Ex-ministros da Saúde lançam manifesto em defesa do SUS

Ex-ministros da Saúde lançam manifesto em defesa do SUS

Já leu
Da esquerda para direita, cinco dos seis ex-ministros que assinaram o manifesto: Humberto Costa, José Saraiva Felipe, José Agenor Alvarez da Silva, José Gomes Temporão, Arthur Chioro.

A saúde como valor solidário, direito de cidadania e dever do Estado nunca esteve tão ameaçada como agora. O alerta está destacado no manifesto SUS, Saúde e Democracia: desafios para o Brasil, apresentado por ex-ministros da Saúde, segunda-feira, 5/8/2019, durante a realização da 16ª Conferência Nacional de Saúde, em Brasília. Assinado por Humberto Costa, José Saraiva Felipe, José Gomes Temporão, José Agenor Alvarez da Silva, Alexandre Padilha e Arthur Chioro, o manifesto foi entregue ao presidente do Conselho Nacional de Saúde, Francisco Pigatto, no Ato em Defesa do SUS. No texto, os ministros apontam o impacto do sistema no aumento da expectativa e melhoria das condições de vida da população e observam que a atual política de aprofundamento de cortes dos gastos sociais, “em contexto de negação de direitos e de desvalorização das políticas universais, intensifica retrocessos e ameaça descaracterizar o SUS”.

 

Veja abaixo a íntegra do manifesto:

SUS, SAÚDE E DEMOCRACIA: DESAFIOS PARA O BRASIL

Brasília 5 de agosto de 2019

Ano da 16ª Conferência Nacional de Saúde

Nas três últimas décadas foram desenvolvidos imensos esforços para organizar e colocar em funcionamento o Sistema Único de Saúde, a partir dos princípios constitucionais que o conformam: universalidade, equidade e integralidade. O SUS pressupõe um projeto de sociedade que se expressa em valores civilizatórios, como igualdade, justiça social e democracia. Nesse contexto, a saúde é um valor que envolve cuidado, sustentabilidade e produção de saúde para a cidadania, articulando cuidados individuais e coletivos ao desenvolvimento econômico e aos direitos humanos.

O SUS, que é uma política de Estado e não de governo, é resultante de uma construção da sociedade brasileira e vem resistindo tenazmente a severos ataques de ordem política e econômica ao longo de sua existência. A saúde como valor solidário, direito de cidadania e dever do Estado, contudo, nunca esteve tão ameaçada como agora.

São expressivos e, objeto de reconhecimento internacional, os avanços na atenção primária consubstanciada na Estratégia de Saúde da Família (ESF), na Política Nacional de Imunização (PNI), na redução expressiva da mortalidade infantil, na Vigilância Epidemiológica e Sanitária, na política de Assistência Farmacêutica, de transplantes de órgãos, no Samu, na política de Aids/Hepatites, na Reforma Psiquiátrica, no combate ao uso de tabaco, na política do sangue, entre outras políticas públicas exitosas.

O campo da pesquisa e da inovação se fortaleceu, assim como a implantação de uma política industrial voltada para a produção nacional de tecnologias estratégicas para o país, a política de fortalecimento do Complexo Produtivo da Saúde, mediante parcerias entre laboratórios públicos e empresas privadas.

Todo esse processo permitiu que o país construísse uma ampla rede de atenção à saúde que hoje atende às necessidades da maior parte da população brasileira, com importante impacto no aumento da expectativa e na melhoria das condições de vida e na redução de iniquidades e desigualdades.

A magnitude e a relevância dessas realizações sem dúvida teriam sido mais expressivas, de maior alcance e de resultados mais profundos, não fossem os impasses estruturais, que impuseram ao longo dessa trajetória, fortes limites organizacionais e financeiros que impediram a plena realização de seus fundamentos.

Isso se expressa com clareza quando se analisa a estrutura do financiamento da saúde. Investimos cerca de 9% do PIB em saúde, mas desse valor apenas 46% corresponde ao gasto público, ou seja, a maior parte das despesas em saúde onera o orçamento das famílias e empresas. Nenhum sistema universal tem investimentos públicos tão baixos como o nosso, e quando se acresce a isso uma renúncia fiscal e tributária expressiva a cada ano, o quadro de subfinanciamento se agrava.

É nesse contexto que incide a EC 95 que, ao colocar a austeridade como princípio constitucional, congela os gastos por 20 anos e subjuga as necessidades de saúde da população às metas fiscais, impondo ao SUS o status de sistema desfinanciado, colocando em risco até a sua sobrevivência.

