Environmental health risk reduction in Brazil: conquests, limits and obstacles

Freitas, Carlos Machado de; Rocha, Vânia; Silva, Eliane Lima e; Alpino, Taís de Moura Ariza; Silva, Mariano Andrade da; Mazoto, Maíra Lopes

doi:10.1590/1413-81232018236.04702018

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ARTICLE • Ciênc. saúde colet. 23 (6) • June 2018 • https://doi.org/10.1590/1413-81232018236.04702018 copy

Environmental health risk reduction in Brazil: conquests, limits and obstacles

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The 1988 Constitution represents an important achievement in terms of rights and an important pact sealed around a long-term strategy for the nation’s future based on a social development model oriented towards reducing the risk of disease and injuries and an ecologically balanced environment. These achievements manifested themselves in policies, institutionalization and the creation of spaces for public participation. The article outlines the main achievements, limits and obstacles that have affected the environmental and health agendas in the last 30 years since the creation of the Unified Health System . The achievements are framed within the broadening of political space for public participation and the institutionalization of the theme of environmental risks within the SUS, while the limits are framed in the relationship between development and trends of environmental risk at global/regional, local and community scale. Finally, obstacles are outlined showing that the parliamentary coup of 2016 not only accentuated existing limits, but also represents a giant represent a giant step backward in various areas related to environmental health.

Environmental health; Environmental risk reduction; Health risk reduction; Sustainable development; Unified Health System

Administration	Year	Conference
Sarney Administration (1985-1990)	1986	1^st Work Management and Health Education
		8^th Health
		1^st Oral Health
		1^st Women’s Health
		1^st Workers’ Health
		1^st Health of Indigenous Peoples
	1987	1^st Mental Health
Collor Administration (1990 a 1992)	1992	9^th Health
Collor Administration (1990 a 1992)	1992	2^nd Mental Health
Franco Administration (1992-1994)	1993	2^nd Oral Health
	1993	2^nd Health of indigenous peoples
	1994	1^st Conference on Science, Technology and Innovation
		1^st Conference on Science, Technology and Innovation in Health
		2^nd Work Management and Health Education
		2^nd Workers’ Health
		1^st Food and Nutrition Security
Cardoso Administration (1995-1998)	1995	1^st Social Assistance
	1996	10^th Health
	1997	2^nd Social Assistance
Cardoso Administration (1999-2002)	2000	1^st Health
	2001	3^rd Social Assistance
		3^rd Health of indigenous peoples
		3^rd Mental Health
		1^st Health Surveillance
Lula Administration (2003-2006)	2003	1^st Aquaculture and Fishing
		4^th Social Assistance
		1^st Cities
		5^th Children’s and Adolescents’ Rights
		8^th Human Rights
		1^st Children & Youth on the Environment
		1^stMedications and Pharmaceutical Assistance
		1^st Environment
		12^th Health
	2004	1^st Local Productive Arrangements
		2^nd Conference on Science, Technology and Innovation
		2^nd Conference on Science, Technology and Innovation in Health
		9^th Human Rights
		1^st Sports
		1^st Women’s Policy
		3^rd Oral Health
		2^nd Food and Nutrition Security
	2005	2^nd Aquaculture and Fishing
		2^nd Local Productive Arrangements
		5^th Social Assistance
		2^nd Cities
		3^rd Conference on Science, Technology and Innovation
		3^rd Conference on Science, Technology and Innovation in Health
		1^st Culture
		6^th Children’s and Adolescents’ Rights 2nd Environment
		1^st Promotion of Racial Equality
		3^rd Workers’ Health
	2006	1^st Disability Rights
		1^st Rights of Older Persons
		10^th Human Rights
		1^st Solidarity Economy
		1^st Professional and Technological Education
		2^nd Sports
		3^rd Work Management and Health Education
		2^nd Children & Youth on the Environment
		1^st Indigenous Peoples
		4^th Health of Indigenous Peoples
Lula Administration (2007-2010)	2007	3^rd Local Productive Arrangements
		6^th Social Assistance
		3^rd Cities
		7^th Children’s and Adolescents’ Rights
		2^nd Women’s Policy
		13^rd Health
		3^rd Food and Nutrition Security
	2008	1^st Professional Learning
		1^st Brazilian Communities Abroad
		1^st Sustainable Rural Development
		2^nd Disability Rights
		11^st Human Rights
		1^st Basic Education
		3^rd Environment
		1^st Youth Policies
		1^st Lesbian, Gay, Bisexual, and Transgender Policies and Human Rights
	2009	3^rd Aquaculture and Fishing
		4^th Local Productive Arrangements
		7^th Social Assistance
		1^st Communication
		2^nd Brazilian Communities Abroad
		8^th Children’s and Adolescents’ Rights
		2^nd Rights of Older Persons
		1^st Indigenous Peoples’ School Education
		3^rd Children & Youth on the Environment
		2^nd Promotion of Racial Equality
		1^st Human Resources and Federal Administration
		1^st Environmental Health
		1^st Public Security
	2010	4^th Cities
		4^th Conference on Science, Technology and Innovation
		4^th Conference on Science, Technology and Innovation in Health
		3^rd Brazilian Communities Abroad
		2^nd Culture
		1^st Civil Defense and Humanitarian Aid
		2^nd Solidarity Economy
		1^st Education
		4^th Mental Health
Rousseff Administration (2011-2014)	2011	5^th Local Productive Arrangements
		8^th Social Assistance
		3^rd Rights of Older Persons
		3^rd Women’s Policy
		2^nd Youth Policies
		2^nd Lesbian, Gay, Bisexual, and Transgender Policies and Human Rights
		14^th Health
		4^th Food and Nutrition Security
	2012	9^th Children’s and Adolescents’ Rights
		1^st Decent Employment and Education
		1^st Transparency and Social Control
	2013	4^th Aquaculture and Fishing
		6^th Local Productive Arrangements
		9^th Social Assistance
		1^st Technical Assistance and Rural Extension
		5^th Cities
		4^th Brazilian Communities Abroad
		3^rd Culture
		1^st Regional Development
		2^nd Sustainable Rural Development
		4^th Children & Youth on the Environment
		4^th Environment
		3^rd Promotion of Racial Equality
		5^th Health of indigenous peoples
	2014	2^nd Civil Defense and Humanitarian Aid
		2^nd Education
		1^st Migrations and Refuge
Rousseff Administration (2015-2016)	2015	7^th Local Productive Arrangements
		10^th Social Assistance
		3^rd Youth Policies
		15^th Health
		4^th Male and Female Workers’ Health
		5^th Food and Nutrition Security
	2016	4^th Women’s Policy
	2016	3^rd Lesbian, Gay, Bisexual, and Transgender Policies and Human Rights
Temer Administration (2016-2017)	2017	8^th Local Productive Arrangements
		11^st Social Assistance
		1^st Health Communication
		2^nd Women’s Health

