The challenge of decolonizing knowledge: the Marielle Franco Favela Dictionary.

Dominant social groups describe favelas based on negative stereotypes, which are increasingly being challenged by various collective actors. Originating from a collaborative effort carried out by academics and favela residents, the Marielle Franco Favela Dictionary is an online platform that aims to spread alternative narratives regarding these territories and their populations through collective knowledge building. This article discusses the common ground and points of contention regarding the different forms of knowledge held by academics, activists, and favela residents. Furthermore, we reconstruct the trajectory of the Dictionary's creation, and in so doing overcome certain tensions and incorporate other languages and registers able to support the production of memory in favelas.

Los sectores dominantes de la sociedad describen las favelas a partir de definiciones negativas a priori, que han sido cuestionadas por diversos actores colectivos. A partir de una iniciativa conjunta de la comunidad académica y quienes residen en las favelas, se crea el Diccionario de Favelas Marielle Franco como una plataforma en línea que, a través de la construcción colectiva del conocimiento, busca difundir diferentes narrativas sobre estos territorios y sus poblaciones. En este artículo, discutimos cómo se produjeron los acuerdos y divergencias entre el conocimiento de la comunidad académica, activistas y habitantes de barrios marginalizados; y presentamos la trayectoria de la construcción del Diccionario, que busca superar tensiones y así incorporar otros lenguajes y registros capaces de sustentar las producciones y memorias de las favelas.

[Social rights: difficult to construct, easy to destroy]. / Derechos sociales: difíciles de construir, fáciles de destruir.

The purpose of this article is to reflect on contemporary tensions between the social protection system in Brazil - which in the past 30 years has come to be organized as a social right and has been part of the construction of democracy in the country - and the current process of its dismantling under an authoritarian populist regime. From the theoretical perspective adopted in this article, structural characteristics and circumstantial factors are examined in order to explain the difficulties that have been faced in constructing a legal and institutional architecture for social rights, and on the other hand, why at present it is so easy to destroy it in practice.

El objetivo de este trabajo es reflexionar, desde el caso de Brasil, sobre las tensiones actuales entre el sistema de protección social ­que en los últimos 30 años se organizó como derechos de la ciudadanía y como parte de la construcción de la democracia en el país­ y el proceso de desmantelamiento en el período actual por un régimen populista autoritario. Desde la perspectiva teórica presente en este trabajo, se indaga sobre las características estructurales y los factores de la coyuntura que nos permiten explicar por qué ha sido tan difícil la construcción de la arquitectura legal e institucional de los derechos sociales y, al revés, por qué resulta tan fácil en la actualidad destrozarla en la práctica.

[Local governance in the decentralized health care system in Brazil]. / Governança local no sistema descentralizado de saúde no Brasil.

OBJECTIVE: To analyze the changes in local health care governance resulting from the decentralization process associated with the Unified Health System (SUS) in Brazil between 1996 and 2006. METHODS: A questionnaire was answered in 1996 and again in 2006 by all city officials involved in health care management in Brazil. Information was collected on the innovative characteristics of administrative practices in terms of three dimensions: social, management, and care. The present article analyzes the results relating to the social dimension (relationship between municipal officials and the various community actors) according to four attributes: preparing the budget (degree of influence of various actors), establishing priorities, accountability, and flow of information to the community. RESULTS: The influence of municipal secretaries of health and health councils on budget preparation has increased, with a decrease of local politician influence. In prioritizing health issues, local politicians and spontaneous demands have also become less influential, with strengthening of the influence of technical opinions and proposals by health councils and conferences. Public disclosure of results has become institutionalized as a result of the diversification of stakeholders (especially municipal secretaries and health councils) and of the methods available for disclosure, even though balance sheets are still the most common type of information disclosed (which imply technical knowledge for interpretation of results). Finally, the information conveyed to the community still mainly refers to health actions and campaigns and functioning of health services, even though a larger amount of innovative information is being communicated. This was observed in all regions and in cities of all sizes, with a more progressive trend in the South of Brazil. CONCLUSIONS: The relationship between government and society has changed toward a more democratic standard of local governance, despite the maintenance of centralized government decision-making practices. The process of decentralization still faces important obstacles to the establishment of a more participative model, with enhanced social control, accountability and interaction between government and society.

A public policy approach to local models of HIV/AIDS control in Brazil.

