Deafness in the Brazilian care policy: a genealogical analysis

Vianna, Nubia Garcia; Andrade, Maria da Graça Garcia; Lemos, Flávia Cristina Silveira; Rodriguez-Martín, Dolors

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FREE THEMES • Ciênc. saúde coletiva 27 (04) • Apr 2022 • https://doi.org/10.1590/1413-81232022274.09142021 copy

Deafness in the Brazilian care policy: a genealogical analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Deafness can be understood from the clinical-therapeutic and the socio-anthropological perspectives. The study aims to perform a genealogical analysis of deafness; that is, an analysis of the practices of knowledge and power in Brazilian health policy. This is a qualitative, documentary study based on the theoretical assumptions of Foucault. Researchers selected 23 documents and conducted eight semi-structured interviews, which were also considered documents, with a non-probabilistic sample using the snowball technique. The genealogical analysis showed that health policies aimed at people with hearing impairment result from the power and knowledge relationships in the field of deafness, in which the medical-pathological discourse is seen as the real perspective, understanding deafness as a disability to be corrected. The socio-anthropological approach, which recognizes the deaf through the perspective of difference and the use of sign language, is a subject discourse that has not found space in health policy. The study highlighted the contradictions between the achievements related to the access to technologies and the propositions of the health sector, whose policy directs its actions exclusively to reach a listening standard, disregarding the multiplicity of deaf individuals.

Key words:
Deafness; Right to health; Health policy; Accessibility; Communication barriers

Normative documents (laws, decrees and directives) related to people with (hearing) disabilities
N	Document	Year	Subject/Topic
1	Law No. 7,853	1989	This law provides for support for people with disabilities, their social integration, for the Brazilian National Coordination for the Integration of People with Disabilities (CORDE), in addition to establishing the jurisdictional protection of collective or diffuse interests of these people, disciplining the actions of the Public Ministry, defining crimes and providing other provisions
2	Decree No. 914	1993	This Decree establishes the Brazilian National Policy for the Integration of People with Disabilities and provides other provisions
3	Directive GM/MS No. 1,278	1999	This Directive approves the indication and contraindication criteria for cochlear implants in the form of Appendix I
4	Decree No. 3,298	1999	This Decree regulates Law No. 7,853, of October 24, 1989, provides for the Brazilian National Policy for the Integration of People with Disabilities, consolidates the protection rules and provides other provisions
5	Law No. 10,436	2002	This Law provides for the Brazilian Sign Language (BSL)
6	Directive MS/GM No. 1,060	2002	This Directive approves the Brazilian National Health Policy for People with Disabilities
7	Directive GM/MS No. 2,073	2004	Brazilian National Hearing Health Care Policy
	Portaria MS/SAS 587	2004	Norma regulamentadoras para a implantação e funcionamento das Redes Estaduais de Atenção à Saúde Auditiva.
8	Directive MS/SAS No. 587	2004	This Directive establishes regulatory standards for the implementation and operation of State Hearing Health Care Networks
9	Decree No. 5,626	2005	This Decree regulates Law No. 10.436, of April 24, 2002, which provides for the Brazilian Sign Language (BSL) and Article No. 18 of Law No. 10.098, of December 19, 2000
10	Social Agenda - Citizenship rights for people with disabilities	2007	This document aimed to present the priorities defined for the Social Agenda of People with Disabilities during President Lula's Government
11	General Comments of the Convention on the Rights of Persons with Disabilities	2008	This document aimed to support legislative advisors and consultants of federal and state representatives and senators, managers and technicians, political, union and social leaders and each person, with or without disability, with regard to the Convention on the Rights of Persons with Disabilities
12	Decree No. 186	2008	This Decree approves the wording of the Convention on the Rights of Persons with Disabilities and its Optional Protocol, signed in New York, on March 30, 2007
13	Decree No. 6,949	2009	This Decree promulgates the Convention on the Rights of Persons with Disabilities and its Optional Protocol, signed in New York on March 30, 2007
14	History of the Political Movement of People with Disabilities	2010	This book tells the history of the social movement of people with disabilities in Brazil, as well as the public policies and main actions carried out by the Brazilian Government
15	Decree No. 7,612	2011	This Decree institutes the Brazilian National Plan for the Rights of Persons with Disabilities - Living Without Limits
16	Directive MS/SAS No. 793	2012	This Decree establishes the Care Network for People with Disabilities in the scope of the Unified Health System
17	Guidelines for Attention for Neonatal Hearing Screening	2012	These Guidelines guide multidisciplinary teams for the care of hearing health in childhood, with a focus on Neonatal Hearing Screening, in the different points of care of the network
18	Convention on the Rights of Persons with Disabilities	2012	It aims to promote the content of the Convention on the Rights of Persons with Disabilities to all Brazilians, in compliance with the provisions of the Convention
19	Brazilian National Plan for the Rights of Persons with Disabilities - Living Without Limits	2013	It presents the goals and actions divided by plan axis - access to education, social inclusion, health care and accessibility - in order to disseminate information and serve as a tool for the implementation and inspection of public policy
20	Hearing, physical, intellectual and visual rehabilitation instruction from a Center Specialized in Rehabilitation (CER) and qualified services in a single modality	2013	Complementary document to the directives and also serves to support municipal and state managers with regard to the organization of points of care, especially rehabilitation services regarding the physical structure, equipment, professionals (categories and quantitative), as well as premises for the exercise of practices of care
21	New Comments on the Convention on the Rights of Persons with Disabilities	2014	This document assesses the measures taken by the Government towards compliance with the prerogatives of the Convention on the Rights of Persons with Disabilities, which was ratified by Brazil in 2008
22	Brazilian National Plan for the Rights of Persons with Disabilities - Living Without Limits	2014	It reports the historical context that led to the development of the plan; the actions of each of the four axes; and the management and monitoring processes of the Living Without Limits Plan
23	General guidelines for Specialized Care for People with Hearing Impairment in the Unified Health System (SUS)	2014	The document guides professionals on aspects related to cochlear implant surgery and bone-anchored hearing aids, such as clinical and audiological assessments, follow-up and speech-language rehabilitation, surgery and pre- and postoperative follow-ups and criteria for indications and contraindications

