Hello, In this class, we will talk about the actions and strategies for Workers' Health in the SUS, as advocated by the National Worker's Health Policy. The objective of this block is to know the actions, strategies, challenges, and perspectives of Worker's Health, focusing on its strengthening and its perspective as a social Conquest. It is the result of the demands and pressure that the Brazilian population has exerted throughout history in the formulation of public policies in the country.
We would like to highlight that even though these achievements are within the scope of the SUS, Worker's Health is mainly expressed as a perspective of the relationship between work and health not only for individuals but also for collective and population groups. In this sense, we hope it serves as an inspiration to people, whether workers and their families, or students and professionals from the various areas involved with the protection of workers both in the public and private spheres. This is because Worker's Health mainly seeks to transform productive processes turning them into promoters of health and not of illness and death.
Always considering, as Ramazzini said, the job performed, that is, taking into account the insertion of the workers themselves in the productive processes. Considering both the individual, collective, biological, social, and political aspects, Worker's Health interventions can be systematized into three axes. The health promotion axis stems from the premise of work as a promoter of health, quality of life, personal fulfillment, and community commitment, and not as a promoter of overload, suffering, and exploitation.
Thus, we understand that accidents and illnesses are not inherent to work processes. They are yet another expression of the lack of prioritization of the Worker as a human being and citizen with rights, including decent work, which is one of the UN's sustainable development goals for example. The health promotion axis seeks to strengthen the autonomy of workers through education, health, communication, and information activities, as well as participatory management of workers and the general population in the health system, always bearing in mind healthier production processes for human beings, animals, and the environment.
Therefore, we need to articulate the formulation of public policies, regulatory processes, and intersectoral protective norms aimed at sustainability and equity affecting the social determination of health in the country. In the health care axis, we seek to recognize all citizens of working age as potential workers, therefore, the need to investigate their working conditions, whether current or previous, when applicable, thinking about preventive actions to diagnose, treat, and rehabilitate more appropriately. In this sense, we identify the relationship between the health condition and work or a causal link; the notification of cases, which are compulsory notifications both in the public and private sectors when relevant, and also a discussion with workers about prevention measures, especially collective ones, and their labor and social security rights.
In the VISAT axis, which stands for Worker Health Surveillance, we seek preventive and more assertive, and effective actions. For that, we need to take into account the reality of the places and work processes in the different sectors and production chains. Through the surveillance of work environments and processes, Health Professionals check the working conditions in public or private establishments in partnership with professionals from other sectors as well as the workers themselves.
We also seek to identify and investigate the risks and dangers to which workers are exposed, and the implementation of recommended measures both in compliance with legal provisions, such as the NRs, as well as other documents issued by the Public Ministry, and by the Health Surveillance or collective agreements for example. We also have epidemiological surveillance of diseases and work-related health issues that are carried out based on the actions of feeding and monitoring information such as compulsory notifications or data on mortality, hospitalization, and clinical care in addition to communication with other services and institutions such as trade unions, the Public Ministry of Labor, Social Security, and police departments specialized in labor and public security. In the interface with environmental health surveillance, we have integrated actions to monitor the rates and forms of contamination of the environment and the population through pesticides, heavy metals, and petroleum derivatives for example.
Thus, these three axes; promotion, assistance, and surveillance contemplate the strategies of the National Worker's Health Policies, such as the actions of VISAT integrated with other components of health surveillance, and the analysis of the productive profile and health situation of the working population to carry out and monitor interventions. The structuring of the RENAST to propagate work as a determinant of health, professional training and development of studies and research on Workers' Health, and intersectoral articulation including the participation of workers. In over 30 years since the implementation of the SUS and Workers’ Health, we can observe advances made, especially in the increase of Workers’ Health services throughout the country, particularly through the CERESTs, which are reference centers for Workers' Health, and specific funding for the area.
Consequently, this leads to the propagation and expansion of Workers' Health practices, which we have for example in the VISAT axis, public health surveillance actions, and articulations with workers and unions. We also have the qualification and the increase in notifications of diseases and work-related health issues, mainly through an intrasectoral articulation, that is, within the health services sector itself. There are also permanent educational activities, or continued education in the SUS.
This is true for both managers and the working population. With an emphasis on primary care, we have Workers’ Health support actions for individual or collective cases aiming at strengthening the Clinical Reasoning of the health teams that serve this population, and thus, the accumulation of knowledge and practices in the area. The most important thing to consider about the institutionalization of Workers' Health, in the services, and the scientific community, is its continuity and strengthening of the area based on the propagation of the ethical and political commitment of Workers' Health.