OBJECTIVES: We investigated involvement and cooperation patterns of local Brazilian AIDS program actors and the consequences of these patterns for program implementation and sustainability. METHODS: We performed a public policy analysis (documentary analysis, direct observation, semistructured interviews of health service and nongovernmental organization [NGO] actors) in 5 towns in 2 states, São Paulo and Pará. RESULTS: Patterns suggested 3 models. In model 1, local government, NGOs, and primary health care services were involved in AIDS programs with satisfactory response to new epidemiological trends but a risk that HIV/AIDS would become low priority. In model 2, mainly because of NGO activism, HIV/AIDS remained an exceptional issue, with limited responses to new epidemiological trends and program sustainability undermined by political instability. In model 3, involvement of public agencies and NGOs was limited, with inadequate response to epidemiological trends and poor mobilization threatening program sustainability. CONCLUSIONS: Within a common national AIDS policy framework, the degree of involvement and cooperation between public and NGO actors deeply impacts population coverage and program sustainability. Specific processes are required to maintain actor mobilization without isolating AIDS programs.

A Frente pela Vida e a atualização do Movimento da Reforma Sanitária Brasileira / The Front for Life and updating the Brazilian Health Sector Reform Movement

RESUMO Objetivou-se analisar a Frente pela Vida (FpV), um ator da sociedade civil organizado no campo da saúde, que buscou incidir politicamente diante da crise sanitária da pandemia da covid-19 no contexto do governo Bolsonaro. As informações foram obtidas por meio de revisão documental de publicações da FpV, bem como pela observação participante de reuniões, manifestações, lives e eventos nos quais participou ou organizou, além de entrevistas com participantes do seu grupo operativo. A análise considerou as categorias origem, trajetória, atores, gestão, relação entre a FpV e movimento sanitário, sustentabilidade, desafios e perspectivas da FpV. Os resultados evidenciam que a FpV capitaneou uma grande rede de políticas formada por sujeitos individuais e coletivos, entidades científicas e organizações representativas de diversos segmentos da sociedade civil, conformando uma atualização do movimento sanitário com ampliação de sua base de sustentação social. Sua trajetória contemplou, principalmente, a ação técnico-científica e política em múltiplas arenas, tendo nos Poderes Executivo, Legislativo e Judiciário, e na sociedade civil, espaços privilegiados de inserção. Conclui-se que a FpV se revelou importante ator social na conjuntura recente, tensionando o Estado na defesa da vida, do direito universal à saúde e da expansão e fortalecimento do Sistema Único de Saúde.

ABSTRACT This paper examined the Front for Life (Frente pela Vida, FpV), a movement of organised civil society in the health field, which sought to achieve political impact in response to the health crisis caused by the COVID-19 pandemic in the context of the Bolsonaro administration. Information was obtained through a document review of FpV publications, participant observation in meetings, demonstrations, livestreams and events in which the front participated or organised, as well as interviews of participants in its operating group. The analytical categories used were origin, trajectory, movements, management, the relationship between the FpV and the health sector reform movement, sustainability, challenges and the FpV's prospects. The results showed that the FpV has led a large policy network of individual and collective subjects, scientific entities and organisations representing various segments of civil society to update the health sector movement and expand its social support base. Its trajectory has involved mainly technical, scientific and political action in multiple areas, working with the Executive, Judiciary and Legislative branches of government, as well as civil society. In conclusion, the FpV has proved to be an important social movement pressing the State to defend life and the universal right to health and to expand and strengthen Brazil's Unified Health System, the SUS.

The Welfare State in Latin America: reform, innovation and fatigue.

This paper analyses the challenges of building the Welfare State in late democracies in Latin America. The author shows how the literature has identified different social protection patterns in the region and how recent reform models have transformed institutions, in an unfavorable socioeconomic context. The results point to the emergence of a mixture of social protection measures that have increased coverage and reduced poverty, but are unable to guarantee universal citizens' rights and longevity.

El desafío de la descolonización del conocimiento: el Diccionario de favelas Marielle Franco / The challenge of decolonizing knowledge: the Marielle Franco Favela Dictionary

RESUMEN Los sectores dominantes de la sociedad describen las favelas a partir de definiciones negativas a priori, que han sido cuestionadas por diversos actores colectivos. A partir de una iniciativa conjunta de la comunidad académica y quienes residen en las favelas, se crea el Diccionario de Favelas Marielle Franco como una plataforma en línea que, a través de la construcción colectiva del conocimiento, busca difundir diferentes narrativas sobre estos territorios y sus poblaciones. En este artículo, discutimos cómo se produjeron los acuerdos y divergencias entre el conocimiento de la comunidad académica, activistas y habitantes de barrios marginalizados; y presentamos la trayectoria de la construcción del Diccionario, que busca superar tensiones y así incorporar otros lenguajes y registros capaces de sustentar las producciones y memorias de las favelas.

