Regionalização e desigualdades na saúde: aposta na capacidade articuladora da linguagem

Abstract

Ana Luiza d'Ávila Viana & Fabíola Lana Iozzi propose to identify the challenges posed by globalization and the impacts on different scales and dimensions for dealing with health inequalities in Brazil through public policies and regionalization. The article addresses the global territorial reconfigurations oriented by neoliberal policy according to the authors. Changes in forms of local management and territorial changes in Brazil shape the backdrop for resuming the health regionalization agenda related to various organizational and policy cycles in the SUS and for updating the agenda to tackle the huge challenge in Brazil's public policy for health regionalization. One should begin by acknowledging globalization's influence on regionalization and the pertinence of adding the spatial dimension to this analysis, already translated to the health field by various authors. The territory-process understood in its relational dimensions includes multiple interests and actors. This issue is fundamental for understanding a political economy of scales and the revaluation of the regional dimension's role, without failing to assign the proper value to the national state and the new roles it has played. The article shows how the complexity of local-regional levels increases as globalization (viewed as a multi-scalar/multicausal phenomenon) interferes in their dynamics, producing new governance arrangements, management forms, financing, and impacts on public policies, especially in health. The entry of new regional actors vying in the space for power and influence could be positive and help balance interests at the local and central levels. But this would depend on the correlation of forces and the actual scenario. In a scenario of health services supply characterized by a public-private mix, partnerships are expected between private companies and the state. Still, agreeing with the authors, there is always the risk of favoring the market 1 to the detriment of meeting the population's health needs, especially for poorer citizens, whose income does not allow purchasing these services, which requires greater regulation. Contradictions and conflicts between the regional level and the central and local levels (municipalities) would require a permanent model of political negotiation, which extrapolates any forms of application of a normative/technocratic logic. This model would not dispense & legislation, levels of control/regulation, and actual spaces capable of guaranteeing less unequal access and which would include the right to health as expressed in the country's 1988 Federal Constitution.