Dilemmas of the institutionalization of social policies in twenty years of the Brazilian Constitution of 1988

Abstracts

O objetivo é discutir e analisar alguns elementos do processo de institucionalização de políticas sociais no Brasil pós Constituição de 88, em especial as de Seguridade Social. Parte-se do pressuposto de que esse processo apresenta híbridos que comprometem os resultados previstos no modelo constitucional. Por um lado, verificam-se avanços importantes no aparato político-organizacional e na concepção da questão social (aqui tratados através dos elementos de constitucionalização, abrangência e ampliação). Por outro lado, persistem entraves, em especial na universalização, no financiamento e na qualidade dos serviços prestados que são contraditórios aos avanços alcançados. A permanência desses híbridos impede a equidade e a cidadania propostas no modelo da Constituição de 1988.

Política social; Institucionalização de políticas sociais; Seguridade social no Brasil

ARTICLE

Dilemmas of the institutionalization of social policies in twenty years of the Brazilian Constitution of 1988

Lenaura de Vasconcelos Costa Lobato

Programa de Estudos Pós-graduados em Política Social, Escola de Serviço Social, Universidade Federal Fluminense. Campus Universitário do Gragoatá, Bloco E/326, São Domingos. 24210-201. Niterói RJ. [e-mail]

ABSTRACT

The objective is to discuss and analyze some elements of the process of institutionalization of social policies in Brazil after the Constitution of 1988, especially those of social welfare (social security, health and social assistance). It is assumed that this process present hybrids that compromise the results prescribed by the Constitution. From one hand, there are important advances in political and organizational apparatus and in the concept of the social question (treated here through three elements: constitutionalization, scope and expansion). Moreover, obstacles remain, particularly in universalization, financing and quality of services, which are contradictory to the advances achieved. The permanence of these hybrids prevents the fairness and citizenship aimed by the 1988 Constitution.

Key words: Social policies, Institutionalization of social policies, Brazilian social welfare

Introduction

An assessment of the recent period of social policies in Brazil, especially social welfare policies, allows us to identify the existence of institutional hybrids that, on the one hand, enable a decrease in poverty and inequalities, whereas they do not yet provide for the necessary growth of social citizenship. We have borrowed the denomination institutional hybrids from Santos¹, even though the characterization it refers to is different and much simpler and more modest than that of the author, which is applied to the identification of supposedly dichotomic areas as rulers of the social relations of the contemporary Brazil, where a polyarchic morphology would coexist with a social hobbesianism. Here, the denomination intends to characterize opposing - or even dichotomic - institutional zones, which merge and coexist in the field of social issues, especially concerning state intervention by means of public policies.

The idea of institutions concerns ideas, guidelines and norms that rule social life. The State has a privileged, albeit not exclusive, role in the modification or reproduction of these institutions. Public policies contribute to this process, as they define government guidelines that consolidate or modify the attitude of the state concerning collective issues. Public policies are, therefore, an important part of the institutionalization of guidelines and rules of the collective life. They direct concepts, define strategies, allocate resources and give guidelines to society, which may contribute to consolidate a new institutionality concerning different subjects.

This process, as is widely known, is neither linear nor free from conflicts, especially when it comes to social issues. The nature of these conflicts and how they are solved is important in identifying the paths the policy is going to follow. This is important because literature has been overlooking the specificity of the social field in the construction and deployment of social policies, treating them as similar to any other public policy. This is not the case. Social policy is par excellence the place for all conflicts inherent to all forms of inequality and exclusion, and distinguishes itself from other public policies by showing these conflicts in an intense and everyday manner. For the last 20 years, Brazil has been making efforts to change the traditional approach to social problems and build a new institutionality for the social issue. The time has come, however, for us to discuss the future paths of this progress. Where will we be able to reach considering the current rhythm and treatment conditions of the social issue? The idea of hybrids helps us in that it concerns zones that consolidate in the institutionalization process, whereas they are opposed or even contradictory; and some must be excluded to the benefit of others. For instance, how to consolidate the idea of a universal right to health with the current standard of public expenditures on health? The international experience shows that a universal right to health can only be obtained by means of higher public expenditures. There is no evidence of a significant increase in expenditures in recent governments' guidelines. This points out to health occupying a secondary position in state strategies, reinforcing social principles which disqualify the constitutional project of universal health as being a right.

