible for the articulation and effectiveness of intersectoriality in the Occupational Health (OH) policies --, not even in this sector such policies are prioritized as programmatic actions. The respondents reported that the work and its consequences are still scantily incorporated and poorly understood. Health policies have always been fragmented into specific, specialized actions. This organization ignores that the OH is transversal, permeating multiple specialties.

The respondents question both the guiding political trends and the priorities of the diverse governments that Brazil has been going through in the last years, including in the alleged democratic period, which gave neither priority to the Occupational Health intersectoriality nor to the construction of policies and practices that actually promote health and social welfare.

The respondents highlighted in their statements that the logic of productivity and the organization of actions in public services do not really appreciate intersectoral practices, and consequently they end up undermining the effectiveness of the whole system.

Finally, the interviewees indicated economic aspects as unfavorable to workers’ welfare.

Daily challenges for implementing intersectoriality

Educational background, technical-political perspectives of public workers, and their beliefs concerning good practices in Occupational Health were identified as challenges for implementing intersectoriality in the daily practice.

The respondents also noted that there was a great loss of working conditions in all sectors, with workers’ reduction due to retirement, without their respective replacements and also without them having the opportunity to transmit their accumulated expertise and developed skills. This situation led to work meaning demotivation and loss.

Furthermore, there is often a controversial use of public resources, and this is not only due to the scarcity of those still available, but also because of the very possibility of recognizing the contribution of each body to the functioning of the policy as a whole.

We emphasize the political engagement and militancy of the workers of this study. They joined those services during the Brazilian redemocratization process, in the 1980s/1990s. Thereby, they live with regret the breaking up of the Occupational Health as a specific area of knowledge and intervention, and the utopia of a never reached intersectoriality.

Discussion and final remarks

This study allowed us to understand, from the perspective of the Occupational Health professionals, various aspects that interfere in the construction of intersectoriality, in the actions of services in this field ⁵5. Magalhães R , Bodstein R . Avaliação de iniciativas e programas intersetoriais em saúde - desafios e aprendizados . Cienc Saude Colet . 2009 ; 14 ( 3 ): 861 - 8 .^,66. Ornelas AL , Teixeira MGC . Intersetorialidade ou diálogos setoriais? Reflexões a partir da experiência do Projeto Teias-Escola Manguinhos, Rio de Janeiro . Saude Debate . 2015 ; 39 ( 106 ): 659 - 70 .^,1010. Lancman S , Daldon MTB , Jardim TA , Rocha TO , Barros JO . Intersetorialidade na saúde do trabalhador: velhas questões, novas perspectivas? Cienc Saude Colet [ Internet ]. 2019 [ citado 15 Out 2019 ]. Disponível em: http://www.cienciaesaudecoletiva.com.br/artigos/intersetorialidade-na-saude-do-trabalhador-velhas-questoes-novas-perspectivas/17117?id=17117
http://www.cienciaesaudecoletiva.com.br/... . Even though the interviews were focused on intersectoriality, the period in which they were conducted markedly influenced its content, since a considerable amount of changes has taken place in the country and, consequently, directly affecting this field.

In this scenario, the respondents perceived the services they worked for being further depleted and disjointed, functions and coordination extinguished, and Occupational Health protection laws modified. The intersectoriality process, as well as the laws and documents that led to the recognition of their importance, seemed to have been forgotten ¹1. Brasil . Presidência da República . Lei nº 8.080, de 19 de Setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências . Diário Oficial da União . 20 Set 1990 .

2. Brasil . Ministério da Saúde . Coordenação Técnica de Saúde dos Trabalhadores . Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST) . Manual de gestão e gerenciamento, 2006 . Brasília, DF : Ministério da Saúde ; 2006 .^-33. Brasil . Presidência da República . Decreto nº 7.602/2011, de 7 de Novembro de 2011. Dispõe sobre a Política nacional de Segurança e Saúde no Trabalho- PNSST, 08 de novembro de 2011 . Brasília, DF : Casa Civil ; 2011 .^,88. Brasil . Ministério da Saúde . Portaria nº 2.728, de 11 de Novembro de 2009. Dispõe sobre a Rede Nacional de Atenção Integral à Saúde do Trabalhador (RENAST) e dá outras providências . Brasília, DF : Ministério da Saúde ; 2009 . .

