Direito à saúde e integralidade: uma discussão sobre os desafios e caminhos para sua efetivação

O presente artigo discute aspectos que interferem na garantia do direito à saúde e sua relação com o princípio da integralidade. Para tanto, são descritas questões históricas e culturais que contextualizam esta realidade. Também são apontados os limites e as possibilidades para garantia da integralidade como parte do direito à saúde, com foco no SUS. A abrangência do conteúdo do direito à saúde e a limitação daquilo que é efetivamente alcançado demonstram a dificuldade para sua garantia plena, aspecto igualmente observado em outros países. O direito compartimentado vivenciado na prática do SUS é antagônico ao princípio da integralidade em seus diferentes sentidos. Apesar dos desafios para efetivação da integralidade, diversas iniciativas foram identificadas e têm sido utilizadas na perspectiva de superar as dificuldades e alcançar o direito à saúde em sua plenitude.

Suspensão cautelar e cancelamento de registro de medicamentos : garantias constitucionais ao direito à saúde

Inclui bibliografia

Entre o Direito de Reclamar e o Direito à Saúde: Serviço Social em Gabinetes do Cidadão do SNS

As políticas de saúde e o direito à saúde em Portugal sofreram profundas transformações nas últimas décadas, muito contribuíram para estas transformações a crise económica e financeira mundial e a influência de políticas neoliberais. O interesse por esta temática surge de uma prática profissional num Gabinete do Cidadão do Serviço Nacional de Saúde e, pela falta de debate e posicionamento público dos Assistentes Sociais sobre as competências do Gabinete do Cidadão e, do papel dos Assistentes Sociais nesse serviço. Com este trabalho, pretende-se contextualizar: as principais transformações nas políticas de saúde e suas repercussões no direito à saúde nos últimos anos; analisar as alterações legislativas que ocorrem entre a criação do Gabinete do Utente e o Gabinete do Cidadão; analisar o trabalho que os Assistentes Sociais têm vindo a desenvolver no âmbito das competências do Gabinete do Cidadão e do direito à saúde. A investigação de cariz exploratório e qualitativo contou com os contributos de Assistentes Sociais que trabalham em Gabinetes do Cidadão da região norte do país e, que participaram através de inquérito por questionário. Da investigação efetuada concluiu-se que o Gabinete do Cidadão apenas garante o direito a reclamar e não o direito à saúde. As possibilidades que se abrem ao trabalho do Assistente Social no Gabinete do Cidadão, em prol da efetivação do direito à saúde parte do trabalho coletivo. As competências e habilidades do Serviço Social devem ter o intuito de promover a consciência crítica dos indivíduos. / Health policies and the right to health in Portugal underwent profound changes in recent decades, greatly contributed to these transformations the global economic and financial crisis and the influence of neoliberal policies. The interest in this subject arises from a professional practice in the Gabinete do Cidadão National Health Service, and by the lack of public debate and placement of Social Workers on the powers of the Gabinete do Cidadão and the role of social workers in this service. This work aims to contextualize: major changes in health policies and their impact on the right to health in recent years; consider legislative changes that occur between the creation of the Gabinete do Utente and the Gabinete do Cidadão; analyze the work that Social Workers have been developing within the competence of the Gabinete do Cidadão and the right to health. The exploratory research and qualitative nature featured contributions from Social Workers who work in Gabinetes do Cidadão of the northern region of the country, who participated via questionnaire survey. Research conducted it was concluded that the Gabinete do Cidadão only guarantees the right to complain and not the right to health. The possibilities that open to the Social Work Assistant in the Gabinete do Cidadão, for the sake of ensuring the right to health of the collective work. The skills and abilities of Social Work must have in order to promote critical awareness of individuals.