The last 20 years have shown an expressive institutional change in social policies, in many aspects both innovative and progressist when compared to past models. This is evidenced both by its political-organizational apparatus, and by the concept of social issue, which has been supporting the deployment of social policies in recent years.

From the standpoint of the political-organizational apparatus, the construction of national systems such as health and social assistance systems is significant, by means of the expansion of decentralized and unified public bureaucracies with a previously unseen participation of all three government levels, and with an important component of social participation and control. From the standpoint of the concept of social issue, changes can be identified in comparison with previous policies, especially concerning those elements here referred to as constitutionalization (incorporation of the idea of right), scope (incorporation into the public scene and into the governmental agenda) and expansion (recognition of the social production and inter-relation of social problems).

These advancement areas coexist with others where the approach to social policies has a strong focus on poverty (whereas the latter is defined by the income); where social risk is associated with extreme poverty or supported in the contribution (they are either risks of the poor, or covered by social security to the insured); where there is a clear sub-financing and frequent shortage of resources to maintain fiscal balance; fiscal imbalances between regions; excessive autonomy of sub-national entities; low assistance coverage; precarious access; low service quality and feeble integration among sectors.

The permanence of these hybrids is deemed to jeopardize the fairness and citizenship proposed in the model of the 1988 Constitution.

Advances and dilemmas of the institutionalization of the constitutional model

After the 1988 Constitution, social rights also began to encompass the access to health, social security, social assistance, education and housing (in addition to security, leisure, and work). Social welfare became an institution, encompassing health, social security and social assistance. The idea of social welfare represented an advancement in the institutionalization of an expanded model of social protection, which provided for the universalization of access, state responsibility, integration between the three areas, and the creation of a dedicated budget, with new financing sources. It also represented an innovation concerning the responsibility shared among the three levels of government, by means of the decentralization of powers and resources, and social participation and control, with the creation of collegiate institutions and legal attributions of devising and monitoring the deployment of actions.

Despite the principles guiding universalization, social welfare policies maintained access criteria concerning social security and social assistance. Access to social security remained bound to contribution, and social assistance remained bound to necessity. Health was an exception where universalization occurred fully, without any access criteria.

Institutionalization of this model has experienced several conflicts since the Constitution. This can be loosely assigned to the conflicts between the provisions of the Constitution and the governmental projects which follow its enactment, in addition to conflicts intrinsic to the very institutionality of the newborn democracy. The first government elect after the Constitution adopted economic policies with a liberal bias, and restricted the mechanisms set forth in the Constitution for the social area. Subsequent governments maintained restrictive economic policies, also with a strong impact in the social area. What can be observed since then are hybrids of progressist policies with important restrictions concerning coverage, financing and quality of attention, with a low impact on the construction of the intended social citizenship.

Changes in the concept of the social issue

One of the most visible elements in the institutional change which occurred since the Constitution concerns the concept of social issue incorporated to policies and programs implemented since then. At least 3 characteristics can be identified which indicate important changes when compared to previous periods. The first is what Fleury calls constitutionalization, and concerns the guarantee of social rights². Up to the 1988 Constitution the social rights - especially social security and health, were guaranteed only to formal workers, whereas no relation existed between social rights and full citizenship. The very idea of citizenship was vague and absent from people's imagination and principles. A citizen was an individual of Brazilian nationality.

With the Constitution and its resulting policies, a citizen also starts to be considered that member of the community invested with a group of common and universal rights, where social rights are at the center. Democratization is a key factor to this constitutionalization. However, it is important to highlight the role of social policies, since they enable the development of the idea of the State being responsible for the welfare of individuals and the society. This is obviously an ongoing process, punctuated by constraints to full recognition of social rights, by individualization intrinsic to contemporary societies, and by the weight of the personalist tradition of the Brazilian society, where relations and persons are given more importance than citizens and individuals³. In any case, the idea of social assets being guaranteed as citizenship rights is previously unseen in the configuration of Brazilian social policies. The term 'social rights' appears only in the Constitution of 1988; 'citizenship' is only found in the Constitutions of 1946 and 1937, even if only related to nationality; and 'citizen' clearly refers to an individual of Brazilian nationality in all Constitutions prior to that of 1988.

