Contributions of national health conferences to the definition of public environmental and health information policy

Stedile, Nilva Lúcia Rech; Guimarães, Maria Cristina Soares; Ferla, Alcindo Antonio; Freire, Rafaela Cordeiro

doi:10.1590/1413-812320152010.15142014

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Article • Ciênc. saúde colet. 20 (10) • Oct 2015 • https://doi.org/10.1590/1413-812320152010.15142014 copy

Contributions of national health conferences to the definition of public environmental and health information policy

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The relationship between health and the environment has been the object of increased interest from researchers in recent decades with information being the phenomenon that makes it possible to construct a tessitura between the 2 areas. The goal of this article is to examine how the recommendations of the National Health Conferences treat the issue of the environment and information and how they link these two areas with health. The present study is a documentary investigation of a qualitative nature. The documents that comprise the research's corpus are the official reports of the Conferences, from the 1st (1943) to the 14th (2011). The results show that environmental issues have always been present, especially since the 8th Conference in 1986, after which there is an increasing amplification of discussions about the theme. The themes of "health" and "the environment" discussed in the 12th and 13th Conferences demonstrate clear progress toward defining their relationship with quality of life. "Health Information" is referenced as fundamental in almost all the Conferences, achieving the status of priority axis in the 11th Conference. The inclusion of several propositions presented and discussed in the Conferences seems to influence the establishment of public policies in the areas of the environment and information.

Key words
Environment; Information systems; Public policies; Environmental health

