Health Policies In Brazil Research Articles

The Human Disaster and the Urgency of the Intersetorial Join Between Public Social Policies: Lives that are Lost and Stories that Repeat Themselves

Introduction:The human disaster is a permanent challenge for the Brazilian government because the difficulties faced are related to the lack of interface between public policies, resulting in fragile analyses of risk and non-prevention, being that annually several Brazilian lives are lost in disasters that continue to happen.Aim:The article is the result of research and presents the analyses of health policy, actions, and programs developed to anticipate the fire victims of the Nightclub Kiss concert hall that took place in 2013 (Santa Maria, Brazil). The objective was to investigate and analyze the disasters and human disasters, especially the fire of Nightclub Kiss when 242 young people died. Causes and determinants were analyzed in order to subsidize public policies, in particular, the health policy.Methods:A qualitative case study supported by the critical dialectic method with semi-structured interviews, focus group, documentary analysis, and bibliographic review.Results:The experiences accumulated throughout history show that disaster situations require public policies to be able to act readily, resolve, and pay attention to the needs of the population involved. Disasters are increasingly recurrent episodes and generate deep social consequences that mark human life. Managing a human disaster remains a challenge for the health policy in Brazil. The difficulties faced are related to the lack of interface with other public policies. The urgency to incorporate intervention/action strategies into health plans is important. Implementation of prevention and training programs, and adopting strategies and protocols for the whole network of attention is critical.Discussion:It is important to emphasize the importance of broadening the theoretical definitions by overcoming the divergences of the concepts adopted between the theoretical and operational field, by elaborating a review of the Brazilian legislation in order to broaden and contemplate the needs of different people.

Saúde bucal no Brasil: análise do ciclo da política

Antecedentes: A política nacional de saúde bucal do Brasil, instituída em 2004, é considerada a maior política pública deste segmento em todo o mundo. Objetivo: analisar a Política Nacional de Saúde Bucal do Brasil sob a teoria do ciclo das políticas públicas. Métodos: tratou-se de um estudo qualitativo baseado no policy cicle, que buscou analisar o ciclo da Política Nacional de Saúde Bucal do Brasil. Foram utilizados dois métodos para a coleta dos dados: a análise documental e a realização de entrevistas semiestruturadas. Resultados: embora há muito tempo se reconheçam os problemas de saúde bucal da população brasileira, foi no ano de 2003 que se abriu uma janela de oportunidades para que este tema ocupasse a agenda de prioridades do Governo Federal. Instituída em 2004, a política avançou em cobertura de serviços básicos e especializados no território nacional, atendendo a populações prioritárias. A partir do ano de 2016, no entanto, percebe-se sua estagnação dada a conjuntura político-econômica brasileira. Conclusões: os resultados das intervenções demonstram ter ocorrido melhora considerável nos indicadores de saúde bucal; e aumento da cobertura populacional atendida pelas ações e serviços de saúde bucal, fatos estes que recomendam a continuidade da política.

#MinhaExperiênciaNoSUS: um estudo dos sentidos sobre o SUS com-partilhados no Facebook

Resumo O presente artigo apresenta uma análise dos discursos das narrativas de participantes da campanha #MinhaExperiênciaNoSUS. A campanha foi produzida pelo site PenseSUS, que disponibiliza diferentes conteúdos sobre o Sistema Único de Saúde (SUS) para promover o debate e a reflexão acerca da política nacional de saúde no Brasil, e circulou em sua fanpage no Facebook. Com o aporte teórico de autores como Foucault, Pêcheux, Goffman e Charaudeau, descrevemos os sentidos produzidos a partir das experiências dos usuários e suas possíveis significações em termos de produção de memória sobre o SUS. Quais sejam: um Sistema que marca pelo acolhimento, pela presença do médico, pela estrutura física da oferta e por procedimentos tradicionais como a imunização.

