Sistemas de saúde e participação cidadã: algumas reflexões críticas na perspetiva da sociologia da saúde

Abstract

The past ten to fifteen years have seen a rise in the number of initiatives of civil society participation intended to exert pressure toward the reformulation of social ri- ghts. These are no longer viewed as the rights to access to services designed and adminis- tered by the State (according to Marshall's concept of citizenship), but as citizens' demand for an active role in defining public policy and services. This debate, which has been very intense among social scientists since the 1980s, is actively present within the healthcare system. Several studies have been highlighting a strong tension between the technicism of medicine and bureaucratic organization of the health system, on one side, and the communication model of the life word, on the other side. In fact, one of the central issues of health care reforms of the last 20 years has focused on the valorization of the citizens' experience and voice. The paper begin with brief sketches of new sociological approaches aimed at linking social systems with the real world - micro with macro dimensions; struc- ture with action. Then, the actual state of art of citizens' participation in western health systems is presented, as result of a literature review, highlighting both new strategies of patient involvement and critical issues and constraints. In closing, some reflection on the complexity of the relation between the health care system and patient and user associa- tions are presented for discussion.