O Serviço Social na Unidade de Transplantação Hepática Pediátrica e a Criação da Associação de Crianças e Jovens Transplantados ou com Doenças Hepáticas – HEPATURIX pelo Direito à Saúde

Com a crise financeira que se tem vindo a agudizar, com o agravamento da pobreza e exclusão social, associados a problemas de saúde e à emergência de problemas sociais (como o desemprego e a pobreza) tem assomado uma vaga de iniciativas de movimentos da sociedade civil. São novas formas de organização e resposta a situações específicas de grupos de indivíduos na luta por políticas públicas e direitos sociais tais como o da saúde, da habitação, da educação, do trabalho, entre outras. Nos finais da década de 70, em Portugal, a criação do Serviço Nacional de Saúde intenta o acesso à saúde garantido a todos os cidadãos. Nos anos 80 o Estado limita este direito baseado no princípio da justiça social protegendo os grupos mais desfavorecidos. Institui as taxas moderadoras e define as isenções para alguns doentes crónicos. Perante a desigualdade de direitos que daí advém, no Hospital Pediátrico de Coimbra, a partir dos anos 90, surgem movimentos associativos em prol dos direitos de saúde, criados e dinamizados por Assistentes Sociais, nomeadamente as Associações Acreditar em 1993, a Coração Feliz em 1994, a Associação Nacional de Fibrose Quística em 1996 e já no século XXI a Diabéticos Todo o Terreno em 2004 e a Hepaturix em 2006. A Hepaturix – Associação de Crianças e Jovens Transplantados ou com Doenças Hepáticas – fundada já no século XXI e cuja actividade será descrita neste trabalho, tem vindo a lutar pelos direitos sociais desta população, com a colaboração da Assistente Social que, no Hospital Pediátrico de Coimbra, apoia a Unidade de Transplantação Hepática Pediátrica. Entre outros, a isenção das taxas moderadoras para os doentes transplantados e para os dadores vivos assim como o direito aos transportes nas deslocações para o hospital após o transplante, são direitos sociais alcançados pela Hepaturix através da sensibilização do poder político. A Assistente Social tem sido um pilar neste percurso, sendo mediadora entre a instituição e a associação, em prol do direito destas crianças e jovens. / With the financial crisis that has been worsening, with increased poverty and social exclusion associated with health problems and the emergency of social problems (such as unemployment and poverty) there has been a loomed wave of initiatives for movements from the civil society. These are new ways of organization and response to specific situations of groups of individuals in the strike for public policies and social rights such as health, habitation, education, work, among others. In the late 70s, in Portugal, the creation of the National Health Service intents the access to health care guaranteed to all citizens. In the 80s the government limits this right based on the principle of social justice, protecting the most disadvantaged groups. Establishes user fees and defines the exemptions for some chronically ill. Before the inequality of rights resulted from this, there has been a rising of associative movements for health rights, created and dynamized by Social Workers at the Pediatric Hospital of Coimbra, from the 90s on: "Acreditar" in 1993, "Coração Feliz" in 1994, Associação Nacional da Fibrose Quistica" in 1996 and now, in the XXI century: "Diabéticos Todo o Terreno"in 2004 and "Hepaturix" in 2006. The “Hepaturix” - Association of Transplanted Children and Youth or with Hepatic Diseases - founded in the twenty-first century, whose will be discussed in this work, has been fighting for social rights of this population, with the cooperation of the Social Work who, at the Children’s Hospital of Coimbra, supports the Pediatric Hepatic Transplantation Unit. Among others, the exemption of user fees for transplanted patients and living donors as well as the right to transport at dislocations to the hospital after transplant, are social rights accomplished by Hepaturix, through the awareness of political power. The Social Worker has been a pillar in this journey, being a mediator between the institution and the association on behalf of the rights of these children and youth.

Direito fundamental à saúde: parâmetros e alternativas para sua concretização no Brasil

