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Article: The health challenge in the restoration of UNASUR


Paulo Buss*


Fulfilling the motto “Brazil is back in foreign policy”, already in the first hundred days of the Lula presidency, Brazil rejoined Celac and UNASUR actively participated in the executive committee of the World Health Organization, where it presented an unprecedented proposal for a resolution on the health of indigenous peoples; and actively participates in the preparation of a treaty on pandemics and the reform of the International Health Regulations. Moreover, the President visited Argentina, Uruguay, the United States and China and, by the end of April, he will visit Portugal and Spain. 
On April 6, 2023, President Lula signed a decree through which he promulgated the Constitutive Treaty of the Union of South American Nations (UNASUR), signed by the Federative Republic of Brazil, in Brasília, on May 23, 2008. The National Congress had approved the treaty through Legislative Decree 159, of 07/13/2011, but the Brazilian government only now deposited the ratification instrument of the treaty with the Member States of UNASUR, on April 6, 2023, entering in force for Brazil, in the external legal sphere, on May 6, 2023. 

Brazil is preparing a summit gathering Heads of State from the 12 countries of South America to be held in the last week of May, in Brasília, for them to decide what the new UNASUR will be like. For Celso Amorim, foreign policy advisor to the president, Brazil will seek to bring back a reality that should never have been interrupted. Those who will certainly be with Lula in this historic reconstruction include: Fernandez, from Argentina; Boric, from Chile; Arce, from Bolivia; Petro, from Colombia; Maduro, from Venezuela; Santokhi, in Suriname; Ali, in Guyana; as well as Benítez, from Paraguay; Lacalle, from Uruguay; Lasso, from Ecuador; and Boluarte, from Peru. 
In his latest book, Celso Amorim says that Latin America and the Caribbean, more especially South America, constitute our immediate surroundings, and that it is possible to build a strong Latin America and Caribbean, united in their diversity. 

Amorim asserts that the reconstitution of “bonds of trust” is one of the main challenges of a foreign policy that defends national interests without abandoning solidarity and respect for our neighbors. Overcoming brutal inequalities and breaking up with external dependence is, and will continue to be for a long time, a task for everyone who wants a fairer and more autonomous Latin America. The new global geopolitics, with its features of multipolarity and bipolar rivalry between the United States and China, only reinforces this need. 

Scholars and activists of health diplomacy expected the materialization of the promised (and now fulfilled) return of Brazil to UNASUR so as to roll up their sleeves and work in the context of the “expanded concept of health” in the regional diplomacy scenario. With that, it will offer proposals on how health should appear in the governance of the “new” UNASUR. Our Ministry of Health will certainly do the same. Minister Nísia's trip with Lula's delegation to the meeting of Brazil's adherence to CELAC, in January, in Buenos Aires – from where she returned with a broad agreement on health, signed with the Argentine minister of health – signals that the restoration of health cooperation at UNASUR will also receive priority treatment. 

The immediate restoration of UNASUR's Health Council to establish joint actions between the countries is justified not only due to the innumerable benefits it will bring to the health of the populations of South America, as it did in the past, but also to face, today and in the future, the terrible impact of the disorderly (or better yet, non-existent) regional multilateral action in the combat against the COVID-19 pandemic: Of the almost 7 million deaths recorded by the disease in the world so far, no less than 2.95 million occurred in the Americas, and about 1.4 million in the countries of South America, according to the WHO, where Brazil and Peru stood out. 

I wrote in 2020, in this Diplomatique that, with the rise of conservative governments in South American countries between 2015 and 2020, there was a dismantling of historical social achievements, given the implementation of the so-called structural adjustments in most countries affected by the neoconservative wave, which erode fiscal budgets intended for health, education and other social policies, dismantling viable and productive health systems of other times and producing immense inequalities in the area. Brazil resumes the SUS, which was consecrated globally. Colombia and Chile are embarking on profound reforms in their health systems, exhausted by the poor results of the systems designed during the wake of the neoliberal wave of the 1980s and promoted in authoritarian or right-wing regimes. 

Looking to the future, I wrote in the same article that concerted efforts are necessary to achieve universal health coverage and sustainable funding for it, to address the growing burden of non-communicable diseases, including mental health, and to address antimicrobial resistance and the health, economic, social and environmental determinants, as well as air and water pollution and inadequate sanitation. I also said that universal, comprehensive and equitable health systems, funded with public resources, have responded better to the epidemic than “non-systems”, which segment the health care for the population, depending on their purchasing power or social protection provided by employment. 

All these questions remain a challenge to each and every South American nation. This new progressive pink wave that is asserting itself in the region brings the expectation of articulated intersectoral actions, the only way to truly improve the health of the population, which is conditioned, on the one hand, by universal and equitable access to comprehensive health services, and on the other, by the improvement of the quality of life in terms of income, housing and sanitation and other social, economic and environmental policies that are committed to favoring human and planetary health.
Brazil has something to share, with the resumption in the health sector of strategies and/or programs such as the comprehensive primary care (family health), immunizations, local production of inputs and the Mais Médicos program, among others, all of which have already been launched and funded in the first 100 days of the Lula government. In turn, in the broader field of social policies that favor health through extra-sectoral actions, within the scope of the broad concept of health, the relaunch, on new bases, of Bolsa Família – which now brings health requirements, such as complete and prenatal immunization of pregnant women; Minha Casa, Minha Vida; and zero deforestation by 2030. For the funding of social programs, it announces a new fiscal framework and a progressive tax reform. 

More recently, the government announced the resumption of the Economic and Social Council and the National Commission for Sustainable Development, which should also receive a health chamber considering that all policies impact the health of individuals and families, which must be taken into account in their formulation and implementation, a strategy known as health in all policies. 

The new progressive governments in South America have different notions of economic, social and environmental policies, but with a high degree of convergence. The terrible economic and social consequences of the COVID-19 pandemic and the concrete threats of new pandemic processes that, by the handful, have shown that they do not respect borders, call for reflection and demand the resumption of health among the priorities of the new UNASUR that is coming true. It will certainly have the unanimous support of the Brazilian health community and specialists in global health and health diplomacy in the region.  

This article was originally published in Le Monde Diplomatique Brasil

*Paulo Buss is the coordinator of Fiocruz Global Health Center (CRIS)

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