Effects of neoliberal rationality on Brazilian Public Health System recent policies and discourses

Abstract

Abstract Background We analyzed the increasing penetration of neoliberal rationality in recent changes of Brazilian Public Health. We seek to observe if these different discourses and organizational changes represent a lack of accountability for public power and put in risk universal access through a paradoxical defense of equity principle. Methods We performed a discourse analysis of 8 technical documents published by the Ministry of Health from 2016 to 2019 as well as different 5 interviews made with and 6 articles signed by its minister and secretaries. This period comprehends an interim government formed after a controversial impeachment process and the new Ministry staff named after Bolsonaro's election. Results We studied different perspectives of neoliberalism that have been seeking for the last years to untangle the concept of neoliberalism. Inspired by Foucault's thoughts, neoliberalism is understood here beyond as a complex transformation of government paradigms that produces very narrow models of individual freedom and subjectivity and that considers private entrepreneurship as naturally superior to state actions commonly described as inefficient and costly. Often justified by a literature characterized as scientific, we understand that recent Brazilian Public Health formulations have been emphasizing equity to the detriment of universality and overestimating public-private partnerships and private management logic as positive solution for public policies and a prioritization of healthy lifestyle and risk management based on individual and moral autonomy over the role of the State of intervention on health social determinants. Conclusions Recent public speeches and technical documents of Public Health in Brazil at the federal level have been influenced by a neoliberal rationality. These changes require more accurate methods to unravel neoliberalism meanings and practices and preserve hard-won social rights during the re-democratization of Brazil. Key messages Neoliberal rationality of recent Brazilian Public Health discourses represents a lack of accountability for public power and a risk to health universal access. These changes require more accurate methods to unravel neoliberalism meanings and practices and preserve hard-won social rights of our public health system during the re-democratization of Brazil.