If, on one hand, only with the 1988 Federal Constitution the right to health began to receive the treatment of authentic fundamental social right; on the other, it is certain since then, the level of concretization reached as to such right depicts a mismatch between the constitutional will and the will of the rulers. That is because, despite the inherent gradualness of the process of concretization of the fundamental social rights, the Brazilian reality, marked by a picture of true chaos on public health routinely reported on the evening news, denatures the priority status constitutionally drew for the right to health, demonstrating, thus, that there is a clear deficit in this process, which must be corrected. This concern regarding the problem of the concretization of the social rights, in turn, is underlined when one speaks of the right to health, since such right, due to its intimate connection with the right to life and human dignity, ends up assuming a position of primacy among the social rights, presenting itself as an imperative right, since its perfect fruition becomes an essential condition for the potential enjoyment of the remaining social rights. From such premises, this paper aims to provide a proposal for the correction of this problem based upon the defense of an active role of the Judiciary in the concretization of the right to health as long as grounded to objective and solid parameters that come to correct, with legal certainty, the named deficit and to avoid the side effects and distortions that are currently beheld when the Judiciary intends to intervene in the matter. For that effect, emerges as flagship of this measure a proposition of an existential minimum specific to the right to health that, taking into account both the constitutionally priority points relating to this relevant right, as well as the very logic of the structuring of the Sistema Único de Saúde - SUS inserted within the core of the public health policies developed in the country, comes to contribute to a judicialization of the subject more in alignment with the ideals outlined in the 1988 Constitution. Furthermore, in the same intent to seek a concretization of the right to health in harmony with the constitutional priority inherent to this material right, the research alerts to the need to undertake a restructuring in the form of organization of the Boards of Health in order to enforce the constitutional guideline of SUS community participation, as well as the importance of establishing a new culture budget in the country, with the Constitution as a compass, pass accurately portray a special prioritization directed constitutional social rights, especially the right to health

Vigilância em saúde no Brasil: os desafios dos riscos sanitários do século XXI e a necessidade de criação de um sistema nacional de vigilância em saúde

The technological development experienced in the contemporary world are transforming society and relations between State and people. The mobility of human being has reached levels never before imagined and a person can move from one side of the world to the other side in less than 24 hours. This mobility also includes goods and services, giving the keynote of the globalized world of the XXI Century. In this context, the risks of diseases and others health problems are intensely amplified. Nowadays, an epidemic that begins in China can arrive in Brazil the following day. Brazil recognizes health as a universal right and also consider it a State's obligation. Therefore, the State of Brazil is obligated to organize itself to eliminate or control health risks. Today, the organization of the Brazilian State regarding the surveillance of risks of diseases and other health problems is fragmented and includes sanitary surveillance (focused on goods, products and services), epidemiological surveillance (diseases and investigations of other risks) and environmental surveillance in health (the environment in general, including the workplace). This fragmentation causes problems for the management and consolidation of strategic information for health protection. Brazil has the need to think about an other model of organization that put together all "kinds" of surveillances within a single coordinated system, called the National System of Health Surveillance, which would be able to coordinate the various specialties of health surveillance that exists in the country in order to provide a effective system of information and health surveillance, able to face emergency situations of public health

Anotação sintética, numa perspectiva de Direito Público-penal e Direito Privado-civil, ao Acórdão do Supremo Tribunal de Justiça Português, de 19 de Abril de 2012-- A poluição sonora e o direito humano ao descanso e à saúde, sem descurar a necessidade duma adequada política tributária.

