The articles featured in this dossier bring together some of the studies being conducted to understand governance in health on an international scale; in particular, the ethical perspectives and implications related to technical cooperation between countries in the context of the increasing internationalization of health issues.
In this vein, some of the most dedicated Brazilian researchers in the field have written the articles in this volume. The reader will find texts describing prior and problematic experiences that will determine the future of healthcare on an international level. We trust that these texts will be both instructive and enjoyable - as much as they have been for us when we took on the challenge of putting these works together.
This edition opens with "South-South Cooperation: Brazilian experiences in South America and Africa," by Roberta de Freitas Santos and Mateus Rodrigues Cerqueira. The text presents an interesting description of the main guidelines of Brazilian foreign policy, with a special focus on the South-South Cooperation concept. To this end, it concentrates on an analysis of Brazilian technical cooperation initiatives in health implemented in South America and in Africa. While not disregarding current interests and the asymmetries of power prevailing in South-South Cooperation, the article presents a positive view of actions taken by Brazil vis-à-vis its neighbors and African countries.
We then have "International cooperation for science and technology development: a way forward for equity in health" by Priscila Almeida Andrade and Denise Bomtempo Birche de Carvalho. In the scenario that evolved from the 1990s onwards, this article brings an analytical focus to bear on the research, development and innovation in health priorities of developing countries. The authors have a less optimistic view regarding the potential institutional gains resulting from Brazil's involvement in the current global health context.
Fernando Pires-Alves and Marcos Chor Maio present the work "Health at the dawn of development: the thought of Abraham Horwitz." Horwitz was the director of the Pan American Health Organization (PAHO) in the period from 1958 to 1975. This happened to be one of the most prolific periods in the trajectory of PAHO. For example, it was during this period that the Alliance for Progress (1961) was established. Proposed and led by the United States, it consisted of an economic and social aid program for Latin America. What could be called an "era of development" was born. Initiatives like the first ambitious Ten-Year Public Health Program for the Americas would garner not only the political and financial support they needed, but also help to develop the policy guidelines to sustain them. Based on his position as director of PAHO and his contribution to the organization, Horwitz played a pivotal role in the construction of the ideology that fostered the relationship between health and social and economic development. We can safely say that his legacy, albeit not presently felt, has been decidedly long lasting.
"The Juscelino Kubitschek government and the Brazilian Malaria Control and Eradication Working Group: collaboration and conflicts in the Brazilian and international health agenda, 1958-1961," by Renato da Silva and Carlos Henrique Assunção Paiva, is about the experiences of the Working Group for the Control and Eradication of Malaria in Brazil during the government of President Juscelino Kubitschek. The negotiations and tensions related to proposals defended by the Brazilian scientific community and by the World Health Organization, in relation to their battle against malaria form the backcloth to this text. It shows that relations between national actors and international organizations and/or the international community, even though these may be subject to flagrant power asymmetries, cannot simply be weakened because of - supposedly stronger - outside influences that are contrary to established domestic interests. The juxtaposition of resistance and negotiation to formulas and guidelines imposed from abroad give the measure, on the one hand, of the scientific expertise and tradition that are already established in the country and, on the other hand and for the same reason, demonstrate the capacity of the scientific community and national state agents to impose their interests, if only in part. In other words, cooperation in health is not a zero-sum game.
This is followed by the work by Luiz Eduardo Fonseca and Celia Almeida who offer "International cooperation and the implementation of health policies in a post-conflict situation: the case of East Timor." The focus of the study is the first health policy document for East-Timor. In analytical terms, this is certainly one of the most interesting periods in the country's history, since, during the construction of national health policies, the country was under the transitional administration of the United Nations (1999 to 2002). The authors were interested in observing the relationships between different national and foreign actors during this political construction process. The support of international cooperation in rebuilding the health system during the post-conflict period is, therefore, in evidence and analyzed as part of the process to reconstruct the State and establish a political and institutional framework in the country.
Researchers Janete Lima de Castro, Rosana Lucia Alves de Vilar and Raimunda Medeiros Germano have written "Education, ethics and solidarity in international cooperation," which centers on an account of technical cooperation between Brazil and countries in the Andean region on the lines of the International Course on Human Resources Policy Management in Health. These efforts were led by the Universidade Federal do Rio Grande do Norte and mediated by PAHO and, according to the authors, drew on values based on concepts of ethics and solidarity which are seen as an essential part of the international technical cooperation process. In other words, the authors challenge us to think of technical cooperation not only from the strategic political and economic interests related to it, but also from an instrumental perspective, based on a universe of values related to ethics and human solidarity.
In the section Images, we find an interesting work by Alejandra Carrillo Roa and Felipe Ricardo Baptista e Silva. Under the title "Fiocruz as an actor in Brazilian foreign relations in the context of the Community of Portuguese-Speaking Countries: an untold story," the authors describe the role of the Oswaldo Cruz Foundation (Fiocruz) as a relevant actor within the scope of the Portuguese-speaking world. The perspective adopted in the text is that of a "public health framework cooperation," according to which the Brazilian government, through the intermediation of institutions such as Fiocruz, performs a positive role, both in constructing better health standards and living conditions in partnership with foreign countries, as well as in helping to promote their technical and technological independence.
Following on from the list of articles commented upon here, Books & Networks introduces three reviews that, in varying forms, address the universe of issues under discussion in this dossier. Carmen Beatriz Loza discusses the book organized by the Spanish anthropologist Gerardo Fernández Juárez, Salud, interculturalidad y derechos: claves para la reconstrucción del Sumak Kawsay-Buen Vivir. In the next review, Tyara Kropf Barbosa, Alejandra Carrillo Roa and Neilia Barros Ferreira de Almeida introduce the Virtual Library on Bioethics and Diplomacy in Health. Finally, Thiago Rocha da Cunha and José Paranaguá de Santana present the Fiocruz Center for Studies on Bioethics and Diplomacy in Health (Nethis/Fiocruz) website, in which specialized sources of information can be consulted for studies at the interface of public health, bioethics and international relations.
We would like to thank the authors who have written the texts reproduced here, as well as PAHO for their support to this joint project of Nethis and História, Ciências, Saúde - Manguinhos, highlighting the dedication and professionalism of their coordination team, with special thanks to Marcos Cueto, Jaime Benchimol and Roberta Cerqueira. We would also like to thank the peer reviewers whose valuable assistance is always relegated to anonymity despite the importance of their contribution.
Carlos Henrique Assunção Paiva and José Paranaguá de Santana
Publication Dates
-
Publication in this collection
Jan-Mar 2015
