Health: directions for the transition



Health is a sector in which the destructive power of the government of Jair Bolsonaro has been proven

This will not be an ultraliberal government, but it will be a neoliberal government. I have answered this way to anyone who asks me about the Lula 2023-26 government, the Lula-3, as many have referred to it. In conversations on social networks, I repeated this statement on a few occasions, being received sometimes with indifference, sometimes with advice to be less “pessimistic”, sometimes with indignant rejection of the statement: “but the government hasn’t even started yet”, they replied.

There is, however, nothing new in my observation and it is not even an accusation against Lula or anything like that.

An Argentine friend, knowing about my participation in Lula's campaign, asked me “Luego tell me how they prepare to return”. From a Chilean friend and a Colombian friend came practically the same direct question: “¿Y en la salud, que van hacer?”

Everyone wants to know about Lula-3.

I stayed to talk, next week, with journalists from the Guillotine, the podcast of The Diplomatic World, to talk about my book SUS: a revolutionary reform – to defend life (Authentic), released in April. But I've already been warned that they won't stick to the book and will also ask me “about the future government”.

Lula-3 is already a government preparing to formally assume the functions of head of the Brazilian Executive and State. The “government in the making”, building its political viability, began well before the October elections, way back, when the political alliance was established that would result in the “Juntos Pelo Brasil” front. There, it was tacitly decided that the government would not be ultraliberal, but neoliberal, since this was a requirement derived from the political viability of the political alliance, and a condition recognized by the party organizations that constituted it, that the Front's program, necessary for the defeat political-electoral power of the extreme right, nestled in the Bolsonaro government, could not go beyond neoliberalism. The socialist program, dreamed of by sectors of the PT and by allies such as the PSOL and others, would remain for another political context, in another historical period. Not now.

The alliance forged by Lula, Geraldo Alckmin and political leaders close to both was widely celebrated. The election result revealed the success of the decision taken at the beginning of the year. But, now, it is necessary to govern with everyone who “is in the boat”. That's just what it's about. Not ultraliberal, neoliberal. The problem for Lula will be to keep that comma exactly where it is, as he will not lack pressure to change the phrase to “ultraliberal, not neoliberal”, according to messages that “the market” never ceases to send him. It remains to be seen what history will tell us about the position of the comma, although even stones know that life is not grammar, but often dramatic.

It is not, therefore, a matter of “pessimism”, nor of criticism of a “government that has not even started”.

With the speech on the night of October 30, made shortly after the Superior Electoral Court (TSE) recognized his victory over Jair Bolsonaro, with 60,3 million votes (50,9%), against 58,2 million votes ( 49,1%) obtained by his opponent, Lula was immediately in charge of the government of the Republic that, politically, began there. Although, legally and administratively, Lula-3 starts only after taking office, on 1/1/2023, in political terms Lula already governs Brazil, as widely recognized worldwide. The skirmishes on highways and the pathetic demonstrations in front of military installations, committed by Jair Bolsonaro's acolytes, only confirm that although "the pen" has not yet changed hands, Jair Bolsonaro commands less every day, according to the rules of transitions from governments in democratic states.

But let there be no illusions about this: Jair Bolsonaro commands less each day, but he has consolidated his political leadership over a vast contingent of voters, and over citizens who, more than voters, are very little attached to civil rights such as voting and to be voted on, despite appreciating words like “free” and “freedom” – which, in their mouths, always seem out of place. It is true that a few million votes for Jair Bolsonaro stemmed from political domination, derived from well-known practices of economic pressure on voters placed in the “halter” and the shameless use of all kinds of benefits that control over appointments to positions of trust and over the application of public money provides those in government.

However, the expressive vote and the many demonstrations, since the electoral defeat, of millions of people in favor of Bolsonaro, despite the disaster that was his government, allows us to foresee many difficulties for the Lula-3 government, since they are evident both the ignorance and the contempt of many, millions throughout Brazil, for the advances in representative democracy and the rule of law that we conquered in 1988.

A fact that signals positively in the face of these difficulties is the process by which Lula is composing his government and making himself aware of the problems he will face. The Transition Commission (CT) and the constitution of various sectoral groups that are subsidizing it, with diagnoses by area of ​​government action, with which situation maps are being produced and measures to be taken in the first 100 days of government, or immediately after taking office, it at the same time proves the disaster of the Bolsonaro government and indicates measures to be taken to start repairing damage. And this has been done with broad participation of what is politically organized in the Brazilian democratic field.

