Carlos Augusto Grabois Gadelha

Saúde e inovação: uma abordagem sistêmica das indústrias da saúde

Recognizing the importance of generating and disseminating innovation for the social and economic development of capitalist countries and the systemic, institutional, and historical nature of this process, this paper emphasizes the need to deal with innovation in the health sector within a framework linking economic, institutional, and policy dynamics. Analysis of the main health goods industries (manufacturers of pharmaceuticals, vaccines, and diagnostics) shows that in the developed countries there is a certain compatibility between the health system and the innovation systems in terms of requirements, and that the state is an essential player in this articulation. In Brazil, however, there is a marked disconnection between the health and innovation systems. The few initiatives aimed at this link have enhanced the competitiveness of national agents and have been essential elements in national health policy. Based on this analysis, it is argued that beyond its social dimension, health policy is a strategic means to consolidate a dynamic innovation system, with direct effects on national development.

Desenvolvimento, complexo industrial da saúde e política industrial

This paper puts health questions within the context of national development and industrial policy. It follows the idea of structuralist, Marxist and Schumpeterian approaches, in which industry and innovations form determining factors for the dynamism in capitalist economies and relative positions within the world economy. All countries that have developed and started to compete under better conditions with advanced countries have had an association between strong industry and an endogenous knowledge, learning and innovation base. However, in the field of health, this vision presents problems because business interests move according to the economic logic of profit rather than to meet health needs. The notion of the health-industrial complex is an attempt to provide a theoretical reference that enables linkage between two distinct types of logic: health and economic development. This study has sought to show, on the basis of foreign trade data, how disregard for the logic of health policy development has led to a situation of economic vulnerability in this sector, which may limit the objectives of universality, equality and comprehensiveness. Within this context, a cognitive and political break with these antagonistic visions that put health needs on one side and industrial needs on the other is proposed. A country that aims to reach a condition of development and independence requires strong innovative industries and an inclusive and universal health system, at the same time.

O complexo industrial da saúde e a necessidade de um enfoque dinâmico na economia da saúde

This article develops an analytical approach towards the study of health industrial complex, comprising the set of productive activities on health and their interdependencies, according to a perspective of political economics and innovation. The capitalist enterprising logic penetrates all the productive segments, involving as well the industries which were already traditionally working on these bases, as segments having organization forms on which it was possible to verify the acquaintanceship of enterprising logic with others that were moved away from them, as vaccine production and biological products, phyto-derived and health care services. The article analyzes the interaction between the health system and the economical-industrial system, explaining how it has been succeeding a dichotomy on the relation between both of them, which is expressed by the deterioration of the innovation potential of the country and on a growing and worrying external vulnerability of health politics. It is suggested that the traditional neoclassical approach of health economics is not sufficient to attend health industrial complex, due to the intensity of the process of structural change, and the need of a theoretical alternative approach incorporating the dynamics of economic and institutional transformation, of accumulation and innovation.

Evidence-informed frameworks for cost-effective cancer care and prevention in low, middle, and high-income countries

Evidence-informed frameworks for cost-effective cancer prevention and management are essential for delivering equitable outcomes and tackling the growing burden of cancer in all resource settings. Evidence can help address the demand side pressures (ie, pressures exerted by people who need care) faced by economies with high, middle, and low incomes, particularly in the context of transitioning towards (or sustaining) universal health-care coverage. Strong systems, as opposed to technology-based solutions, can drive the development and implementation of evidence-informed frameworks for prevention and management of cancer in an equitable and affordable way. For this to succeed, different stakeholders-including national governments, global donors, the commercial sector, and service delivery institutions-must work together to address the growing burden of cancer across economies of low, middle, and high income.

Oportunidades na indústria de medicamentos e a lógica do desenvolvimento local baseado nos biomas brasileiros: bases para a discussão de uma política nacional

OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population.

Medicamentos genéricos no Brasil: impactos das políticas públicas sobre a indústria nacional

This paper echoes recent works of Abrasco1, Gadelha2 and Guimaraes3 emphasizing the need for a better integration between health policies and industrial development and innovation policies as the only way to keep the economic benefits generated by health expenditures in the country instead of letting them escape through imports and threaten the continuity of the social policy by growing trade deficits. Although presenting the generic drug policy as a successful case in integrating social policies aimed at a better access to quality drugs for the population with economic policies aimed at industrial development, this paper discusses the impacts and limitations of the referred policy in a dialog with Abreus analysis of industrial competitiveness in the Brazilian generics industry.

Saúde e territorialização na perspectiva do desenvolvimento

The relationship between health and development is complex and lies in the field of political economy, given that it involves different social, political, and economic interests. In the Brazilian case, this association is particularly relevant in terms of the territorial dimension, in light of the central role of healthcare services in the organization of the urban network and the demarcation of territorial schedules and limits. In the theoretical-conceptual field, this study explores analytical areas that approach the relations between health and development, as well as between health and the territorial issue; and analyzes the history of the decentralization and regionalization policy in the Unified National Health System (SUS) and Federal investments that constitute the basis for its spatial evolution. Based on this conceptual review and empirical data, the study attempts to establish theoretical and political-institutional connections between health and development. The aim is thus to support the discussion on challenges facing a new role for health in the Brazilian development model, historically marked by economic and social inequalities with strong territorial overtones.

