When thinking about health and quality of life, the object of the formulation of public health policies, it is known that one should not to consider only problems caused by something originating from the biological dimension, that is, from the human body itself said. Health problems can also be caused by so-called social, economic and political determinants. Since the advent of the industrial revolution and the emergence of large urban agglomerations, it was perceived that the quality of health would be intrinsically linked to factors external to human life. Social determinants end up causing social inequities in health, which signify health inequality between population groups. In countries like Brazil, with enormous social inequalities, this inequality is considerable.
As society becomes complex, the social determinants also increase their degrees of complexity, a fact that makes the fight on the part of the State more and more difficult. From a historical and sociological point of view, it is possible to say that today there are determining factors that did not exist before, such as the exacerbated urbanization process, the issues environmental factors in the sense of pollution, the aging of the population, the worsening concentration of income, structural unemployment, in short, a series of phenomena characteristic of the days current. Not to mention the problems arising from the mere population increase or life expectancy as, for example, the scarcity of water resources, the issue of urban waste conditioning, sanitation, among others. Thus, it is up to the government to think about public policies that can consider and understand this greater complexity of facts.
Therefore, health is not just a biological phenomenon, but has a social dimension. Differences between quality and life expectancy among individuals are due to their social status, a condition linked to levels of education, access to services, good food, etc. Thus, it is necessary to consider that there are economic, social and political determinants. This analysis is important and, certainly, counts as encouragement for the discussions that take place in national terms, (starting from the Municipalities, passing through the States, to the Union), as seen in the 14th. National Health Conference held in 2011 and its preparatory conferences.
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Therefore, the debate and awareness of civil society are very important, since consequences arising from negative actions of each individual (in the sense, for example, of pollution from cities) can be repaired by positive actions of education and awareness. However, it is a fact that the confrontation of social determinants is done through public policies, which should promote equity in access to living conditions. Social determinants are not directly linked to the scope of health, but they influence human life at the same time.
What is clear when considering the relevance of social determinants in the design of public policies is that, in cases like Brazil, health also depends, fundamentally, on social justice. This is what Amélia Cohn (2006, p. 245), when saying that “in societies like Brazil, with one of the highest levels of social inequality on the planet, what effectively starts to matter is how to implement policies social and health that, by prioritizing the most socially vulnerable segments at first, do so with the logic of universalization, comprehensiveness and equity in care to health [...] depends above all on a society that participates in a citizen and responsible way so that social rights are constituted as a reality marked by greater justice Social".
Thus, to finish, it is worth paying attention to the speech of Vasconcelos and Pasche (2006, p. 558) who state that: “[...] the biggest challenge of the SUS continues to be to promote changes in the organization of services and care practices to ensure access and improve the quality of care at all levels of attention. Thus, changes in policy and management processes must be oriented towards the purposes of the system, which aim to ensure quality care and respond in a timely manner to the health problems and needs of the population".
Paulo Silvino Ribeiro
Brazil School Collaborator
Bachelor in Social Sciences from UNICAMP - State University of Campinas
Master in Sociology from UNESP - São Paulo State University "Júlio de Mesquita Filho"
Doctoral Student in Sociology at UNICAMP - State University of Campinas