Política Nacional de Atenção Integral à Saúde do Adolescente em Conflito com a Lei (PNAISARI) no Estado do Rio de Janeiro: um estudo exploratório das contribuições da economia política marxista na compreensão do Estado e das políticas de saúde no século XXI

Abstract

The present study explored of the State in steering the National Policy on Comprehensive Health Care of Adolescents in Conflict with the Law (PNAISARI) in the State of Rio de Janeiro the contributions of the Marxist Political Economy. It discusses that the State is a relational, complex, and contradictory permeated by the dispute of different ideological views and that the development of public policies, including health policies, happens in the context of a distributive conflict. In the case study of the PNAISARI, it became evident that the publication of resolutions 1.082 e 1.083 leaded to the decentralization to municipalities contributing in the acknowledgement of the right to health of the adolescents under socio-educational measures and in the sanitary responsibility of the municipalities. The decentralization process of the health system to the municipalities was characterized by a low commitment of the State Secretary of Health leading to fragile negotiations and little dialog between health and socio-educational public managers in the commitment to adolescent´s health. In this context, the structural problems of the SUS that limits the possibilities of comprehensive and universal care. As conclusions, the dissertation reaffirms that the right to health of adolescents includes confronting the social determinants of health that deeply influence their lives and health, fighting against the neoliberal ideology that impedes the development of universal social protection in Brazil.