José Paranaguá de Santana

Um olhar sobre a Cooperação Sul-Sul em Saúde

O artigo apresenta uma breve revisao sobre o significado da cooperacao tecnica no seio da ONU, ressaltando a dimensao politica, isto e, das relacoes entre os Estados. Destaca a importância da saude nesse contexto, tomando como referencias a situacao das Americas e do Brasil. Analisa uma experiencia, na area da saude, ilustrativa do novo paradigma denominado de Cooperacao Sul-Sul, ressaltando a triangulacao de uma agencia intergovernamental. Conclui resumindo os argumentos que situam um determinado processo de cooperacao internacional no marco desse paradigma.

Cooperação em saúde na perspectiva bioética

This study considers the scenario of international relations in the transition to the twenty-first century as a backdrop for reflection on the bioethical perspective of international cooperation in health. It presents an exploratory analysis of the interdisciplinary scientific production in bioethics and public health in the international context, revealing that the focus and confluence of both issues has scant coverage in terms of diplomatic relations. It describes the methodology used to select publications cataloged in this interdisciplinary area from two bibliographic sources available on the web (93 articles in BVS/BIREME and 161 in PubMed), pointing to difficulties in locating this literature. The potential of the epistemological approach that flourished in Latin America under the guise of the Bioethics of Intervention in addressing the challenges that confront the international cooperation system, identified as the benchmark for analysis of South-South cooperation in health, is recommended. It concludes by proposing systematization and broadening of knowledge at the intersection of bioethics, public health and diplomacy, whose projection in the political and institutional field can contribute to reducing inequalities in health conditions among nations.

Regional integration and south-south cooperation in health in Latin America and the Caribbean

This paper analyzes whether south-south cooperation is legitimately a recent practice or merely an improved version of previous regional integration processes in Latin America and the Caribbean. The authors reviewed and systematized the historic development of subregional integration processes in Latin America and the Caribbean and focused on health cooperation in the following contexts: the Central American Integration System, the Andean Community of Nations, the Caribbean Community, the Amazon Cooperation Treaty Organization, the Southern Common Market, and the Union of South American Nations. The study concludes that the conceptual and methodologic foundations of south-south cooperation in health were born from and nurtured by the processes of regional integration in Latin America and the Caribbean. This paper posits that regional political and economic integration initiatives bring potential benefits to the health sector and act as an important mechanism to develop south-south cooperation in this domain. The study recommends furthering this type of research to provide information that will allow national and multilateral agencies, or other stakeholders, to formulate and implement better policies for international health cooperation that target reducing inequities and promoting health and well-being for all people.

Desenvolvimento, Desigualdade e Cooperação Internacional em Saúde

A key approach for the analysis of the relationship between development, inequalities and international cooperation in health is to admit that the problems associated with inequalities between countries at different stages of development could be mitigated through international cooperation.

Dimensões Bioéticas da Cooperação Internacional em Saúde: ainda uma questão polêmica?

This essay stresses the importance of undertaking a critical analysis of international cooperation for health based upon reflections on diplomacy, acknowledging the ethical limits and possibilities of cooperation within this context. It emphasizes the importance of adopting an historical perspective, highlighting the circumstances surrounding the consolidation of the current international system, whereby, after two world wars, the victorious countries created the United Nations Organization, which today brings together all the worlds nations, notwithstanding the fact that the majority of countries are in favor of significant changes to its institutional framework. It also stresses the importance of the bioethics dimension, despite the systematic disregard of principles adopted in relevant UN documents, especially in view of inequalities pari passu with asymmetries of knowledge and enjoyment of innovations that separate nations. This reflection also suggests that South-South cooperation is fundamental to the analysis of the inequality and dependence that demarcate North-South and East-West bipolarity. These reflections are, in short, important guiding elements for deepening analysis and resolutions in the arena of international cooperation for health, leaving aside catastrophic visions and idealistic illusions.Resumo O presente ensaio destaca a importância de analises criticas sobre a cooperacao internacional em saude a partir da reflexao sobre a diplomacia, reconhecendo os limites e as possibilidades eticas da cooperacao nesse contexto. Enfatiza a importância da perspectiva historica, ao destacar as circunstâncias da consolidacao do atual sistema internacional, quando, apos dois conflitos belicos mundiais, os paises vitoriosos criaram a Organizacao das Nacoes Unidas, que hoje reune todas as nacoes do Mundo, embora a maioria dos paises seja francamente favoravel a mudancas expressivas dessa institucionalidade. Ressalta a relevância da dimensao bioetica, conquanto principios aprovados em documentos da propria ONU sao sistematicamente desconsiderados, principalmente em vista da evolucao das desigualdades pari passu as assimetrias de conhecimento e usufruto de inovacoes que segmentam as nacoes. A reflexao tambem destaca a cooperacao Sul-Sul como fundamental para as analises em torno da desigualdade e dependencia demarcadoras da bipolaridade Norte-Sul e Leste-Oeste. Sao esses, em suma, os elementos guias para o aprofundamento da analise e dos encaminhamentos relativos a cooperacao internacional em saude, deixando de lado visoes catastroficas ou ilusoes idealistas.

História, saúde e seus trabalhadores: o contexto internacional e a construção da agenda brasileira

los historiadores y los funcionarios de salud de lo que antes se llamaba “la periferia” tenemos posibilidades de convencer a la salud internacional que los eventos particulares que ocurrieron en algun lugar o periodo considerado “remoto” sirven para comprender problemas actuales de una manera integral. El contexto politico global exige a los historiadores que digan algo sobre dos asuntos recurrentes para la historia: el cambio y la continuidad. Sin embargo, esta incertidumbre no va a durar para siempre y llegara un momento en que la estabilizacion de algun orden politico puede hacer pensar que la historia es “inutil” para comprender la salud. Mi esperanza es que para entonces la historia de la salud esta mas institucionalizada en varios paises latinoamericanos. Por ejemplo, que los cursos de historia de la salud sean obligatorios en las escuelas de salud publica de la region, y que la produccion cientifica historica reciba mas reconocimiento de otros investigadores sociales y de salud. Por ello los historiadores de la salud deberian redoblar sus esfuerzos por hacer comprender que la riqueza de la historia hay que buscarla en la obtencion de una perspectiva de larga duracion que ayude a comprender – mirando al pasado – temas actuales como la interaccion entre las agencias internacionales y los servicios locales de salud, y la relativa capacidad de los actores locales de modificar prioridades y decisiones de las metropolis.