Beer, water, sex and the SUS

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By Paulo Capel Narvai*

The sanitary blackout in Rio de Janeiro affects several areas. The poor quality of the capital's water has been reported by health surveillance agencies for a long time. It is the result of politics in the appointment of directors, the massive layoffs of technicians and the abandonment of projects to maintain water sources.

Rio de Janeiro is experiencing a “sanitary blackout”, say Carioca leaders of CEBES, the Brazilian Center for Health Studies. The crisis is not restricted, however, to health services, such as basic health units, outpatient clinics and hospitals, which are laying off employees and paralyzing activities as a result of decisions by companies hired to manage them that claim they do not receive what the government owes them. The layoffs affect more than 5 employees. But health is much, much more than health services.

In the middle of Carnival 2020, the city is hit hard by the waters. The rains bring the chronic problems of flooding and, with them, the risk of leptospirosis, in addition to the proliferation of Aedes aegypti and other health problems. But the biggest difficulty of this period is with the public water supply, which has a disgusting color and smell, contaminated by geosmin - and it is not known whether also by infiltration products in the distribution network, a fact denied by CEDAE, the State Company of Waters and Sewage of Rio de Janeiro[1].

The one-note samba of the privatist ideology (“scrap, privatize, cut; scrap, privatize, cut; scrap, privatize, cut; scrap, privatize, cut”), it is known, is at the origin of the “sanitary blackout”. SUS health services in the city suffer from chronic problems of withdrawal of their resources by gangs specialized in stealing them, weakening administrative controls, lack of transparency, disrespect for health councils and abandonment of public administration principles. Privatized, worsened the quality of care.

The poor quality of CEDAE's water results from the allocation of positions and politics in the appointment of its directors, mass dismissals of high-level technicians, strategic to the company's operation, and failure to prioritize the execution of projects necessary for the maintenance of springs that provide water to the state capital and other municipalities in the region. The so-called technical criteria for filling management positions in ministries and public companies, so vaunted in election campaigns, are nothing more than ideology. Witzel in RJ and Bolsonaro in the federal government, govern for their voters, betray campaign commitments and government programs registered with the Electoral Court, disdain the public interest and attack the Brazilian State.

In Rio de Janeiro, specialists have been warning for some time about the meaning of the breakdown in the management of SUS units, both in the capital and in the state of Rio de Janeiro. The poor quality of the capital's water has also been reported by health surveillance agencies for a long time. The SUS, which monitors water, fulfills its mission, but this is not enough.

Meanwhile, the samba follows a single note: “scrap, privatize, cut; scrap, privatize, cut; scrap, privatize, cut; scrap, privatize, cut”. The lucrative CEDAE is in the crosshairs of the federal government, which wants to take over the company as payment for the debt of the State of RJ and then – guess what? – privatize it, of course. It is estimated that sanitation services, including water treatment, earned CEDAE around BRL 800 million in 2019.

Also in Minas Gerais, health surveillance has done its job well and had its actions publicly recognized by detecting health problems, including deaths, as a result of drinking beer contaminated with diethylene glycol[2]. The first victim of the intoxication would have been a woman, who died on December 28, 2019. It was even considered sabotage, resulting from a trade war, which was soon discarded by the police as the investigations deepened.

The subject was widely reported, but as often happens, little or no attention was given to SUS and health surveillance professionals. As mentioned by sanitarian Antonio Dercy Silveira Filho, in a post with great repercussions on social networks, public health workers in the municipality of Belo Horizonte and the state of Minas Gerais “managed to establish the causal link between the 'mysterious illness' which initially affected an upper-middle-class neighborhood in BH and the contamination of a batch of beer”.

For this, they put into practice the principles of the epidemiological investigation method developed in the mid-nineteenth century in London “by the physician John Snow, the father of modern epidemiology”. In this way, they were able to “stop the progression of the disease and demand the necessary measures for social reparation”. Do you know who they are? – asked Silveira Filho –, “they are Public Servants of the SUS, with due job stability and who acted to protect society as a whole.

You who defend the end of SUS or the end of server stability or worse, the replacement of all state-owned public labor by private, think and answer for yourself: (1) Do you live in an upper middle class neighborhood? Do you think you don't use the SUS because it's only for the poor? Do you drink beer? So you could be one of the infected who got sick, right? (2) Without the SUS, would the private sector carry out such an investigation? Where is the economic interest? In healthy or sick people arriving at hospitals and offices? (3) Supposing that a team of workers from the private initiative, not stable, paid to carry out the Epidemiological and Sanitary Surveillance, did so and discovered that the best-selling beer was the culprit of the new disease. Faced with the economic and political interests that structure our society, what would happen to the investigation? What would happen to these workers without stability? Now… (4) Did you understand the importance of SUS? (5) Did you understand the importance of the autonomy and job stability of public servants? (6) Do you understand how vulnerable you will be if this ends?”

But while Antonio Dercy Silveira Filho rightly asks us to defend the SUS, as it “is one of the greatest achievements of Brazilian society”, and everyone uses the SUS in some way, Senator Marcio Bittar, from the MDB of Acre, rapporteur for the Proposed Amendment to the Constitution 188/2019, which deals with the Federative Pact, warned that it obtained the green light from the Minister of Economy, Paulo Guedes, to end the minimum floors for health and education[3]. If the deleterious effects of EC-95/2016 were not enough, that of the spending cap, also known as EC of Death, now Guedes, the Minister-Mãos-de-Soura, wants to remove the financing floor. The SUS, which since its creation has suffered from chronic underfunding, was under threat of defunding with the EC da Morte and, if Senator Bittar's “recipe” is approved, it will be without any funding.