Another differential in the concept of social issue is what may be referred to as scope, and concerns the incorporation of several social problems to the public scene and governmental agenda, which started relying on a dedicated legal framework of strategies and actions with defined responsibilities, and based on a specific understanding of the problem. Since the Constitution, the country developed specific policies for problems traditionally only dealt with either privately or in the environment of working relations, with low state intervention, or restricted to the existence of disputes taken to court. Important examples of this scope are policies for protection of the child and the adolescent, among which one can highlight the policy against the sexual exploitation of these segments, and the policy against child labor; the policy against domestic violence; the policy for promotion of racial equality; policies for protection to the elderly and to the disabled, among others.

In addition to offering a range of rights and public actions for long standing and extremely complex social problems, this scope has been favoring the popularization of controversial issues, in that it discusses traditional and excluding social relations. Recent examples illustrate this controversy, such as the discussion on lowering the criminal age for young offenders protected by the Statute for Children and Adolescents (Estatuto da Criança e do Adolescente - ECA). The Statute applies a differentiated legislation for children and young individuals committing criminal offenses. Recent hideous crimes involving young adults brought to public attention the approach given to crime in this segment - needy young individuals in the vast majority, with no education of family bonds. Light has also been shed on which assumptions the state intervention must be based on, whether on criminalization or on protection - and the limits of such protection. Other examples are the racial quotas, which have raised a profitable discussion on the origins of and means of fighting racial discrimination in the country, and issues as domestic violence or sexual orientation.

Themes related to inequality and exclusion are thus incorporated, outgrowing the economic aspect and reaching the idea of recognition as the central element of citizenship⁴. This scope also creates an important movement of initiatives in the civil society, NGOs and even companies towards the creation and development of social projects and programs, which, aware of their limited effectiveness in the resolution of problems, represent an important element in the construction of social bonds.

This scope is shared not only by the "new" policies, in areas without previous specific regulation, but also by innovative views of already traditional policies. Such is the case, for instance, of anti-hunger policies, which generated previously unreleased programs, such as the Family Grant Program (Bolsa Família Program) which have been making public, in democratic debate, different views on its efficacy and effectiveness^5-7. The discontinuity of the traditional pattern of offering raw benefits to the impoverished, with transfers in cash with no intermediaries, starts a new relationship with poverty and the impoverished that would not be possible without their incorporation as minimally acknowledged individuals.

The third element indicative of a new concept on the social issue would be the expansion, and it refers to the recognition of the social production of social problems and of the close relationship among them. The democratization and the inclusion of previously excluded players in the public scene and in the process of selecting policies enabled a critical debate on past experiences and the modernization of concepts and practices. Recognition of the social production of social problems obviously does not assume a radical criticism of the social issue in its relationship with the structural inequalities of the capitalism. Inversely, it advances towards the identification of histories of exclusion and social inequalities as sources of the current problems and of society's responsibility for them, incorporating, in a previously unseen manner, the demarginalization of these problems and removing them solely from within the sphere of individual and family responsibilities or behavioral conduct.

This expansion can be observed in several policies, especially health (an expanded concept of health) and social assistance policies, such as assistance to the youth, childhood and anti-poverty policies. Changes can already be seen in the very implementation of these policies. In addition to the Family Grant Program (Bolsa Família Program), the anti-poverty policies also encompass the Continuous Cash Benefit (BPC), a benefit of one minimum wage intended for the elderly and disabled persons with per capita family income under ¼ of the minimum wage. The benefit was regarded with distrust by social security managers and by society itself, since its claimants were usually seen as profiteers and lazy individuals who wanted to avoid work, did not contribute to welfare and therefore should not be entitled to receive any income⁸. However, it already appears as linked to necessity and right⁹. These are slow changes, as they hinge on complex symbolic reconstructions. The State, however, can positively interfere in this reconstruction by means of policies¹⁰.

Recognition of the social production of social problems required knowledge of the close relation existing between them. Sectorialization has always been a hallmark of Brazilian social policies, stimulated by the restriction of the process of creation of social policies within the sphere of the technical framework of the public bureaucracy, without intermediation with relevant players; or by the centralized tradition of the State, which always favored dispute among different areas. Today, the need for cooperation among different social areas is acknowledged; more than that, the lack of integration is recognized as an important cause of low effectiveness. Nevertheless, efforts towards associating them are still feeble.

