| OLD REPUBLIC (1889-1930) |
Need for a public health structure, improving the flow of people and merchandise7. Disease is interpreted as a block on the Nation’s progress in terms of modernization and civilization8 Philanthropic organizations introduce philosophical and valorizing conceptions of technical practices and scientific inquiry9
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Health inspections, vaccination, the gathering of statistical and epidemiological data, as well as the health education strategy to inculcate personal hygiene habits and prevent disease, were understood as activities related to public health9,10
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There was no professional project in public health. However, the gradual espousal of hygienic and eugenic policies and ideologies promoted the development of a national identity that intersected with the thinking and activities surrounding the health-related practices of the professionals of the time11
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Office of the General Director of Public Health (DGSP, 1897)12 Pro-Sanitation League (1918)8 Reform of public health, rural sanitation, construction and expansion of health services (1910-1930)8 Establishment of the model of health centers (1920-1930)12 Creation of the Retirement and Pension Funds (Eloy Chaves Law, 1923)12
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| VARGAS ERA (1930-1945) |
Democracy and citizenship restricted to classes of workers supported by corporatist principles13 Establishment of the Estado Novo (1937-1938)13
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Radio broadcasting of scientific and health information; compilations about ways of living and preventive actions regarding care for newborns and expectant women (1939)14
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Medical students on scholarships taking postgraduate courses in public health at Johns Hopkins University incorporated US public health practices and injected them into the country’s public health services15
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Creation of the Ministry of Education and Public Health (1930)16 Social security and occupational health instituted by the Ministry of Labor, Industry and Trade13 Retirement and Pension Institutes extended to cover most formal sector urban workers (1933-1938)13 Separation between medical services (Ministry of Labor, Industry and Trade) and other health-related actions (Ministry of Education and Public Health)13
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| DEMOCRATIC INSTABILITY (1945-1964) |
Liberal populist governments under a democratic regime with developmentalist economic policies Emergence of social struggles for labor rights (1960)15
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Flourishing of health education with a vision of balancing scientific and popular knowledge, prospecting approximations with science in the community Emergence of social thought in health, critical of the structures and logics of health practice |
Critique of the “biologization” of course contents in health-related education, particularly public health, with a view to having a more bio-psycho-social approach17
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Creation of the Ministry of Health (1953)12 Need to municipalize health services, under pressure from developmentalist sanitarians movement15 Laws unify urban workers’ social security rights (1960)12
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| MILITARY DICTATORSHIP (1964-1985) |
Emergence of the Brazilian Health Reform Movement and struggles for democracy Slow and gradual opening toward the democratic regime |
Two ideological profiles permeating sanitarians in state employment: in favor of and indifferent to the Brazilian Health Reform Movement and the process of re-democratization. |
Creation of stricto sensu graduate courses in Public Health and Collective Health (1970) Proposal for a scientific field based on social determinants for understanding health-disease processes: Collective Health18 Creation of research institutions in the Public Health/Collective Health area, Abrasco and Cebes, which encourage |
Creation of the National Social Security Institute (INPS) (1966)12 Creation of the Brazilian Center for Health Studies (1976) and of the Brazilian Collective Health Postgraduate Studies Association (1979) Creation of the National Medical Attention and Social Security Institute (INAMPS) (1977) and expansion of health service coverage12
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a public health identity in the various segments active in the Collective Health project (1970) |
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| DEMOCRATIC TRANSITION (1985-1988) |
New Constitution (1988) The unconcluded Health Reform19 Health as a right of the citizenry and duty of the State |
Sanitarians remain divided between politicization and passivity in the face of democratic struggles |
Epidemiology and Social Sciences provide the framework for the development of three dimensions of sanitarians work: a) Planning; b) Administration of actions in the health field; and c) Surveillance20
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Expansion of Integrated Health Actions12 Unified and Decentralized Health Systems (1987)12
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NEW REPUBLIC (1988 - PRESENT) |
Incentive to unrestricted outsourced work Alteration in the Labor Code (CLT) making agreements between employers and employees override the labor legislation |
Intensification of public health activity in public sector health management positions and in academic research19
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Expansion of undergraduate courses in Collective Health leading to activity by professionals in defense of SUS and the Brazilian Health Reform. In these courses’ National Curricular Guidelines there are skills, abilities, attitudes and knowledge in the fields of: a) Health Management; b) Attention to Health; and c) Health Education21
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Creation of the Single Health System (Sistema Único de Saúde - SUS) (1988)12 Constitutional Amendment 29, defining SUS funding and the responsibilities of the federal, state and municipal governments (2000)12 Approval of Constitutional Amendment 86/2015, which consolidates underfunding for SUS; de-linkage from federal revenues for 21 years. |