ABSTRACT: Dominant social groups describe favelas based on negative stereotypes, which are increasingly being challenged by various collective actors. Originating from a collaborative effort carried out by academics and favela residents, the Marielle Franco Favela Dictionary is an online platform that aims to spread alternative narratives regarding these territories and their populations through collective knowledge building. This article discusses the common ground and points of contention regarding the different forms of knowledge held by academics, activists, and favela residents. Furthermore, we reconstruct the trajectory of the Dictionary's creation, and in so doing overcome certain tensions and incorporate other languages and registers able to support the production of memory in favelas.

Derechos sociales: difíciles de construir, fáciles de destruir / Social rights: difficult to construct, easy to destroy

RESUMEN El objetivo de este trabajo es reflexionar, desde el caso de Brasil, sobre las tensiones actuales entre el sistema de protección social -que en los últimos 30 años se organizó como derechos de la ciudadanía y como parte de la construcción de la democracia en el país- y el proceso de desmantelamiento en el período actual por un régimen populista autoritario. Desde la perspectiva teórica presente en este trabajo, se indaga sobre las características estructurales y los factores de la coyuntura que nos permiten explicar por qué ha sido tan difícil la construcción de la arquitectura legal e institucional de los derechos sociales y, al revés, por qué resulta tan fácil en la actualidad destrozarla en la práctica.

ABSTRACT The purpose of this article is to reflect on contemporary tensions between the social protection system in Brazil - which in the past 30 years has come to be organized as a social right and has been part of the construction of democracy in the country - and the current process of its dismantling under an authoritarian populist regime. From the theoretical perspective adopted in this article, structural characteristics and circumstantial factors are examined in order to explain the difficulties that have been faced in constructing a legal and institutional architecture for social rights, and on the other hand, why at present it is so easy to destroy it in practice.

Giovanni Berlinguer: socialist, sanitarian, and humanist!

This article highlights important aspects of the biography of Giovanni Berlinguer that led him to become a prominent scientist and political activist. His works were marked by a strong socialist conviction and deep humanism. His contribution to health in Brazil ranged from a vast academic output in the field of public health to an active involvement in the Brazilian Health Movement. His later publications addressing everyday bioethics reveal the common thread that runs through his entire works: the use of science to demonstrate the social determinants of health; the fight against unjust inequality; the defense of life against exploitation; and the struggle to prevent the commoditization of life, the human body, and health care.

Capitalismo, democracia, cidadania - contradições e insurgências / Capitalism, democracy, citizenship - contradictions and insurgencies

RESUMO O objetivo deste ensaio foi discorrer sobre as relações entre capitalismo, democracia e cidadania, tendo como foco as transformações recentes em todos os componentes da tríade Estadonacional, mercado capitalista e cidadania, que caracterizaram a construção da modernidade ocidental e geraram a democracia de massas, o Welfare State - ou Estado de Bem-Estar Social - e o mercado regulado. A globalização da economia levou à desterritorialização da produção e circulação de mercadorias e de capitais, em uma fase de predomínio da lógica de acumulação financeira, dissociando o mercado da dimensão nacional, sob a qual se exerce o poder político estatal. É preciso entender, no entanto, que as tensões entre capitalismo e democracia, e mesmo entre democracia e cidadania, são constitutivas dessa relação, nem sempre sendo contradições antagônicas, pois, em conjunturas específicas, diante das lutas socias e do acúmulo de forças em certas fases do processo de acumulação, pôde-se construir uma nova correlação de forças e viabilizar propostas contra-hegemônicas. A etapa atual deve ser compreendida como parte do acirramento dessas contradições, não como uma situação implacavelmente estagnada. A proposta é pensar, nesta conjuntura, o lugar da democracia e da cidadania.

ABSTRACT The aim of this essay was to discuss the relations between capitalism, democracy and citizenship, focusing on the recent transformations in all components of the triad National-State, capitalist market and citizenship, which characterized the construction of Western modernity and generated mass democracy, Welfare State, and regulated market. The globalization of the economy led to the deterritorialization of the production and circulation of goods and capital, in a phase of predominance of the logic of financial accumulation, dissociating the market from the national dimension, under which the political power of the state is exerted. It must be understood, however, that the tensions between capitalism and democracy, and even between democracy and citizenship, are constitutive of such relation, not always being antagonistic contradictions, because, in specific conjunctures, in the face of social struggles and the accumulation of forces in certain phases of the process of accumulation, it was possible to build a new correlation of forces and to achieve viable anti-hegemonic proposals. The current stage must be understood as part of the aggravation of these contradictions, not as a relentlessly stagnant situation. The proposal is to think, in this juncture, about place of democracy and citizenship.