Political and organizational expansion

In addition to elements linked to the concept on the social issue, the institutional change of the social policy in recent years can be identified by the expansion of the political and organizational apparatus, especially by means of the construction of unified and nationwide systems; of the consolidation of public bureaucracies, of the democratization of this apparatus and of the joint participation of the different levels of government in the management of the different policies.

Among the nationwide systems, we can highlight the construction of the health and social assistance systems, essential parts of Social Welfare. The Unified Health System (SUS) is responsible for providing universal assistance to the entire population regarding medical assistance and collective actions. The construction of a nationwide, unified system, provided for by the Constitution and resulting from a long-lasting movement, dating back from the 1970s, which fought for the unification of the structures in charge of health and operating at the time, which represented an organizational dichotomy with serious consequences for assistance to health. In addition to being unified, the system was conceived as nationwide, covering the entire territory and the entire population, and decentralized, incorporating the three government levels. After the course of its 20 years, SUS is fully consolidated in the entire national territory, despite its countless problems, especially that of never having reached a truly universal status, since an important part of the population owns or intends to own private health insurance plans, which offer greater access guarantees and faster assistance¹¹.

SUS's magnitude becomes evident when one examines the numbers of service production. The decentralized framework functions with instances of agreement and decision on resources and initiatives among the three government levels, and each level has defined responsibilities and assignments. At the same time, the system also relies on a powerful structure for social control, with health councils with representatives from the government, businessmen, civil society and professionals. These councils currently serve as models for several social policy areas as mechanisms for democratization and social participation in devising and managing policies, despite the countless problems they undergo concerning the representation and effectiveness of social control¹².

Another system, created more recently, is the Unified Social Assistance System (SUAS). Since the Constitution, social assistance has been undergoing an important institutionalization process, in a pattern which differs from that on which it had developed itself. The creation of SUAS borrows many of its guidelines from SUS. It is based on the very idea of a system - uncommon in the social assistance mechanisms - with a relation and bond among the parts, a single, decentralized command, and social participation. The proposed structure can be considered revolutionary for Brazilian standards, or even when compared to more advanced international systems.

Social assistance is the main example of a recent construction of a public bureaucracy in the social field. With the decentralization and the creation of countless social programs, it has been growing in the municipalities and states, with a more democratic configuration than that of those structures formerly responsible for it.

Contradictions and obstacles to the constitutional model of citizenship

Despite these improvements, the institutionalization of social policies still contains fields that may be regarded as contradictory to them, and may compromise the consolidation of the constitutional model. One can highlight the privilege to poverty-centered policies, at the expense of universalization; the continued existence of serious restrictions to expenditures and the low symbolic effects on the benefits of social solidarity, resulting from a low quality of services provided.

Initially one could highlight the unknown impact of universal social policies on the recent decrease of inequalities, and emphasis on focal policies, especially income transfers. Brazil recently celebrated the achievement with an anticipation of the millennium goals concerning poverty decrease¹³. According to PNAD (National Household Survey) data, carried out by the Brazilian Institute for Geography and Statistics (IBGE)¹⁴, considering the PPP Dollar, the rate of Brazilians living in extreme poverty decreased from 8.8% to 4.2%. Taking the minimum wage as a reference, the extreme poverty rate decreased from 28% to 16% of the population, and the poverty rate from 52% to 38%¹³.

As for inequality, data indicate that, between 2001 and 2005, the income of the poorest 10% increased at an annual rate of 9.2%, and that of the richest 10% decreased 0.4% per year. The Gini coefficient reached 0.566 in 2005, after 5 years of continued decrease¹³. There are several recent economic studies analyzing the decrease in Brazilian inequality^15-18 and, although this decrease is generally acknowledged, there is no agreement on which factors exerted more influence on the phenomenon, nor on its importance or its possibilities to be sustained in the future. Studies point out such factors as the economic growth, decrease in inflation, recovery of the minimum wage, increase in formal job offer, growth of the microcredit, income transfer programs and rural retirements. Although there is no consensus on which factors were most influent on the decrease, income transfers are predominantly seen as a major influence. The size of the decrease, or whether it is substantial, also divides economists. Soares¹⁵ develops a study comparing the decrease of our inequality to that of some countries selected in the period when their social protection system was developed, and concludes that Brazil's rates are even higher, and therefore our decrease is even more substantial. Despite the strength of the study, one should note the limits set to the periods of comparison and the significant differences in service offer and in the composition of welfare structures of the compared countries, in addition to the utilized database structure. Salm¹⁷, on the other hand, criticizes the conclusions of recent studies on the decrease of inequality, especially Ipea's¹⁸, which highlights the role of transfers, drawing attention to the limitations of the variables employed, and especially to the small period of time for any conclusions to be drawn on any positive effects of the decrease. Without going into the merits of the discussion among economists, this element truly deserves attention, especially if one considers the transfers as having a central role in the decrease of inequality.

