The collective health movement and health policy in Brazil: from regime transition/democratization to democracy and neoliberalism (1970s to 2014)

Abstract

This paper analyses how the Brazilian Collective Health Movement (CHM) and its main representatives have influenced the policymaking process for health policy during distinct political periods: from regime transition/re-democratization to democracy (1970s to 2014). We develop a contextual descriptive analysis, involving a literature and documentary review, and interviews with key players. We take into account the political macro contexts (democracy and economic model), governmental coalitions, ideas and actions of the CHM, relationships of the CHM within society, institutionalization of participatory channels, and the interrelations between the Ministries of Economics, of Health and of Social Security. Three main periods were identified: 1) The transition to democracy and Constituent Assembly period, with the fight for and creation of the new national Unified Health Care System (SUS). 2) The first years of re-democratization, during the implementation of the institutional foundations of the SUS (1989- 2002). 3) The period of democracy with neoliberalism (from 2003-2014), when a managerial and participative approach coexisted and conflicted with attempts to subordinate health care policy to the developmental model. The results indicate that the influence of the CHM was less dominant in subsequent years, characterized by the institutionalization of civil participation in health councils, by the prominence of the economic model, and by a more institutionalized political action of movement leaders in the Health Secretaries and the Ministry of Health. In conclusion, we highlight the relevant political lessons regarding the CHM’s possibilities of effective revival in the years to come.