MOOCS Saúde Mental Relacionada ao Trabalho - 15 - Configurações atuais

Hello, In this class, we will continue discussing workers' health policies in Brazil and addressing the current configurations, specifically since the Federal Constitution of 1988. Considering that health practices are directed by health policies, we can add that the level of organization and pressure that civil society exerts is closely related to the social policies assumed by the State. In other words, bringing this to Brazil, we can say that it was the social pressure at the time of our re-democratization that made the conquest of universal rights possible.

In normative terms, we will highlight the Federal Constitution of 1988; The Organic Health Law (LOS in Portuguese) and some SUS ordinances; National policies on safety and health at work and on workers' health as a way of illustrating the trajectory of workers' health in Brazil. The Federal Constitution was enacted in 1988. It is also called the Citizen Constitution or Magna Carta and is the result of a years-long process of elaboration by the Constituent Assembly.

It also partially incorporated the Brazilian Sanitary Reform project, considering social rights related to health, social security, and social assistance. It is up to the SUS, among other attributions, to carry out sanitary, epidemiological, and workers' health surveillance activities. It was in this new Constitution that the actions of health services were decentralized to the municipalities.

The Organic Health Law (law 80-80) was published in 1990. In it, we had the regulation of the SUS, where work is recognized in the social determination of health, thus reinforcing the execution of workers' health actions by the health system. So, workers' health is defined as a set of activities intended, through epidemiological and health surveillance, to promote, protect, recover, and rehabilitate workers' health, considering the risks and health problems arising from work conditions.

Thus, it also indicates actions to provide assistance and information to workers and union entities on relevant and pertinent matters. Studies and research for evaluation and innovation focused on environments and work processes that promote health and the participation of workers in the standardization, supervision, and control of their working conditions. In 1998, two specific regulations on workers' health were published, one in July on Worker's Health Surveillance, which is the VISAT, and one in October on the procedures and actions of the Worker's Health Service.

These norms, in addition to reinforcing what was already being advocated, also added some aspects that expand the practice of workers' health in an intersectoral way. Here, we highlight the universality of the health coverage for informal, self-employed, domestic, retired, and unemployed workers in addition to workers who were already covered by social security before the constitution. We also reinforce the integrality as a convergence of health promotion, surveillance, and assistance activities.

The participation of the community of workers in the actions, with regard mainly to the dissemination of information and participation in research interventions carried out by the health services. All this to transform work processes as health promoters. In 2002, the decree implementing RENAST, which is the National Network of Integral Attention to Worker's Health, was published.

Despite having been somewhat controversial in its implementation, due to being directed towards assistance services, we highlight the stimulus for the creation of the Reference Center for Occupational Health (CEREST), quantitatively expanding its services across the country and also directing exclusive resources and financing for the area of workers' health. All of this is linked to action plans for workers' health to be carried out by states and municipalities. In 2005, we had the publication of a new ordinance for the expansion of RENAST, which was revoked by the 2009 ordinance, to adjust the RENAST to the reorganization that the SUS had been going through in the perspective of primary care as an organizer of healthcare networks.

In 2004, we had the publication of ordinances that added work accidents and some of the diseases related to work as compulsorily notifiable health problems. That is, all health services, whether public or private must notify their respective Secretary of Health of any confirmed or suspected cases of work-related illnesses or injuries. Among these problems, we have the notification of work-related mental disorders, which will be seen in the next module.

There are also repetitive strain injuries, exogenous poisoning, as in the case of pesticides, and work accidents as well. In 2011, the National Policy on Safety and Health at Work, the PNSST was published. This policy is an inter-ministerial policy for the promotion of health and the improvement of workers’ quality of life, as well as the prevention of work-related illnesses and accidents through the elimination or reduction of occupational risks.

The principles of the PNSST are universality, social dialogue, and integrality, emphasizing prevention as a precedent for assistance, rehabilitation, and reparation actions. It recognizes the need for continuous articulation between government actions in an intersectoral way and defines the responsibilities of the Ministry of Labor, Social Security, and Health, without restricting the participation of other related sectors. In this sense, what we observe is much more a division of actions, maintaining what had already been done before, such as, for example, inspections in the work environment for the Ministry of Labor, professional rehabilitation, and the assessment of working capacity by Social Security agencies and surveillance and health care by the Ministry of Health.

We did not have, for example, more explicit and concrete proposals of integration between these Ministries for intersectoral actions. The following year, in 2012, we had the publication of the National Occupational Health Policy. The PNSTT, which, unlike the PNSST, deals with actions and guidelines within the scope of the SUS, as a way of institutionalizing and registering this counter-hegemonic perspective of caring for workers' health care, which is what workers' health in the SUS proposes.

The PNSTT institutionalized the principles and guidelines that, to a certain extent, were already being developed by the services, by the workers, and by the scientific community committed to the workers' health movement since the 1980s. It emphasizes the integrality of health care for workers in the articulation of actions for the promotion, prevention, assistance, and recovery of health, placing emphasis, as in the PNSST, on prevention and preventive actions, and, above all, on valuing the perspective of the worker in the actions. The PNSTT recognizes that for its effectiveness and impact on the reduction of work-related deaths and illnesses, substantial changes are and will be necessary for the health sector, from the organization of network services to the interdisciplinary performance of the teams of professionals in the SUS.

It also considers that these deaths, illnesses, and injuries are a result of development models and production processes in society, thus indicating the need for economic and development policies that are consistent with the protection of workers' lives and health. In the next class, we'll go into more detail about workers' health actions, taking into account their advances, challenges, and perspectives. But before that, we will indicate the reading of a text, until then.