Health sector reform and social determinants of health: building up theoretical and methodological interconnections to approach complex global challenges

Abstract

Health Sector Reform and Social Determinants of Health are central issues for the current international policy debate, considering the turbulent scenario and the threat of economic recession in a global scale. Although these themes have been discussed for a long time, three major issues still calls the attention of the scientific community and health policymakers. The first one is the matter of how to approach scientifically the intricate connections between them in order to understand the consequences of policies for healthcare services, once this debate will become much more tensioned in the coming years. The second one is the lack of explanatory frameworks to investigate the policies of reform strategies, simultaneously observed in a variety of countries within distinct health services, which aim to achieve multiple and contradictory goals vis-à-vis the so-called social determinants of health. The third one is the challenge that governments face in developing and sustaining equitable health services, bearing in mind the intense political dispute behind the health sector reform processes. This article discusses an all-embracing theoretical and methodological scheme to address these questions. The aim is to connect macro-and middle-range theories to examine Social Determinants and Health Sector Reform interdependent issues, with view to developing new knowledge and attaining scientific understanding upon the role of universal and equitable healthcare systems, in order to avoid deepening economic crises. Keywords HEALTH SECTOR REFORM AND SOCIAL DETERMINANTS OF HEALTH: UNCOVERING STRUCTURAL AND HISTORICAL INTERCONNECTIONSHealth Sector Reform (HSR) is a complex global phenomenon, involving several layers and dimensions of simultaneous change, embedded by a structural process of reform which goes well beyond sector boundaries. Since the early 1990's, authors such as Collins, Hunter, and Green 1 have pointed out the phenomenon of an orthodox approach to the health sector shaping a "new reform agenda", guided by the market throughout the world. Curiously, this overall strategy was diametrically opposed to the previous period of reform, which lasted from the end of the World War II until the end of the so-called Golden Years. That historical period was marked by political agreements and social pacts, intrinsically connected to the idea of Social Determinants of Health (SDH), resulting in the establishment of public healthcare as a worker's or citizen's right, inserted on the social protection agenda of most industrialized countries. These political agreements spawned the implementation of a variety of models of National Health Services, offering varying degrees of access to comprehensive care, RESUMO: A Reforma do Setor Saúde e os Determinantes Sociais em Saúde são questões centrais para o atual debate político internacional, considerando o cenário turbulento e a ameaça de recessão econômica em escala global. Embora esses temas venham sendo discutidos há longo tempo, três grandes questões ainda chamam a ate...

Cooperação entre academia e governo para avaliar a Atenção Primária à Saúde no Sistema Único de Saúde

“…O processo de reforma do setor público brasileiro, sobretudo a partir dos anos 2000, com a segunda geração de mudanças institucionais, tem influenciado a adoção de novos programas governamentais no campo da saúde na tentativa de melhorar a oferta de serviços aos cidadãos 1 . Os esforços nesse contexto da Nova Administração Pública têm levado ao incremento dos processos de cooperação entre a academia e organismos governamentais no Sistema Único de Saúde (SUS).…”