Resumo Hospitais e outros centros de tratamento de saúde geram um volume de resíduos cada vez maior, dos quais cerca de 15% podem ser infecciosos, tóxicos ou radioativos. A Organização Mundial da Saúde começou a enfrentar o problema na década de 1980. Inicialmente, concentrou-se nos países ricos, depois mudou o foco para os países pobres, onde métodos de eliminação inseguros, como aterros sanitários e incineradores inadequados, preocupavam. Aos poucos, a compreensão do problema passou por mudanças, inclusive do enfoque no conteúdo do resíduo hospitalar considerado “perigoso”, passando para todas as formas de resíduos, e da aceitação do resíduo médico como um inconveniente inerente aos cuidados de saúde de alta qualidade, até o conceito de que evitar a produção de resíduos hospitalares faz parte dos cuidados de saúde de alta qualidade.

Abstract Hospitals and other health facilities generate an ever-increasing amount of waste, approximately 15% of which may be infectious, toxic, or radioactive. The World Health Organization has been addressing the issue since the 1980s. After initially focusing on high-income countries, it then focused on low-income countries, with unsafe disposal methods in landfills and inadequate incinerators as major concerns. Gradually, the understanding of the issue has undergone several shifts, including from a focus on the component of medical waste considered “hazardous” to all forms of waste, and from accepting medical waste as a necessary downside of high-quality healthcare to seeing the avoidance of healthcare waste as a component of high quality healthcare.

Resumo Entre 1979 e 1989, o governo da República Democrática Alemã (RDA) prestou assistência médica à Nicarágua sandinista. Após a ajuda emergencial inicial, os sandinistas adotaram um sistema de saúde baseado na atenção primária à saúde (APS), o que dificultou o apoio da RDA. A moeda não conversível, o caráter repressivo da liderança da RDA e a falta de experiência com os processos de APS limitaram o auxílio da RDA ao estabelecimento do novo sistema de saúde. Após 1985, com a paralisação do sistema, a assistência da RDA foi revitalizada com a doação do Hospital Carlos Marx. Prestando serviços a 300 mil pessoas, combinou pessoal e equipamento de uma instituição estritamente alemã-oriental com alguma integração com os sistemas locais.

Abstract Between 1979 and 1989 the government of the German Democratic Republic provided health assistance to Sandinista Nicaragua. After initial relief aid, the Sandinista embrace of a primary health care-based health system made East German health support difficult. The non-convertible currency, the repressive quality of the East German leadership, and the lack of experience with primary health care processes all limited its potential to provide support. After 1985, when implementation of this system stalled, East German health assistance was revitalized with the donation of the Hospital Carlos Marx. Providing medical services to three hundred thousand people, it combined elements of a strictly East German institution, using German personnel and equipment, with some integration into local systems.

The economic depression of the 1930s represented the most important economic and social crisis of its time. Surprisingly, its effect on health did not show in available morbidity and mortality rates. In 1932, the League of Nations Health Organisation embarked on a six-point program addressing statistical methods of measuring the effect and its influence on mental health and nutrition and establishing ways to safeguard public health through more efficient health systems. Some of these studies resulted in considerations of general relevance beyond crisis management. Unexpectedly, the crisis offered an opportunity to reconsider key concepts of individual and public health.