Duas quest?es permanentes em um século de políticas de saúde no Brasil republicano

摘要

This article discusses the dilemma centralization versus decentralization in health policies of the republican Brazilian State during the twentieth century. It develops the central hypothesis that the dichotomy centralization/ decentralization of functions, services and activities in Brazilian public policies, mainly in the health policies, expresses the concentration/deconcentration dichotomy of social power in civil society. The centralization/decentralization dichotomy as it appears in health policies since the foundation of Brazilian republic, illustrates the authoritarian character of this republic, as a consequence of the concentration of the social power in the hands of a small elite. Analysis of health policies in different conjunctures seems to demonstrate that decentralization tends to be defined by the state and other political actors in a geopolitical sense, rather than in a political sense. The article demonstrates also that during the 90s there has been a real process of decentralization, but still with a very little distribution of power.