Oral history respondents
Subject position	Institutional place
Deaf Leadership No. 1	Member of the National Federation of Education and Integration of the Deaf (FENEIS) and of the National Council for the Rights of Persons with Disabilities (CONADE).
Deaf Leadership No. 2	Member of the National Federation of Education and Integration of the Deaf (FENEIS) and of the National Council for the Rights of Persons with Disabilities (CONADE).
Manager of the Secretariat of Human Rights	General Coordinator of the National Council for the Rights of Persons with Disabilities (CONADE).
Manager No. 1 of the Ministry of Health	Member of the General Coordination of Health of Persons with Disabilities of the Ministry of Health
Manager No. 2 of the Ministry of Health	Member of the Health Technical Area for Persons with Disabilities of the Ministry of Health
Advisor of the Ministry of Health	Member of the General Coordination of Medium and High Complexity of the Ministry of Health and, previously, of the Health Technical Area for Persons with Disabilities of the Ministry of Health
Representative No. 1 of Rehabilitation Center	Member of the Advisory Committee on the Implementation of the Care Network for People with Disabilities
Education policy researcher and consultant at the Ministry of Education	Researcher from Public University

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

NG Vianna, substantially contributes to the conception, design, analysis, data interpretation, paper writing and approval of the version to be published. MGG Andrade, substantially contributes to the design, analysis, data interpretation, critical review of the paper and approval of the version to be published. FCS Lemos contributes to the analysis and interpretation of data, critical review of the paper and approval of the version to be published. D Rodriguez-Martín, contributes to the analysis and interpretation of data, critical review of the paper and approval of the version to be published.