Hello, I'm Irina. I'm an occupational therapist, sanitarian, and specialist in workers' health. I did my Master's in Public Health and I'm currently doing my PhD in Public Health at USP.
In this module, we will talk a bit about the historical panorama and the current configurations of workers' health policies in Brazil, always considering the protagonism and autonomy of workers as fundamental elements for their health conditions. Therefore, the objective of this and the next class is to learn about the trajectories of health policies and practices aimed at the Brazilian working population emphasizing Workers’ Health in the SUS (the Brazilian Public Health System), and its aspects, which differ from its historical antecedents. To do this, we will review what you saw in module one about the Health and Disease process, and we can consider that its relationship with work is dated, in a broader sense, to the end of the 17th century, with doctor Bernardino Ramazinni.
He was considered a pioneer in the systematization and teaching of workers' health problems, having published the Workers' Disease Treatise, in which he identified certain illness characteristics that were related to certain trades or specific work conditions. Therefore, he considered it essential in medical practice to ask the question “What is your occupation? ” because that could already say a lot about the condition that the individual to be treated presented.
He also highlighted the importance of visiting workplaces and hearing from workers themselves about what and how they performed their work. What we also saw is referred to as “real work. ” After that, it was only in 1830, in the context of the Industrial Revolution, that we saw the creation of occupational medicine.
This occurred at the time of the urbanization of European cities, where working conditions, especially in factories, were extremely precarious and unhealthy. Considering that at that time, most of the workers, who were factory workers, had no access to medical or health care, except for philanthropic ones, this scenario was generating a lot of illness, and these illnesses resulted in the absence of workers, if not their death, or permanent incapacity for work. For employers, this meant a loss of workforce.
So, concerned with reducing the loss of the workforce, and not exactly with taking care of the worker's health, medical services were created inside the factories, that is, with doctors at the service of the employers. The first of these experiences was in England, in 1830, however, it was only in 1960 that they were named “Occupational Medicine Services. ” It was in that same period, around the middle of the 20th century, that in the post-war context, Europe and North America were resuming their industrial production, with the insertion of new technologies, both in industrial processes and new chemical products.
These innovations, along with the accumulation of illnesses and accidents, which until then were characteristic of factory work, occupied an ever-increasing place in the social, political, and economic scenario, thus revealing the limits of occupational medicine. As occupational medicine is a uniprofessional approach centered solely on the medical professional and has a predominantly curative vision focused on the individual scope of the health and disease process. To respond better to health demands, other fields of knowledge were included, such as ergonomics, industrial hygiene or occupational hygiene, and toxicology.
This configures what we call an occupational health approach. Occupational health aims at interdisciplinarity in teams, becoming an area of activity for services and research called health and safety at work. The idea is to intervene in work environments to control occupational hazards.
In Brazil, for example, this is expressed through Regulatory Norms (RNs in Portuguese). A criticism of this form of action, which is based on the regulation of working conditions, is, for example, the definition of safe levels of exposure to toxic substances and the limits of tolerance. The problem is that these tolerance limits differ from country to country, that is, some populations may be exposed to higher levels than others, and precisely the most protected populations tend to be those of countries that are already more economically and politically consolidated.
In addition, occupational health continues to be developed mainly in companies, serving much more the interests of employers than the protection of workers' health. Thus, in this sense, occupational health continues to consider the worker as the object of its intervention and not as the subject of its action. In that same period, we created public policies of social protection in Brazil, that is, State policies that indicated the rights of access to health services, for example.
In the 1920s, the CAPS (retirement and pension funds) were created based on German social security policies. They covered only formal workers and taxpayers. Initially, they started with workers located in more strategic economic sectors, such as railways and banking, and this coverage expanded over the years due to pressure from workers in other sectors that were not covered.
It is in this scenario of lack of understanding of workers as subjects of their practices and restricted access to health services that workers' health emerges. In Brazil, in the last years of the military regime, there was an intense social mobilization. In this context, the guidelines of the trade union movements and the workers came together with the guidelines of the Brazilian health reform movement, which configured what is known as “workers' health.
” In practice, in the early 1980s, we had the experiences of workers' health programs (PSTs in Portuguese) in the states of the Southeast, South, and Northeast. And then, together with what was already being produced by occupational medicine and occupational health, the workers' health teams were adding workers' participation in this process. As public health services, the PSTs also sought integration with other health services and sectors, such as labor and social security.
As a social and political movement, we were influenced by the Italian labor movement, which mainly sought the active participation of workers in health, safety at work, and social security policies, as it was in England, with the universalization of access to health services regardless of social security contribution. We also had the contribution of Latin American social medicine, which highlighted the importance of work in the social determinants of health. It is through the new Federal Constitution of 1988 that workers' health becomes a field of action of public health by the SUS, the Unified Health System.
This institutionalization can be considered a great advance, since health practices in their social and historical context, are guided by current health policies. We will discuss the developments of this process in the next class.
