Editorial

Abstract

This new issue of 'Saúde em Debate' (Health in Debate) begins with a reflection on the book 'Everyday Bioethics', by Giovanni Berlinguer. The author, who died in April last year, was one of the great mentors of the Health Reform in Brazil and even published, in 1988, the book 'Reforma Sanitária-Itália e Brasil', in partnership with Sonia Fleury and Gastão Wagner. The journal continues with a series of articles in which predominate the themes of organization, management, and evaluation of health services. The set of articles, preceded by the article about Giovanni Berlinguer, calls us to reflect on the course of Health Reform and health policies in Brazil. Over time, public policies tend to have a course marked by relative stability or, better said, by a certain directionality, however, at times, that course is interrupted by great and rapid changes. The course of stability that is favored by the very institutionalization of a policy suggests that policies change only gradually incrementally. However, in times when the problems pile up or when new problems emerge, there may be significant changes that suggest that the course of public policies is episodic. The process of these changes is set by a number of factors, including the general political and social context, the mobilization of political actors both new and old, the conflicts that oppose or combine the actors. The effectiveness of changes will also significantly depend on the institutional structures of formulation and definition of policies and how such structures delimit access to the process, but not only. Speeches and ideas that support changes are also important. The creation and implementation of the Unified Health System (SUS) show that overall dynamics of public policies. With the process of transition from the military government to a democratic one, a window of opportunity was opened. At that time, several factors concurred to enable a radical change in health through the creation of the SUS: the entry of political actors who had been previously repressed or marginalized in the area (sanitarians, trade union movements of health professionals, trade union movements), the emergence of new institutional structures of health policymaking (VIII National Health Conference, the National Constituent Assembly), the production of new discourses and ideas on health (health is democracy, unified health system, the principles of universality, equity, completeness, hierarchy, and decentralization) that enabled the section 'Da Saúde' (Of Health) as an integrant part of the chapter 'Seguridade Social' (Social Security) of the 1988 Federal Constitution (BRAZIL, 1988). After the long period of political transition, the SUS gradually found a political context full of ambiguities: the institutional structure of policymaking was extended with new devices (conferences and councils) aiming at popular participation, but at the same time the traditional old policy persisted, and the secular resistance of the middle classes and elites to social policies that promote socia...