Essa política de aprofundamento de cortes dos gastos sociais, em um contexto de negação de direitos e de desvalorização das políticas universais, intensifica retrocessos e ameaça descaracterizar o SUS. A fragilização do SUS se soma ao ataque a várias políticas públicas fundamentais no processo saúde-doença e no conceito ampliado de saúde que envolve a natureza simultaneamente biológica, subjetiva e social dos problemas de saúde

Essa base constitutiva das políticas de saúde está sendo desconstruída por mudanças em políticas de grande impacto na saúde, sem que o Ministério da Saúde e o parlamento sejam ouvidos, entre as quais podem ser destacadas:

  • os retrocessos nas normas de segurança nos ambientes de trabalho e legislação referente a acidentes de trabalho e doenças profissionais;
  • propostas referentes à legislação do trânsito que impactam na morbimortalidade por acidentes envolvendo veículos automotores (velocidade nas estradas, normas e regras para condução, “cadeirinha das crianças”, número de pontos para ter a carteira cassada);
  •  os ataques ao Estatuto da Criança e do Adolescente;
  • as restrições ao amplo acesso à educação e informação e a fragilização das políticas voltadas aos direitos sexuais e reprodutivos;
  • as reiteradas ameaças ao estatuto do desarmamento;
  • o aumento dos benefícios fiscais para a indústria de refrigerantes, indo na contramão do que se faz em todo o mundo;
  • o ataque à educação pública e a ameaça à ciência nacional com o drástico contingenciamento do orçamento setorial;
  • a liberação sem critério de agrotóxicos e pesticidas e as ameaças à saúde, ao meio ambiente e à sustentabilidade;
  • a nova política de drogas, que possibilita a internação involuntária de usuários, prioriza as comunidades terapêuticas e a abstinência como objetivo do tratamento da dependência, ao invés das políticas voltadas ao tratamento de saúde de usuários, focadas na redução de danos;
  • a proposta do MInistério da Justiça para redução do preço do cigarro que fragilizará a exitosa política de prevenção e controle do tabaco.

Da mesma forma é preciso atenção redobrada para os riscos da fragilização da regulação do setor privado na saúde. As constantes iniciativas do mercado com a intenção de flexibilização de regras de cobertura, da introdução de planos populares e de reajustes dos planos de saúde, devem ser combatidas.

A visão hegemônica no governo e no parlamento, assentada sobre uma falácia, é a de que a saúde, ao invés de investimento, é gasto e que a gestão em moldes empresariais, mesmo em um contexto de redução dos gastos, permitirá fazer mais com menos, ainda que isso comprometa a qualidade de vida e ameace a segurança dos cidadãos e famílias.

Daí também decorre a visão largamente disseminada – e da qual divergimos frontalmente – de que o SUS não pode ser universal, pois “não cabe no orçamento” e deve se destinar apenas a prover cuidados mais simples aos mais pobres. Essa visão equivocada desconhece, para além dos benefícios diretos do SUS sobre a saúde da população, que as atividades relacionadas ao setor saúde – serviços, medicamentos, vacinas e equipamentos -, respondem por cerca de 8,5% do PIB e incorporam setores estratégicos de inovação – tecnologia de informação, biotecnologia, microeletrônica, química fina, nanotecnologia, entre outros – com ampla repercussão em todos os setores da economia, e responderam por 10% dos postos formais de trabalho qualificado, empregando em torno de 9,5 milhões de brasileiros em 2015.

A disseminação da imagem de um SUS precário, refém de trocas político-partidárias, atendendo a interesses privados e insustentável com recursos públicos, apaga da percepção pública os importantes avanços obtidos e fragiliza sua sustentação social.

O SUS precisa e pode ser aperfeiçoado, pois é um patrimônio da nação brasileira e uma política social a ser preservada e valorizada como bem comum de valor inestimável, como ocorre em outros países com sistemas universais de saúde, a exemplo do Inglaterra, Canadá e Portugal entre outros.
Assim, a reafirmação de um sistema público e universal no campo da saúde fundamenta-se, em primeiro lugar, em princípios civilizatórios e de justiça, mas também em evidências sobre as vantagens dos sistemas públicos universais em termos de custo-efetividade nas comparações com outros modelos, baseados no setor privado, planos e seguros de saúde.

É preciso, mais do que nunca, fortalecer e ampliar a participação social na formulação, acompanhamento e fiscalização das políticas de saúde em todas as esferas de governo. Respeitar e implementar as decisões das conferências e dos conselhos de saúde, aprimorando e garantindo a democratização do Estado e a participação cidadã é fundamental para os destinos do SUS e do país.

O SUS é uma conquista do povo brasileiro. Sua consolidação e aperfeiçoamento são eixos fundamentais para a sobrevivência do Estado de Direito Democrático e na afirmação de políticas públicas de inclusão social.

Por ser a expressão real desses valores, a defesa de uma saúde pública moderna, de qualidade e respeitada pela sociedade deve ser baseada em uma ética do cuidado e na sustentabilidade política, econômica e tecnológica do SUS, o que exige a reafirmação do SUS – universal, equânime, integral e gratuito – como o sistema de saúde para todos os brasileiros e brasileiras.

Brasília, 5 de agosto de 2019.

Humberto Costa

José Saraiva Felipe

Jose Agenor Alvarez da Silva

José Gomes Temporão

Alexandre Padilha

Arthur Chioro

 

 

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