Administration	Year	Events	Comments
Sarney Administration (1985-1990)	1986	1^st Workers’ Health Conference	To promote the discussion of studies and proposals addressing workers’ health issues: “New approaches to occupational health care” and “national workers’ health policy”.
Collor Administration (1990 a 1992)	1990	Law 8.080 (September 19).	Deals with health promotion, protection and recovery and the organization and operation of services, among other provisions. Determines that the promotion of occupational health is one of the functions of the SUS, stipulates that the environment and work are determinants of health, and assigns the provision of conditions that ensure the physical, mental and social well-being of people and the community to public health.
Franco Administration (1992-1994)	1994	2^nd Workers’ Health Conference	Reflection on and critical assessment and definition of strategies to promote the formulation of a national workers’ health policy from the perspective of changes in workers’ living and working conditions.
Cardoso Administration (1995-1998)	1995	National Plan for Health and the Environment in the context of Sustainable Development	“Guidelines for Implementation” addressing the linkages between health and the environment in the context of sustainable development produced by the Ministry of Health. Outcome of a work process involving the Executive Branch and civil society.
	1996	NOB-SUS 01	Determines that the promotion of occupational health is one of the functions of health care.nção à saúde.
	1998	Ministerial Order Nº: 3.120 (July 1)	Approves a normative instrument governing workers’ health surveillance within the SUS.
		Normative Instrument governing workers’ health surveillance	Defines basic procedures related to workers’ health surveillance.
		Ministerial Order Nº: 3.908 (October 30)	Provides guidelines on the provision of occupational health services in the NHS and determines operational norms aimed at defining functions and responsibilities to guide the provision of occupational health services to urban and rural workers by state and municipal health departments, taking into consideration the differences between men and women.
		Primary Environmental Care	PAHO guidance for the implementation of Primary Environmental Care, aimed at structuring health and environmental instruments considering the strategies outlined by Agenda 21, concepts of sustainable development, and sustainable spaces, environments and cities.
	1998-1999	Incorporation of environmental surveillance in the field of public health policies	Aimed at structuring environmental health surveillance in the former FUNASA, involving health and environmental themes.
Cardoso Administration (1999-2002)	1999	Ministerial Order Nº: 1.399 (15 December)	Regulates the NOB SUS 01/96 defining the functions of the three spheres of management of the SUS in relation to, among others, epidemiology and disease control and environmental surveillance.
	1999	VIGISUS Project	Project Structuring Health Surveillance in the Unified Health System (VIGISUS, acronym in Portuguese) - agreement between FUNASA and the World Bank aimed at structuring environmental health and enabling the monitoring of a range of environmental risk factors connected with human activity and the natural environment.
	2000	Decree Nº: 3.450 (May 9)	Restructures the National Health Foundation including as one of its functions the management of the National System of Epidemiological and Environmental Health Surveillance.
	2000	FUNASA Directive Nº: 410 (August 10)	Approves FUNASA’s internal regiment, defining the functions of the Environmental Health Surveillance General Coordination Office (CGVAM, acronym in Portuguese).
	2001	Normative Instrument Nº: 01FUNASA (September 25)	Regulates the National Environmental Health Surveillance System (SINVAS, acronym in Portuguese) and the functions of the federal, state and municipal governments in relation to environmental health surveillance.
	2002	Ministerial Order Nº: 1.679 (September 20)	Created the National Workers’ Healthcare Network (RENAST, acronym in Portuguese).
Lula Administration (2003-2006)	2003	Law 10.683 (May 28)	Provides that environmental health and individual and collective health promotion, protection and recovery, including workers and indigenous peoples, shall be the function of the Ministry of Health.
		Law N°: 10.683 (May 28)	Provides that the Ministry of Health shall be responsible for environmental health and collective health promotion, protection and recovery, including workers and indigenous peoples.
		Decree Nº: 4.726 (June 9)	Restructured the Ministry of Health creating the Health Surveillance Secretary whose function is to manage the National Health Surveillance System, which includes the National de Environmental Health Surveillance Subsystem (SINVSA, acronym in Portuguese).
