Two moments, a permanent agenda: health is democracy, democracy is health

Lucia Regina Florentino Souto José Carvalho de Noronha About the authors

THIS ISSUE COMES OUT A FEW DAYS BEFORE THE 16TH NATIONAL HEALTH CONFERENCE, convened in 2018 by the National Health Council, with the motto: Democracy and Health. Aware of the times that Brazil has been going through in recent years, the Conference wisely adopted the idea that the 16th will be the 8th + 8 = 16, that is, that it should focus on the main themes discussed at the historic 8th Conference: Health as a Right, Consolidation of the Unified Health System (SUS) and Financing of the SUS11 Conselho Nacional de Saúde. 16ª Conferência Nacional de Saúde: democracia e saúde [internet]. [acesso em 2019 jul 18]. Disponível em:

The Cebes (Brazilian Center for Health Studies), when it was founded in 1976, clearly understood that health and democracy constitute an indivisible pair. One can not exist without the other. And it knew that the struggle to secure health and democracy was not not a longterm, but a permanent one. What we may have underestimated was the aggressiveness of our enslaver elites against any social advance and their incurable rapine effort and short-term gains, lack of a national project, and disengagement with sovereignty and democracy.

The first moment, 1986, of the 8th Conference was a time of closing a long dictatorial cycle of suppression of basic civil rights and the creation of a space of political renegotiation that was convened by the National Constituent Assembly. Despite the defeat of the amendment for direct elections in 1984, a result of intense popular mobilization, there was room for the accomplishment of what many call a ‘popular constituent for health’, which was the Eighth. It paved the way for the Constituents to incorporate into the Constitution of 1988 the three central pillars of health policies in the country, inscribed in article 196: 1) Health [as] the right of all and the duty of the state; 2) guaranteed by social and economic policies aimed at reducing the risk of disease and other health hazards; and 3) universal and equal access to the actions and services for their promotion, protection and recovery.

It was, indeed, a short time, perhaps it lasted only 3 years. Badly proclaimed, the ‘Citizen Constitution’, as Ulysses Guimarães called it, began to be eroded. First, because of the change in the composition of the government, with the ousting of the ministers with the greatest social commitment. Secondly with the beginning of the reduction of health share in the social security budget that had been established in the transitional provisions awaiting further constitutional regulation.

Some of its elements, however, could be preserved and allowed, despite the contraction of resources and the decentralization of actions to municipalities, to increase the pressure for the consolidation of a public health system; and the SUS was born and grew up. Nonetheless, its strength was not sufficient to consolidate at its margin, aided by significant tax subsidies, a private system of health plans and insurance aimed at higher income strata of society. The possibility of a truly unique, democratic, and equitable system has moved more and more away from the horizon22 Noronha JC, Tavares LT. A política de saúde nos anos 90. Ciênc. Saúde Colet. 2001; 6(2):445-450..

The so desired representative and participatory democracy suffered successive shocks. Hyperinflation at the end of the Sarney Government paved the way for the Collor adventure. The neoliberal wave that dominated the world invaded Brazil in both FHC governments, despite some health gains in the administration of ministers Jatene and Serra. The election of Lula in 2002 paved the way for the distributive social policy agenda to gain ground with a strong impact on the health conditions of the poorest populations33 Souto LRF, Noronha GS, Costa AM, et al. Civilização ou barbárie. Saúde debate. 2018; 42(3):125-144.. However, such agenda ended when Dilma was elected for her second term and with increasing pressure from the rentier elites that led to her arbitrary impediment and the subsequent election of Bolsonaro after the ‘cassation’ of Lula, who was the absolute leader of public opinion polls. Dilma’s impeachment, Lula’s arrest, and a systematic campaign of demonization of politics led by the great media groups and the sinister alliance of members of the judiciary shook the small economic, social, and political advances of the early years of the twenty-first century. Only the rentier elites have been successful in recent years44 Souza J. A elite do atraso: da escravidão a Bolsonaro. Rio de Janeiro: Estação Brasil; 2019..

The time of the 16th Conference is now, 2019. The right to health shaken, the state’s duty under heavy fire, developmental and distributive economic and social policies suppressed, universal and egalitarian access canceled. It is time for endurance and combat. It is time to update the agenda. To reaffirm democracy and to ensure social participation. To defend the right to health and the state’s responsibility for its guarantee. There is no possibility whatsoever that the ‘invisible hand’ of the market will fulfill this mandate.

We must resume the way of building the SUS, now unsettled in many of its foundations, especially that of universal and equal access to health actions and services. Access has never been as socially stratified as it is today in Brazil. The segmentation by caste of the health services throughout Brazil is scandalous. The state-of-the-art hospitals of São Paulo with their luxury are an assault to the small hospitals, which can hardly be called by that name, which serve three quarters of the Brazilian population.

It is necessary to return to the bases of solidary and sustainable financing of social security. To revoke the absurd Amendment 95 that froze government discretionary spending. To reject the absurd proposal of social security reform, especially the change to the capitalization regime that transfers resources from the poor and lower-middle classes to the financial system and reduction of hard-earned benefits. It is necessary to end the financial loot that, from January to May 2019, has already sucked in R$ 240 billion from Brazilian economy.

It is necessary to resume the inclusive and sovereign development of the country. There will be no health in a nation in which more than half of its economically active population is unemployed or underemployed. Work must be guaranteed for all! It is not possible that the concentration of rural property subverts the capacity of production of healthy food and without poison for Brazilian men and women. Bread must be guaranteed for everyone. Land must be democratized. It is intolerable for us to live an undeclared civil war in which more than 63,000 people are murdered each year, which proposes the release of possession and carrying of weapons for all and that encourages interpersonal conflicts. Brazil needs peace! We need to defend democracy at all costs.

At this crucial moment in the political life of the country, between a civilization project of inclusion, solidarity versus barbarism, we are engaged, participating in the mobilization and preparatory process, organizing Free Conferences to make the 16th National Health Conference a milestone just as the 8th Conference, of a radical commitment of the Brazilian population to the defense of health as a right of citizenship, not a commodity accessible only to those who can afford it.

Health is democracy, health is right of citizenship!

The fight continues, and victory is certain!

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  • 1
    Conselho Nacional de Saúde. 16ª Conferência Nacional de Saúde: democracia e saúde [internet]. [acesso em 2019 jul 18]. Disponível em:
  • 2
    Noronha JC, Tavares LT. A política de saúde nos anos 90. Ciênc. Saúde Colet. 2001; 6(2):445-450.
  • 3
    Souto LRF, Noronha GS, Costa AM, et al. Civilização ou barbárie. Saúde debate. 2018; 42(3):125-144.
  • 4
    Souza J. A elite do atraso: da escravidão a Bolsonaro. Rio de Janeiro: Estação Brasil; 2019.
Centro Brasileiro de Estudos de Saúde RJ - Brazil