[Reactions to institutional violence: patient strategies for facing infringements of the right to health in Brazil]. / Reacciones a la violencia institucional: estrategias de los pacientes frente al contraderecho a la salud en Brasil.

In this article we identify evidences of inequalities, prejudices and discrimination in the access and utilization of public health services belonging to the Brazilian Unified Health Care System, considering them to be institutional violence and a negation of rights, in order to look at the reactions of the subjects victimized by this process. This research study utilized different methodologies, articulating participant observation, semi-structured interviews, focus groups and dramatization. The results highlight the trajectory in seeking health care as the main expression of inequalities, strengthened by structural factors such as the precarious condition of health care services, which potentiate power asymmetries, and the presence of discrimination derived from stigmas and prejudices. Most patients' reactions to the situation of institutional violence seek an individual solution to the problem, often reaffirming the conditions that generate rights violations. Few patients' reactions question the systemic conditions that determine the continued discrimination.

The new profile of local managers in the decentralized health system in Brazil / O novo perfil dos gestores locais no sistema de saúde descentralizado no Brasil

ABSTRACT This article analyzes the impact of decentralization on the recruiting standards for the position of municipal health secretary, aiming to understand the extent to which local power has been democratized, as a consequence of the Unified Health System (SUS) implementation. Municipal health secretaries all over the country answered a questionnaire at two different times in the decentralization process - 1996 and 2006 - achieving representative results. The goal was to collect data about their socioeconomic, professional profile, political trajectory and public life. Results show that there are more women, brown ('pardos') and low-income people holding the position, and that the qualification of municipal health secretary improved in the period between the two surveys. However, this does not apply to the larger cities and more developed regions, where competition for this position has led to a recruiting standard that combines high levels of professionalism with restricted access for disadvantaged groups. We also found that municipal health secretary are now more politically engaged in manager's associations than in their previous insertion in civil society networks.

RESUMO Este artigo analisa o impacto da descentralização sobre os padrões de recrutamento para o cargo de secretário municipal de saúde, visando compreender em que medida o poder local tem sido democratizado, como consequência da implementação do Sistema Único de Saúde (SUS). Os secretários municipais de saúde de todo o País responderam a um questionário em dois momentos diferentes no processo de descentralização - 1996 e 2006 - alcançando resultados representativos. O objetivo era coletar dados sobre seu perfil socioeconômico, profissional, trajetória política e vida pública. Os resultados mostram que há mais mulheres, pardos e pessoas de baixa renda que ocupam o cargo, e que a qualificação de secretário municipal de saúde melhorou no período entre as duas pesquisas. No entanto, isso não se aplica às grandes cidades e regiões mais desenvolvidas, onde a competição por essa posição levou a um padrão de recrutamento que combina altos níveis de profissionalismo com acesso restrito para grupos desfavorecidos. Constatamos também que os secretários municipais de saúde estão agora mais envolvidos politicamente nas associações de gestores do que na sua inserção anterior nas redes da sociedade civil.

The Welfare State in Latin America: reform, innovation and fatigue / O Estado de Bem-estar Social na América Latina: reforma, inovação e fadiga / El Estado del Bienestar en Latinoamérica: reforma, innovación y agotamiento

Abstract: This paper analyses the challenges of building the Welfare State in late democracies in Latin America. The author shows how the literature has identified different social protection patterns in the region and how recent reform models have transformed institutions, in an unfavorable socioeconomic context. The results point to the emergence of a mixture of social protection measures that have increased coverage and reduced poverty, but are unable to guarantee universal citizens' rights and longevity.

Resumo: O artigo analisa os desafios da construção do Estado de Bem-estar Social nas democracias tardias da América Latina. O autor mostra como a literatura identifica diferentes padrões de proteção social na região, e como os recentes modelos de reforma transformaram as instituições em um contexto socioeconômico desfavorável. Os resultados apontam para a emergência de uma mistura de medidas de proteção social que aumentaram a cobertura e reduziram a pobreza, mas que não conseguem garantir os direitos universais e a longevidade dos cidadãos.

Resumen: Este trabajo analiza los desafíos de construir un Estado de Bienestar en las tardías democracias latinoamericanas. El autor muestra cómo dentro de la literatura se han identificado patrones diferentes de protección social y cómo se han transformado las instituciones con los recientes modelos de reforma, dentro de un contexto socioeconómico desfavorable. Los resultados señalan el surgimiento de una mezcla de medidas de protección social, que han incrementado la cobertura en salud y reducido la pobreza, pero que son incapaces de garantizar los derechos universales de los ciudadanos y su esperanza de vida.

