Enhancing citizenship through nursing care in Brazil: Patients' struggle against austerity policies

Abstract

Interpersonal relations play a critical role in both the conception and dynamics of Brazilian citizenship. Under the influence of neoliberalism, patients must build strategies to access high‐quality health care services. This study aimed to analyze the role of interpersonal relations involved in the access to and delivery of health care services in Brazil amid the influence of austerity policies and the role of nurses in enhancing citizenship through nursing care. Thirty‐one patients in a public hospital in Rio de Janeiro, Brazil, participated in qualitative interviews. A lexical analysis was conducted to analyze the interview data using Alceste® software, version 2012. The results were interpreted in light of both theoretical constructs of the Brazilian citizenship and biological subcitizenship propositions. Two lexical classes revealed contents about strategies used by patients to access high‐quality health care. In the context of budget cuts due to austerity policies, cultural aspects of Brazilian citizenship have influenced access to high‐quality health care services by creating two distinct conditions. Some patients acted as super‐citizens, while others acted as subcitizens. Nurses across the globe must spearhead the struggle for universal and equitable health care access at all levels, without losing sight of wider sociocultural aspects.

Sharing the burden of treatment navigation: social work and the experiences of unhoused women in accessing health services in Santa Cruz

“…Within analyses of interactions between healthcare systems and patients, scholars have noted that more neoliberal systems increasingly place the burdens of disease management onto patients directly (May et al, 2014). The theory of biological sub-citizenship we are using here is a useful framework to analyze how these burdens became embodied in our interviewees' experiences (Da Silva & de Ferreira, 2020;Sparke, 2017). Neoliberal institutions that provide health care services to unhoused populations increasingly place the burden of health care navigation on them as individuals.…”

“…Another net effect of these co-pathogenic cascades is a form of disenfranchisement from health rights which we refer to here as "biological subcitizenship." This term follows literature that has sought to analyze ways populations are excluded from meaningful care under regimes of neoliberalism and disease-specific treatment (Da Silva & de Ferreira, 2020;Sparke, 2017). Biological sub-citizenship highlights how the 21st century promises of precision biomedicine, personalized health investment and participatory health management have led to increased health rights for some and subcitizenship for others (Rose & Novas, 2005;Whittle et al, 2017).…”