No Brasil, a reforma da escola médica ancorada na medicina preventiva difundiu-se, em grande medida, durante a ditadura militar (1964-1985). O projeto preventivista é investigado aqui para além de uma reorganização curricular, estando imbuído de um papel social e político evidenciado, especificamente, pelo modo como caracterizou os homossexuais na ditadura militar. Foram analisadas publicações do “Jornal do Brasil” sobre congressos científicos que tematizaram o preventivismo no combate aos comportamentos desviantes na juventude, com destaque ao homossexualismo. A tese de Sérgio Arouca estruturou as principais discussões presentes e embasou a análise das publicações coletadas. Como resultado, os homossexuais, tidos como degenerados desde o século XIX, foram descritos como ameaças patológicas à família, à moral e à segurança nacional, sendo necessária a sua profilaxia a partir de recomendações médico-preventivas no ambiente escolar e familiar e da repressão política direta do Estado.

This work articulates the analysis of two elements of the relation between health and democracy, which are the universal access and the social participation in health, with experiences of municipal health managers in 2019 and 2020. The central thesis adopted is that there is a crisis in the health-democracy binomial expressed in the issues of access and participation and which has, as one of its points of origin and expression, the successful strategies for implementing the health reform project by the sanitary movement at the end of the 20th century. The work is based on empirical research realized by semi-structured interviews with five local health managers in the ABC region of São Paulo. From the interviews, it was identified that the universalization of access has materialized in the municipalities due to the substantial increase in individual consumption of medical care services, in its most positive sense, and the radicalization of its expansion culminates in a broad process of medicalization of society. In the case of social participation in health, it was identified that, within the scope of the Health Councils, a participatory exercise is poor in social innovation and politically emptied, which highlights the historical characteristics of the primacy of the State in the formulation of health policy, while expressing the marks of managerialism and market logic that are characteristic of contemporary capitalist societies.Concomitantly, the municipalities has experienced a emergence of new forms of social participation through information and communication Technologies by publications and expressions of individuals on social networks. The content of the publications is unpredictable for public management, exceeding the limits of space and time of classic government activities.