O PRINCÍPIO DA EQUIDADE E O SISTEMA ÚNICO DE SAÚDE: Análise das externalidades e internalidades que influenciam a saúde da população negra em São Luís – MA a partir da atuação do Ministério Público.

Abstract

The present work aims to problematize the internalities and externalities that influence the health of the black population, especially that of São Luís - MA, from the performance of the Public Ministry, with a view to executing the principle of equity in the Health System. At the beginning, considerations about the methodological course of the research are presented, placing it in the bibliographic and documentary analysis of the descriptive-exploratory type, qualitative approach and hypothetical-deductive reasoning, and to support the third chapter, the technique of evaluation of Public Policies . The hypothesis is that, depending on socioeconomic conditions and ethnicity, the health of a population is influenced by the social environment and by economic and political power differently. In the case of the black population, the environment determines special conditions of vulnerability that demand the implementation of Public Equity Policies in the Health System. It happens that it is not enough that these are defined only on paper, their effectiveness must be supervised by the Public Ministry. The investigation is structured with the objective of evaluating the externalities and internalities that affect the health of the black ethnicity and that impact on the effectiveness of the principle of equity in health in the Public Health System; and in the specific objectives, it aims to understand the health/disease process and how its differentials impact on the health of the population; to analyze the externalities and internalities that affect the black population and if there is a relationship between such factors and the health of the black ethnicity of São Luís - MA; to analyze equity as a guiding principle of the Brazilian Health System; Finally, in order to analyze whether State and Municipal Public Policies for the Health of the Black Population are being applied, the performance of the Public Ministry was evaluated, as an organ for the defense of citizenship. From the collected results, the hypothesis is confirmed, noting that externalities and internalities impact the health of the black population not only because of the historical context of disadvantage, but mainly because of institutional and structural racism rooted in Brazilian society. With a view to reducing these determinants in the health of this ethnic group, the Public Ministry should work hard so that differentiated policies are applied in the Health Sector. The development of the research adopted the theoretical framework the Theory of Justice as Equity (Rawls) and Justice as Social Choice (Sen); and brings as a general conclusion that the absence of actual filling of the race/color question in the forms of the Unified Health System, prevents the impact of social determinants from being quantified and policies being directed without wasting money.