Brazil has the greatest cultural diversity in Latin America, with more than 300 indigenous peoples, who speak 274 languages and have their own worldviews and ways of life (IBGE, 2012IBGE - INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. Estudos especiais: o Brasil indígena: língua falada. Rio de Janeiro, 2012. Disponível em: <Disponível em: https://bit.ly/35Awn1R >. Acesso em: 23 abr. 2017.
https://bit.ly/35Awn1R... ). Since the Portuguese arrived 520 years ago, indigenous peoples have been fighting for recognition and for the right to assert their identities. Thus, they have resisted centuries of integrationist policies that understood them as primitive and aimed to assimilate them into society and the world of work and productivity.

The first legal references to indigenous people relate to the use of their land and to their right to be integrated into national society. The creation of the Indian Protection Service in the early 20th century and of the National Indian Foundation in the 1960s were the result of attempts to remoralize the country, given the negative repercussions of the massacre of indigenous peoples by the Brazilian government (Gomes, 2012GOMES, M. P. Os índios e o Brasil: passado, presente e futuro. São Paulo: Contexto, 2012.; Raminelli, 1996RAMINELLI, R. Imagens da colonização: a representação do índio de Caminha a Vieira. Rio de Janeiro: Jorge Zahar, 1996.). Only in the 1988 Federal Constitution were indigenous people recognized as Brazilian citizens, entitled to preserve their culture and customs (Brasil, 1988BRASIL. Constituição da República Federativa do Brasil de 1988. Diário Oficial da União, Brasília, DF, 5 nov. 1988. Disponível em: <Disponível em: https://bit.ly/3iHvibW >. Acesso em: 14 set. 2020.
https://bit.ly/3iHvibW... ). Thus, indigenous rights began to take heed of the “ancestry of [indigenous] presence in the territory” (Garnelo, 2014GARNELO, L. O SUS e a saúde indígena: matrizes políticas e institucionais do subsistema de saúde indígena. In: TEIXEIRA, C. C.; GARNELO, L. (Org.). Saúde indígena em perspectiva: explorando suas matrizes históricas e ideológicas. Rio de Janeiro: Editora Fiocruz, 2014. p. 107-144., p. 112, our translation).

Although discussions on indigenous rights have undergone significant advancements, the relationship between the Brazilian State and indigenous peoples is another story. Projects aiming to alter and reverse indigenous rights are a frequent occurrence in the National Congress. A few examples are Bill 692/1991, which deals with mining on indigenous lands, and Constitutional Amendment Proposal 215/2000, which attempts to confer the National Congress exclusive power to demarcate indigenous lands or ratify the ones that have already been demarcated (Brasil, 1991BRASIL. Câmara dos Deputados. Projeto de Lei nº 692/1991. Dispõe sobre a mineração em terras indígenas e dá outras providências. Brasília, DF, 1991. Disponível em: <Disponível em: https://bit.ly/35yBy23 >. Acesso em: 8 mar. 2018.
https://bit.ly/35yBy23... , ²⁰⁰⁰BRASIL. Câmara dos Deputados. Proposta de Emenda à Constituição nº 215/2000. Acrescenta o inciso XVIII ao art. 49, modifica o §4º e acrescenta o §8º, ambos no art. 231, da Constituição Federal. Brasília, DF, 2000. Disponível em: <Disponível em: https://bit.ly/2ZEGIWK >. Acesso em: 8 mar. 2018.
https://bit.ly/2ZEGIWK... ). These bills exemplify the fragility of these peoples’ constitutional inroads and the constant threat posed by a growing Brazilian-government conservatism and by an accelerated expansion of agribusiness borders.