A firsthand description of childbirth's pathways into Brazilian health policies: interview with Maria do Carmo Leal and Marcos Dias

This interview discusses the pathways that brought childbirth into Brazilian public policies. Maria do Carmo Leal and Marcos Dias are active participants in this journey, in academics as well as activism. In the interview, the participants reflect on the challenges to achieving change in the Brazilian health care model and highlight the importance of women's participation and their movements in reaching this goal.

First-order Claims: Representing Blacks within Health Care Policies in Brazil

ABSTRACTOne of the most influential and radical constructivist proposals within the recent turn to theories of representation is to recast representation as a claim, emphasising its dynamic, ubiquitous, performative and unstable nature. Such a depiction seems to render representation a highly contingent and evanescent phenomenon, though the desire to succeed leads claim-makers to seek credibility and remain attentive to context. The aim of this paper is twofold. First, it sheds light on cases where the constraining of ‘context’ is not exogenous, as both the audiences’ criteria for judging claims and the discursive repertoire of social movements are constructed by and through processes of discursive negotiation. The article proposes to distinguish first-order and second-order claims to shed light on the endogenous relation between context and the credibility of claims. During long-term processes of discursive negotiation, the former succeed in defining as givens the moral and factual value of representative claims, granting credibility to the latter. Second, it shows how slow and piecemeal the construction of first-order claims is by looking at the case of the black feminist movement’s representative claims and influence within healthcare policies in Brazil. Making claims for specific policies on racial grounds was an extremely difficult task for these movements, as such claims were at odds with the progressive, universalistic framework used by public health professionals. In addition, a discursive repertoire did not even exist within the black movement to make claims within the field of health. Mobilisation by black feminist women over a thirty-year period was crucial to both placing health at the centre of the black movement’s agenda, and to growing recognition within Brazilian health policies of the importance of race.

Mental health policy in Brazil: what's at stake in the changes currently under way.

Mental health policy in Brazil: what's at stake in the changes currently under way.

Reducing social inequalities in the oral health of an adult population.

The objective of this study was to evaluate the association between social inequality indicators and oral health conditions in an adult population. This prospective cohort study assessed a probabilistic sampling of adults (aged 20-64 years) living in Piracicaba, São Paulo, Brazil. Oral examinations were performed in 2011 and 2015, conducted at home, and used the decay-missing-filled (DMFT) index of permanent teeth, the Community Periodontal Index (CPI), and the visible biofilm criterion. A questionnaire was administered to determine demographic and socioeconomic aspects and dental services used, and collect oral health-related quality of life (OHRQoL) data. Social inequality indicators were evaluated according to social class (high, middle or low) and type of dental service used (public, health insurance or private), and compared with oral health conditions (visible biofilm, DMFT and incidence of tooth loss, periodontal pockets and bleeding, and OHRQoL), evaluated between 2011 and 2015. Analysis using chi-squared or Fisher tests (p < 0.05) and Cochran's Q test was conducted separately for each category analyzed between 2011 and 2015 (p < 0.05). A total of 143 adults who participated in an earlier study were examined after four years of follow-up. Although the occurrence of oral disease did not decrease over the study period (4 years), there was a reduction in inequality among lower social classes in regard to presence of tooth decay and oral health impact on self-perceived quality of life between 2011 and 2015 (p < 0.05). These results suggest that the Brazilian National Oral Health Policy has achieved its principles, especially that of greater equity.

Integrating Science, Technology and Health Policies in Brazil: Incremental Change and Public Health Professionals as Agents of Reform

AbstractBrazil has encouraged an ambitious set of policies towards the pharmaceutical industry, aiming to foster technological development while meeting health requirements. We characterise these efforts, labelled the ‘Complexo Industrial da Saúde’ (Health-Industry Complex, CIS), as an outcome of incremental policy change backed by the sustained efforts of public health professionals within the federal bureaucracy. As experts with a particular vision of the relationship between health, innovation and industry came to dominate key institutions, they increasingly shaped government responses to emerging challenges. Step by step, these professionals first made science and technology essential aspects of Brazil's health policy, and then merged the Ministry of Health's new focus on science, technology and health with industrial policy measures aimed at private firms. We contrast our depiction of these policy changes with a conventional view that relies on a partisan orientation of the executive.