Resumo: 1 – Sumário do Acórdão do Supremo Tribunal de Justiça, de 19 de Abril de 2012; 2 – Texto completo do Acórdão do Supremo Tribunal de Justiça, de 19 de Abril de 2012: cfr. http://www.dgsi.pt/jstj.nsf/954f0ce6ad9dd8b980256b5f003fa814/fc664c231f3e73cf802579ea003d91d2?OpenDocument&Highlight=0,polui%C3%A7%C3%A3o , 2 de Junho de 2012; 3 – Anotação sintética; 3.1 – Introdução à anotação sintética e suas características neste caso concreto; 4 – Algumas referências constitucionais centrais em relação a Direitos humanos e, nomeadamente, a um Direito humano a um meio-ambiente sadio, saudável em todas as suas vertentes e sentidos – o exemplo central do artigo 9.º da CRP; 4.1 – Algumas referências constitucionais centrais em relação a Direitos humanos e, nomeadamente, a um Direito humano a um meio-ambiente sadio, saudável em todas as suas vertentes e sentidos – o exemplo central do artigo 66.º da CRP e o Regime Geral do Ruído; 5 – O direito humano ao descanso e à saúde, rectius o direito ao ambiente sadio vs o direito ao lazer e/ou exploração económica de indústrias de diversão, rectius o direito à liberdade de iniciativa económica privada; 6 – A violação do direito humano, de personalidade, ao descanso e à saúde, rectius o direito a um ambiente sadio, numa perspectiva de Direito privado e Direito civil; 7 – A criminalização da poluição, designadamente a criminalização da poluição sonora – uma perspectiva de Direito público e Direito penal; 8 - A necessidade duma adequada política tributária que compatibilize desenvolvimento sustentado com a protecção dum meio ambiente sadio e com qualidade de vida; 9 – Conclusões. § Abstract: 1 - Summary of the Judgment of the Supreme Court of April 19, 2012, 2 - Complete text of the Judgment of the Supreme Court of April 19, 2012: cf. http://www.dgsi.pt/jstj.nsf/954f0ce6ad9dd8b980256b5f003fa814/fc664c231f3e73cf802579ea003d91d2?OpenDocument&Highlight=0,polui%C3%A7%C3%A3o , June 2, 2012, 3 - Synthetic Note: 3.1 - Introduction to synthetic annotation and its characteristics in this case 4 - Some references constitutional power over human rights and in particular to a human right to a healthy environment, healthy in all its forms and meanings - the central example of Article 9. of CRP; 4.1 - Some references constitutional power over human rights and in particular to a human right to a healthy environment, healthy in all its forms and meanings - the central example of Article 66. No of CRP and the General Noise; 5 - the human right to rest and health, rectius the right to healthy environment vs. the right to leisure and / or economic exploitation of industries fun, rectius the right to freedom of private economic initiative; 6 - the violation of human personality, to rest and health, rectius the right to a healthy environment, a perspective of private law and civil law; 7 - criminalization of pollution, including the criminalization of noise - a perspective of public law and criminal law; 8 - the need for appropriate tax policy that reconciles sustainable development with the protection of a healthy environment and quality of life; 9 - Conclusions.

A Audiência Pública da Saúde: questões para a judicialização e para a gestão de saúde no Brasil

O termo judicialização vem sendo utilizado nos países para nomear os mais diversos fenômenos que se diferenciam quanto à intensidade, profundidade e historicidade. A recente inserção do Poder Judiciário no campo da saúde no Brasil pode ser percebida como uma forma de "judicialização da política". O termo, entretanto, carece de uma definição mais clara, que permita identificar mais precisamente a profundidade desse fenômeno no Brasil. Nos últimos anos, observou-se no Brasil um aumento vultoso do número de ações judiciais voltadas para a garantia do direito à saúde. Isso implicou, entre outras cosias, uma apropriação rápida dos gestores da saúde da expressão "judicialização da saúde". Muitas das ações da área da saúde têm chegado à instância máxima do Judiciário brasileiro. A fim de refletir sobre essas ações, o Supremo Tribunal Federal (STF) convocou uma Audiência Pública (AP) para ouvir de toda a sociedade questões relacionadas ao direito à saúde. Cinquenta pessoas tiveram a oportunidade de se pronunciar nessa audiência. Assim, com base na análise da retórica, este estudo observa as falas desses oradores, buscando compreender o posicionamento perante o fenômeno da judicialização, os principais argumentos utilizados e as consequências para a gestão em saúde.

Advocacia em saúde no Brasil contemporâneo

Apresenta-se o conceito de advocacia em saúde, por meio da descrição de seus elementos, sua prática e seus agentes. A necessidade da formulação de tal conceito surge da função que tem a universidade, entre outras, de identificar demandas sociais e oferecer alternativas que busquem a superação de obstáculos. A ênfase é centrada na participação social, assegurada na Constituição, promulgada em 1988, e que desde então tem sido tomada como referência no desenvolvimento dos mecanismos de construção da cidadania, especialmente quando relacionada à conquista do direito à saúde.

