Quando a saúde dos trabalhadores é uma questão de saúde pública? : a construção social de uma política de saúde dos trabalhadores na Região 28 de saúde do Rio Grande do Sul.

Abstract

This thesis analyzes the social construction of a policy of integral attention to the health of workers in Region 28 of Health of Rio Grande do Sul. This is a study that, on the one hand, attentive to the historical process of discussion and implementation of public health policies for workers in Brazil, since the creation of the Unified Health System in the 1980s; On the other hand, it is concerned with analyzing the repercussions of the transformations that have occurred since the last decades of the twentieth century in work and in the forms of organization of production and labor, not only on workers' health, but especially on the individual and collective strategies of health promotion and coping with the health problems of people living at and from work. The research problem was objectified in the following question: how did the process of regionalization of the policy of integral attention to the health of workers in Region 28 of Health (RS) occurred? Defining from this questioning not only the general objective of the thesis, but also its specific objectives: to analyze the process of institutionalization of the policy of integral attention in Occupational Health in Region 28 of Health (RS); analyze the actions carried out by the public sector in Region 28 of Health aiming at the construction of a regional health policy for workers; analyzing business strategies in Region 28 of Health to promote the health of workers, prevent diseases and accidents and deal with cases of work-related diseases; analyze strategies that workers use for the prevention and care of diseases related to their working conditions. From the point of view of the methodological approach, the investigation implied in the construction of the thesis took as theoretical-methodological support historical materialism, with emphasis on the categories of historicity, totality, historical singularities, contradiction. Data collection was performed in the thirteen municipalities belonging to Health Region 28 and involved the collection of documents, interviews and the application of research forms. The research forms were applied with two hundred and seventy workers and the interviews with six workers with diagnosis of work-related illness, eighteen company representatives, three business leaders, four representatives of workers' unions and health professionals involved with worker health policy (Regional Health Coordination, Regional Reference Center for Occupational Health and Municipal Reference Units for Worker's Health). Workers' health policies express social actions conditioned by macro-structural tendencies, but they are also influenced by local and regional historical experiences. The results of the study indicate that the different social agents involved in the construction of a regional workers health policy do not act autonomously because they deal with different interests and forms of institutional and political relationship; which allows us to understand that in a process of implementation of public policies we can not only work with the normative perspective, in the expectation that it, by itself, can transform the socio-historical reality. This understanding considers the concrete contexts of work, organization, establishment of strategies by the different historical agents and socio-political participation in the very definition of worker health policies. Thus, when analyzing this thematic by complex and conflicting nature, it is evident the need for interdisciplinary approaches and intersectoral and interinstitutional articulations that contemplate the diverse elements involved in the work relationship and the health-disease process.