An index of Brazilian frailty and its association with social factors

BackgroundThe Brazilian population is aging rapidly and it is necessary to establish tools to map the elderly population regarding its frailty, which is a common adverse condition during the aging process. The National Health Survey (PNS in Portuguese) data makes it possible. ObjectiveThis study aimed to construct a frailty index (FI) of the elderly Brazilian population using the PNS data, in order to compare it with the index of other population and to measure its association with social factors. MethodA set of the PNS variables was selected to carry out the index, taking into account criteria identified in the literature. The FI score was categorized as: non-frail (FI ≥ 0.10); vulnerable (0.10 < FI ≥ 0.21); frail (0.21 < FI ≥ 0.45); and most frail (FI > 0.45). A logistic regression model was adjusted to measure the association of the FI with some risk factors and social factors. ResultsThe Brazilian FI, calculated with 26 variables, presented a mean score of 0.13 and the best was a gamma distribution. Of the individuals, 53.9% were non-frail, 30.1% vulnerable, 13.6% frail and 2.5% most frail. The variables that significantly distinguished each level of the frailty were: self-perceived health status; instrumental activities of daily living (IADL); and difficulty in hearing, seeing and concentrating. Additionally, socio-demographic and sedentary lifestyle were identified as risk factors. ConclusionThe proposed index showed a similar distribution to the ones observed in the literature and it is associated with social factors. These findings are useful to guide the planning of the Brazilian health policy for the elderly population.

RESIDÊNCIAS MULTIPROFISSIONAIS EM SAÚDE COMO FOMENTADORAS DA FORMAÇÃO INTERPROFISSIONAL: PERCEPÇÃO DE NUTRICIONISTAS SOBRE AS PRÁTICAS COLABORATIVAS

O papel formador do Sistema Único de Saúde nos processos de integração ensino-serviço, vem estabelecendo as Residências Multiprofissionais em Saúde (RMS) como uma de suas estratégias para o fortalecimento das políticas públicas de saúde, no Brasil, tendo como uma de suas principais interfaces a atuação interprofissional. O profissional nutricionista tem conquistado espaço nas equipes de saúde para contribuir com seu saber específico e, enquanto profissional da saúde, em todas as perspectivas da Rede de Atenção à Saúde. O estudo avaliou a percepção sobre a formação interprofissional e o desenvolvimento de competências para práticas colaborativas de nutricionistas residentes inseridos no contexto das Residências Multiprofissionais em Saúde do Nordeste Brasileiro. Trata-se de um estudo exploratório, do tipo transversal com dados de uma realidade, de caráter descritivo-analítico e natureza quantitativa. Os dados foram coletados durante o ano de 2015, a partir de questionário eletrônico hospedado na ferramenta do Google Docs, através de escala atitudinal tipo Likert. O público alvo da pesquisa foi residentes do segundo ano das RMS dos nove estados do Nordeste. Para análise dos dados, foi utilizado o teste estatístico não-paramétrico de Mann-Whitney. Os resultados apontaram que os nutricionistas residentes apresentam a mesma compreensão que os demais residentes das outras categorias profissionais sobre o desenvolvimento das práticas colaborativas nas RMS. Observou-se que, mesmo diante dos desafios postos pelos programas de residências, os residentes consideram que as Residências Multiprofissionais em Saúde possibilitam o desenvolvimento de competências para uma prática colaborativa em saúde no contexto do SUS.DOI: 10.12957/demetra.2018.33495

Oral health care in the Xingu Indigenous Park, Brazil, from 2004 to 2013: an analysis based on evaluation indicators

