de M Pontes Ana Lucia, Santos Ricardo Ventura
Departamento de Endemias Samuel Pessoa, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, Brazil.
Departamento de Antropologia, Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Health Policy Plan. 2020 Nov 1;35(Supplement_1):i107-i114. doi: 10.1093/heapol/czaa098.
Given the challenges related to reducing socio-economic and health inequalities, building specific health system approaches for Indigenous peoples is critical. In Brazil, following constitutional reforms that led to the universalization of health care in the late 1980s, a specific health subsystem was created for Indigenous peoples in 1999. In this paper, we use a historical perspective to contextualize the creation of the Indigenous Health Subsystem in Brazil. This study is based on data from interviews with Indigenous and non-Indigenous subjects and document-based analysis. In the 1980s, during the post-dictatorship period in Brazil, the emergence of Indigenous movements in the country and the support for pro-Indigenous organizations helped establish a political agenda that emphasized a broad range of issues, including the right to a specific health policy. Indigenous leaders established alliances with participants of the Brazilian health reform movement, which resulted in broad debates about the specificities of Indigenous peoples, and the need for a specific health subsystem. We highlight three main points in our analysis: (1) the centrality of a holistic health perspective; (2) the emphasis on social participation; (3) the need for the reorganization of health care. These points proved to be convergent with the development of the Brazilian health reform and were expressed in documents of the Indigenist Missionary Council (CIMI) and the Union of Indigenous Nations (UNI). They were also consolidated in the final report of the First National Conference on the Protection of Indigenous Health in 1986, becoming the cornerstone of the national Indigenous health policy declared in 1999. Our analysis reveals that Indigenous people and pro-Indigenous groups were key players in the development of the Indigenous Health Subsystem in Brazil.
鉴于在减少社会经济和健康不平等方面存在诸多挑战，为原住民建立特定的卫生系统方法至关重要。在巴西，20世纪80年代后期的宪法改革促使医疗保健实现了普及，1999年为原住民创建了一个特定的卫生子系统。在本文中，我们从历史角度对巴西原住民卫生子系统的创建进行背景分析。本研究基于对原住民和非原住民受访者的访谈数据以及文献分析。20世纪80年代，在巴西后独裁时期，该国原住民运动的兴起以及对支持原住民组织的支持，帮助确立了一项政治议程，该议程强调了一系列广泛问题，包括制定特定卫生政策的权利。原住民领袖与巴西卫生改革运动的参与者建立了联盟，引发了关于原住民特殊性以及建立特定卫生子系统必要性的广泛讨论。我们在分析中突出了三个要点：（1）整体健康观的核心地位；（2）对社会参与的强调；（3）医疗保健重组的必要性。这些要点被证明与巴西卫生改革的发展相契合，并在原住民传教士理事会（CIMI）和原住民民族联盟（UNI）的文件中得到体现。它们还在1986年第一届全国原住民健康保护会议的最终报告中得到巩固，成为1999年宣布的国家原住民健康政策的基石。我们的分析表明，原住民和支持原住民的团体是巴西原住民卫生子系统发展的关键参与者。
