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Ciência & Saúde Coletiva

On-line version ISSN 1678-4561Print version ISSN 1413-8123


LUZ, Madel Therezinha. Two permanent issues in a century of health policies in Republican Brazil. Ciênc. saúde coletiva [online]. 2000, vol.5, n.2, pp.293-312. ISSN 1678-4561.

This article discusses the dilemma centralization versus decentralization in health policies of the republican Brazilian State during the twentieth century. It develops the central hypothesis that the dichotomy centralization/ decentralization of functions, services and activities in Brazilian public policies, mainly in the health policies, expresses the concentration/deconcentration dichotomy of social power in civil society. The centralization/decentralization dichotomy as it appears in health policies since the foundation of Brazilian republic, illustrates the authoritarian character of this republic, as a consequence of the concentration of the social power in the hands of a small elite. Analysis of health policies in different conjunctures seems to demonstrate that decentralization tends to be defined by the state and other political actors in a geopolitical sense, rather than in a political sense. The article demonstrates also that during the 90s there has been a real process of decentralization, but still with a very little distribution of power.

Keywords : Health Policies; Democracy; Centralization [Decentralization]; Concentration [Deconcentration].

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