In 2011, the Brazilian National Oral Health Policy redefined its model of care for indigenous peoples, recommending the use of epidemiology and follow-up of the impact of activities using adequate indicators. The current study aimed to analyze trends in these indicators, proposed by the Brazilian Ministry of Health, in the Xingu Indigenous Park, Brazil, from 2004 to 2013. This was a quantitative study using secondary data from the Xingu Special Indigenous Health District and the Xingu Project of the Federal University of São Paulo. The coverage rate for first dental visit exceeded 60% in all the years analyzed except 2009 and 2010 (44.7% and 53.4%, respectively). The basic dental treatment indicator showed a significant increase, from 44.9% to 79.9%, between 2006 and 2008. The proportion of tooth extractions decreased from 24.3% in 2004 to 3.8% in 2011. Mean coverage of supervised collective toothbrushing showed the highest variation (1.2 to 23.3%). Access to oral health showed good coverage, and the indicator for completed treatment showed a higher percentage when compared to other indigenous peoples during the same period. Better performance on the tooth extractions indicator may have been due to the change in focus of care through partnerships with universities, although the indicators for supervised toothbrushing suggest the need to prioritize preventive measures. Changes in indigenous healthcare management, with weakening or absence of partnerships, may have negatively influenced the program's indicators.

Assistência à mulher frente à violência sexual e políticas públicas de saúde: revisão integrativa

Objective: To analyze the evidence on scientific production regarding the care for women subjected to sexual violence (SV) focused on their perception as well as that of health professionals and in relation to public health policies in Brazil. Methods: Integrative review study that identified 21 articles in SCIELO, Medline, Lilacs and Redalyc databases published in the period from 2005 to 2016 in Portuguese. The study analyzed the effectiveness of public policies in Brazilian services. The following themes emerged: Health care service for women subjected to SV; Women’s perception of care after SV; Health professionals’ performance in the care of SV victims. Results: The comprehensive care recommended by the Ministry of Health is disrespected in 87.5% of the states in the country due to inadequate outpatient settings and professionals who are not trained to serve women according to the norms. There is a predominance of a traditional and fragmented medical care that values the hegemonic biomedical model of care and neglects preventive and health promotion actions. Women are unaware of their rights and suffer because of a society that still blames them for the sexual assault. Conclusion: There are still obstacles to the effective implementation of policies targeted at the care for women subjected to SV, and health professionals need adequate training and environment to care for them. There is a gap in the scientific production regarding women’s perception of the treatment of SV relating public safety and health in the country.

Desospitalização, moradias assistidas e inclusão social no contexto da política brasileira de saúde mental

Objetivo: Investigar a inclusão social das pessoas com transtornos mentais, com história de internação de longa permanência em um hospital psiquiátrico, transferidas para residências terapêuticas em uma vila de Porto Alegre (RS). Método: Esta foi uma pesquisa qualitativa descritiva associada às técnicas de observação participante e entrevistas em profundidade. Foram realizadas 25 entrevistas com os moradores locais. Resultados: A Vila Cachorro Sentado é uma área invadida, em meio a um bairro de classe média, dominada pelo tráfico de drogas e pelo comércio ilegal de produtos roubados. A vida social na vila é restrita ou inexistente; a discriminação e o estigma estão presentes, inclusive com atitudes hostis. O retraimento das pessoas com transtornos mentais desospitalizadas pode ser constatado. Conclusões: A criação das residências terapêuticas, em meio à realidade da vila, compromete o alcance dos objetivos de reinserção social, liberdade e retomada de autonomia das pessoas com transtornos mentais transferidas para esses serviços substitutivos.

