WE LIVE A CRUCIAL YEAR OF DISPUTE OVER PROJECTS and the refoundation of Brazil on new bases, overcoming the slavery matrix that structures a country of hunger and of intolerable inequality.

We approach the most important elections of our lives. In October, the Brazilian people will decide, through the electronic vote, if we will resume the paths of full democracy or if we will continue the barbarism of an authoritarian, excluding, misogynist government that annihilated historic achievements of the people in the fields of health, work, culture, and social policies.

The historic and exemplary struggle of the Brazilian Sanitary Reform Movement conquered, with broad popular participation, health as a universal right of citizenship in the 1988 Constitution, contrary to the global trend of the ultra-neoliberal project that was opposed to the idea of health as a universal right, and not as a commodity.

That year, in a bold moment, this collective movement that had the Brazilian Center for Health Studies (CEBES) as one of its protagonists placed health in the Brazilian constitution as a universal right for all and a duty of the State. Today, more than 32 years later, we had to face the 2016 coup and an economic, political, social, cultural, environmental, health crisis: a destruction of rights and the biggest health catastrophe in the history of this country, the COVID-19 pandemic, exposing the failure of the ultra-neoliberal project.

Since 2016, the Brazilian people have been suffering the excesses of public policies that have destroyed rights conquered in several areas. The situation worsened after 2020, when the pandemic began and this nefarious project of denialism, of death, which took the lives of about 700.000 people in this country. Most of these deaths could have been avoided had it not been for the criminal project led by the current President of the Republic and his Ministers of Health. However, the Brazilian people chose to live and gave an overwhelming response in favor of science, opting for Life by adhering en masse to the vaccine.

There was a growth in the awareness that popular organization is essential to expand the social and political force that sustains the country’s refounding agenda.

In this context of great challenges, the Front for Life, which brings together numerous historical entities of the Health Reform Movement, convened the National Free, Democratic, and Popular Health Conference. Since April 7, the date on which the campaign was boosted by a great act in the National Congress with the presence of all the participants of the Front for Life and parliamentarians, around 120 free regional and local conferences have been held throughout Brazil, expressing the great national mobilization with the formation of popular committees, basis for the refoundation of the country.

For a long time the Brazilian health movement has not had such a deep consensus around the guidelines that represents a shift in the affirmation of health as a universal right: 100% public health; revocation of Constitutional Amendment No. 95 to make financing available for the Unified Health System (SUS) and expand public funding; State career for health professionals; qualifying regionalized care to ensure comprehensive and quality health care; health as a strategic axis of development and to broaden and deepen democracy.

During the Conference, held on August 5, in São Paulo, Luiz Inácio Lula da Silva, candidate for President of the Republic by the Brasil da Esperança Coalition^{11 Brasil. Tribunal Superior Eleitoral. Eleições 2022: TSE já recebeu nove registros de candidaturas à Presidência da República. Comunicação TSE. 2022 ago 12. [acesso em 2022 ago 18]. Disponível em: https://www.tse.jus.br/comunicacao/noticias/2022/Agosto/eleicoes-2022-tse-ja-recebeu-nove-registros-de-candidaturas-a-presidencia-da-republica.
https://www.tse.jus.br/comunicacao/notic...} , was given the document ‘Health as a Right’, which represents the full force of the health movement in Brazil.

The objective is to have the social and political forces supporting this new moment in the country, in which we want to ensure care and well-being policies at the national level and universal citizenship rights. Furthermore, health has become a mandatory point on this priority agenda, especially at this time when we are fighting a battle to overcome the enormous health crisis of the COVID-19 pandemic, won by the resilience of the Brazilian people. The SUS came to belong to the whole of society, being the central point of an entire broad discussion of care and well-being.

Democracy, the universal right to health, to life, and to the SUS are in the guidelines indicated by the document delivered to candidate Lula and legitimize the inclusion of health at the center of discussions for a democratic-popular government program to be chosen by free and direct vote at the polls in October. Brazil demands that health be treated as a right, not as a commodity.

