A health activist
By the time he joined Odebrecht in 1992, Sebastião Loureiro, MD, had devoted nearly 30 years to the fields of preventive medicine and public health. He used his considerable experience to help formulate the Group’s health care policy
written by ◦ João U.G. Sant’Anna photos by ◦ Almir Bindilatti

Today, 13 years later, he is sharing the concepts of entrepreneurship and management he learned at Odebrecht with academia. After obtaining his medical degree from the Federal University at Bahia (UFBa) in 1964, Sebastião Loureiro did his residency in preventive medicine at the University of São Paulo (USP) in Ribeirão Preto before going on for a master’s in public health and tropical medicine in London and a doctorate in epidemiology in the United States. He co-founded and directed the Department of Medicine of the UFBa Medical School, conceived and helped create the Collective Health Institute – a Brazilian benchmark for graduate studies in that field – and is now developing its Health Economics Program. He has played an outstanding role in debates on public health care policy that gave rise to Brazil’s public health service (SUS) in its present form, and the Brazilian constitutional concept that health care is a civil right and the government’s duty. His distinguished career has earned him the title of Professor Emeritus from UFBa, which he received on December 15th at a ceremony at the university’s central administration building. In this interview, he talks about preventive medicine, globalization and stress, among other subjects.

Odebrecht Informa – What are the main health problems facing major companies today? Do they arise from specific professional activities or are they just common problems that everyone brings to the workplace?

Sebastião – That depends on the nature of the company and its activities. People engage in a wide range of activities at Odebrecht, some of which have their own unique characteristics. For example, there are more inherent risks in the Engineering & Construction area than those to which the general public is exposed. Many different kinds of people work in the administrative area, and they tend to have the same problems you’d expect to occur in the general population. However, at the Odebrecht Group and most other companies, executives are an exception to this rule. Odebrecht has always offered its members opportunities and recognition but there is also an intense demand for performance and results. Executives have to deal with specific types of stress arising from our organizational culture, as well as the way people view and respond to that culture. Some people set challenges for themselves that require overwhelming physical and mental effort. But that is not exclusive to just Odebrecht. The stress rate among Brazilians in general is very high – approximately 20%.

“Stress has been with us since prehistoric times. Prehistoric man dealt with temporary stress when he went out to hunt or fight for a territory”

OI – Stress can be viewed as a necessity or a necessary evil. Is any of that true?

Sebastião – Stress has been with us since prehistoric times. Prehistoric man dealt with temporary stress when he went out to hunt or fight for a territory. Our bodies became accustomed producing involuntary physiological responses that would help us confront danger and make life-or-death decisions on the spot. Today, this is becoming increasingly necessary – you have to keep an eye on your purse, be careful where you park your car, and so on. We are once again confronting stressful situations because we need to be ready for the unexpected: it’s the fight or flight reaction. At work, we negotiate contracts, deal with clients, and go through situations where we have to be sharp and on-the-ball. To do so, we need to increase the flow of adrenaline and other hormones coursing through our bodies. But it’s more psychological than physical. We have to be alert and focused. If this just happens sporadically and afterwards people go out to spend time with friends or do sports, they can handle the situation well and won’t suffer any serious consequences. But there’s a “red line” for stress. At that point it can start to have negative side effects. That red-line point varies from person to person. Some people are psychologically stronger and others are more vulnerable. You have to get to know a person to determine how much stress they can tolerate. Then, as a doctor, you have to warn them and help them get to know their own limitations, because it isn’t productive to go beyond them. The company’s leaders have to be aware of this.

OI – What are the guiding principles for Odebrecht’s health care policy?

Sebastião – They are the principles of the Odebrecht Entrepreneurial Technology (TEO). One is that each individual is responsible for developing his or her own health. People are the main beneficiaries of this, because good health is key to achieving personal and professional fulfillment. If they don’t see things that way, there is nothing we can do for them. This is a fundamental principle. It is up to the Group to create the conditions for enabling each individual to maintain and develop his or her health, but they are responsible for the rest. Norberto Odebrecht is even more exacting: your health is not just your affair. It also matters to your family and the Group. Another principle is that Odebrecht’s health care policy focuses on health promotion and preventive medicine. Curative medicine should be a last resort.

OI – What sort of impact are the processes of productive restructuring and globalization having on people’s health?