Saúde e desenvolvimento no Brasil: avanços e desafios

The structural sustainability of the Brazilian health system refers to the countrys pattern of development according to how this pattern is expressed and reproduced in the Brazilian population. This derives not only from its social dimension, but also from the economic one, as it accounts for a significant part of the gross domestic product and of job creation, and produces a great impact on the generation of innovation and national competitiveness. The federal government has institutionalized the role of health in the national development agenda due to its strategic aspect. Despite this, the fragility of its productive base continues to be a major vulnerability for the National Health System and for Brazils competitiveness in a global environment. This signals that the virtuous establishment of the relation between health and development involves the rupture of cognitive and political paradigms that separate, in an impermeable way, the economic from the social order.A sustentabilidade estrutural do sistema de saude brasileiro remete ao padrao de desenvolvimento do Pais em funcao de como este se expressa e reproduz na saude de sua populacao. Isso decorre nao somente de sua dimensao social como tambem da economica, uma vez que responde por parcela significativa do produto interno bruto e da criacao de empregos, e exerce relevante impacto na geracao de inovacao e competitividade nacional. O governo federal tem institucionalizado o papel da saude na agenda de desenvolvimento nacional devido a seu carater estrategico. A despeito disso, a fragilidade de sua base produtiva continua configurando importante vulnerabilidade para o Sistema Nacional de Saude e para uma insercao competitiva em ambiente globalizado, sinalizando que a efetivacao virtuosa da relacao entre saude e desenvolvimento envolve uma ruptura de paradigmas cognitivos e politicos que separam, de forma estanque, a ordem economica da social.

Inovação na indústria química e biotecnológica em saúde: em busca de uma agenda virtuosa

Pharmaceutical and biotechnology industries comprise a major production subsystem of the health industrial complex in Brazil. It stands out for both its economic importance and its prominent role in developing new technologies in strategic areas. Strengthening the local production of generic drugs in the last decade has significantly increased the number of Brazilian companies in the local pharmaceutical market and has been an important turning point for this industrys growth. However, there remain major structural bottlenecks both in terms of production and continuous innovation. These bottlenecks reveal the high vulnerability of the Brazilian National Health System and point to the need of public policies that promote strengthening the production base and innovation in the pharmaceutical industry and that at the same time meet health-related social demands in health in Brazil.As industrias de base quimica e biotecnologica compoem um dos subsistemas produtivos do Complexo Produtivo da Saude, que se destaca tanto pela sua relevância economica como pela sua importância no dominio de novas tecnologias em areas estrategicas. A consolidacao do segmento de producao de medicamentos genericos na ultima decada proporcionou um aumento significativo da participacao de empresas nacionais no mercado farmaceutico e representou um importante ponto de inflexao na trajetoria de crescimento do setor. Entretanto, ainda ha importantes gargalos estruturais tanto na base produtiva como em termos de seu dinamismo inovativo. Tais gargalos revelam a elevada vulnerabilidade do Sistema Nacional de Saude e apontam para a importância da criacao e implementacao de politicas publicas que articulem o desenvolvimento da base produtiva e da inovacao na industria farmaceutica com o atendimento das demandas sociais relativas a saude no Pais.

O complexo econômico-industrial da saúde e a dimensão social e econômica do desenvolvimento

O papel estrategico da saude na agenda de desenvolvimento nacional tem sido crescentemente reconhecido e institucionalizado. Alem de sua importância como elemento estruturante do Estado de Bem-Estar Social, a saude e protagonista na geracao de inovacao - elemento essencial para a competitividade na sociedade do conhecimento. Contudo, a base produtiva da saude ainda e fragil, o que prejudica tanto a prestacao universal de servicos em saude quanto uma insercao competitiva nacional em ambiente globalizado. Essa situacao sugere a necessidade de uma analise mais sistematica das complexas relacoes entre os interesses produtivos, tecnologicos e sociais no âmbito da saude. Consequentemente, e necessario aprofundar o conhecimento sobre o Complexo Economico-Industrial da Saude devido ao seu potencial de contribuir para um modelo de desenvolvimento socialmente inclusivo. Isso significa reverter a hierarquia entre os interesses economicos e os sociais no campo sanitario, e assim minimizar a vulnerabilidade da politica de saude brasileira.The strategic role of health care in the national development agenda has been increasingly recognized and institutionalized. In addition to its importance as a structuring element of the Social Welfare State, health care plays a leading role in the generation of innovation - an essential element for competitiveness in knowledge society. However, health cares productive basis is still fragile, and this negatively affects both the universal provision of health care services and Brazils competitive inclusion in the globalized environment. This situation suggests the need of a more systematic analysis of the complex relationships among productive, technological and social interests in the scope of health care. Consequently, it is necessary to produce further knowledge about the Economic-Industrial Health Care Complex due to its potential for contributing to a socially inclusive development model. This means reversing the hierarchy between economic and social interests in the sanitary field, thus minimizing the vulnerability of the Brazilian health care policy.