National health conferences/themes	Year	Aspects related to the environment	Aspects related to health information
1^st National Health Conference / The health and welfare situation of the states	1941	The goals were targeted at management by state health service administrators. Themes related to the environment: national campaigns against leprosy and tuberculous; and the situation of the country's cities with regard to water and sewage services. There is reference to the quantity, collection, removal, and disposal of garbage.	Developed together with education, the single reference to health information is the question: From which municipalities of the state are bio-statistical data obtained?
2^nd National Health Conference / Legislation regarding hygiene and occupational safety as well as providing medical assistance and preventive healthcare for workers and pregnant women	1950	There are no formal reports concerning this conference, but according to CONASS (2009), its agenda sought to analyze the dominant viewpoints among healthcare workers. Medical and preventive care for workers and pregnant women were discussed without any relevant reference to the environment.	There are no formal reports concerning this conference.
3^rd National Health Conference / Decentralization in the area of health	1963	The focus was on the analysis of the health situation and the reorganization of the health system, with proposals for decentralization, the redefinition of the roles of government powers, and the proposal of a National Health Plan. The report shows 4 themes: a) the sanitary situation; b) the distribution of medical-sanitary activities; c) municipalization; and d) the National Health Plan. The environment is cited in relation to the need for the execution of sanitation measures, specifically the water and sewage supply. The municipality is responsible for performing the environment-supply activities, the control of waste and garbage.	The report points to the difficulties of the "Statistical Services existing at the top of the Ministry of Health" in maintaining and organizing the scarce data derived from the states and that could be used for statistics on the overall national environment. For the correction of this situation, it proposes the creation of national "Registration Areas", in addition to the consolidation of national bio-statistical and health-statistical services. In the conclusions, it cautions that the statistical services are one of the problems for health in Brazil. Yet, in the recommendations, it establishes that it is up to the municipality to collect statistical data.
4^th National Health Conference / Human resources for activities in health	1967	The theme was not an object of analysis, but one of its advancements was the implementation of the National System of Epidemiological Monitoring.	Because it centered on the formation of the RH, professional development, and the creation of a National Health Policy, the "information" theme did not contain records that warrant highlighting.
5^th National Health Conference / Formation of the National Health System and its institutionalization	1975	The only relationship that it establishes with the environment is a suggestion that colonization, agriculture, and irrigation projects should be submitted to the Ministry of Health so that they met the minimum requirements to prevent the outbreak or spread of endemic diseases.	It recommends developing mechanisms of information integration and that municipalities should supply comparative statistics on vital, epidemiological, operational, and cost information at central levels. It recognizes the need of a good IS and that importance of the information, decision, and control triad, in addition to the inexistence of an information collection, registration, consolidation, analysis, and distribution system and of professionals able to operate it.
6^th National Health Conference / Control of large endemic diseases and the internalization of health services	1977	In the first axis of discussions, it very tenuously presents the relationship between the environment and the main endemic diseases that ravaged the country and points to the need for the expansion of the sanitation services (understood as a basic service).	In the second thematic axis, it recommends the maintenance of an acceptable IS to guide actions and programs and the exchange of information. This was the first time that the expression "information systems" appears in the reports.
7^th National Health Conference / Extension of healthcare actions through basic services	1980	It sought the strengthening and definition of AB, which considers the services rendered to the environment as an integral part of the primary health services and sanitation, especially regarding water quality priorities. It advocated the creation of the National Plan of Basic Services. It considers basic medical care as an "unwavering" right of a human being.	In the discussions of the basic text "The extension of action and services by means of primary care", the need for a unified, cross-institutional IS that adheres to not only administrative need but also user tracking in reference and counter-reference services was recommended. It stresses the need to improve the quality of information.
8^th National Health Conference / Health as a right, reformulation of the National Health System, and sectoral financing	1986	It includes the environment as a fundamental variable in the concept of health, in addition to defining health as a right that can only be effective, among other factors, by the availability of the "acceptable quality of the environment" (p.5). In the financing of the health sector, it suggests additional taxes on polluting firms and firms engaged in deforestation.	The issue of health information was not a focus of the discussion.
9^th National Health Conference / Municipalization is the way	1992	It recommends enacting the National System of Health Monitoring and ensuring to the population information related to environmental risks and the adverse effects of products and services for monitoring water and other inputs. The link between health policy and basic sanitation was considered indispensable.	It recommends ensuring local health councils have access to information and all the data sources. The access to (quality, clear, and accessible) information was considered fundamental to ensuring the democratization and feasibility of the SUS. It advocates the creation of a National System of Health Information and the allocation of specific resources for this purpose.
10^th National Health Conference / Construction of a healthcare model	1996	The environment is not a central focus, but in the defense of health as a right and quality of life, it establishes that federal, state, and municipal governments should define a sanitation policy that is integrated within the National Health Policy. It recommends the organization of a National Conference of Health, Sanitation, and the Environment. It emphasizes the importance of the collection and allocation of radioactive waste and the municipal management of water and sewage, investments in basic sanitation (water, sewage, street cleaning, the ultimate fate of waste, urban drainage), bringing these actions under the purview of the SUS. It recommends the development of education and environmental protection, (health services, domestic, and industrial waste treatment, in addition to recycling). In item 6, which addresses primary healthcare, it shows the need to promote environmental monitoring.	It advocated that "access to information and knowledge is the citizen's right and should be guaranteed by the state" (p. 19). Item 2.6 integrally addresses "health Information, education, and communication", emphasizing the need for the definition of a National Policy of Health Information, Education, and Communication that covers the interests of users, professionals, and research centers that pursue the public interest and that have a strategic character in the organization of all the activities and services of the SUS. Moreover, it recommends the implementation of a National System of Health Information that covers the production, organization, and release of data on the many aspects related to health. This system requires the development and integration of all data from existing Information Systems.