Sebastião – They have several impacts on numerous levels. One of the areas that has felt the greatest impact of this restructuring process is human resources, where the most costs are being reduced. This puts a strain on the people who remain with the company. Those who leave lose their jobs and face a number of problems, but those who stay have to take on more responsibilities and start multitasking. This increases their work load massively and can cause health problems as well: increased stress and physical and mental strain. Most companies are also outsourcing their health programs, particularly in operational areas, which has drastically reduced the efficiency of occupational medical care. In time, these two factors could have a negative impact.

OI – In professional terms, what does it mean to receive the title of Professor Emeritus?

Sebastião – The UFBa School of Medicine was the first medical school established in Brazil. It is very prestigious. The Collective Health Institute got an excellent rating following the Brazilian Ministry of Education and Culture’s official evaluation. UFBa also has one of the top health departments in the country among federal universities. Therefore it is a tremendous honor. I believe that this recognition is the result of almost groundbreaking work at UFBa that sought to establish a different view of medicine that focuses on health and its promotion instead of disease, and concentrating on preserving health and preventing health risks and hazards. I’ve had the opportunity to work with an excellent team of people who are ethically committed to the principles of balanced health, creative, involved, qualified (most of them have doctorates from foreign universities), and very productive. The Department has grown as a result and become a national benchmark by structuring the conditions for creating the Collective Health Institute. I believe that the title of Professor Emeritus is a form of recognition for the work of that entire team.

“Good health is key to achieving personal and professional fulfillment. If people don’t see things that way, there is nothing we can do for them”

OI– At the moment you are helping organize conferences of the Latin American Social Medicine Association and the International Health Policy Association in 2007 in the city of Salvador. What role do these associations play?

Sebastião – I am a former chairman of the Latin American Social Medicine Association and am now on the board. It is an important organization that has spotlighted the debate on the role of society in illness. Previously, the focus was strongly on the individual and the family. Social medicine seeks to determine how the organization of the community influences individuals and how that can increase or reduce the probability of getting ill. The association has played an important part in disseminating this view in Latin America through its local centers in countries like Uruguay, Argentina, Peru, Chile, Mexico, Venezuela and Colombia, in addition to Brazil.

OI – What about the International Health Policy Association?

Sebastião– That organization is more academic. It brings together researchers and teachers from all European countries, as well as the United States, Canada, Mexico, Brazil and Chile. It was founded in Europe and has its headquarters there. It focuses on health care policy issues in terms of the organization and financing of the health-care system, and supports universal public health care. Brazil’s national health system, or SUS, is strongly influenced by that organization’s policies, particularly the Italian and British branches.

OI – How did you come to chair these two associations?

Sebastião – The Brazilian Collective Health Association (Abrasco), which I also chaired, played an important role in this debate on health care reform in Brazil. I believe that that was what led to my election to the chairmanship of the Latin American Association and later to the International Association. The administration of Abrasco had a very clear, consistent and cohesive political view of health issues in Brazil. We followed a strategy of forming political alliances with all segments of civil society as well as political parties. This process of debate was very important to rethinking and reforming the health care system. The result was the SUS and the determination that all citizens have a right to health care services, which are the constitutional responsibility of the State.

“The experience of applying TEO in the area of health has been an important lesson in life. I am always telling my colleagues about the principles I’ve learned and am still learning through my work at Odebrecht”

OI – You have been with Odebrecht for 13 years. How did you come to join the company?

Sebastião – I was a visiting professor at the University of Montreal in Canada, and was nearing the official retirement age in Brazil. I had received an offer to stay in Canada and came back to Brazil to mull it over. Then I found out from a colleague that Odebrecht was looking for someone to update its health-care policy, in view of the organization’s growth and diversification. I thought that it would be interesting to take on this new challenge, since all my previous experience had been in government and academia, where people develop proposals and do research but don’t actually see them carried out. I saw it as an opportunity to apply the knowledge I had acquired to a large population of workers. After all, Odebrecht had 37,000 members, let alone their families. I found that highly motivating.

OI – What has been most enriching to your professional development during your years with Odebrecht?

Sebastião – Economic management and entrepreneurship. That is something I learned here and I’m taking back to academia. During my time with Odebrecht, I have come to realize that most government and corporate spending is on health care. And the cost of medical services is very high. The thing that has interested me most in this new area is building up experience in the fields of supplementary health care, company members’ health insurance and dealings with insurance companies. I have also found the lessons I’ve learned about the Odebrecht Entrepreneurial Technology very enriching to my perception of people’s capacity to realize their plans by using a method and the principles of valuing people and applying discipline and creativity. The experience of applying TEO in the area of health care has been an important lesson in life. I am always telling my colleagues at the Health Economics Program about the principles I’ve learned and am still learning through my work at Odebrecht.