In Latin America, the link between state, crisis and health configures an equation in permanent tension. It is not a simple game of causes and consequences, but a dynamic plot where the State is, at the same time, agent, scenario and victim of social transformations.
Far from being a neutral variable, the State constitutes the central node that articulates – or should articulate – the links between citizenship, rights and public policies. However, every time society enters into crisis, its legitimacy is questioned. Social disarticulation, the increase in inequalities and the deterioration of essential services, such as health, evidence not only the crisis of an economic model, but also the structural limits of the state apparatus.
In the health system this tension is expressed crudely. Precarization, undercover privatization and unequal access to medical care reflect the decline of the State as a guarantor of rights. In this scenario, health ceases to be a common good to insert itself in market logics, consolidating a citizenship fragmented by the level of income.
Historically, the State in Latin America oscillated between the promotion of well -being and the capture for particular interests. The border between the public and the private has always been porous: institutions, resources and public decisions have often been controlled by actors that represent sectoral interests rather than groups.
Today, the big question is no longer only if the State must intervene, but can and wants do it. In times where the limits of the “present state” are discussed against the advance of neoliberal logic, it is urgent to redefine its role not from paternalism, but from an ethical, efficient and equitable management.
Rethinking the State implies assuming that without its articulating and distributive action, the health system becomes another reflection of the crisis. The real challenge is to build a model where the State is not a lack of deficiencies, but a transforming actor capable of guaranteeing rights in adverse contexts. Because without strong public health, there is no full citizenship.
Carlos Felice Fioravanti
E-mail: [email protected]
Instagram: @carlosdfelice
You may also interest you
By CEDOC
Image gallery