The size of Brazilian misery and poverty is very sensitive to these income programs, hence their positive and important impact on their decrease. Governmental transfer programs currently reach 25% of the population, or 54% of households with per capita income under ¼ of the minimum wage, but their faults lie specifically in their lack of association with universal social policies¹⁴. Without association with structural social policies, such as health, education, coverage of labor risks, dwelling and access to land, the social gains of growth and transfer will find obstacles in a population deprived of education and access to basic living and sanitation conditions, and potentially more ill. The option for policies focusing on poverty, whereas the latter is always measured by the income, has restrained treatment of other basic necessities, which limit themselves the effects of income. One of the highest impact indicators in recent years was the decrease in malnutrition in children under one year of age. This results from a combination between income transfer and an increased coverage of vaccination and basic health assistance. On the other hand, one of the negative results of income transfers was the low impact on illiteracy¹⁴, which requires a good educational framework for young individuals and working adults outside the regular school age. Emphasis on social benefits of initiatives focusing on the poor has obscured the serious restrictions imposed on universal policies, and do not ensure the continuity of inequality decrease. Combined with an economic model that encourages expenditures with payment of interests, this represents an important obstacle in the fulfillment of the constitutional principles in the social field. Marcio Pochman¹⁹, Ipea's president, shows that the union's total expenditures in health, education and investments for the period between 2000 and 2007 corresponded to a mere 43% of expenses with interests. The average of the latter within the same period represents 54% of the entire national revenue in year 2006.

Financial and coverage restrictions are also identified in welfare policies, where one can identify a return to insurance, to a system of contributing workers, as opposed to the universalization provided for by the Constitution. Despite the acknowledged importance of retirements for the decrease of poverty in Brazilian municipalities, recent reforms in Social Security have privileged the fiscal rigor and disregarded inclusion^20-23. It is estimated that half of the EAP - Economically Active Population - is not part of the Social Security system, which represents a problem of huge proportions in the future²⁴. Some initiatives towards broader inclusion in social security were discussed in the National Forum on Social Security, implemented by the government in 2007 (which had the participation of nothing less than 9 unions or confederations of workers' representatives), but the final conclusions were general and only recommended the creation of incentives for a greater welfare inclusion²⁵. On the other hand, substantial suggestions included proposals for measures restricting access to the Continuous Cash Benefit, such as a revision of the "family" concept and a gradual increase of the age to qualify for the benefit. The positive recent increase of formal jobs is not enough to overcome the social security exclusion issue, since there is no guarantee that the current growth standards will remain, nor a comprehensive public policy to solve the informality issue in the labor market.

Social policies suffer from palpable and visible problems that compromise the entire efforts undertaken so far. The low quality of services offered in the universal fields of education and health is widely known. Education, although not a part of social security, is one of the most comprehensive policies. Universal access to basic education is now a reality. However, recent report from Unesco points out that Brazil is the only Latin American country with over 500 thousand children outside the school system²⁶, even after a decade of universalization policies. Quality is admittedly a serious problem. Among Latin American countries we have one of the lowest learning rates of essential subjects, and the second highest school failure rates (only lower than Suriname)²⁷. Federal expenses with education have remained at the minimum levels required by law (18%) and GDP invested in education is of 3.9%, much lower than other countries with similar economic situations.