In addition to the mobilizations that took place, there is the aftermath of the August encounter, and Front for Life is already producing notebooks with all the contributions that came from the local and regional conferences and, moreover, those that were added on the 5th of August, as material to be made available for national debate.

This broad process of organization and debate will certainly contribute to the accomplishment of a vigorous and historic 17th National Health Conference in 2023.

Basic guidelines

The final document^{22 Centro Brasileiro de Estudos de Saúde. Leia a Carta Compromisso da Conferência Livre Democrática e Popular de Saúde Entregue ao Lula. [acesso em 2022 ago 14]. Disponível em: https://cebes.org.br/carta-compromisso-da-conferencia-livre-democratica-e-popular-de-saude-lula/29492/.
https://cebes.org.br/carta-compromisso-d...} is a synthesis of care policies and universal rights and was prepared jointly by the entities and movements that make up the Front for Life^{33 Associação Brasileira de Saúde Coletiva, Centro Brasileiro de Estudos de Saúde, Rede Unida, et al. Plano Nacional de Enfrentamento à Pandemia da Covid-19. Frente pela Vida. 2020 jul 15. Versão 2. [acesso em 2022 ago 14]. Disponível em: https://frentepelavida.org.br/uploads/documentos/PEP%20COVID-19_v2.pdf.
https://frentepelavida.org.br/uploads/do...} , including the Cebes, the National Health Council, the Brazilian Association of Collective Health (ABRASCO), the Unified Netword, and the Brazilian Society of Bioethics, expanded with the suggestions received during the conference. The document was built on five fundamental axes: the first is universal access to health; the second is the articulation of networks, taking into account integrality and equity; the third is related to the Economic and Industrial Health Complex (CEIS); the fourth, shared management and social control of the SUS; and the fifth, the management of work and education in health.

To ensure the goal of 100% public health, it is important to resume decent, adequate, stable, and consistent funding. One of the measures is the repeal of Constitutional Amendment No. 95, which currently allocates 60% of the 9.46% of the Gross Domestic Product (GDP) that circulates in health to the private sector, both for health plans and insurances and for medicines that constitute catastrophic expenses. One of the ways to obtain financing is to advance towards obtaining a democratic tax reform that makes it possible to reduce this intolerable inequality existing in the country.

The document also points to a quality care network in service instances, which can contemplate the entire population with respect and dignity. It is necessary to overcome the bottlenecks of specialized care; to affirm the issue of territory; the Family Health Strategy articulated with the issue of social assistance policies, education, all universal rights policies territorially, producing health and sanitary goals in order to have a decent service to the Brazilian population in all its health needs. Furthermore, if we affirm health as a public good, we cannot have precarious professionals. Health needs to be an attractive career, a dignified public career for all health professionals, so that they have working conditions, with continuing education and qualified training as a way of valuing those professionals who are responsible for the quality of care. Therefore, it is very important to establish a public career in the State for SUS professionals.

With regard to development, the government needs to invest in and expand the Economic and Industrial Health Complex, the country’s strategic growth axis. Brazil will only gain with sovereignty and health security when it can have a CEIS with autonomy and greatness to produce its own medicines and make new discoveries (research), to reduce the high costs of imported products. Public policies should privilege knowledge, learning, and, above all, innovation, to strengthen the CEIS, addressing and articulating action strategies that manage to generate a high degree of innovation, high dynamism in terms of growth rate and competitiveness.

Finally, another fundamental axis is that of popular participation. It is essential to deepen and expand the democratic question in this civilizational moment of great political impasse. ‘Health is democracy, democracy is health’ has always been the motto that guides our activities. Therefore, at this turning point of Brazilian society, of recovery and affirmation of democracy, it is important that it contemplate, in a radical way, a control of society over health policies and actions, with participatory budgeting and organized territories producing life throughout Brazil.

References

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