SciELO - Scientific Electronic Library Online

vol.23 issue7Sustaining Social Protection and Provision: the front line in the battle for the Good Society author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links


Ciência & Saúde Coletiva

Print version ISSN 1413-8123On-line version ISSN 1678-4561

Ciênc. saúde coletiva vol.23 no.7 Rio de Janeiro July 2018 


International context and national policies: challenges facing social protection and health systems in a changing world

Cristiani Vieira Machado1 

Eleonor Minho Conill2 

Lenaura de Vasconcelos Costa Lobato3 

1Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. Rio de Janeiro RJ Brasil.

2Observatório Ibero-Americano de Políticas e Sistemas de Saúde, Universidade Federal de Santa Catarina. Florianópolis SC Brasil.

3Universidade Federal Fluminense. Niterói RJ Brasil.

The action of the National States in the social area constitutes a remarkable phenomenon of the twentieth century. Several advanced capitalist countries have established comprehensive systems of social protection that expanded in the postwar period under different regimes. In developing countries, these systems have generally been more limited, segmented, and focused on groups within the formal economy.

From the end of the twentieth century and in the early twenty-first century, demographic and epidemiological changes, transformations in capitalism and global geopolitics have affected the social question and posed new challenges for these policies. Analyses have pointed to a strengthening of neoliberalism and neoconservatism in various parts of the world, with threats to the values of solidarity that form the basis of social protection systems. Among the contradictions observed on a global scale, it is worth noting the coexistence of improvements in some social indicators with the persistence or expansion of inequalities between nations and social groups. Such changes brutally affect developing countries where these systems are fragile and less inclusive than those of advanced capitalist nations1.

This thematic issue seeks to contribute to the understanding of the context and processes of changes in social protection and health systems in the past few decades, as well as to discuss its determinants and challenges in different countries. To achieve this, it includes articles by authors from several international and national research institutions with experience in studies on the contemporary transformations of social and health policies.

This issue begins with an introductory article by Peter Evans that explores the dilemmas of social protection advocacy in an era of regressive capitalism. The author comments on the contributions of the articles to the understanding of the contradictions between the quest for well-being and the imperatives of capitalist dynamics. He invites readers to reflect on the challenge of building the oppositional agency necessary to strengthen social provision.

The following articles offer four types of contributions. The first group of authors presents recent trends in reforms in social protection systems. The second group discuss the implications of globalization, financialization, and the hegemony of neoliberalism for these systems, with a focus on international agendas or their repercussions in specific contexts. The third group is represented by studies on health systems from a comparative perspective, addressing different themes and countries (configuration and performance of systems, decentralization/regionalization, hospital work). Lastly, there are case studies of countries on critical issues for health services (primary care, pharmaceutical care, labor management) that situate cases on the international context or highlight relationships between international and national actors.

In addition to the multiplicity of the analytical approaches and themes, the articles in the issue vary in terms of the scale of analysis (global, international, regional, national) and cover several regions and countries: Europe, Latin America; OECD, BRICS; Spain, France, Portugal; Argentina, Brazil, Chile, Mexico and Paraguay; Algeria and Mozambique. One of the main contributions of the comparative perspective is to identify common challenges to the countries, even if they are expressed in accordance with the particularities of each social background2.

Brazil is emphasized in several texts. In the year when the 1988 Constitution celebrates its 30th anniversary, under threats of dismantling social rights enshrined therein, it is essential to understand the challenges facing the consolidation of Social Security and the Unified Health System, in the light of broader issues related to the development model and the insertion of the country in the international scenario. We hope that the the thematic issue will contribute to this reflection and raise new questions.


1. Haggard S, Kaufman RR. Development, democracy, and welfare states: Latin America, East Asia, and Eastern Europe. Princeton: Princeton University Press; 2008. [ Links ]

2. Temporão JG. Sistemas universales de salud en el mundo en transformación. In: Giovanella L, Oscar F, Faria M, Tobar S, organizadores. Sistemas de salud en Suramérica: desafios para la universalidad, la integralidad y la equidad. Rio de Janeiro: Instituto Suramericano de Gobierno en Salud (ISAGS); 2012. p. 13-20. [ 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.