So, we can consider that the greatest achievement is the universality of access to health services and the commitment to the protection of workers, as subjects of their actions, and not the exploitation of their workforce by having the worker as the object of health actions. In this sense, studies and research point to numerous challenges, but it is worth remembering that, to some extent, many of these challenges only exist because of the achievements and advances in the field of work and health relations. Thus, the idea here is to present the challenges in an articulated way with the perspectives for the future that we intend.
We can then go back to the historical background thinking about the health service linked to companies and therefore focused much more on maintaining production than protecting workers, in addition to the public policy prior to the Federal Constitution of 1988, which guaranteed rights only to workers in the formal labor market without considering informal, retired or unemployed workers. That is why we reinforce the perspective of Workers' Health as a social achievement of Brazilian civil society. This historical trajectory in the field of work and health relations, since Ramazine in the 1700s passing through occupational medicine, occupational health, and philanthropic assistance to finally arrive at Workers’ Health and social security, shows the lack of prioritization of worker protection, and thus, we manage to raise awareness about the importance and the difference of the Workers’ Health perspective in the SUS.
Considering the perspective of Workers' Health in the SUS, which is more recent than previous ones, we can perceive an absence of this perspective in professional training, whether in technical or undergraduate courses in the various areas involved with worker protection or even in continued education activities of professionals who already work, for example, in the SUS or other sectors, such as labor and social security. At the same time, we can see an increase in scientific production and postgraduate courses in Worker's Health, especially around the 2010s, and this provides the conditions for Workers’ Health to be consolidated and strengthened both in the curricula of health courses and in the daily practices of professional training. Thus, we introduce this theme in order to propagate and legitimize the identification and recognition of work-health relations, emphasizing the importance of work in the social determination of Health.
Considering the macropolitical context, what we have is the advance of neoliberal policies since the 1990s, and therefore, economic and development policies, and international relations that are much more concerned with responding to globalization and external fiscal adjustment instead of valuing sectors such as health, education, social security, and social assistance. This is evidenced especially in the overlap of policies. For example, we have investment policies for agribusiness, including the encouragement of the indiscriminate use of pesticides that harm both human life and the environment, while this same type of investment policy does not apply to the SUS, for example.
Within the scope of the government, we have managed to point out the needs of the Workers’ Health area making it possible to implement the PNSTT (National Occupational Health Policy). In partnership with workers, organized civil society, public servants, and the scientific community, a report by the technical chamber of Workers' Health in the National Health Council was elaborated indicating the creation of an additional 300 CERESTs in Brazil. We also have the configurations of the world of work, which in the case of Brazil and other less favored countries in globalization, have unemployment as a structuring factor for the maintenance of harmful forms of work.
Thus, it is very important to recognize, value, and strengthen the struggle of workers and trade union movements to legitimize claims, as well as add elements for technical and political discussions. In addition, we also overlap old issues of late industrialization, which lead to high rates of accidents at work, for example, along with the technological advances in the automation and computerization of production, and the shift in the predominance of the secondary sector to the tertiary sector, i. e.
, in the provision of services. This creates new risks and dangers related to the organization of work processes, much more than the physical or visible aspects, which implies the emergence and growth of work-related illnesses such as cardiovascular diseases, mental disorders, and cancer. These are complex issues that require intersectoral action.
In this regard, we know that this concept is very recent, and paths need to be discovered, reaffirmed, and valued to achieve its effectiveness. There are many diverse initiatives by Workers' Health services and professionals that seek articulation with services and professionals from other sectors that are more committed to protecting the workers' health than to maintaining production. We can also think about an intersectoriality that goes beyond the traditional partners, such as Labor, Social Security, and the Public Ministry, thinking about an articulation with the population, which we will call “transitoriality”, and that can be observed in the growing wave of movements such as conscious consumption, agroecological communities, family farming, the international debate on the sustainability of human ways of life, and the environment.
These are examples of political and everyday initiatives and proposals that are more consistent with the health of workers, the general population, and the planet. The Workers' Health movement has a history marked by advances and retreats, but mainly by the defense of the right that all workers have to live, produce, and share the wealth they build with their work. For that, they need to be healthy.
I hope these classes have helped you understand a little more about the achievements and disputes in the field of Workers' Health protection, and I'll stop here. Bye, bye.
