Carlos Eduardo Siqueira

Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy

BackgroundThis study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested.MethodsDrawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods—2004 to 2008 and 2008 to 2012—were analyzed.ResultsOur findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery.ConclusionDespite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.

Does Informal Employment Exist in the United States and Other Developed Countries

This editorial argues that informal employment does exist in developed countries and needs to be studied as such to complement the existing literature mostly published on informal work in developing countries.

Musculoskeletal disorders and perception of working conditions: A survey of Brazilian dentists in São Paulo

OBJECTIVESnTo investigate the prevalence of work-related musculoskeletal disorders amongst dentists who work in public clinics in São Paulo, Brazil, to investigate their awareness of the presence of risk factors in the workplace, disability due to pain, and the influence of pain on this awareness and disability.nnnMATERIAL AND METHODSnA cross-sectional study was conducted among 204 dentists who work in public health clinics in the northwest of São Paulo, Brazil. The data was collected through interviews, using the Nordic Questionnaire and the Work-Related Activities that May Contribute to Job-Related Pain Questionnaire. In the case of workers who reported pain, the Pain Disability Questionnaire (PDQ) and the Numeric Pain Scale were also administered. Statistical analyses were performed using SPSS 21.0.nnnRESULTSnMost dentists (81.4%) had musculoskeletal disorders, especially in the neck, shoulders and lower back. We found that the presence of symptoms in the neck (15.7%), shoulders (12.7%) and lower back (15.7%) were the major causes of absenteeism over the past 12 months. Occupational risk factors perceived as the most problematic ones were: bending or twisting the back in an awkward way, continuing to work when injured or hurt and working in the same position for long periods. Comparison between the symptomatic and asymptomatic dentists showed a statistically significant difference (p < 0.05) in the perception of occupational risk factors. The analysis of the intensity of pain and disability with PDQ in the symptomatic dentists showed an average pain intensity of 3.8. Mean scores of the PDQ total (11.46) and its dimensions - functional condition (7.1) and psychosocial condition (4.4) - suggest a moderate disability in the dental surgeons. There was a strong t correlation (r = 0.697) between pain intensity and the total score of disability caused by pain.nnnCONCLUSIONSnPain and work-related musculoskeletal disorders interfere significantly with the dentists lives. In the case of dental surgeons there is a significant correlation between pain intensity and disability. Int J Occup Med Environ Health 2017;30(3):367-377.

Socioeconomic and Health Profile of Haitian Immigrants in a Brazilian Amazon State

We analyzed the sociodemographic profile, migration journey, health conditions, and health care access and utilization among recent Haitian immigrants to the Brazilian Amazon state of Mato Grosso. We conducted a cross-sectional study with a probabilistic sample of 452 Haitians. We administered a bilingual questionnaire from December 2014 to February 2015. Data were analyzed using chi square tests to evaluate differences among groups. The majority of participants were married men younger than 35xa0years old. They mostly came from the Haiti’s Artibonite Department, living in Brazil for less than a year. Half of the participants were employed at the time of the interviews, and 81.8% relied exclusively on the Brazilianxa0Unified Healthcare System for medical care. The overall health profile and health care access were good. Haitian migration to Brasil is a case of South–South migration driven by economic needs. Our population had good health status despite socioeconomic challenges.

0308 A brazilian look at occupational health and safety in the usa: observation and learning with cosh groups

Labour laws in the United States of America are less protective than the norms of most countries, including Brazilian ones. However, there is a strong militant movement for occupational safety and health in USA, organised in an articulated network that includes university professors and students, trade unionists, community leaders, public agents and various sectors workers. The successful experience of the social activism of the Committees on Occupational Safety and Health (COSH) groups, which have been advocating for the safety and health of workers in the United States for 45 years, deserves propagation and study because it can inspire similar initiatives in Brazil and in other countries . This exploratory research collected data through open interviews with workers, lawyers, teachers, researchers and activists heard between October/2013 and March/2014, as well as directed observation and interviews made during three events held in Boston and Baltimore (COSH Network, APHA 2013 and National Worker Safety and Health Conference). The results show that COSHs are alliances that promote education and advocacy for workers’ health and safety. They articulate a national agenda to improve health and safety conditions for immigrant workers under the prevention bias, providing information and support in Spanish and other languages, as well as advocating for just compensation for workers who are ill or injured at work. They also carry out activities to integrate health and safety activism into organised campaigns, as well as advocate for the respect of existing health and safety laws and fight for new protections for workers.