A mediação como instrumento concretizador do direito fundamental à saúde: uma alternativa à judicialização de conflitos Natal 2013

In Brazil, the 1946 Constitution enshrined the right to health, having it defined as the possession of the best state of health that the individual can achieve. Already the Federal Constitution of 1988 lifted that right to the status of fundamental social right, which transcends the effectiveness and cure of the disease is based on the joint liability of public entities for the provision of a quality service, efficient and prioritize human dignity and comprehensive evaluation of patients. According to the World Health Organization, the definition of health, first characterized as the mere absence of disease, has become recognized as the need to search for preventive mechanisms to ensure the welfare and dignity of the population. Garantista this context, the growing seem lawsuits that deal with the implementation of public policies, especially in the area of the right to health, the omission of which the Government can result in the risk of death. Hence the concern of law professionals about whether or not the intervention of the judiciary in cases that deal with providing material benefits of health care. It claims to break the principle of separation of powers, disobedience to the principle of equality and the impossibility of judicial intervention in the formulation of public policy to try and exclude the liability of public entities. In contrast, the judiciary has repeatedly guardianships granted injunctions or merit determining the supply of materials indicated by the medical benefits that accompany the treatment of patients who resort to a remedy. In this context, mediation, object of study and resolution presented in this work, is presented as an instrument conciliator between the reserve clause and the right to financially possible existential minimum, as it seeks to serve all through rationalization of health services , avoidance of negativistic influence of the pharmaceutical industry, with prioritizing the welfare of the individual and the quality of relationships. This is alternative way to judicialization that in addition to encouraging and developing active citizen participation in public policy formulation also allows the manager to public knowledge of community needs. It is in this sense that affirms and defends the right to health is no longer the mere provision of medical care and prescription drugs, but a dialogue conscious existential minimum to guarantee a dignified life

Parâmetros de concretização judicial do direito fundamental à saúde no fornecimento de medicamentos

In Brazil, social rights have always been considered secondary legal categories, whose implementation could wait for the pending of political decisions. At the end of the Second World War, International Law emphasizes the protection of human beings, raising his dignity as a legal pillar of the legal orders and one of the main foundations of Constitutions. At the post-positivism Constitutionalism, the realization of social rights receives special attention with the assumption of supremacy and normativity of the Constitutions, while the judiciary participates in the realization of democracy, not only as applicator of laws, but also as the guardian of constitutionality of the acts and administrative omissions, creatively contributing to the constitutional achievement, filling gaps and normative state omissions. In this aspect, the supply of medicines, whose costs can not be supported by the individual, keep a close connection with the right to life, health and dignity of the human being, as the subject of numerous lawsuits directed against the Public Administration. Such phenomenon has caused intense debate regarding judicial activism and legitimacy of these decisions, particularly on the need to define what are the limits and possibilities considering the principle of separation of powers and the principle of reserve of the possible; bieng this the problematic developed in this research. Thus, this research aims to verify the legitimacy of judicial decisions that determines to the Public Administration the compulsory providing of medicine to those who can not afford the cost of their treatment, as well as, contribute to the dogmatic constructions of parameters to be observed by judicial interference. Regarding the methodology, this research has an investigative and descriptive caracter and an theoretical approach based on bibliographical data collection (judicial and doutrine decisions) that received qualitative treatment and dialectical approach. As a result, it is known that the judicial decision that determines the supply of medicines to those individuals who can not afford them with their own resources is legitimate and complies with the democratic principle, not violating the principle of separation of powers and the reserve of the possible, since the judicial decison is not stripped with an uniform and reasonable criteria, failing to contain high burden of subjectivism and witch signifies a possible exacerbation of functions by the judiciary, suffering, in this case, of requirement of legal certainty. It is concluded that the Court decision that determines the government the providing of medicine to those who can not afford the cost of treatment should be based on parameters such as: the protection of human dignity and the minimum existencial principle, the inafastable jurisdiction principle; compliance critique of the possible reserve principle; subsidiarity of judicial intervention; proportionality (quantitative and qualitative) in the content of the decision; the questioning about the reasons for non-delivery of the drug through administrative via; and, finally, the attention not to turn the judiciary into a mere production factor of the pharmaceutical industry, contributing to the cartelization of the right to health