PP35 The National Oral Health Policy In Brazil: A Review Of The Literature

Introduction:The National Oral Health Policy (NOHP) “Smiling Brazil” was launched in 2004, with the goal of reorienting the model of oral health care in the Unified Health System. Up to then, this area was impaired by limited access and curative procedures. The NOHP aims to reorganize Primary Health Care in Oral Health, expand and qualify Specialized Care and add fluoride in the public water supply. This review will bring a reflective view of NOHP evaluation.Methods:This review work searched for evidence on the Bireme and Google Academic databases, with the keywords “Evaluation” and “National Oral Health Policy” in October 2017. The search was limited to full texts in Portuguese, English and Spanish. After reading the titles, the abstracts and finally the complete texts, the articles that did not correspond to the evaluation objective of the NOHP were excluded.Results:Of the 381 initial articles found, fifteen were selected for inclusion in this study. The majority reported advances in the quality and scope of oral health care with expanded access and provision of services, such as preventive actions, health education, fluoridation of the public water supply and an increase in population coverage. There was also an improvement in the main indicators, in resolution, financial investments and epidemiological surveys. Moreover, few studies showed improvement in user satisfaction. Conversely, difficulties were identified in overcoming the traditional care model, in training and professional appreciation. Challenges included the need to expand access to fluoridated water, increase coverage, build a more comprehensive care network and reduce regional disparities.Conclusions:After 13 years, advances and challenges can be observed in the quality and comprehensiveness of oral health care in Brazil. There is evident improvement in indicators; however there remains a lack of access and resolution in the actions, with a large number of regional discrepancies.

Prevalence and characteristics of chronic pain in Brazil: a national internet-based survey study

ABSTRACT BACKGROUND AND OBJECTIVES: The prevalence of chronic pain has been increasing in the world, and it is considered the most underestimated health care problem impacting the quality of life. Furthermore, there is little consensus regarding the burden of chronic pain in Brazil. The present study aimed to investigate the prevalence of chronic pain in the general Brazilian adult population, and the socio-demographic, clinical, medical conditions and pain locations on the body. METHODS: A cross-sectional Internet-based survey was conducted in a nationally representative sample of Brazil adults to estimate the prevalence, sociodemographic correlates and characteristics of chronic pain in the Brazilian population. Twenty-seven-thousand and three hundred forty-five (27,345) representative residents were contacted. RESULTS: From 27,345 individuals, 20,830 (76.17%) presented chronic, recurrent, or long-lasting pain, lasting for at least 6 months. Nearly half of the respondents were 65 years older (48.15%) and the prevalence was higher in females (84,60%) than males (16.40%). The prevalence of primary chronic lower back pain was 59.85%; of primary rheumatoid arthritis was (59.78%) and primary osteoarthritis pain was 69.02%. Half of the respondents with chronic pain experienced daily pain, and average (past 3 months) pain intensity was moderate at 57.28%. CONCLUSION: Chronic pain affects more than two-thirds of the population of Brazil. Our findings revealed a high prevalence and severity of chronic pain and suggested that it is a public health problem in Brazil. Risk factors are being a woman, advanced age and low levels of household income. There is a need for improved health policies in Brazil for patients with chronic pain.

Comparison of social thermalism in health systems

Social Thermalism refers to access of balneotherapy in National Health System. Although Brazil has no great tradition in balneotherapy, Social Thermalism is proposed in the National Policy of Integrative and Complementary Practices in Brazilian in the Public Health System. However, it is necessary to establish guidelines, financing, training for the implementation of balneotherapy in Brazil. Therefore, it is necessary to understand the social thermalism in different health systems in order to elaborate a proposal for Brazilian health system. Objectives: To compare Social Thermalism in different European health systems, aiming a proposal of possibilities to enhance this practice in Brazil. Methodology: Official documents were studied from European countries that have Balneotherapy in public health system. The following aspectswere analyzed: Access / Coverage, Financing, Organization and provision of services, Essential medical products and technologies, Problems and current trends. Preliminary results indicated that there are different forms of access of balneotherapy in National Health System, for example, while in France there are no restrictions as to age, in Spain the IMSERSO (thermalism program) is aimed at those over 65 years of age. Also another difference is about therapeutic indication and duration of treatment: in Germany there is a mandatory prescription by specialist in resort therapy or spa doctor; in Spain the prescription is indicated by the doctor. Portugal: spa doctor, general practices or specialist. France and Italy there are a mandatory prescription by general practitioners or specialist. Number of days of treatment: Germany: 18, Spain: 10 to 12 days; France: 18; Italy: 12 and Portugal 12 to 21 days. Financing: Portugal - after cutting off in 2011, Ministry of Health studies a proposal for reimbursement in 2018. France: Social security reimburses treatments since 1947; however occurred a freezing of the base of reimbursement for cares since 2013. Problems and current trends: health systems experience similar problems, such as tendency of not to cover certain treatments by health plan, freezing of financing, lack of investment in infrastructure, lack of research support. Also there are few health professionals specialized in this area. Therefore, it is necessary to stimulate training of health professionals in this area, investing in research that promote benefits of this modality, elaborating guidelines and financing for maintenance of health resorts and application of thermal practices. Preliminary considerations: This study aims to deepen comparison of balneotherapy in different National Health Systems, describing their approaches and distances, giving visibility to the problems faced in health systems and to identify future trends. This knowledge may facilitate discussions for growth of balneotherapy in public health policies in Brazil.

