In October 2014, the Brazilian Center for Health Studies (Centro Brasileiro de Estudos de Saúde — Cebes) held a preparatory seminar for the XIII Congreso Latinoamericano de Medicina Social y Salud Colectiva of the Associación Latinoamericana de Medicina Social (known as Alames). By the end of it, the ‘Carta do Brasil’ was approved, consisting of 12 items, which were transcribed in this space of dialogue with the reader, reaffirming the commitment of Cebes with the content of this document: 1. Latin America currently lives a critical political period, facing concrete possibilities of setbacks to the progresses achieved by more leftist/popular governments concerning social rights and even the strategy for articulating Latin America itself, as the conservative right, supported by imperialism and incessantly conspiring against those governments, seeks to regain in various ways the hegemony of power in the region; 2. It must be recognized that the leftist/popular governments and the revolutionary processes in course in Latin America are still far from overcoming the political guidelines and the neoliberal programs, were unable to provide the deep transformations that society requires and could not overcome the primacy of the interests of the capital. It must also be recognized that the way of the political game, which characterizes the bourgeois democracy, has been proving itself to be insufficient to guarantee the achievements and ensure more significant advances in the economic and social policies favorable to the class that lives off work; 3. The political strategies of the leftist governments in Latin America face difficulties. Popular participation, in spite of the great advances observed in the progressive governments of the subcontinent, has yet to fully achieve its independence and autonomy from the State. There have been promoted policies of inclusion and income distribution, but they were often built on individualized and depoliticized policies, and political problems were treated like technical problems; 4. The Latin American left has been facing a lot of problems to win the battle of communication. Part of it believed that, when they took power the State could be transformed, but did not consider that, rather than that, the bureaucratic structure of the State could end up transforming them; 5. The political parties engaged in popular causes need to find their legitimacy. The party programs are not too different from one another from the ideological point of view, and we can see an inconsistency between the party program and its exercise, largely because of the coalitions that they conduct to govern, resulting in a political and a representation crisis. Despite this disenchantment, the parties remain important to articulate ideologies, political fields and an autonomous popular participation with real participation in the State, which is still the main inducing agent of change; 6. There are real difficulties in identifying the revolutionary actor that can boost a process of social transformation. Whence, there must be a careful reading of the urban and rural social movements, of the peripheral subjects, that emerge from the contradictions of the capitalist system itself. Recognizing how these subjects have been acting and performing slow deeper transformations in ways of living, making the criticism of the economic model and pointing to other social projects; 7. This is a time for reconstructing the agenda and building a socialist project, regionally articulated, since one isolated country alone has no way to carry out projects that break with the globalized capitalist logic, based on individualism and consumption, that does not respect the nature and endangers the planet; 8. A project that seeks to build a new model of State and society must have as presuppositions the sovereignty of countries, regional coordination, solidarity between and within countries, sustainability aiming at the future of the new generations, building new consensus from unrestricted democracy and popular participation; 9. The discussion about new possible ways to a process of transition to socialism must consider Latin American experiences, which, as reformer and/or revolutionary forces, sought to build a popular State as a means to building an egalitarian, socialist world; 10. The progressive governments of Latin America need to promote structural reforms, driven by social movements. Some reforms need to be made urgently in order to ensure democracy itself, like the reform of the media, tax reform, land reform, judicial reform and political reform; 11. The fight for health cannot be a sectorial fight. The health policy needs to gain an anti-capitalist content. The progresses achieved in this sector, as for example the Unified Health System (Sistema Único de Saúde, known as SUS) in Brazil, were a result of broader struggles that won the accession of the whole society. The targeted social policies that cost 0.5% of Gross Domestic Product (GDP) are not enough, for they continue to attend to the interests of the capital. We must fight for universal social policies; 12. Entities like Cebes and Alames must take over the articulation in regional level, recovering the moment of emergence of Social Medicine, of Public Health and of the fight for the right to health in Latin America. In this process, contributing for the interpretation of reality, identifying the contradictions and building a discourse that makes sense for everybody. This articulation must transform the fight for health in a fight for the construction of a new project of society.

We understand that the content of ‘Carta do Brasil’ is a warning and a call for militants of the Brazilian Sanitary Reform Movement to the political action, which must surpass national limits and integrate to the struggle of the social movements of Latin America.

Cebes National Board

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