Abstract
The article aims to describe the renewed role of regional policies in territorial reconfigurations in the recent and predominantly neoliberal phase of globalization. It further aims to identify some of the impasses that such transformations produce with their multiple scales and dimensions for strengthening public policies focused on confronting health inequalities in Brazil. The article's discussion begins with a brief review of the characteristics of current territorial reconfigurations in a world in constant transformation, but oriented by neoliberal policy in its multiple dimensions. The article then discusses the changes in local management formats in developed countries. The authors go on to analyze territorial changes in Brazil in recent years, after which the debate addresses the reform agenda in health regionalization and the political cycles in the organization of the Brazilian Unified National Health System (SUS). Finally, the article systematizes some of the impasses in regionalization policy, based on recent studies in which the unit of analysis was Brazilian health regions in the country's different major geographic regions. The issues identified in the article, also emphasized in the specialized literature, show that the region/networks dyad has not been fully strengthened during the regionalization process in Brazil. A key task for the public policy of regionalization of health in Brazil should be to continue to push forward with the reform agenda in order to mobilize the territory's diversity and the directive coordination of strategic national policy.
Highlights
The article aims to describe the renewed role of regional policies in territorial reconfigurations in the recent and predominantly neoliberal phase of globalization
The context of neoliberalism and the new management model have altered the design of public policies and their field of action, bringing changes to the nature of management on its different scales in various parts of the world
Health policy has experienced periods of major transformations driven by changes in populations’ epidemiological profile, state reforms, neoliberal macroeconomic policy, and transformations resulting from technological progress and innovations
Summary
A change in the health care model is imperative given the Brazilian population’s current epidemiological profile, alongside accelerated aging, intense urbanization, and growing inequality in access to goods and services in recent years. Brazil’s epidemiological context features important differences between the country’s major geographic regions, related to distinct demographic profiles, socioeconomic conditions, access to health services, and prevalence of risk factors for chronic noncommunicable diseases (NCDs) 39 (https:// saudeamanha.fiocruz.br). In this context of inequality, a large share of Brazil’s health regions suffer a shortage of services and difficulties in linking to referral services for chronic conditions. The health regions analyzed showed low rates of physicians residing locally in many of the regions, and the circulation of physicians between health regions shows similar patterns, with dependency on physicians from other regions varying from 30% to 40% 27 (http://www.resbr.net.br) This situation highlights the relevance of conceiving different strategies to retain physicians in health regions. Financing that is more aligned with regionalization policy is imperative, given the exhaustion of municipal budget funds, the limited systemic and equitable rationality in state spending, and underfinancing at the federal level [40,41]
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