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História, Ciências, Saúde-Manguinhos

versão impressa ISSN 0104-5970versão On-line ISSN 1678-4758

Hist. cienc. saude-Manguinhos vol.25 no.4 Rio de Janeiro out./dez. 2018 


The promise of history: Astana, São Paulo, and the challenges in Brazil

Marcos Cueto

André Felipe Cândido da Silva

1001 Science editor, researcher, Casa de Oswaldo Cruz/Fiocruz. Rio de Janeiro – RJ – Brasil

2001 Science editor, researcher, Casa de Oswaldo Cruz/Fiocruz. Rio de Janeiro – RJ – Brasil

For a very long time, historians have been working under an assumption not too often disclosed: to understand the past is a means for people, institutions and countries to acquire a long-term overview on their achievements, challenges and possibilities. It is also true that there are official historians who have used history to legitimate present-day institutions, and embellish heroes and commemorative dates. Others honestly believe that their duty consists of nothing more than to gather information, “uncover” past facts, and fail to put too much emphasis on interpretation. Notwithstanding, the discipline has prevailed because it involves a promise that goes beyond its frame as a professional activity or its manipulation by the status quo: History is necessary to understand the present, to speak truth to power, and to fuel hope – no matter how controversial and many times put under scrutiny – that, despite the historical turnarounds, some form of progress exists, or will in the future, and that it is possible to be in a better position than how we were and how we currently stand.

According to many historians, this development is not straightforward, but rather complex and poses discouraging setbacks. At the same time, these historians suggest that several contemporary stakeholders, who are currently active, have the capacity to go forward, resist, survive and reinvent themselves. At this point in time, when persistency is a priority for many in Brazil, given its critical moment in its political history, is when we need historians the most to help reaffirm the legitimacy of indispensable values such as: the relevance of science and public health, the solidarity to be expressed thru robust social programs, the much-needed struggle for gender equality, the necessity for a strong and secular state, and the unquestionable eradication of homophobia and any form of discrimination, as well as the importance to adhere to multilateral progressive goals, like the ones promoted by the United Nations Organization (UNO).

The UNO – more precisely, the World Health Organization (WHO) and the United Nations International Children’s Emergency Fund (UNICEF) – promoted at the end of October of the current year a world event framed in the struggle for some of the values mentioned above: the Conference of Astana, held in the Russian region of Kazakhstan. During this important gathering, the “Declaration on Primary Health Care: from Alma-Ata towards universal health coverage and the Sustainable Development Goals” was approved (the English version of the declaration is available in: <>). One of the more laudable motivations of this Declaration was to reinforce the historical 1978 Declaration of Alma-Ata, which outlines that public health is a right for all people in the world, that technocratic solutions on their own are useless to improve poor life conditions that result in common illness, and that health professionals should be at the forefront in the fight against poverty. To these motivations was added the ambitious third Goal of the Millennium Sustainable Development Goals set recently by the United Nations, which establishes the need to “guarantee a healthy life and promote well-being for everyone at every age of their life” by the year 2030. There is no doubt the Declaration of Astana will be thoroughly discussed in the following weeks by health professionals around the world.

That is why it is important to review the historical literature on the context, actors, achievements and problems posed by Primary Health Care; it is important to review it in order to evaluate the risks and challenges posed by multilateral proposals (Pires-Alves, Cueto, 2017; Cueto, 2004, 2018). At the same time, it must be understood that it will not be possible to meet the goals established in Astana without universal health care systems that need to be properly funded and staffed with sufficient human resources, which imply a forefront attack against social inequality and a solid political commitment. Unfortunately, the engagement in supporting universal health care systems by many Latin American governments is not clear, which can undermine the implementation of the Declaration of Astana and the Sustainable Development Goals. Regardless, during the following months, we will have a debate on the potential for this Declaration to be a reality, or at least a flagship for health care movements.