11^th National Health Conference / Making the SUS effective: acess, quality, and humanization in healthcare with social control	2000	The environment theme appears as one of the basic elements in terms of basic sanitation, but it is not the central focus of analysis. do saneamento básico, mas não é foco central de análise.	It restated that communication, education, and information are essential components for equality, quality, and the humanization of services and for supplying social control in the SUS. It indicated the needs for the creation of networks between society and governments, the socialization of information (especially in the Health Councils), and the importance of this socialization for the process of the political maturation of social control in all spheres.
12^th National Health Conference / Health as a right of all and a duty of the state: the healthcare that we have, the SUS that we want	2003	The report is organized into 10 thematic axes, but none is specifically about the environment. Nonetheless, in the general directives, it includes the healthy environment as one of the aspects to be covered in broad and intersectoral social policies. This theme becomes transversal and passes through several axes, reinforcing the relationship between health, the environment, and quality of life (e.g., item 42 of the general directives, which exhibits aspects to link and to ensure actions that promote a healthy environment, based on those established in Agenda 21). There is stress on the use of pesticides, the quality of water, the protection of flora and fauna, waste control, and environmental education. It highlights the need for links between epidemiological monitoring, sanitation, the environment, food, and nutrition.	The report is organized into 10 thematic axes, the 10th of which addresses health communication and information. It argues in favor of the development and implementation of joined policies on information and communication; information access; strengthening and integrating IS in the 3 spheres of government; quality information and access to it for supporting users, professionals, managers, and SUS entities. It reiterates the need for the permanent development of the system and intersectoral integration. General directives include: increasing Information Systems, promoting the implementation of decentralized systems of geo-processing in health, researching, systematizing, and publicizing epidemiological and statistical data related to the promotion of health.
13^th National Health Conference / Health and quality of life: state policies and development	2007	The Conference was organized into thematic axes I, II and III, highlighting the following environmental issues: a) implementation of policies for environmental intervention with self-sustainable labor; reduction in the generation of pesticides and "garbage", its packaging, pickup and disposal; expansion of health surveillance actions; respect for nature and the preservation of the environment; the development of intersectoral actions for the implementation of practices and public policies for sustainable development in municipalities; construction of an intersectoral network of support for health and for socio-environmental justice; development of studies about the action of pollutants; and warnings to populations exposed to environmental risks (Axis I); b) approval of legislation for sanitary responsibility for the implementation of the Policy of Basic Sanitation and the Protection of the Environment and for environmental monitoring of air and soil quality for protection from risks; inclusion of the mapping of areas used by the PAC (Axis II); and c) supervision and control of pesticide and chemical product use and recommending the inclusion of the environmental health thematic in the 3rd National Environmental Conference, in addition to recommending that the directives of the National Policy of Environmental Health be defined in the 1st National Environmental Health Conference (which would occur in 2009).	The issue was addressed in 3 axes. In the first, the following were focused on: the need for the development of the National System of Control, Evaluation, and Monitoring of the indicators of health and the System of Mortality Information (Sistema de Informação de Mortalidade - SIM); and access to updated indicators. It recommends improvements in the scope and quality of information and the creation of a national database, made available by networks for the use of professionals. Axis II addresses the execution of the SUS charter and the digitization of user care (electronic medical recordkeeping); ensuring and investing in the Integral Information Systems for the SUS in all municipalities and integrating the existing databases (SIM, Sinasc, Sinan, SIA, SIH, SIAB, Sismasus). Among those unpublished, it addresses the editorial policies of information in the SUS, the reformulation of the IS of primary care and that of MS, by means of Datasus, resuming the discussion of PNIIS; resuming and expanding the National Network of Health Information Project (Projecto RNIS - Rede Nacional de Informações em Saúde); seeking conformity in the technological infrastructure of the health sector with the standards of interoperability of electronic governance and promoting effective accessibility to information. For the CNS and its state and municipal councils to ensure financial resources, axis III recommends that the Commission of Health Communication and Information of the CNS work intersectorally and that commissions of health communication, information and informatics be created in state and municipal councils.
14^th National Health Conference/"Everbody uses the SUS! The SUS in social secirty, public policies, and the Brazilian people's heritage"	2011	Directive 9 of the 14th CNS contains 20 proposals in which 12 directly relate to environmental issues, reinforcing the unmistakable relationship between health, environmental conditions, promotion and prevention, and quality of life. Among the primary deliberations is the reinforcing of responsibility for environmental damage of any institution or person who harms the environment. It broadens the need for intersectoral actions, interlinking and tying health, education, the environment, welfare, and sanitation for the protection of the environment, the increase in basic sanitation services, water quality, adequate disposal of waste and garbage, including rural areas. It reinforces the importance of the implementation of the National Policy of Solid Waste, citizens in the use of pesticides, the implementation of public policies for sustainable energy and the eradication of dumps and the reclamation of damaged areas. It urges Brazil to support national and international initiatives in environmental protection. It recommends, even if mandatory, presenting health councils with public health impact reports.	Report organized into 15 directives. In proposal 25 (Directive 1), it recommends unifying the databases of the sectoral polices that compose the social security system (CADSUS/Saúde, CAD SUAS/ Assistência Social e Base da Previdência [Social Care and Welfare Basis]/BPC), and proposal 7 (Directive 2) stresses the guarantee of transparency in services and control pacts. It emphasizes the importance of financing for informatics teams, the reevaluation of data and health indicators by the SIAB, the computerization of the units, and the implementation of electronic medical record keeping. In Directive 12, of the 15 proposals approved, 11 relate to the SIS, with an emphasis on: improvement and integration of the various Information Systems (implementation of a single database); training and the computerization of services, interlinking health, social security, and social assistance; the guarantee of financial, technical, and technological resources for the implementation of the SUS charter; the creation of national medical records; the implementation of the Telehealth and Telemedicine Program; the guarantee of connectivity for all municipalities (EAD); the construction of a Strategic Communication Plan; the enactment of a system of computerized control (Sisreg); the maintenance of updated data for users; the restructuring of the Information Systems enrolling the services of AB.

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[1] Collaborations

NLR Stedile participated in the overall organization of the article, performance of the content analysis of the National Health Conferences, development of the general table for the display of the summaries of the reports, discussions, and interpretations. MCS Guimarães participated in defining and guiding the work's methodology, the general editing of the article, the evaluation of the aspects related to public policies addressing health information, discussions, and interpretations. AA Ferla participated in the general editing of the article and the analysis of the aspects related to public policies concerning the environment and health. RC Freire deepened the literature review and the aspects related to health and formatted the article to journal norms.