In addition to low quality, health also presents serious problems related to iniquity regarding access to and utilization of services. Such problems are still intensely linked to social and geographical conditions, and the decrease of inequalities is still feeble^27-30, including periods of higher public investments. The private plan and insurances sector is consolidated as an alternative for the medium layers of the population. This does not necessarily mean the population regards it as offering services of much higher quality. Private plans offer guaranteed access to services, whereas SUS offers an uncertain situation. Almost all worker categories demand private health insurance plans for their affiliates, whereas SUS, although maintained by all, is increasingly seen as a system for the poor, at least concerning medical assistance. It is claimed that SUS provides much more than medical assistance, and that even the latter covers the more costly procedures, and that in collective initiatives it covers everyone. These are solid statements that, when associated to the powerful inclusion of unassisted segments, reveal the power of this system and reinforce the highly including (and not excluding) characteristic of universalization. However, they are not enough to answer the basic question: if SUS is on the path of consolidating itself in compliance with the constitutional principles or not. On the path of a system that materializes the principle of citizenship, or of an inclusive system, but consolidating itself as fragmented and unequanimous. One can also argue on the limits of a sectorial reform in a very fragmented and uneven society. This is again reason enough to justify the step, but it does not explain the direction chosen.

Access is also precarious in the majority of welfare policies due to a still low coverage of programs, despite the vigor of some, such as the Family Grant Program (Bolsa Família Program) and BPC. Smaller programs, however, have low coverage, like programs intended for the young and children at risk, such as Projovem and Sentinela, and job and income generation programs. The ratio between benefits and services in social assistance expenditures indicates a probable inversion of goals in social assistance. Resources intended for the Continuous Cash Benefit and for the Family Grant Program (Bolsa Família Program) exceed by 14 times those intended for regular social assistance services³¹, which are those provided by the social assistance network, directly tackling the individual and family needs of citizens. There is clear evidence here of priority being given to focused transfer, at the expense of universal policy. With regards to financing, SUAS provided assistance to SUS in defining a decentralized framework for resource transfer, assigning different responsibilities to states and municipalities. Similarly to what occurred with SUS, adherence of states and municipalities was seen where the resources transferred hinge on low investments, but remains very low in more complex services that demand more resources, especially human.

Both in social assistance and in health, sectorial interference in financing is very low, as it is defined within the economic field, and not based on needs. Social security has greater stability, but is always attacked as being responsible for the weight of public expenditures. The fiscal reform in progress in the National Congress will be another hard blow on social welfare, according to studies carried out by specialists^32-34. If approved, it would remove approximately 38% of the resources of the area. The fiscal reform also proposes that the Disentailment of Union Resources (DUR), which removed R$ 38.6 billion from social welfare in 2007 alone³⁵, should be maintained until 2011.

Funding restrictions, incomplete universalization and low efficacy of social welfare policies are likely areas that present the biggest hindrances to the goals set forth in the Constitution. They are real contradictions to the proposed model, directly compromising its results, preventing the gradual construction of social solidarity principles. Literature has drawn attention to several other important institutional hindrances in social policies. These include policy management; methods used for resource distribution in each of the different systems; limits resulting from the federal agreement for funding fluidity and efficiency and assignment of responsibilities in systems based on decentralized logic; the tradition of previous policies, which set forth professional conduct and management systems that do not comply with the post-Constitution concepts; intermediation of interests favoring individual interests; and political decision and representation framework. Despite the importance of these elements, they can probably be subsumed under projects focusing on constitutional goals, establishing appropriate resources, and searching for universalization and service quality.

The necessary question to pose is whether the progresses in the institutional and political framework of the post-Constitution welfare policies will be able to meet constitutional goals without appropriate funding, with fragmented access structures and low service quality. Or we will reach the point of acknowledging that what was reached was a democratic modernization of these policies, leaving the conservative framework of state intervention in the social issue unchanged, privileging private interests (whether related to the accumulation of capital, corporations, or political capital) and maintaining the structure of inequalities intact, albeit renewed.

Conclusion

Social policies, especially those of social welfare, suffer from the dilemma of showing progress in several areas, whereas they present important restrictions regarding the provisions of the 1988 Constitution. This study has attempted to shed light on some facets of this dilemma. The institutionalization of the principles and apparatus provided for in the Constitution is defined by hybrids whose permanence may compromise the goals of a democracy established in broad citizenship. The idea of hybrids intends to demonstrate that the current hindrances can represent more than those obstacles common to a complex policy implementation process. It is necessary to determine to which extent these hindrances can be gradually solved by means of a deeper implementation of social policies, or whether they are route changes that deviate social policies from the model provided for by the Constitution.

