Carta do editor

Abstract

The 25th anniversary of Brazil's Unified Health System (Sistema Único de Saúde, SUS) was commemorated throughout all of 2013, in the form of numerous debates, news reports, and interviews. In our fi rst issue of História, Ciências, Saúde-Manguinhos for 2014, we present some contributions to the many analyses that explore the directions taken by this major development in the history of Brazilian public health-analyses that generally convey a worrisome tone. The s o-called Brazilian miracle was coming to an end and our "lost decade" was dawning when General João Baptista Figueiredo took command as the last national president (1979-1985) under the military dictatorship (likewise the object of new historical evaluations as Brazil this year marks 50 years since the 1964 coup d'état). Rising oil prices, an unbridled foreign debt, skyrocketing infl ation, and recessionary policies helped spur the broad movement known as the "Elections Now" campaign in 1982 and 1983. (It should be noted here that under the administration prior to Figueiredo, Geisel had inaugurated a "slow and gradual political liberalization.") Notable among the various forms of popular mobilization seen back then were those that combined the fi ght for redemocratization with proposals to reform the health system. Under the auspices of the federal Chamber of Deputies, the top leaders of the public health reform movement came together in 1978 at the fi rst Symposium on National Health Policy and approved a document containing the movement's key principles. These leaders were in step with the global trend in the health sector that put primary health care at the fore. At that time, prevailing thought in the medical fi eld was drawing from the same sources that fed the demise of the cold war. The movements of students, workers, and intellectuals that had erupted in 1968 contested not just the capitalist system and bourgeois culture and ideology but also the medical establishment, accelerating the collapse both of vertical models for eradicating diseases and of the associated developmentalist ideology, according to which "underdeveloped" countries would follow the same path as the United States and Western Europe if they were equipped with sophisticated medical technologies. Studies both inside and outside the fi eld of medicine, including some from the realm of historiography, helped bury this view of the world and of health. On the international plane, the watershed moment came in September, 1978, at the International Conference on Primary Health Care, held in Alma-Ata, in the former Soviet Union. The basic principles of the Declaration of Alma-Ata included: emphasis on healthcare technology suited to the needs of the poor rather than on sophisticated technology consumed by an urban minority; an opposition to medical elitism and exaggerated specialization; and the valuing of community health agents, room for traditional knowledge, and health as a tool of socioeconomic development that can reach rural areas and the poor peripheries of large cities through ho...