Former Minister of Health Adib Jatene, was sadly known in the National Congress as the "minister of the saucer", because without assured resources to finance our universal health system, every year, with each approval of the Annual Budget, there was Jatene " passing Pires” to get resources for the SUS. The approval of Constitutional Amendment 29, in 2000, established minimum resources for financing SUS public health actions and services, for the Union, States and Municipalities, although it was only in 2012 that Complementary Law 141 regulated it, thus granting some financial stability to the SUS.

But Guedes-Scissorhands has other plans for our tax money. There will certainly be resources for health (and also for education), but attention: mayors, governors and the federal government will be “free” to allocate these “health” resources in any area, or, in other words, , wherever you like. The end of the budget allocation represents one of the most serious attacks on the SUS, among many that have affected it since its creation, on May 17, 1988.

For now, however, there are resources and, as everyone uses the SUS, Minister Damares Alves also wants to get her hands on public health money. She sent the bill for the publicity campaign on sexual abstinence as a population strategy for contraception to the Ministry of Health. She doesn't want anyone having sex “before the time” and, according to her belief, the decision “of the time” is up to the State and not to those who want to have sex.

The motto of the campaign is “I chose to wait” and woe betide anyone who chooses the opposite, because for the minister it is up to the State, and the government she represents, to encourage young people not to have sex, to postpone the onset of sexual life, and “raise awareness” among young people about what a sexual relationship is and its consequences. Recommending a “condom”, no way, because according to the federal government, “contraceptives are not 100% effective” (sic). São Paulo deputy Janaína Paschoal (PSL/SP) went further and said that she would be even more emphatic, because “sex is for adults”[4]. Minister and deputy, and a lot of people, believe that their convictions are enough and enough to design, define and implement public policies. It's democracy fake ongoing.

Minister Mandetta, of Health, warned that his Ministry’s position is that “abstinence cannot be our only or main policy” and that “religious issues should not guide” the topic of teenage pregnancy[5]. But he will put SUS money in the “no sex” campaign. The National Health Council does not agree[6]. In its 325th Ordinary Meeting, held in January 2020, counselors criticized the proposal of the federal government, led by Damares. For the CNS, information and sex education are more effective ways of preventing pregnancy and sexually transmitted diseases, among young people and adults.

Present at the CNS meeting, Julieta Palmeira, Secretary of Policies for Women in Bahia, presented the initiative entitled “Respect the Mines”, created to combat harassment at Salvador's carnival. For her, “we are moving from a concept of attention to a moment of autonomy over our body”, highlighting the importance of debating what she called “toxic masculinity”, understood as a repressive stereotype that defines male behavior marked by violence , sex, status and aggression. For her, this cultural standard of ideal masculinity “harms men and women, but women lose their lives”.

Cristiane Cabral, professor at the Department of Health, Life Cycles and Society at the Faculty of Public Health at USP, states that adopting abstinence as a policy implies failing to develop “affective and emotional skills on how to relate to one’s own body, with the cycle menstruation (for girls) and with the partner. (…) There is a mistake in thinking that age alone will bring maturity and help this young person to decide. It's not age that does that, it's sex education, and it needs to start as soon as possible”.

The USP professor also criticizes the federal government's intention to change the perspective of sexual and reproductive rights to a moral and religious reference, because when the silence on the subject is broken, that is, "when you put the conversation about sex from one frankly and not only within the family, but also for educators and in the health system, there is learning and the dimension of a right”.

The disrespect, violation and non-recognition of rights, placed at the political-ideological center of the federal government to please part of society, is spreading every day throughout the Brazilian State, and leaving its marks in the disgusting water, in the beer that kills and in sex that is not done for pleasure, but only to procreate. A sex that represses and doesn't want to enjoy it for the sake of it. A sex that, transformed into moralistic and religious public policy, prunes, prunes, prunes.

* Paulo Capel Narvai is senior professor of Public Health at USP.

Notes

[1]. Expert contests Cedae and says that the river water is not drinkable: 'If the animals don't want it, why should we drink it?' Good morning Rio, G1 Rio de Janeiro, 24/01/2020. Available in https://tinyurl.com/r4tlo5x   

[two]. Backer director: “Don't drink Belorizontina, whatever the batch”. Marcellus Madureira, UOL Cotidiano, 2/14/01. Available in https://tinyurl.com/ts9on9k

[3]. A federative pact is one of the priorities of the government and Congress in 2020. Agência Senado, Senado Notícias, 14/01/2020. Available in https://tinyurl.com/qrd5hmx

[4]. Abstinence policy fails to discuss sexuality with youth. Giovanna Galvani, CartaCapital, 19/01/2020. Available in https://tinyurl.com/r3htjc3

[5]. Minister of Health disagrees with Damares on campaign for sexual abstinence. Brazil 247, 28/01/2020. Available in https://tinyurl.com/qv7smaz

[6]. CNS criticizes policy that proposes sexual abstinence as a contraceptive method for adolescents. National Health Council, Susconecta, 24/01/2020. Available in https://tinyurl.com/qllwphw 

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