Significant progresses can be identified both from the standpoint of the social issue concept and from that of the construction of the political and organizational apparatus but the pace at which they advance and the dynamics resulting from their interaction present serious hindrances. Social welfare also needs to be reexamined, so as to maintain its principles. The benchmark must be a broader and constant protection of citizens. Social welfare must be more than just the umbrella that ensures resources linked to structured benefit and service systems, so that it becomes the reference for thoughts and actions involving the social protection of today and of tomorrow. It is necessary to recover the place of universal policies, and endow them with appropriate funding and structure, linking them to economic policies. There is no human development in contexts of deep inequality such as is found in Brazil without aggressive universal policies for social security, education, dwelling, income and land distribution. It is necessary to link focused and universal policies, and merge them into universal social welfare and protection systems. Ineffective progressive policies impair the democratic social cohesion.

The Constitution of 88 brought, above all and with all its limitations, the goal of a democracy associated with social fairness. It is possible and necessary to restore this goal.

References

• 1. Santos WG. Razões da desordem Rio de Janeiro: Rocco;1993.
• 2. Fleury S. Saúde e democracia no Brasil: valor público e capital institucional no Sistema Único de Saúde. In: XI Congresso Internacional del Clad sobre la reforma del Estado y de la Administración Pública;2006 Nov 7-10; Ciudad de Guatemala; 2006.
• 3. Da Matta R. Carnavais, malandros e heróis Rio de Janeiro: Zahar; 1979.
• 4. Fraser N. Redistribución, reconocimiento y exclusión social. In: Inclusión social e nuevas ciudadanias: condições para la convivencia y seguridad democráticas Colombia: Ed. Pontifícia Universidad Javerian; 2003.
• 5. Silva MO. O Bolsa Família: problematizando questões centrais na política de transferência de renda no Brasil.Cien Saude Colet 2007; 12(6):1429-1439.
• 6. Monnerat GL, Senna M C M, Schottz V, Magalhães R, Burlandy L. Do direito incondicional à condicionalidade do direito: as contrapartidas do Programa Bolsa Família.Cien Saude Colet 2007; 12( 6):1453-1462.
• 7. Peliano AM. Desafios e perspectivas da política social [texto para discussão n. 1248]. Brasília: IPEA; 2006.
• 8. Sposati A. Benefício de Prestação Continuada como Mínimo Social. In: Sposati A, editor. Proteção Social de Cidadania: inclusão de idosos e pessoas com deficiência no Brasil, França e Portugal São Paulo: Cortez; 2004.
• 9. Lobato LVC, Góis JBH, Senna MCM, Reis MF, Vasconcellos M. Avaliação do Benefício de Prestação Continuada. Brasil. Ministério do Desenvolvimento Social e Combate à Fome. Avaliação de Políticas e Programas do MDS - resultados. Brasília: MDS - SAGI; 2006. p. 285-342.
• 10. Evans P. Government Action, Social Capital and Development: Reviewing the Evidence on Sinergy.World Development 1996; 24(6):1119-1132.
• 11. Lobato LVC. Reforma sanitária e reorganização do sistema de serviços de saúde: efeitos sobre a cobertura e utilização de serviços [dissertação]. Rio de Janeiro (RJ): Escola Nacional de Saúde Pública, Fiocruz; 2000.
• 12. Labra ME. Existe uma política de participação e controle social na saúde? Contribuições para um debate urgente Rio de Janeiro: Cebes; 2008. [acessado 2008 dez 14]. Disponível em: http//www.cebes.org.br
• ¹³
  Brasil. Presidência da República. Instituto de Pesquisa Econômica Aplicada e Secretaria de Planejamento e Investimentos Estratégicos, coordenação.Objetivos de desenvolvimento do milênio: relatório nacional de acompanhamento Brasília: Ipea, MP, SPI; 2007.
• ¹⁴
  Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional por Amostra de Domicílios. Acesso a transferência de renda e programas sociais 2006 Rio de Janeiro: IBGE/MDS; 2008.
• 15. Soares SSD. O ritmo de queda da desigualdade no Brasil é adequado? Evidências do contexto histórico internacional [texto para discussão n. 1339]. Brasília: IPEA; 2008.
• 16. Arbix G. A queda recente da desigualdade no Brasil. Nueva Sociedad 2007; 212. [artigo na Internet] [acessado 2008 dez 14]. Disponível em: http://www.nuso. org/upload/portugues/2007/Arbix.pdf
• 17. Salm C. Sobre a recente queda da desigualdade no Brasil: uma leitura crítica In: Paes de Barros R, Nathan M, editors. Desigualdade de renda no Brasil: uma análise da queda recente. v.1 Brasília: IPEA; 2006.
• ¹⁸
  Instituto de Pesquisa Econômica Aplicada (IPEA). Sobre a recente queda da desigualdade no Brasil [nota técnica]. Brasília: Ipea; 2006.
• ¹⁹
  Instituto de Pesquisa Econômica Aplicada (IPEA). Distribuição funcional da renda no Brasil: situação recente [comunicado da presidência n° 14]. Brasília: IPEA; 2008.
• 20. Boschetti I. Implicações da Reforma da Previdência na Seguridade Social Brasileira. Psicologia e Sociedade 2003;15(1):57-96.
• 21. Dain S. Correção de rota. Teoria e Debate 2003; 16(53):27-29.
• 22. Fleury S. A seguridade inconclusa. In: INESC. AEra FHC e o Governo Lula: Transição? Brasília: INESC; 2004.
• 23. Marques RM, Mendes A. O governo Lula e a contra-reforma previdenciária. In: III Colóquio de Economistas Políticos da América Latina;2003 Oct 16-18; Buenos Aires; 2003.
• ²⁴
  Associação Nacional dos Auditores Fiscais da Previdência Social (ANFIP). Seguridade e desenvolvimento: um projeto para o Brasil Brasília: ANFIP; 2003.
• ²⁵
  Brasil. Ministério da Previdência Social. Fórum Nacional de Previdência Social. Síntese das atividades desenvolvidas. Brasília: Ministério da Previdência Social; 2007. [acessado 2008 dez 15]. Disponível em: http://www.previdenciasocial.gov.br/arquivos/office/4_081010-120045-048.pdf
• ²⁶
  Organização das Nações Unidas para a Educação, a Ciência e a Cultura (UNESCO). Superando a desigualdade: por que a governança é importante? Relatório de Monitoramento Global de Educação para Todos. Paris: UNESCO; 2008.
• 27. Travassos C, Viacava F, Fernandes C, Almeida C. Desigualdades geográficas e sociais na utilização de serviços de saúde.Cien Saude Colet 2000; 5(1):133-149.
• 28. Travassos C, Oliveira EXG, Viacava F. Desigualdades geográficas e sociais no acesso aos serviços de saúde no Brasil:1998 and 2003.Cien Saude Colet 2006; 11(4):975-986.
• 29. Lima-Costa MF, Matos DL, Camarano AA. Evolução das desigualdades em saúde entre idosos e adultos brasileiros: um estudo baseado na pesquisa nacional por Amostra de Domicílios (PNAD 1998, 2003). Cien Saude Colet 2006; 11(4):941-950.
• 30. Castro MSM. Desigualdades sociais no uso de internações hospitalares no Brasil: o que mudou entre 1998 e 2003. Cien Saude Colet 2006; 11(4):987-998.
• 31. Sposati A. O primeiro ano do Sistema Único de Assistência Social. Serviço Social e Sociedade 2006; 27(87):96 -122.
• 32. Delgado GC. Reforma Tributária e suas Implicações para os Direitos Sociais (Seguridade Social). [acessado 2008 dez 14]. Disponível em: http:// www.cebes.org.br
• 33. Jorge EA, Mesquita ACS, Miranda J. Reflexões preliminares sobre o impacto da reforma tributária no financiamento da seguridade social e especificamente da saúde. In: XXIV Congresso do Conasems; 2008 abr; Brasília; 2008.
• ³⁴
  Centro Brasileiro de Estudos de Saúde (Cebes). Carta do Rio de Janeiro: em defesa da seguridade social. [acessado 2008 dez 14]. Disponível em: http:// www.cebes. org.br
• 35. Salvador E. A reforma tributária desmonta o financiamento das políticas sociais.Carta social e do trabalho 2008; 8:20-26.

Publication Dates

• Publication in this collection
  15 June 2009
• Date of issue
  June 2009

History

• Accepted
  29 Jan 2009
• Reviewed
  27 Jan 2009
• Received
  21 Jan 2009