Organizações Sociais de Saúde (OSS): Privatização da Gestão de Serviços de Saúde ou Solução Gerencial para o SUS?

Revisamos criticamente a literatura publicada no Brasil sobre as Organizacoes Sociais de Saude como modelo de gestao de servicos de saude ambulatoriais e hospitalares para o Sistema Unico de Saude. Optamos pelo metodo de revisao integrativa, atraves de busca na base de dados cientificas Literatura Latino-Americana e do Caribe em Ciencias da Saude (Lilacs) e na biblioteca eletronica Scientific Electronic Library Online (SciELO). Foram identificados 31 artigos que atenderam aos criterios de inclusao. Os estudos publicados ate 2015 sobre as OSS sao metodologicamente insuficientes e nao permitem generalizacoes sobre a maior eficiencia da gestao de servicos de saude por meio das OSS em comparacao com a gestao publica. Mesmo com a falta de dados empiricos conclusivos na literatura cientifica revisada, ha fortes argumentos legais, administrativos, e politicos que sugerem que as OSS nao se constituem como solucaoxa0 para resolver os problemas de gestao de servicos no SUS. Embora se apresentem como modelo “sem fins lucrativos” ou filantropico e fundamentado em tecnicas gerenciais modernas e eficientes, as OSS tendem a fortalecer a privatizacao do sistema publico de saude brasileiro.

Documento Faz Diferença.pdf

Los inmigrantes brasilenos han vivido diversos desafios en los ambitos social, laboral y de salud en los Estados Unidos. El objetivo de este estudio es analizar el perfil de las trabajadoras domesticas brasilenas en Massachusetts, Estados Unidos, valiendose de la descripcion de sus condiciones laborales y percepciones respecto a su estado de salud. Se trata de un estudio transversal con 198 empleadas domesticas de Massachusetts, reclutadas por un muestreo tipo bola de nieve. El instrumento utilizado abordo caracteristicas demograficas, condiciones de trabajo y percepcion del estado de salud de los participantes. Los datos se analizaron mediante el software SPSS 21.0. Entre los entrevistados, un 95,5% eran mujeres, un 62,1% con edad entre 30-49 anos y un 55,6% no eran legales. Se observaron diferencias estadisticamente significativas entre las participantes legales y no legales en variables sociodemograficas, de condiciones de trabajo y de salud. El estatus inmigratorio irregular parece afectar negativamente las condiciones de vida y salud de las trabajadoras domesticas.Brazilian immigrants in the United States experience various social, labor, and health challenges. This study aimed to analyze the profile of female Brazilian domestic workers in Massachusetts, USA, through a description of their working conditions and self-rated health. This was a cross-sectional study of 198 domestic workers in Massachusetts, recruited with snowball sampling. The instrument addressed participants demographic characteristics, work conditions, and self-rated health. Data were analyzed with SPSS 21.0. Among the interviewees, 95.5% were women, 62.1% were 30 to 49 years of age, and 55.6% were undocumented. Documented and undocumented participants showed statistically significant differences in demographics, work conditions, and health. Irregular immigrant status appears to have a negative impact on domestic workers living and health conditions.

The Impact of the Siamese Twins Outsourcing and Precariousness.pdf

Graça Druck and Carles Muntaner offer two different approaches to discussing the impact of outsourcing or contracting out and precariousness (terceirização and precarização in Portuguese) on worker health and safety, a topic that has been under-researched in Brazil and maybe worldwide. Druck is a labor sociologist who has a long trajectory studying outsourcing, particularly in the petrochemical industry in Bahia. She provides an important contribution to the debate on the relationship between outsourcing and workplace mortality by describing the current status of outsourcing in Brazil, and the legal and political struggle around Bill 4,330. Druck first situates the growth of outsourcing in Brazil as part of the flexible accumulation brought about by productive restructuring and neoliberal policies in the 1990s. She then summarizes the evidence available in the peerreviewed and gray literature in Brazil to argue that the weight of evidence indicates that there is a strong relationship between outsourcing and precariousness, which combined produce job insecurity, intensification of work, increased exploitation and segmentation of the workforce into first and second class workers, unsafe and unhealthy working conditions, and weakening of trade unions and labor power, among other impacts. These impacts were empirically demonstrated in the petrochemical, electrical, and construction sectors in Brazil through data that compared outsourced and permanent workers, which showed higher mortality rates in the former. Yet, she did not list any longitudinal (or even cross-sectional) epidemiological study that controls for confounding variables and compared workplace morbidity and mortality in different workplaces or sectors of the economy. Maybe such studies are still lacking in Brazil. Muntaner, a social epidemiologist with a long trajectory studying relationship between condiC. Eduardo Siqueira

