EDITORIAL

Crisis situation, health and social inequality: what is the responsibility of nursing?

The time that is lived is not the time of the logic of global capitalism. The widespread feeling of drift and the ability to understand the political, economic and social processes are in lockstep with the speed with which the changes have been taking place. In Brazil, we are not talking about socially agreed expected changes, but instead about a disassembly process of public policies and many state actions, nothing really better or more comprehensive, in terms of social protection of the most vulnerable groups. The most recent examples that most mobilize indignation has been the sudden and growing implementation of the so-called austerity measures, with a cut in the distribution of public resources to education and health, although there are still ways to protect, via tax exemptions, industrial sectors and the financial capital, represented by the big banks. These changes take place in the midst of social relations marked by the intensification of the collective expression of conservative forms of thinking, with superficial, little elaborated and historically mistaken analyses of democracy, civil and human rights, cultural diversity and other issues.

Social media, a space for maximum expression of individuality protected by anonymity, has been the privileged field for these expressions, which, however, also advance to collective action, which is almost always violent, marked by prejudice and hatred, generating a daily life in which more and more often there is less condition for respectful dialogue between the differences. The repressive apparatus of the Brazilian State, historically aligned with this view of hatred and conservatism, has been acting under the orders of a judiciary whose actions have extrapolated the scope of the fair trial and the protection of basic rights to a great extent, confusing the citizens regarding the republican separation of powers. What we have seen is a judiciary which acts as the executive power, protected by a legislative power of very low representativeness , and whose characteristic has been ostentatious and media actions, which rouse polarized and segregating attitudes. A vicious circle that replaces forms of sociability built based on a pluralist and diverse vision, favoring voluntary and excluding acts that dangerously lead to situations of barbarism.

In the health sector, the historic fight that professionals and social movements have been building towards an inclusive and universal health system, always bumped into privatizing interests and into visions marked by a neoliberal hegemonic thinking that seems to understand health financing just as an expense, not as a social investment for the sovereignty and full life of people, which in fact that is what it is. This view completely denies the possibility of thinking and building a comprehensive and universal public health care via public policies, and imposes the organization of other new forms of social struggle.

With the advancement of this unfavorable and somber political-economic conjuncture, there are many questions about the negative impacts on the health of the population. Poverty and unemployment, especially in the outskirts of large cities, bring immediately visible results, such as increased population living on the streets, and it is expected that in the short term, other problems are produced, affecting the health of vulnerable groups.

The responsiveness of the public health system, which is compromised, should be questioned. Public policies are not limited to "solving" social inequality issues: under certain circumstances, depending on what they are, and how they are implemented, they may result in increased inequality and social injustice, given their discretionary power and exclusion. The very concept of "vulnerability" and "risk", in the health sector, can involve a social agency able to result in the exclusion of a portion of the population.¹

According to a recent bulletin² concerning public policies and inequalities, published by the Institute of Economic and Applied Policies (IPEA), it is necessary to consider the implementation of public policies as the result of complex interactions and pacts that come to being not only at the macrosocial level. The daily implementation, by the social agents, of the diverse policies in course is marked by the relative variables to the conceptions and world views of these same agents, who are part of the Brazilian society and live, as everyone else, this same confused conjuncture of crisis, and the same sensation of drift. About these social agents, the same text points out:

Because of the conditions under which they do their work - resource scarcity, excessive demands, detachment from the spheres of central formulation, complexity of rules and immediacy of the face-to-face meetings with users, they inevitably end up enjoying some degree of discretion in the execution of their tasks. The daily use of discretion, in turn, involves uncertainties and dilemmas about how to act in each situation. In their decisions on how to proceed in each situation, the agents turn to complexity reduction processes and simplification of uncertainties and dilemmas, by means of differentiation, trial and classification of users cared for in a restricted set of categories (formal and informal), which comes associated with certain types of action and referrals in the service/benefit that was offered. These processes mingle elements stemming from both the impetus of front-line agents to gain more control over their routines and workload and moral judgments based on the prevailing values ​​and preconceptions of a society.^2:9

When analyzing social policies, nursing, being the most numerous and widely inserted category within the various levels of implementation of the health sector policy, constitutes a significant contingent of social agents. We are subjected, like other social agents, to the limits imposed by work and life conditions, as well as our actions are buoyed by the better understanding of our role as social practice. On the one hand, we want to ensure our control over our working process and professional autonomy. On the other hand, we must be clear that this control and autonomy can be given at the expense of a discretionary action, which excludes rather than including, even though we are not fully aware of these implications in our troubled day-to-day work.

It is worth leaving a question, aimed at promoting reflection, which is addressed to all those who choose, every day, to keep on working in nursing, within the public health system: what is our share of responsibility? How are we going to fulfill our ethical, political, techno-scientific and humanistic principles for a kind of health that is truly for everyone, not just for some?

Helena Maria Scherlowski Leal David
Associate Editor

REFERENCES

1. Bornstein Vera Joana, David Helena Maria Scherlowski Leal, Araújo José Wellington Gomes de. Agentes comunitários de saúde: a reconstrução do conceito de risco no nível local. Interface (Botucatu) [Internet]. 2010 Mar [cited Oct 20 2017]; 14 (32): 93-101. Available at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-32832010000100008&lng=pt. http://dx.doi.org/10.1590/S1414-32832010000100008.

2. Instituto de Pesquisa Econômica Aplicada, IPEA. Políticas Públicas e Desigualdades Boletim de AnálisePolítico-Institucional. Vol. 13 (Oct.2017); IPEA: Brasília;cited Oct 20 2017]; Available at: http://ipea.gov.br/portal/images/stories/PDFs/boletim_analise_politico/171020_bapi_13.pdf