“It might have been simpler and even taken less work to organize a Conference with just a handful of delegates. The restroom lines wouldn’t have been so long and phone calls wouldn’t be so difficult due to lack of tokens. The turnout truly exceeded all our expectations. But this is the right path. We have to learn to live with adversity, with the community. And this is how we’ll build our collective project, knowing that we may even make mistakes, but that we’ll never lose our way in building a more just society for Brazil” 11. Arouca S. Democracia é saúde. In: Anais da 8ª Conferência Nacional de Saúde, 1986. Brasília: Centro de Documentação, Ministério da Saúde; 1987. p. 35-42. (p. 42).
Democracy is Health: that was the title of the speech by Sergio Arouca at the 8th National Health Conference in 1986 (we’ve just quoted his closing remarks). The famed and beloved public health doctor chaired the event’s organizing committee while he was president of Oswaldo Cruz Foundation (Fiocruz). His stirring words celebrated the 4,000-plus delegates, which included the health system’s users for the first time. His description of the scene evokes a time that featured efforts to expand public health’s political base, years before cellphones flooded the airwaves, and above all with growing diversity and mass participation in Brazil’s health conferences.
The year was 1986 and José Sarney was the country’s President, heading the first civilian government after 20 years of military dictatorship. It was a time of intense political struggle and high hopes for the National Constitutional Assembly, which drafted the 1988 Constitution and marked Brazil’s re-democratization. The 8th National Health Conference was thus a crucial arena for strengthening the Health Reform movement and the push for Constitutional guarantees of political and social rights, especially the right to health. Previous institutional milestones included the founding of the Brazilian Center for Health Studies (Cebes) in 1976 and the Brazilian Association of public Health (Abrasco) in 1979. Importantly, representatives of the Health Reform movement were named to key positions in the national health administration: Hésio Cordeiro as President of the National Institute of Medical Care in Social Security (INAMPS), Sergio Arouca as President of Fiocruz, and Eleutério Rodriguez Neto as Executive Secretary of the Ministry of Health 22. Escorel S. Sergio Arouca: democracia e reforma sanitária. In: Hochman G, Lima NT, organizadores. Médicos intérpretes do Brasil. São Paulo: Editora Hucitec; 2015. p. 614-26..
Fiocruz is now preparing wholeheartedly to welcome the 12th Brazilian Congress of public Health, known affectionately as “Abrascão” (“big Abrasco”), so the reference to Arouca’s speech is not accidental. The concerns with infrastructure and logistics appear in many of the queries and comments by participants both inside Fiocruz and from other organizations and groups, echoing Arouca’s words on the complexity and beauty of collective projects that involve such diverse political actors in mass events like “Abrascão”. To quote an appropriate (and affectionate) expression by the editors of CSP, the congress is a “marvelous mess”. But Abrasco actually has an impressive track record organizing events, as does Fiocruz itself, including National Vaccination Day, the traditional Fiocruz for You event. We truly are well prepared and well equipped for the congress, relying on participation by institutions from Rio de Janeiro in the Local Organizing Committee as well as painstaking collaboration with the Abrasco Board of Directors and Executive Secretariat. Fiocruz will have the honor of participating in the pre-congress activities at Rio de Janeiro State University (Uerj) and will take huge pleasure in welcoming congress participants at its central campus in Rio de Janeiro.
Meanwhile, violence is on the rise in Rio de Janeiro (according to various indicators), and the city is under military intervention in an effort to ensure public security. The population is reeling from the still-unsolved assassination of City Councilwoman Marielle Franco (who will receive a posthumous tribute at the 12th Congress) and her driver Anderson Silva. It is thus all the more symbolic that the event will be held on the Manguinhos campus. Since establishing the institutional program on Violence and Health, coordinated by the Latin American Center for Research on Violence and Health, Sergio Arouca National School of Public Health (Claves/Ensp), Fiocruz has approved guidelines for its institutional work in this field of research and practice, in the face of what the World Health Organization (WHO) considers one of the most daunting global health problems. We are certain that the notion of the right to the city and to the urban infrastructure and services, shaped as an effectively democratic public space, will be reaffirmed during this special moment for the congress on the territory where Fiocruz is located, next to several favelas, an inseparable part of Rio’s landscape, economy, and culture.