The Federal Constitution and the recognition of indigenous peoples’ right to identity were not enough to end their genocide. During her mission to Brazil in 2016, the United Nations’ special rapporteur on the rights of indigenous peoples pointed out that “a matter of most pressing concern is the extent of documented and reported attacks on indigenous peoples” (Tauli Corpuz, 2016TAULI CORPUZ, V. Declaração de fim de missão. Genebra: Conselho de Direitos Humanos das Nações Unidas, 2016. Disponível em: <Disponível em: https://bit.ly/35GIrhR >. Acesso em: 15 fev. 2017.
https://bit.ly/35GIrhR... , p. 4), especially reprisals in the form of land reoccupation and violence against indigenous people when they find themselves in urban environments. According to the Indigenist Missionary Council, recent years have witnessed an increase in murders and attacks against indigenous people, mainly in the state of Mato Grosso do Sul (Cimi, 2018CIMI - CONSELHO INDIGENISTA MISSIONÁRIO. Relatório violência contra os povos indígenas no Brasil: dados de 2017. Brasília, DF, 2018. Disponível em <Disponível em https://bit.ly/3mmunQI >. Acesso em: 23 out. 2018.
https://bit.ly/3mmunQI... ).

Based on the premise that land is neither a material good nor a form of property, indigenous peoples continue to fight for the demarcation of their territory, which constitutes their fundamental demand before the Brazilian State. As Guajajara put it, “the struggle for Mother Earth is the mother of all struggles” (2017GUAJAJARA, S. 518 anos depois: “A luta pela mãe-terra é a mãe de todas as lutas”: carta por uma candidatura indígena, anticapitalista e ecossocialista à presidência do Brasil. Gama Livre, [s. l.], 1º dez. 2017. Disponível em: <Disponível em: https://bit.ly/3iubclH >. Acesso em: 13 abr. 2018.
https://bit.ly/3iubclH... , our translation). Crucial to ensuring the indigenous way of life and, in this sense, to maintaining and restoring health, the issue of land demarcation cannot be disassociated from the issue of healthcare.

After many struggles for recognition, indigenous peoples have finally constituted themselves as an important social force in the drive to influence public policies. After Indians in Movement (Krenak, 2015KRENAK, A. Encontros. Rio de Janeiro: Azougue, 2015.; Munduruku, 2012MUNDURUKU, D. O caráter educativo do movimento indígena brasileiro (1970-1990). São Paulo: Paulinas, 2012.) were able to secure Chapter VIII of the Federal Constitution, entitled “Indians” - a legal break with policies based on the science of human evolution and on government-directed indigenous integration with the national community (Souza Lima, 2015SOUZA LIMA, A. C. Sobre tutela e participação: povos indígenas e formas de governo no Brasil, séculos XX/XXI. Mana, Rio de Janeiro, v. 21, n. 2, p. 425-457, 2015.) - these peoples became even more present in the field of public-policy construction.

This process was influenced by several factors: the organization of land demarcation policies, guaranteed by the Federal Constitution and established by Decree 1,775/1996; health policy, with the demand for a differentiated care subsystem approved by Law 9,836/1999BRASIL. Lei nº 9.836, de 23 de setembro de 1999. Acrescenta dispositivos à Lei no 8.080, de 19 de setembro de 1990, que “dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências”, instituindo o Subsistema de Atenção à Saúde Indígena. Diário Oficial da União, Brasília, DF, 24 set. 1999. Disponível em: <Disponível em: https://bit.ly/3hsVciw >. Acesso em: 14 set. 2020.
https://bit.ly/3hsVciw... ; educational policy, which ensured intercultural, bilingual and differentiated indigenous school education by means of Law 9,394/1996 (Paula; Vianna, 2011PAULA, L. R.; VIANNA, F. L. B. Mapeando políticas públicas para povos indígenas. Rio de Janeiro: Laced/UFRJ, 2011.).

However, it is important to note that the production of public policies does not end with the publication of a legal text. For the country’s indigenous peoples, the struggle in favor of said policy’s permanence, effectiveness and proper implementation is never-ending. Thus, the Indigenous Peoples Health Services National Policy is inseparable from the intense disputes and protagonism of the indigenous population (Funasa, 2002FUNASA - FUNDAÇÃO NACIONAL DE SAÚDE. Política nacional de atenção à saúde dos povos indígenas. 2. ed. Brasília, DF, 2002. Disponível em: <Disponível em: https://bit.ly/3iqvzA2 >. Acesso em: 14 set. 2020.
https://bit.ly/3iqvzA2... ).