Health is a sector in which the destructive power of the government of Jair Bolsonaro has been proven. It's not that it's new, or that the facts, very serious, were not known. But the CT health group now has the support of institutions and bodies of the federal government itself, such as the Federal Court of Accounts (TCU) and technical areas of the Ministry of Health, proving with data and official documents the disaster so many times announced, by various means, as I myself disclosed here on the site the earth is round. In health, the emblematic situation, and one of the most serious in the sector, concerns the National Immunization Program (PNI), hard hit by active denialism and anti-vaccination, practiced daily as ideological manipulation from the highest echelons of the Bolsonaro government, incessantly since who took over the Planalto Palace, just to whip up the Bolsonarist mass.

Created on September 18, 1973, with the participation of sanitarians such as Ciro de Quadros, who had been involved in the smallpox eradication campaign in Brazil, as part of efforts to advance polio control and concerned about the outbreak of meningitis epidemic, which the civil-military dictatorship tried to hide, the PNI is a program of the Brazilian federal government that was formulated and implemented as a public policy, 15 years before the creation of the SUS, which would take place in 1988.

The data that are now made public, about the lack of control over vaccination coverage, which plummeted to unusual levels throughout Brazil, after displaying model standards worldwide, contained in TCU reports, prove the crime against humanity committed by the Brazilian government. Assuming he was attacking SUS, the object of explicit hatred by Bolsonaro and members of his family, the President of the Republic acted, in an appalling manner, from the Planalto Palace, against his own people.

Several other areas of health, however, such as mental health, were greatly impacted by destructive actions deliberately driven from the highest levels of government and the Ministry of Health.

On the last 9th of November the front for life, formed in 2020, and articulated under the leadership of Abrasco, the Associação Brasileira de Saúde Coletiva, bringing together more than 550 entities and social movements, was received by the health group of the Transition Commission, in meeting coordinated by former Minister of Health Arthur Chioro. Among other topics, the serious problem of underfunding of the SUS was emphasized.

According to ABrES, the Brazilian Association of Health Economics, an entity that integrates Frente Pela Vida, “since 2018, we have already lost BRL 37 billion, and if nothing is done, we will lose another BRL 23 billion”. Without adequate funding, the SUS will continue to be at risk and, with it, the health of the population, which with the covid-19 pandemic has come to have a positive perception of the SUS, as a State institution that, despite its many problems, exists and works to serve the public interest in health. In the pandemic, it fulfilled its mission, despite the many attacks that came from precisely where the system's defense was expected to come from. Our universal health system is, today, more necessary than ever.

The Frente Pela Vida, whose slogan (“We won’t let them forget: immediate investigation and accountability of the crimes of the federal government in the covid-19 pandemic in Brazil”) leaves no doubt as to its purposes, promises to remain active in 2023 and in the coming years . Better for Brazil, since one of its most relevant contributions was to have, since its constitution, articulated different health projects for Brazil, formulated in the democratic field in different instances of society, such as health entities, social movements, university centers and political parties and given political expression to this set. Frente Pela Vida has been of inestimable value to the Lula-3 government, whose health group continues to listen to other social segments.

In two letters I wrote to Oswaldo Cruz, and made public here on the website, I updated the master on the missteps of the SUS and public health in the country. in the first Letter to Oswaldo Cruz, that of 26/10/2020, written at the height of the pandemic, I denounced the disdain for vaccines and vaccination. At second letter, on 3/08/2021, I expressed my indignation and why not say, disgust, when I found that the President of the Republic had awarded the Medal of Merit Oswaldo Cruz, in the gold category, to his wife, as “recognition for her outstanding performance in the field of scientific, educational, cultural and administrative activities for the beneficial results for the health of Brazilians”. were also awarded the Doctor Oswaldo Medal, shamefully polluting it, the ministers at the time Milton Ribeiro (Education), Fabio Faria (Communications), Gilson Machado (Tourism), Carlos Alberto França (Foreign Relations), João Roma (Citizenship), Luiz Eduardo Ramos (Casa Civil), Paulo Guedes (Economy), Rogério Marinho (Regional Development), Tarcísio Freitas (Infrastructure), Tereza Cristina (Agriculture, Livestock and Supply) and Walter Braga Netto (Defense).

Politics is also – and a lot – actions in the symbolic world. Due to the symbolism involved in these shameful decorations, I ask permission from the Transition Commission to indicate that these grants be immediately revoked, as of 2/1/2023, which commemorates the Sanitarian's Day, in honor of the memory of Oswaldo Cruz and in respect of the more than 690 killed by the pandemic in our country.

PS: Bolsonaro's wife and several ministers were awarded the Oswaldo Cruz Medal of Merit, defiling it, and insulting the doctor's memory. On Sanitarista Day, January 2, Lula's act revoking these grants should be published.

*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic).


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