EDITORIAL

Universal access in health and the challenges for the Brazilian nursing in a crisis situation

We have seen the resumption of the use of old concepts from kinds of logic and meanings that are different from which they originated. The various uses made by the concepts relate to projects of different natures, be they historical, political or institutional. As a professional category, we must identify the various uses made by concepts and also in which political-institutional fields they have been used.

Health as a right was a proposal from the National Health Conference of 1986 and affirmed by the Brazilian Federal Constitution of 1988, which entailed the construction of a health project based on the idea of universal access.

The concept of health access qualifies a set of interactions and relationships in order to confront and give concrete response to health problems and needs, and presents itself as an open concept, subject to change in accordance with the historical context. Some authors consider that there is a shift in history that will develop the understanding of the concept of access beyond merely seeing it as a service provision, including the results obtained as well. This brings to the debate political arguments and factors related to subjects who seek the services, to the ability of continuing to care, and even the understanding of what health is. In this sense, a premise that we have to consider is that there is not a single project at stake.

In the case of Brazil, the question of access articulates with the ways in which the entities and organs of the nursing class, collectively, have joined the Health Reform ideas, especially from the 1980s, when the principles that should sustain an inclusive and democratic health project started to get clearer. Based on the thought of public health physicians such as Sergio Arouca, the concept of universal access does not dissociate itself from a political understanding around the themes of justice and social equality. Health is democracy, and vice versa, and the idea of the expanded concept of health distancing itself from the uncompromising defense of the conception of health as the right of every person, and a duty of the State, through public policies, should not be accepted.

Access is one of the factors that contributes to the promotion of social justice, and it should be considered in its current context, as a threat to structures and policies that configure a welfare state, which were really difficult to be conquered in decades of social mobilization and qualification of the Unified Health System (SUS – Sistema Único de Saúde) as an equity policy. In this context, various interests govern various projects. Taking into account that there is a breakdown of the model of capital accumulation, around the world, and that the health sector is one of the highest consumers of financial resources, all proposals around the expansion of coverage need to be analyzed considering the difficulties of the countries, in particular those linked to late capitalism such as Brazil, to ensure adequate public resources, which opens loopholes for the participation of the private sector, by providing targeted health procedures.

Recent proposals of reorganization of health systems based on the concept of universal coverage of services have been discussed and questioned by entities such as the Brazilian Center for Health studies (CEBES), the Latin American Social Medicine (ALAMES) and the Brazilian Association of Collective Health (ABRASCO), that put in question the risk of simplifying a complex situation, which has macro-political and economic determinants, through potential provision of basic services. In this sense, it is necessary to distinguish the concept of universal access from universal coverage, since the latter refers to the possibility of widespread offer of procedures and actions of health according to people's ability to pay. In other words, despite talking about universal coverage, this type of model reduces the population's right to health.

Accordingly, reaffirming the social commitment of the Revista Enfermagem UERJ, we remind you that only public and universal systems like SUS can ensure health for everyone and the right to health. It seems to us that, in times of institutional and political crisis, and in the field of social rights, the biggest challenge of the Brazilian nursing is to realize that we are the support base of SUS and that we will only be strong if we unite around its strengthening.

Helena Maria Scherlowski Leal David
Sonia Acioli
Associate Editors