The Health Conferences were fundamental for the discussion and elaboration of a health policy for indigenous peoples. The 8th National Health Conference in 1986 can be regarded as the starting point for this construction. By defending the universality of the Brazilian National Health System (SUS), the Conference changed indigenous peoples’ relationship with the health system. Everyone finally had the right to health, which was no longer treated exclusively as a benefit of labor. As such, health became a field of struggle marked by intense potential for political articulation. Autochthonous peoples would have to be included in this new healthcare system through a specific subsystem, following a differentiated path of integration (Confalonieri, 1989CONFALONIERI, U. E. C. O Sistema Único de Saúde e as populações indígenas: por uma integração diferenciada. Caderno de Saúde Pública, Rio de Janeiro, v. 5, n. 4, p. 441-450, 1989.).

Even though they recognized the distance between the State’s system of action and their own modes of organization, indigenous peoples understood the importance of participating in the debate on the creation of the SUS, as reported by Krenak, in Vieira’s portrayal (2019VIEIRA, N. B. S. “Tem que ser do nosso jeito”: participação e protagonismo do movimento indígena na construção da política de saúde no Brasil. 2019. Tese (Doutorado em Ciências) - Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, 2019., p. 84, our translation):

Thus, as a form of care complementary to indigenous healing, Law No. 9,836/1999BRASIL. Lei nº 9.836, de 23 de setembro de 1999. Acrescenta dispositivos à Lei no 8.080, de 19 de setembro de 1990, que “dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências”, instituindo o Subsistema de Atenção à Saúde Indígena. Diário Oficial da União, Brasília, DF, 24 set. 1999. Disponível em: <Disponível em: https://bit.ly/3hsVciw >. Acesso em: 14 set. 2020.
https://bit.ly/3hsVciw... created the Indigenous Health Subsystem (SASI). It was the result of intense mobilization of native peoples through the 8th and 9th National Health Conferences and the 1st and 2nd National Indigenous Health Conferences.

After 30 years of SUS and 21 years of SASI existence, Brazilian healthcare has undergone several advancements. Nevertheless, debates on the occasion of the 30-year anniversary of the SUS remained silent in regards to indigenous-people healthcare (Bahia, 2018BAHIA, L. Trinta anos de Sistema Único de Saúde (SUS): uma transição necessária, mas insuficiente. Caderno de Saúde Pública, Rio de Janeiro, v. 34, n. 7, e00067218, 2018.; Paim, 2018PAIM, J. P. Sistema Único de Saúde (SUS) aos 30 anos. Ciência & Saúde Coletiva, Rio de Janeiro, v. 23, n. 6, p. 1723-1728, 2018.), the considerable visibility the theme had obtained in the last two decades notwithstanding. In this sense, it is necessary to return to the essence of collective-health building in the 1970s. Although marked by tensions, this process “not only establishes a critique of the naturalistic universalism of medical knowledge, but breaks with the concept of public health, denying its monopoly of biological discourse” (Nunes, 2013NUNES, E. D. Saúde coletiva: uma história recente de um passado remoto . In: CAMPOS, G. W. S. et al . (Org.). Tratado de saúde coletiva. 2. ed. São Paulo: Hucitec, 2013. p. 19-40., p. 26, our translation). At the present moment - when the main challenge for the consolidation of SUS is political - economic determination is among the greatest threats (Paim, 2018PAIM, J. P. Sistema Único de Saúde (SUS) aos 30 anos. Ciência & Saúde Coletiva, Rio de Janeiro, v. 23, n. 6, p. 1723-1728, 2018.). The same is true in regards to the consolidation and permanence of the SASI.

Within this context of political resistance in favor of the permanence and qualification of the SASI, another concern is the organization required to prevent and combat the covid-19 pandemic. The more than 300 indigenous peoples inhabiting this territory experience different realities: for instance, some people live in isolation, while others are city dwellers. However, they are all subject to a common threat: social vulnerability in the face of the pandemic. Historically speaking, infectious diseases have been responsible for thousands of deaths in indigenous communities. These diseases - which reached communities by means of non-indigenous persons - were mysterious from the standpoint of indigenous peoples. Their traditional medicines provided no means for fighting viruses and caring for people with infectious diseases.

