This article, titled “Políticas em saúde, saneamento e educação: trajetória da participação social na saúde coletiva” (Policies in health, sanitation, and education: trajectory of social participation in collective health), authored by Andrezza de Souza Piccoli, Débora Cynamon Kligerman, and Simone Cynamon Cohen, addresses the critical issue of social participation within major public policies in Brazil.
Purpose and Scope of the Article: The primary objective of the article is to analyze the extent to which Brazilian public policies in health, sanitation, and education incorporate social participation through mobilization and whether they effectively enhance social control. It provides an overview of social participation in these public policy areas, tracing its trajectory from the Federal Constitution of 1988 up to the present day. The authors aim to reflect on whether widespread social movements translate into participative public policies where governors truly engage with the populace.
Methodology: The study is a qualitative, bibliographical-documentary research conducted through the content analysis of specific legal frameworks where social participation is addressed. The core legal documents analyzed are:
- The Federal Constitution of 1988 (Brasil, 1988).
- Lei nº 8.080/1990, the Organic Law of the Unified Health System (SUS) (Brasil, 1990a).
- Lei nº 11.445/2007, the National Policy on Basic Sanitation (Brasil, 2007).
- Lei nº 13.005/2014, the National Education Plan (Brasil, 2014).
To deepen the analysis and compare advancements in social participation, the study also included more specific laws and policies:
- Lei nº 8.142/1990, which governs community participation in SUS management (Brasil, 1990b).
- Lei nº 12.305/2010, the National Solid Waste Policy (Brasil, 2010).
- Lei nº 9.795/1999, the National Environmental Education Policy (Brasil, 1999).
The researchers systematically searched these legislations for terms such as “Participação social” (social participation), “Participação da comunidade” (community participation), “Mobilização social” (social mobilization), “Controle social” (social control), “Sociedade organizada” (organized society), and “Conselho” (council). The analysis focused on whether these laws incorporated the perspective of society’s organization and mobilization for social participation, and if they presented mechanisms for effective social control.
Key Concepts and Definitions:
- Social Participation: Defined as the various actions undertaken by different social forces to influence the formulation, execution, inspection, and evaluation of public policies and/or basic social services. This participation can manifest through popular work (e.g., mutual aid), citizen mobilization to negotiate with authorities, or the occupation of public spaces.
- Social Mobilization: Implies an active process where people and groups are empowered to improve their living conditions and increase their autonomy in decision-making, thereby exercising effective social control.
- Social Control: Refers to the mechanisms and procedures that guarantee society access to information, technical representation, and participation in policy formulation, planning, and evaluation processes related to public services.
Main Findings and Insights:
- Discrepancy in Terminology: A significant finding is that the terms “social participation,” “social mobilization,” and “organized society” do not appear at all in the core structural policies (Constitution, SUS Law, Sanitation Law, Education Plan). “Community participation” appears only once in the Constitution and the SUS Organic Law, primarily through councils and conferences.
- Emergence of “Social Control”: The term “social control” is found exclusively in laws published in the 21st century (after 2007), specifically in the National Basic Sanitation Policy and the National Education Plan. This suggests a shift in the profile of social participation in the public sphere, as expressed in the law. The National Solid Waste Policy (2010) is notable as the only studied legislation that explicitly presents social mobilization as a mechanism for effective social participation.
- Prominence of “Councils”: The term “council” is the most frequently observed across the studied norms, appearing 66 times in the Constitution and 13 times in the SUS Organic Law and National Education Plan. This indicates that the experience of health councils (such as those in SUS) has served as a historical and ongoing starting point for the institutionalization of social participation across the health, sanitation, and education sectors in Brazil. However, the article notes challenges, as councils can sometimes act as a mere endorsement for managers’ decisions rather than fully materializing sought-after achievements.
- Sector-Specific Observations:
- Health: The health sector has the oldest consolidated experience with social participation through councils. The Lei nº 8.142/1990 explicitly details community participation in SUS management.
- Sanitation: The National Basic Sanitation Policy (2007) defines “social control” as a core principle and mandates its inclusion in sanitation plans. The sanitation field is identified as potentially the one that most incorporates social participation in its public policies, especially due to the explicit mention of “social control” and the single appearance of “social mobilization” in the National Solid Waste Policy.
- Education: The National Education Plan (2014) shows significant advancement by incorporating strategies for social participation, including “articulation,” “collaboration,” and “public consultation”. However, the National Environmental Education Policy (1999) notably lacks most of the searched terms related to social participation, suggesting a more traditional pedagogical approach.
- The Role of PEAMSS: The article highlights the National Environmental Education and Social Mobilization for Sanitation Program (PEAMSS) (Brasil, 2009) as a potential starting point for the effective realization of social participation through mobilization. Developed collaboratively by various ministries and social actors, PEAMSS emphasizes a critical, transformative, emancipatory, and propositional approach to community participation, encouraging active contribution and social control from diagnosis to evaluation. Its formulation is seen as possibly influencing later policies, especially in sanitation, where terms like “social control” became more prominent after 2007.
Challenges and Conclusion: Despite the legal frameworks, the authors conclude that Brazil still has a long way to go in effectively mobilizing for social control. The study suggests that the State may not genuinely expect empowered and mobilized public participation. True social participation requires an empowerment process where individuals and groups are strengthened to exercise effective control. The current situation is often characterized by political co-optation rather than genuine representation of national interests.
The article strongly argues that creating policies and legislations that merely include social control is insufficient; it also requires stimulating social actors to interact articulately and proactively with public authorities. For social participation to be effective, it must involve emancipatory actions with a transformative perspective on realities, focusing on collective health outcomes. This requires starting from the specifics of each territory, building social organization from the local level upwards, and fostering conflict and problematization to drive critique, resistance, and possibilities for change.
Reference: Piccoli, A. D. S., Kligerman, D. C., & Cohen, S. C. (2017). Políticas em saúde, saneamento e educação: trajetória da participação social na saúde coletiva. Saúde e Sociedade, 26, 397-410.
