A Right to Health
Medicine, Marginality, and Health Care Reform in Northeastern Brazil
In 1988, a new health care system, the Sistema Único de Saúde (Unified Health Care System or SUS) was formally established in Brazil. The system was intended, among other goals, to provide universal access to health care services and to redefine health as a citizen’s right and a duty of the state. A Right to Health explores how these goals have unfolded within an urban peripheral community located on the edges of the northeastern city of Fortaleza. Focusing on the decade 1998–2008 and the impact of health care reforms on one low-income neighborhood, Jessica Jerome documents the tensions that arose between the ideals of the reforms and their entanglement with pervasive socioeconomic inequality, neoliberal economic policy, and generational tension with the community.
Using ethnographic and historical research, the book traces the history of political activism in the community, showing that, since the community’s formation in the early 1930s, residents have consistently fought for health care services. In so doing, Jerome develops a multilayered portrait of urban peripheral life and suggests that the notion of health care as a right of each citizen plays a major role not only in the way in which health care is allocated, but, perhaps more importantly, in how health care is understood and experienced.
This excellent ethnography . . . will appeal to many audiences and lends itself well to undergraduate teaching. What is particularly attractive about the book is its deft handling of ethnographic evidence: it shows rather than tells. This approach is gratifying because it trusts the scholarly reader to draw suggestive connections to multiple bodies of contemporary theory rather than hammering together an ambitious theoretical armature with a few slender tacks of ethnographic detail. It is inviting to the student reader because it is a lively, funny, touching read – full of memorable, evocative description and incident – that students will readily be able to mine for social theoretical points. . . . Jerome’s analysis offers keen insight into the current political situation in Brazil.
[A] compelling and timely ethnography…A Right to Health combines a detailed history of Brazilian health care with compelling illness narratives.
[Jerome's] goal is to explore the relationship between a formal right to health care and the way in which people experience that right...Jerome shows that patronage and dependency have continued to dominate favela life, as reciprocity among family members, friends, and neighbors, and the presence of good or bad bosses dominate the life of its inhabitants...Excellent.
Weaving ethnography and historical material, this book shows how low-income Brazilians have actively demanded, pragmatically secured, and sometimes rejected rights to healthcare. This carefully researched and clearly written work illuminates the changing and complex relationship between health and citizenship in Latin America.
The citizenship project in Brazil since the constitution of 1988 has become a critical case study. Recently, along with Cuba, it has provided a model to other Latin American countries that have incorporated health as a fundamental right of citizens and implemented universal health systems. This book is a timely analysis of the Brazilian case, and, I think, the first from this point of view in anthropology.
- Acknowledgments
- Introduction
- Chapter 1. Pirambu: Historical and Contemporary Accounts of Citizenship in a Favela
- Chapter 2. A History of Welfare and the Poor in Ceará
- Chapter 3. Democratizing Health Care: Health Councils in Pirambu
- Chapter 4. Prescribing Knowledge: Farmácia Viva and the Rationalization of Traditional Medicine
- Chapter 5. Favors, Rights, and the Management of Illness
- Chapter 6. Public and Private Medical Care for a New Generation in Pirambu
- Conclusion: A Politics of Health
- Notes
- References
- Index