Despite the fact the interviewees pointed towards intersectoriality as an evidently utopian construct, taking into account the numerous challenges to its operationalization that precede the current political context since 2015, with the President Dilma Rousseff’s impeachment and her subsequent mandate annulment the following year, the country undergoes an acute process of public policies disarticulation -- a formal aspect that somehow guaranteed the legitimacy of this practice. The fragmentation and extinction of some ministries, the emptying of the Occupational Health and Social Welfare services, the recent labor reform ¹²12. Brasil . Presidência da República . Lei nº 13.467, de 13 de Julho de 2017. Altera a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei nº 5.452, de 1 de Maio de 1943, e as Leis nº 6.019, de 3 de Janeiro de 1974, 8.036, de 11 de Maio de 1990, e 8.212, de 24 de Julho de 1991, a fim de adequar a legislação às novas relações de trabalho . Diário Oficial da União . 14 Jul 2017 . p 1 .^,2121. Brasil . Ministério da Economia . Secretaria de Previdência [ Internet ]. Brasília : Ministério da Economia ; 2019 [ citado 19 Abr 2019 ]. Disponível em: http://www.previdencia.gov.br/2019
http://www.previdencia.gov.br/2019... ^,2222. Krein JD . O desmonte dos direitos, as novas configurações do trabalho e o esvaziamento da ação coletiva: consequências da reforma trabalhista . Tempo Soc . 2018 ; 30 ( 1 ): 77 - 104 . doi: http://dx.doi.org/10.11606/0103-2070.ts.2018.138082 .
http://dx.doi.org/10.11606/0103-2070.ts.... , and the ongoing social welfare reform ⁹9. Lourenço EAS , Lacaz FAC , Goulart PM . Crise do capital e o desmonte da Previdencia Social no Brasil . Serv Soc Soc . 2017 ; 130 : 467 - 86 . doi: http://dx.doi.org/10.1590/0101-6628.119 .
http://dx.doi.org/10.1590/0101-6628.119... ^,1313. Brasil . Câmara dos Deputados . Proposta de Emenda à Constituição nº 6-A, de 2019, do Poder Executivo, que “modifica o sistema de previdência social, estabelece regras de transição e disposições transitórias, e dá outras providências” (PEC00619) [ Internet ]. Brasília : Câmara dos Deputados ; 2019 [ citado 15 Out 2019 ]. Disponível em: https://www.camara.leg.br/proposicoesWeb/fichadetramitacao?idProposicao=2192459
https://www.camara.leg.br/proposicoesWeb... are examples of this process.

The Social Welfare Reform has already started “from the edges” on the basis of the Social Welfare Benefit Review Program (PRBP)^kkThe PM makes it harder to grant social security benefits and strives to restrain fraud. Retrieved from https://www2.camara.leg.br/camaranoticias/noticias/trabalho-e-previdencia/570684-mp-dificulta-concessao-de-beneficios-previdenciarios-e-busca-coibir-fraudes.html . , which has induced many former retirees, who were retired due to disability or to long-time work absence, to go back to the labor market. This policy, coupled with the lack of a framework tailored to the professional rehabilitation of these former insureds, as well as the absence of return and job retention programs, will engender in the short term a population that has neither work nor social welfare ¹²12. Brasil . Presidência da República . Lei nº 13.467, de 13 de Julho de 2017. Altera a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei nº 5.452, de 1 de Maio de 1943, e as Leis nº 6.019, de 3 de Janeiro de 1974, 8.036, de 11 de Maio de 1990, e 8.212, de 24 de Julho de 1991, a fim de adequar a legislação às novas relações de trabalho . Diário Oficial da União . 14 Jul 2017 . p 1 .^,1313. Brasil . Câmara dos Deputados . Proposta de Emenda à Constituição nº 6-A, de 2019, do Poder Executivo, que “modifica o sistema de previdência social, estabelece regras de transição e disposições transitórias, e dá outras providências” (PEC00619) [ Internet ]. Brasília : Câmara dos Deputados ; 2019 [ citado 15 Out 2019 ]. Disponível em: https://www.camara.leg.br/proposicoesWeb/fichadetramitacao?idProposicao=2192459
https://www.camara.leg.br/proposicoesWeb... ^,2323. Brasil . Ministério da Economia . Instituto Nacional do Seguro Social [ Internet ]. Brasília : Ministério da Economia ; 2018 [ citado 19 Abr 2019 ]. Disponível em: https://www.inss.gov.br/tag/revisao/
https://www.inss.gov.br/tag/revisao/... .

