A Política Nacional de Saúde Bucal no Brasil: análise sócio-histórica de 2003 a 2018.

Abstract

The National Oral Health Policy (NOHP) published in 2004 configures an update of the State's social response before the oral health problems of the population and their determinants. We analyzed the social space of the NOHP in Brazil, at the federal level, in the period from 2003 to 2018, through a case study of socio-historical approach, based on the reflexive sociology of Pierre Bourdieu and the contributions of Patrice Pinell. Documentary, bibliographic, and secondary data analysis, and in-depth interviews with 27 agents from the national formulation and implementation space were conducted. Their capitals, trajectories, networks of relations, positions taken, main issues at stake and disputes over the NOHP were analyzed. Transformations, continuities, and ruptures of the NOHP were evidenced. The formulating agents were all dentists, mostly men, white and of average social origin. Participation in the student movement and work in public management were decisive aspects for the development of more critical political dispositions, and for entering the field of Collective Health, and Collective Oral Health. The NOHP had a greater impulse in the Lula Government, with continuities and a slower pace in the Dilma Government. The creation of the Specialized Dental Clinics and Regional Prosthodontics Laboratories, the regulation of oral health assistant and technician, and the participation of oral health in international cooperation were new elements in the policy during the Lula Government. In the Dilma Government, the PMAQ-AB, the PMAQ-CEO, and the GraduaCEO stand out, although the latter has not been implemented. There was a reduction in the symbolic capital of the Coordination starting in the Dilma Government, which was aggravated in the Temer Government, whose neoliberal agenda of fiscal austerity strongly modified the historical conditions of possibility for the NOHP. From 2015 on, successive changes in the Coordination affected the national implementation, with progressive reduction of results in the indicators of public dental services. Of the initiatives that were not consolidated and may become "possible dead", prosthetics in primary care and the expansion of teams with oral health technician stood out. Specialized care of public supply was an open "possibility", but a "poor" service for "poor people" is still an issue to be faced. The training of dentists, with more robust theoretical elements on Collective Health, politics, power, among other topics, and the confrontation of the hegemonic care model, still predominantly curative, restorative, and school dentistry, were also insufficient. The approval of legislative bill 8.131/2017, which seeks to make the NOHP a component of Unified Health System of Brazil, can contribute to its legal, political, and financial support. It can be considered that there is a dental space aiming at becoming a field in consolidation, in the sense proposed by Bourdieu, with specific rules and laws. The elaborated proposal of dental capital represents a contribution to this analysis. To know and recognize its rules and objects in dispute is part of the sociological work of the historical process underway in Brazil, with defense of the expansion of oral health in the Unified Health System, universal, integral, and health-promoting.