	2004	Ministerial Order Nº: 777 (April 2004)	Establishes technical procedures for the mandatory reporting of occupational injuries and diseases in the Sentinel Service Network of the SUS.
	2005	Normative Instrument N° 01. Ministry of Health(March 7)	Defines the functions of the federal, state and municipal governments in relation to environmental health surveillance and provides that SINVSA shall be responsible for the following core areas: water intended for human consumption; the air and soil; environmental contaminants and chemical substances; natural disasters; accidents with hazardous materials; physical factors; and the workplace. Includes procedures related to the epidemiological surveillance of diseases and injuries diseases resulting from human exposure to agrochemicals, benzene, lead, asbestos and mercury.
		Ministerial Order Nº: 1.125 (July 6)	Lays out the aims of the SUS’s workers’ health policy, comprising the provision of comprehensive healthcare; intra and intersectoral integration; structuring of the workers’ health information network; support for research and investigation; staff training and development; and community participation in the management of these actions.
		Ministerial Order Nº: 2.437 (December 17)	Deals with the expansion and strengthening of the RENAST within the SUS.
		3rdWorkers’ Health Conference	Promoted an in-depth discussion of decent working conditions, the protection of the right to a healthy environment, decent housing and living conditions, and comprehensive healthcare.
Lula Administration (2007-2010)	2007	Ministerial Order Nº: 1.956 (August 14)	Provides that all work carried out by the Ministry of Health related to workers’ health shall be managed and coordinated by the Health Surveillance Secretary (SVS, acronym in Portuguese) through the Coordinator-General of Environmental Health Surveillance, department responsible for coordinating the Environmental Health Surveillance System, including the workplace.
	2009	Ministerial Order Nº: 2.728 (November 11)	Deals with the RENAST.
		Ministerial Order Nº: 3252 (December 22)	Approves guidelines for executing and funding health surveillance actions and confirms the need for combined surveillance actions involving the different areas of surveillance (epidemiological, sanitary, environmental health, workers’ health and health promotion), in order to control health risks and determinants ensuring comprehensive healthcare that adopts both an individual and collective approach to health problems.
		1stNational Conference on Environmental Health	The theme was “Environmental health in the city, countryside and forest: building citizenship, quality of life and sustainable territories”. The ministries of health, cities and the environment were involved in its organization. The conference’s guidance document provided important recommendations for the formulation of the National Environmental Health Policy.
	2010	1o Brazilian Symposium on Environmental Health	Proposed studies and debate about the environmental and health impacts of unsustainable production and consumption patterns, occupational diseases; environmental justice; and alternative sustainable development strategies.
Rousseff Administration (2011 a 2014)	2011	Decree Nº: 7.530 (July 21)	Created the Department of Environmental and Workers Health Surveillance (DSAST, acronym in Portuguese) within the Ministry of Health.
	2011	Decree Nº: 7.616 (November 17)	Deals with the declaration of Public Health Emergency of National Importance (ESPIN, acronym in Portuguese), involving epidemiological emergencies; disasters and populations in need of assistance, and creates the Unified Health System National Task Force (FN-SUS, acronym in Portuguese).
	2012	Ministerial Order Nº: 1.823 (August 23)	Creates the National Workers’ Health Policy
	2014	1stNational Conference on Workers’ Health promoted by the CUT	Promoted awareness raising among union leaders as to the importance of centrality of workers’ health-related issues.
		II Brazilian Symposium on Environmental Health	Promoted discussions regarding environmental health education, research and services.
		Public Health Emergency	Defined the SVS’s strategy for preparing for and responding to public health emergencies, including epidemiological emergencies, natural disasters and emergencies involving chemical, radiological and nuclear substances.
Roussef Administration (2015 a 2016)	2015	4th Conference on Workers’ Health	Discussion of and production of a guideline document for the implementation of the National Workers’ Health Policy.

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[1] Collaborations

CM Freitas worked on the conception, scope, analysis and interpretation of the data; as well as the write-up, revision and approval of the version for publication. V Rocha, EL Silva, TMA Alpino, MA Silva and ML Mazoto contributed to the data and information gathering, analysis and interpretation; as well as the write-up, revision and approval of the version for publication.