Within the extent of labor reforms, it begins a process of legitimation of work precariousness through outsourcing, hiring people as self-employed workers (i.e., people working without an employment relationship), introduction of intermittent work, changes in working time rules, rest periods (breaks), vacations, career plans, end of compulsory union dues, etc ¹²12. Brasil . Presidência da República . Lei nº 13.467, de 13 de Julho de 2017. Altera a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei nº 5.452, de 1 de Maio de 1943, e as Leis nº 6.019, de 3 de Janeiro de 1974, 8.036, de 11 de Maio de 1990, e 8.212, de 24 de Julho de 1991, a fim de adequar a legislação às novas relações de trabalho . Diário Oficial da União . 14 Jul 2017 . p 1 .^,2424. Dias EC , Hoefel MG . O desafio de implementar as ações de saúde do trabalhador no SUS: a estratégia da RENAST . Cienc Saude Colet . 2005 ; 10 ( 4 ): 817 - 27 . . Some of those changes directly undermine the Brazilian unions, the workers’ health protection guarantees. Moreover, it is still questionable their impact on the institutions, on the workers’ health, on the labor court and on the other institutions operating in the sector ¹¹11. Brasil . Presidência da República . Medida Provisória nº 870, de 1 de Janeiro de 2019. Estabelece a organização básica dos órgãos da Presidência da República e dos Ministérios . Diário Oficial da União . 1 Jan 2019 . . It is worth noting that this process has not yet been completed. On the contrary, changes continue to occur, and the outlook is rather pessimistic.

Numerous actions have been taking policies apart “from the edges” by emptying the sectors, and without taking into account the interrelationship between them. For instance, the labor reform and deregulation increase the social security deficit and the assumed increase in workers’ illnesses will overload the other sectors involved. In a nutshell, it can be implied that the difficulties in implementing intersectoriality ultimately weakened a systemic view of the field and of how one sector, beyond complementing the actions of the other, is part of a single system that aims at ensuring Occupational Health ¹⁰10. Lancman S , Daldon MTB , Jardim TA , Rocha TO , Barros JO . Intersetorialidade na saúde do trabalhador: velhas questões, novas perspectivas? Cienc Saude Colet [ Internet ]. 2019 [ citado 15 Out 2019 ]. Disponível em: http://www.cienciaesaudecoletiva.com.br/artigos/intersetorialidade-na-saude-do-trabalhador-velhas-questoes-novas-perspectivas/17117?id=17117
http://www.cienciaesaudecoletiva.com.br/... .

This process, known as ultra-liberalism, has been undermining all discussions about work conditions and organization, all the theoretical, empirical, and clinical advances about the work relevance in building the individuals’ health, the richness of their physio-psychosocial development, their know-how, their subjectivity, and the own crucial role of work in people’s lives.

With regard to the Brazilian context, it is known that

In this scenario, primary care would occupy an advantaged position as the health care networks organizer, including the workers’ health ²⁵25. Dias EC , Silva TL . Contribuições da Atenção Primária em Saúde para a implementação da Política Nacional de Saúde e Segurança no Trabalho (PNSST) . Rev Bras Saude Ocup . 2013 ; 38 ( 127 ): 31 - 43 .^,2626. Souza TS , Virgens LS . Saúde do trabalhador na Atenção Básica: interfaces e desafios . Rev Bras Saude Ocup . 2013 ; 38 ( 128 ): 292 - 301 . . Notwithstanding, the articulated work between these two instances, albeit the existence of some successful experiences ²⁷27. Lazarino MAS , Silva TL , Dias EC . Apoio matricial como estratégia para o fortalecimento da saúde do trabalhador na atenção básica . Rev Bras Saude Ocup . 2019 ; 44 : e23 .^,2828. Garbin AC , Pintor EAS . Estratégias de intra e intersetorialidade para transversalizar a saúde do trabalhador em todos os níveis de atenção à saúde . Rev Bras Saude Ocup . 2019 ; 44 : e18 . , seems to be neither perennially nor systematically configured in the daily work of the referred professionals, as stated in the literature ²⁹29. Lacaz FAC , Trapé A , Soares CB , Santos APL . Estratégia saúde da família e saúde do trabalhador: um diálogo possível? Interface ( Botucatu ). 2013 ; 17 ( 44 ): 75 - 87 . . In this sense, health itself, as a potential protagonist of the integration process among the various sectors, as well as the specific practices of its competence, becomes vulnerable, as reinforced by some of the workers interviewed for this study.

To conclude this study, we raise the following question: If the intersectoral practices had been applied, as outlined by the National Occupational Safety and Health Policy (PNSTT), would this be a resistance pillar of the field to face the ongoing social-economic-political changes? This is a hypothesis that should be further investigated.

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