The Brazilian government’s failure to organize and facilitate assistance to native peoples in the face of covid-19 is a sad reminder of the State’s lack of responsibility and disrespect for indigenous rights. Once again, however, indigenous mobilization is manifesting its power and resistance. Acting in parallel to the Executive Power, indigenous peoples are establishing articulations with indigenous, indigenist, and collective-health organizations - and even with the Federal Congress and the Federal Supreme Court (STF) - in order to fight the pandemic. In this sense, we highlight the Indigenous Emergency plan, led by the Articulation of the Indigenous Peoples of Brazil (APIB, 2020APIB - ARTICULAÇÃO DOS POVOS INDÍGENAS DO BRASIL. Emergência indígena: plano de enfrentamento da covid-19 no Brasil. [S. l.], 2020. Disponível em: <Disponível em: https://tinyurl.com/y49cpzqa >. Acesso em: 7 ago. 2020.
https://tinyurl.com/y49cpzqa... ), which in addition to providing assistance to communities, acts to confer visibility to statistics regarding the spread of the pandemic among indigenous peoples, regardless of where they live.

Furthermore, by means of the Non-Compliance Statement of Fundamental Precept 709 (STF, 2020), the APIB was ensured the right to collective construction of a plan to combat the pandemic. This plan is to be implemented by the federal government alongside the Special Department for Indigenous Health, and has the support of the Brazilian Association of Collective Health’s Technical Group in Indigenous Health. Other elaborations include the Emergency Plan in Support of Indigenous Territories, proposed by the Mixed Parliamentary Front in Defense of the Rights of Indigenous Peoples (led by federal deputy Joenia Wapichana) and approved by Law 14,021/2020 (Brasil, 2020BRASIL. Lei nº 14.021, de 7 de julho de 2020. Dispõe sobre medidas de proteção social para prevenção do contágio e da disseminação da covid-19 nos territórios indígenas; cria o plano emergencial para enfrentamento à covid-19 nos territórios indígenas; estipula medidas de apoio às comunidades quilombolas, aos pescadores artesanais e aos povos e comunidades tradicionais para o enfrentamento à covid-19; e altera a Lei nº 8.080, de 19 de setembro de 1990, a fim de assegurar aporte de recursos adicionais nas situações emergenciais e de calamidade pública. Diário Oficial da União, Brasília, DF, n. 129, p. 1-3, 8 jul. 2020. Seção 1.), and the Plano Frente pela Vida, authored by collective-health organizations (Frente pela Vida, 2020FRENTE PELA VIDA. Frente pela vida: plano nacional de enfrentamento à pandemia da covid-19. [S. l.], 2020. Disponível em: <Disponível em: https://bit.ly/2Zz904Y >. Acesso em: 8 ago. 2020.
https://bit.ly/2Zz904Y... ).