Another subject that is to be discussed relates to the way ahead of this journal regarding the future of scientific publications. We recently participated in an event, which is very much important for science and health care: The 20-year Scielo Conference, held in the city of São Paulo, at the end of September. In this meeting, which gathered editors and professionals of scientific journals that belong to the largest network of Brazilian and Latin American scientific publications, the open science movement was discussed (Sánchez-Tarragó et al., 2016). This is a global movement that advocates for universal and equal access, unlimited and with no charge, to the results, methodology and data of scientific research. Open science fully acknowledges the authorship of scientific research, though it rejects the system of commercial publishing houses, which promote closed scientific literature that make knowledge prohibitive for researchers and universities in development countries. Within the subjects discussed in São Paulo some to be highlighted are: the transparency and acceleration of the editorial processes, the ongoing publication of articles in digital platforms, and the adoption of preprints . It is important to explain that preprints are the original manuscripts of scientific research that have not undergone a formal peer review and are submitted to a reputed and prestigious public repository, where they receive comments and acquire a valued DOI (Digital Object Identifier), which is different from the one it will receive once it is formally published in a journal. One of the advantages of this system is the fast track and open discussion on the findings of investigative research. The editors of this journal fully agree with these measures and will implement them in the following year. We admit we must first explore how to adapt a journal on history to more ambitious proposals such as the publication of all data concerning the process of investigation (which implies not only the article, but also the research project which originated it, the methodology and database utilized, and the preliminary reports on the research progress). We are also discussing the necessity to have open assessments that will grant broader acknowledgement to the reviewers and allow more professional discussion among the researchers.

During the event in Scielo, we proposed discussions related to the implementation of open access such as: how to achieve mandatory national policies? Because in Brazil, many institutions, like Fiocruz, are committed with open access; notwithstanding, there are no federal mandatory policies for the country. How to guarantee financing and infrastructure for open access? This is a pertinent question because open access will mean a transformation in infrastructure and re-training of the editorial groups. How to make sure all researchers value the repositories and the publication in open source journals? In other words, how to make open access a transversal axis that involves not only publication, but also education, training and the dissemination of science. How to incorporate the activism for open access with the activism that supports public universities? Because in a broader view, the open access movement is part of a proposal on equal opportunities in public education, which is contrary to the neoliberal policies that seek to privatize public universities or install a production system that is closely linked with the profitable businesses in higher education.

In this edition, we gathered two dossiers that are central to the history of health and public health: the medicalization of childbirth, and child health and mortality. Both dossiers offer novel and complementary perspectives for everyone who is interested in the past and present of public health. These articles are presented in a volume in which we reviewed our instructions for authors resulting in important changes that will facilitate the delivery of works (<>).

In our last words, we mourn the loss of Luiz Fernando Ferreira, Brazilian researcher, a pioneer in paleoparasitology, emeritus professor of the National School of Public Health and member of our editorial group. Likewise, we mourn the loss of our dear American friend and colleague Elizabeth Fee, globally a fundamental reference for historians of public health. We would like to acknowledge her clarity, firmness and kindness to introduce an historical perspective on social contemporary medicine. We manifest our sincere regards to her family, friends and colleagues. Their works, ideas and outstanding impeccable careers show us that hope in times of adversity is possible.


CUETO, Marcos . O legado de Alma-Ata, 40 anos depois. Trabalho, Educação e Saúde , v.16, n.3, p.845-848. Disponible en: . Acceso en: 5 nov. 2018. 2018. [ Links ]

CUETO, Marcos. The origins of primary health care and selective primary health care. American Journal of Public Health , v.94, n.11, p.1864-1874. 2004. [ Links ]

PIRES-ALVES, Fernando Antônio; CUETO, Marcos. A década de Alma-Ata: a crise do desenvolvimento e a saúde internacional . Ciência e Saúde Coletiva , v.22, n.7, p.2135-2144. Disponible en: <> . Acceso en: 5 nov. 2018. 2017. [ Links ]

SÁNCHEZ-TARRAGÓ, Nancy et al. Las revistas científicas en América Latina hacia el camino del acceso abierto: un diagnóstico de políticas y estrategias editoriales. Transinformação , v.28, n.2, p.159-172. Disponible en: <> . Acceso en: 5 nov. 2018. 2016. [ Links ]

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.