Between health needs and agenda-setting: a procedural analysis of the compositional layers of space

Abstract

Abstract Background This study aims to offer a view of the current situation arising in the Brazilian Health System (SUS) regarding the relationship between the health needs of its users and the health policies developed by the system. Methods The qualitative analysis was organised in two stages: 1) Comparative analysis of the social representations of health needs in which the data were analysed by the Health Needs Taxonomy (Matsumoto, 1999), as an instrument to assess health needs, format the interview guide and organise the empirical data; the Theory of Social Representations (Jovchelovitch, 2000) to capture health needs, and Content Analysis (Bardin, 2004), as an instrument of analysis and comparison of perceived needs. 2) Analysis of the agenda-setting in which the data were obtained and analysed by the Grounded Theory (Strauss; Corbin, 1990), Narrative Analysis (Taylor, 1979), and the Procedural Analysis Model (Ferreira; Alencar; Pereira, 2011) for contextual analysis of public health policies. The fieldwork was a Brazilian municipality and 39 representatives of civil society organisations and stakeholders were interviewed. Results The data showed a complex social fabric made of a plot that alternates between conceptual knots and structural voids which has been sewn by many actors and has served multiple purposes. It also showed that an insufficient institutional capacity for assessing needs, professional turnover, managers' personal decision and the manipulation of actors and institutions according to the interests at stake have kept the health needs unmet. Conclusions A positive representation of SUS will only be achieved through both the intertwining between biomedical knowledge to the determinants of health and the strengthening of a democratic culture. Without this perspective, the health system will remain fragile, plentiful in structural knots and voids, and unable to relocate people's health needs from the fringes to the main layers of this social fabric. Key messages An insufficient institutional capacity for assessing needs, managers' personal decision and the manipulation of institutions according to the interests at stake have kept the health needs unmet. A positive representation of SUS will only be achieved through both the intertwining between biomedical knowledge to the determinants of health and the strengthening of a democratic culture.