Wendhausen A, Caponi S. O diálogo e a participação em um conselho de saúde em Santa Catarina, Brasil. [Dialogue and participation in a health council in Santa Catarina , Brazil .] Cadernos de Saúde Pública [Public Health Notebooks] (Rio de Janeiro, Brazil) ) 2002; 18(6):1621-1628.

Objectives: To analyze whether the daily routines of a healthcare council in the state of Santa Catarina , Brazil , favor democratization or its opposite, and whether they perpetuate relationships of inequality and subordination.

Methodology: Analysis of verbal dialogue.

Results: The Brazilian Healthcare Reform was instituted in 1986, with the Eighth National Health Conference. It created the possibility of a democratic model of healthcare, as opposed to the existing model, which could be characterized as authoritarian and exclusivist. The new model established “social control” as a means of guaranteeing the decentralization and municipalization of health. Social control was defined as participation by the consumer in the control and evaluation of healthcare policies and actions. In 1991, federal, state, and municipal health councils were legally created. 50% of the council membership was to be composed of healthcare consumers, with the other 50% composed of healthcare professionals and of representatives from government and private healthcare services. The research demonstrated that the level of education attained by council members determined their ability to induce or to silence discussion by fellow members. Consumers’ education was much lower than that of other council members, who possessed a technical vocabulary unavailable to the consumer.

The council under study adopted dialogue with technical jargon. Regular use of jargon, especially by representatives of the state, reinforced power relationships. Consumers were effectively silenced. The relationships established within this council thus did not allow for the open dialogue envisioned in the Brazilian reform as a central tool of popular participation in healthcare.

Conclusions: The forms of resistance evident in the council under study illuminated openings in the system of power. Such forms of resistance warrant strengthening, tied to strategies that will enable consumers to play a more active role.

Copyright 2007 University of New Mexico