Brazilian mental health policy: perception of relatives from users of the psychosocial care center

Brazilian mental health policy: perception of relatives from users of the psychosocial care center

Dos eventos documentados aos documentos manejados: A política de saúde mental brasileira em disputa

Em dezembro de 2015, a nomeação de Valencius Wurch, para o cargo de Coordenador Geral de Saúde Mental, Álcool e outras drogas, reacendeu os debates acerca da atenção em saúde mental no Brasil, fazendo com que a reforma psiquiátrica voltasse à arena das discussões políticas amplamente divulgadas. A nomeação do gestor gerou notas de repúdio, notas de apoio e mobilizações pelo país e nas redes sociais. Estas ações foram documentadas e alcançaram as páginas dos jornais da grande imprensa, demonstrando a existência de uma disputa em torno da política de saúde mental. Nesse artigo, serão apresentadas as ações contrárias e a favor de Valencius, mostrando como elas se fundamentam em acusações que delimitam fronteiras. A análise das ações e acusações permite propor que a disputa em torno da política de saúde mental se organiza a partir de um interessante movimento de documentar eventos e manejar documentos, atualizando embates mais antigos do processo brasileiro de reforma psiquiátrica. Assim, o objetivo principal deste artigo é, à luz das considerações antropológicas sobre documentos, refletir sobre a dimensão documental dessa disputa.

Práticas e protocolos comunicativos na deliberação de políticas públicas de saúde: um estudo da comunicação no processo decisório em um conselho deliberativo

O artigo apresenta resultados de investigação envolvendo a natureza e a dinâmica dos fluxos de informação e o modelo de comunicação no processo deliberativo da política pública de saúde no Brasil. Por meio de estudo de caso de um conselho gestor de saúde local, destacamos práticas de um modelo vertical na organização de fluxos de informação e comunicação que desconsidera o papel da informação na deliberação da política de saúde.

Gender and schooling inequalities in risk and protective factors for chronic diseases among Brazilian adults.

There is consistent evidence showing that low socioeconomic level, both at the individual and contextual levels, is an important predictor of morbidity and mortality due to noncommunicable diseases. To identify gender and schooling inequalities in the distribution of risk and protective factors for chronic diseases among Brazilian adults. This study included data from 97 468 individuals interviewed in 2012 and 2013 from the Surveillance System of Risk and Protective Factors for Chronic Diseases (VIGITEL). Age-adjusted prevalence ratios at different schooling levels were calculated using Poisson regression. Tobacco use, alcohol abuse and the consumption of meat with visible fat were more frequent among men, while the medical diagnosis of diseases such as diabetes, high blood pressure and dyslipidaemia was more frequent among women. In both genders, the highest level of education was associated with a lower prevalence of tobacco use, excessive consumption of soft drinks and excessive TV time, as well as increased alcohol abuse. The results of this study represent a challenge for public health policies in Brazil, since sociodemographic inequalities reflect differences in the prevalence of risk factors and, consequently, in the prevalence of chronic noncommunicable diseases.