Goodbye, Brazil: Émigrés from the Land of Soccer and Samba. By Maxine L. Margolis. Madison, Wisconsin: Wisconsin University Press, 2013. 289 pages.

This book summarizes the recent history of Brazilian immigration to Europe, the United States, Australia, and New Zealand, as well as to other countries in South America. Maxine Margolis is the right person to write it because she has collected hundreds of articles, books, and news reports about Brazilian emigration and built an international network of Brazilian emigrants and scholars over the last two decades. In addition, she has advised many new scholars of Brazilian migration to the United States. Framed within well-known and accepted theories of migration, the book provides a broad picture of the Brazilian diaspora, its origins and geographical and temporal patterns. Its narrative can be understood by scholars of international migration as well as by policy makers and practitioners. Margolis writes as an anthropologist who conducts qualitative research but also delivers her message to a broad audience by avoiding scientific or technical jargons and translating social science concepts into lay language. One of the main issues raised by this book is the dynamic nature of Brazilian migration, wherein Brazilian sojourners emigrate from and return to Brazil in a relatively short period – a pattern that may be comparable to those who migrate from Mexico to the United States and back. Scholars of international migration should consider this pattern as an example of migratory flows that result from the economic insecurity of today’s globalized world. Traditional economic push–pull factors may change quickly between developed and so-called emerging countries, such as Brazil, if and when conditions in the homeland improve and deteriorate in the destination country. Brazilian migration to the United States and Europe could thus be a harbinger of similar patterns in other continents. A particularly interesting aspect of this book is the development of transnational practices among those who have been called transmigrants, that is, those Brazilians who divide their lives between Brazil and the destination country. These transmigrants have developed transnational networks and may in the future become a larger component of Brazilian migration. There is some evidence that Brazilian migrants who have higher socioeconomic status tend to have strong and regular interactions with both Brazil and the destination country, especially in the United States, Japan, and Europe. For the most part, this book provides accurate information on the Brazilian diaspora. However, due to the strengths and weaknesses of the Brazilian migration literature, the quality and quantity of information reviewed are uneven. International migration scholars will find a reasonably large peer-reviewed and scholarly literature on Brazilian immigration to the United States in English, but some articles and reports are only available in Portuguese. There is also a paucity of scholarly research on Brazilian migration to Africa or elsewhere in South America. The number and depth of studies on Brazilian migration to a few countries in Europe, such as Spain and Portugal, fall between these two poles. As a result, the book is on more solid ground when reviewing Brazilian migration to the United States than to other destinations. Also contributing to this unevenness is the fact that most studies and reports reviewed by the author are time bound and do not account for changes in the last two decades. For example, the socioeconomic profile of Brazilian migrants has

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Historical antecedents led labor organizations and workers health researchers to create a Workers Health Observatory aimed at disseminating credible information and subsidizing the defense of workers health. This paper reviews and analyzes the national and international backgrounds that mobilized the labor unions, labor unions study centers, and workers health researchers to produce a virtual and in person observatory aimed at communicating and storing scientific information. Participant observation and intervention, as well as document review methods were used. The paper starts by discussing the initiatives to overcome neoliberal policies. These iniciatives allowed the Observatoriost to be created in 2010 and kept in activity, compiling documents, press reports and labor union agendas, until 2013. The observatory was co-managed by six associations of labor unions (the so called Centrais in Brazil) through the Editorial Committee, which complied with the diversity and autonomy of the involved actors. The Observatoriost rotatory coordination established by the associations of labor unions Editorial Committee proved they were politically mature and prepared to networking. The main challenges for keeping this initiative were to prepare and integrate researchers and other professionals who would be organically committed to workers struggle for life and health.