Polarização federativa do SUS nos anos 1990: uma interpretação histórico-institucionalista / Federalismo polarizado en el sistema de salud en Brasil / The polarized federalism in the health system in Brazil

Resumo Este artigo busca explicar a dinâmica político-institucional que produziu um quadro polarizado de relações federativas no SUS nos anos 1990, com base no arcabouço teórico do neoinstitucionalismo histórico. Nessa perspectiva, analisa-se a trajetória das relações intergovernamentais como o resultado de uma cadeia de decisões tomadas em contextos singulares dos governos Collor, Itamar e FHC, onde o jogo entre os atores políticos do SUS e as tendências do contexto federativo nacional estabeleceu a direção da estratégia de descentralização em cada etapa. A intensidade de institucionalização dependeu ainda das escolhas desses governos relativas à direção da política nacional e à estrutura de coordenação federativa do Ministério da Saúde, da estabilidade e do volume do financiamento setorial, e das capacidades institucionais de estados e municípios para assumirem novas responsabilidades.

Resumen Este artículo propone un punto de vista histórico-institucionalista para explicar la polarización de las relaciones federativas en SUS a finales en los años 1990. En este enfoque, la trayectoria de las relaciones intergubernamentales es el resultado de una larga cadena de decisiones tomadas en contextos políticos concretos de los tres gobiernos en los años 1990: Collor, Itamar y FHC. La dinâmica de forças entre los actores políticos del SUS y las tendencias del contexto federativo nacional establecieron la dirección de la estrategia de descentralización en cada etapa. La intensidad de institucionalización resultó también de las elecciones de esos gobiernos relativas a la dirección de la política nacional y a la estructura de coordinación federativa del Ministerio de Salud, de la estabilidad y volumen del financiamiento sectorial, y de las capacidades institucionales de estados y municipios para asumir nuevas responsabilidades.

Abstract This article proposes a historical-institutionalist perspective to explain the political and institutional dynamics that polarized the intergovernmental relations in health policy in the 1990s. In this perspective, the history of intergovernmental relations is understood as the result of a long chain of decisions made in particular political contexts of the three governments in the 90s: Presidents Fernando Collor, Itamar Franco and Fernando Henrique Cardoso. During this period, the relations between the political actors of the Brazilian Health Unified System (SUS) and the trends of the national federative context established the direction of the decentralization strategy at each stage. The intensity of institutionalization also depended on the choices of these governments regarding the direction of the national policy and the federative coordination structure of the Ministry of Health, the stability and volume of financing, and the institutional capacities of states and municipalities to take on new responsibilities.

Giovanni Berlinguer: socialista, sanitarista, humanista! / Giovanni Berlinguer: socialist, sanitarian, and humanist!

O artigo assinala importantes fatos na biografia de Giovani Berlinguer, que foram responsáveis por sua trajetória como importante cientista e militante político e cuja obra foi marcada por sua perspectiva como socialista convicto, pesquisador da saúde coletiva e devotado humanista. No Brasil, sua contribuição está entranhada desde a produção acadêmica no campo da saúde coletiva até o Movimento Sanitário. Seus últimos trabalhos sobre bioética do cotidiano revelam o traço que subjaz a toda sua obra: o uso da ciência para demonstrar os determinantes sociais da saúde, abolir desigualdades injustas, defender a vida contra a exploração e prevenir que o corpo humano e a atenção à saúde sejam transformados em mercadorias.

This article highlights important aspects of the biography of Giovanni Berlinguer that led him to become a prominent scientist and political activist. His works were marked by a strong socialist conviction and deep humanism. His contribution to health in Brazil ranged from a vast academic output in the field of public health to an active involvement in the Brazilian Health Movement. His later publications addressing everyday bioethics reveal the common thread that runs through his entire works: the use of science to demonstrate the social determinants of health; the fight against unjust inequality; the defense of life against exploitation; and the struggle to prevent the commoditization of life, the human body, and health care.

Brazilian sanitary reform: dilemmas between the instituing and the institutionalized.

The article presents the trajectory of social policies in Brazil and identifies, at each stage, the existing social protection model. It affirms that the Federal Constitution of 1988, when it introduced the concept of Social Security and created the National Health Care System, represented a rupture with what came before. The subordination of the principles of justice and social inclusion, which guided the design of this new social protection model, to a liberal and monetarist policy had important impacts in the phase of implementation of the social policies. However, the dilemma that such policies go through and, in particular, the construction of the National Health Care System must be analyzed from a theoretical perspective that encompasses the agreements and disagreements between the three movements that characterize Brazilian Sanitary Reform, which are: subjectivation, constitutionalization and institutionalization.