Historiographic considerations on corporatism, regulated citizenship and the history of health care in Brazil: gift or right? (1930-1964)

Abstract

In general, health history scholars observe a split in this field between individual medical assistance, dependent on the Social Security Institutes (IAPs), created in the 1930s, under the control of the Ministry of Labor, Industry and Commerce (MTIC), and the public health, dedicated, in general, but not only, to health actions against epidemics and endemic diseases that were widely spread in the country, subordinated to the Ministry of Education and Public Health (MESP), created at the same time. In this way, we would have, on the one hand, public health as the result of government initiatives aimed at the population as a whole, with a universalized structure of services, not enjoyed, however, as a right; and, on the other hand, individualized health care, whose inclusion, through the corporatism structure of the IAPs, would present a fragmentary, segmented and selective character, therefore, not universalist and non-inclusive, in terms of the so- called “regulated citizenship”, according to a concept coined by political scientist Wanderley Guilherme dos Santos. Our objective, in this article, is to problematize, in the light of the most recent historical literature, this conventional interpretation of the structuring process of health care in Brazil, which tends to characterize it not as a process of struggle for citizenship rights but as government grant or gift, according to the political and ideological objectives of the first Vargas Government. In this sense, we intend to demonstrate how both “regulated citizenship” and “corporatism” were constituted, from the beginning, in arrangements crossed, to a large extent, by disputes and contradictions that gave it a certain degree of flexibility and permeability to absorb the demands for rights from the world of work.