From the perspective of the public health agenda, holding this congress at Fiocruz poses the challenge of affirming the project summarized in the phrase “Democracy is health” and its necessary renewal, revisiting and assessing the 30 years’ history of the Brazilian Unified National Health System (SUS) and the 1988 Constitution, even as we are challenged by serious setbacks to rights on the national and global levels and transformations in the world of work and in various social relations with the so-called 4th Technological Revolution.
Brazilian society is on the eve of defining a political project for the new Presidential term. Once again, it is up to public health to formulate proposals to defend the SUS, democracy, and the future of a country with guarantees for social and civil rights and an economically, socially, and environmentally sustainable development process. Holding the “Abrascão” congress on the Fiocruz campus in this scenario is a significant step in a two-way street, in which both institutions come out stronger as part of the process that began with the founding of Abrasco in 1979 33. Lima NT, Santana JP, organizadores. Saúde coletiva como compromisso: a trajetória da Abrasco. Rio de Janeiro: Editora Fiocruz; 2006.,44. Lima NT, Santana JP, Paiva CHA, organizadores. Saúde coletiva. A Abrasco em 35 anos de História. Rio de Janeiro: Editora Fiocruz; 2015..
Respecting the diversity of areas and agendas in the various working groups, we trust in the academic and political quality of the upcoming congress, as well as in the assessment of positive experiences like the nationwide expansion of the Family Health Program, and the integrated approach to health care, surveillance, and science, technology, and innovation to deal with the country’s old and new challenges, including the essential responses to health emergencies by the scientific community, health professionals, and public laboratories, notably Biomanguinhos and Farmanguinhos, technical units of Fiocruz. At the same time, we await the development of consensuses that allow formulating proposals to deal with the country’s most serious health problems, especially the underfinancing of the health sector. After all, Brazil has a universal public health system where private spending outstrips public expenditures, and where this issue has been the object of constant political and symbolic dispute in recent history, with attempts to disqualify arguments that identify underfinancing as one of the most serious problems for strengthening the SUS.
Holding the “Abrascão” congress at Fiocruz also contributes to participation by many health professionals and students who will be having their first close contact with the public health agenda, thus favoring dialogue with traditional areas like tropical medicine and public health, as well as perspectives and approaches in social medicine and public health. In 2018 we are celebrating the centennial of the Manguinhos Castle, a symbol of the possibility of a science devoted to solving health problems and international recognition of Brazilian science, a fact to be celebrated that can contribute to strengthening the public health agenda through new interdisciplinary dialogues.
Another important challenge is the intersection between the economic and social dimensions of health. It is necessary to advance the definition of a national development project in which health is seen as an opportunity in a country with the world’s largest universal health system and that should not merely be a consumer market. The health sector produces more than a third of all the research in Brazil, employs 12 million workers directly or indirectly, and accounts for 10% of the GDP in production chains that interconnect in the Health Economic and Industrial Complex. It is crucial to face the future with innovation in defense of a project based on social justice, citizens’ rights, and sustainability. This vision, affirmed in the 8th Internal Congress of Fiocruz, also orients action by Abrasco, which has emphasized the need to align industrial, health, and science, technology, and innovation policies under the aegis of the public interest, in order for all these policies to contribute to the country’s economic and social development, environmental sustainability, and improvement in health and quality of life.
Democracy is Health. Sergio Arouca’s rallying cry needs to be reclaimed and updated in Brazilian society’s contemporary political agenda. And it should be seen as part of an agenda of global commitments. The program for the upcoming “Abrascão” congress and the international guest speakers express this movement and represent a breath of hope for everyone who wagers on a truly democratic agenda to defend the role of science, technology, and innovation in health, building a more just world with solidarity.
- 1Arouca S. Democracia é saúde. In: Anais da 8ª Conferência Nacional de Saúde, 1986. Brasília: Centro de Documentação, Ministério da Saúde; 1987. p. 35-42.
- 2Escorel S. Sergio Arouca: democracia e reforma sanitária. In: Hochman G, Lima NT, organizadores. Médicos intérpretes do Brasil. São Paulo: Editora Hucitec; 2015. p. 614-26.
- 3Lima NT, Santana JP, organizadores. Saúde coletiva como compromisso: a trajetória da Abrasco. Rio de Janeiro: Editora Fiocruz; 2006.
- 4Lima NT, Santana JP, Paiva CHA, organizadores. Saúde coletiva. A Abrasco em 35 anos de História. Rio de Janeiro: Editora Fiocruz; 2015.
- Publication in this collection
23 July 2018