In such a complex historic moment, this dossier marks the end of a cycle, started with a doctoral project developed at the Faculdade de Saúde Pública of Universidade de São Paulo. The project analyzed the participation of native peoples in the construction and implementation of the National Health Care Policy for Indigenous Peoples, after the promulgation of the 1988 Constitution. Fruitful debates during the thesis defense “It has to be our way”: participation and protagonism of the indigenous movement in the construction of the health policy in Brazil, by Nayara Begalli Scalco Vieira (2019VIEIRA, N. B. S. “Tem que ser do nosso jeito”: participação e protagonismo do movimento indígena na construção da política de saúde no Brasil. 2019. Tese (Doutorado em Ciências) - Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, 2019.) and the seminar (2019aA SAÚDE INDÍGENA E A ECOLOGIA DE SABERES NO ENFRENTAMENTO DOS DESAFIOS ATUAIS: “TEM QUE SER DO NOSSO JEITO”, 2019, São Paulo. Galeria… São Paulo: IPTVUSP, 2019a. Parte 1. Disponível em: <Disponível em: https://bit.ly/2FEhuAN >. Acesso em: 16 set. 2020.
https://bit.ly/2FEhuAN... , ^2019bA SAÚDE INDÍGENA E A ECOLOGIA DE SABERES NO ENFRENTAMENTO DOS DESAFIOS ATUAIS: “TEM QUE SER DO NOSSO JEITO”, 2019, São Paulo. Galeria… São Paulo: IPTVUSP, 2019b. Parte 2. Disponível em: <Disponível em: https://bit.ly/3kmMPqv >. Acesso em: 16 set. 2020.
https://bit.ly/3kmMPqv... ), with the participation of Ailton Krenak, Ana Lúcia Pontes, Douglas Rodrigues, João Arriscado Nunes, Marília Cristina Prado Louvison and Marina Cardoso, have important contributions to reflections in the field of indigenous health, and deserved to be published. Thus, throughout its four essays - three of them placing special emphasis on the authors’ professional experiences - and two articles, this dossier seeks to appreciate the participation of native peoples in the construction and maintenance of SASI, recognizing their effort to ensure a differentiated indigenous healthcare.

The text “Epistemologies of the South and decolonization of health: for an ecology of care in collective health” proposes a theoretical reflection regarding the need for a new way of “making science” and a new way of thinking about collective health, able to contemplate the myriad existing forms of healthcare. Identifying, recognizing and conferring meaning to the forms of care underlying indigenous medicines and communities are necessary steps in the construction of a differentiated care. Moreover, in collective health, crossing the barrier of science as a restrictive activity towards a science that confers visibility and builds possibilities is fundamental for the production of non-extractivist knowledge.

The next articles in the series, “From participation to social control: reflections based on the indigenous health conferences” and “Social control in the Indigenous Health Care Subsystem: a silenced structure” discuss spaces of social control as well as indigenous participation in the SASI. The first focuses on the different meanings of the terms “participation” and “social control” in the reports of the five National Indigenous Health Conferences, addressing the importance of this space and its transformations. The second reflects on the State’s creation of the Indigenous Health District Councils (Condisi) and the Forum of Condisi Presidents, also discussing the control over debate processes exerted by the bureaucracy - a growing factor behind its distancing from indigenous modes of debate and, consequently, from indigenous demands linked to the construction of differentiated care.

The essay “Better alone than in bad company: contact and contagion with isolated and recently contacted indigenous people in Brazil and challenges for their protection and health care” brings up the debate about the scars left by contact between non-indigenous society and peoples of isolated origin - scars that permeate not only historical memory and culture, but also the body and the immune system - based on the authors’ experience with monitoring these contact expeditions. This debate is as current and relevant as ever, since the Brazilian government has been expressing an interest in reviewing its contact policies, in order to return to the colonial logic of imposing ways of life, customs and culture.

In the essay “The sound of maracas (tribute to Ailton Krenak): indigenous medical practices and public health” the author contributes her experience and reflection to discuss setbacks suffered by public indigenous-health policies. Although present throughout the entire implantation process, these setbacks became more serious at certain junctures, threatening the pillars of differentiated healthcare and social participation. As such, the essay articulates itself with the theoretical reflection proposed here regarding the degree to which hegemonic knowledge and powers put indigenous societies in our country at severe risk.

Finally, we have a special publication by Ailton Krenak, “Reflection on indigenous health and current challenges in dialogue with the dissertation ‘It has to be our way’: participation and protagonism of the indigenous movement in the construction of the health policy in Brazil”. Taking care not to disrespect the orality of Krenak’s speech, the work of transcribing some of his interventions in indigenous-mobilization events is our contribution to opening new paths for reflection in the field of indigenous and public health. To this end, it is essential to discuss Brazil’s “coal” state and our possibilities when it comes to the construction of a collective, differentiated healthcare. Krenak’s words - which shed light on the ways in which a capitalist and doctor-centered society produces disease rather than health - close this dossier, inviting everyone to share and follow this path of reflection, ressignification and collective reconstruction.

Good reading!

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