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2833
e Health Economic-Industrial Complex (HEIC): a strategic
area for both the modernization of the Unied Health System
(SUS) and the creation of future jobs
Abstract is article presents the initial re-
sults of the ongoing research on the new world of
healthcare work in the context of the 4th Techno-
logical Revolution. In addition to identifying the
prole and volume of employment generated by
health activities in Brazil, this investigation also
analyzes the main transformations in the world
of work and employment caused by new tech-
nologies and their potential impacts upon the
eld of the Health Economic-Industrial Complex
(HEIC). e methodology seeks to contribute to a
new vision of health professionals, which includes
not only the employment prole with its techno-
logical content, but also the professionals directly
and indirectly assigned to HEIC. Applying this
methodology to the databases of RAIS and Con-
tinuous PNAD from 2012 to 2019, reveals HEIC’s
high capacity to generate good jobs, even in a con-
text of economic crisis. e health labor market,
both for its scale, complexity, and diversity, and
for its dynamism and potential in terms of the
incidence of 4.0 technologies, indicates that the
development of HEIC can become the engine of
the country’s development, associating innovation
and production with the modernization of the
Unied Health System (SUS) and the generation
of good jobs.
Key words Health Economic-Industrial Com-
plex (HEIC), Development, Labor Market, 4.0
Technologies, Unied Health System (SUS)
Carlos Augusto Grabois Gadelha (https://orcid.org/0000-0002-9148-8819) 1
Denis Maracci Gimenez (https://orcid.org/0000-0002-7343-2328) 2
Juliana Pinto de Moura Cajueiro (https://orcid.org/0000-0002-2098-9341) 3
Juliana Dues Donato Moreira (https://orcid.org/0009-0006-8547-9496) 1
DOI: 10.1590/1413-812320232810.10672023EN
1 Centro de Estudos
Estratégicos da Fiocruz
Antônio Ivo de Carvalho.
Av. Brasil 4036, Prédio
da Expansão, 10º andar,
Manguinhos. 21040-361
Rio de Janeiro RJ Brasil.
carlos.gadelha@ocruz.br
2 Centro de Estudos
Sindicais e de Economia
do Trabalho, Instituto de
Economia da Unicamp.
3 Faculdades de Campinas.
Campinas SP Brasil
ARTICLE
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Gadelha CAG et al.
Introduction
One of the main challenges in the contemporary
world is the promotion of development for gen-
erating good jobs and guaranteeing access to so-
cial rights in face of the new technological para-
digms. In the critical tradition of Latin-American
economic thinking, it refers to recognizing the
concept of development as a process of structural
change, in which the productive system, working
on a revolutionized technical base, is oriented to-
wards the generalization of rights and the guar-
antee of environmental sustainability.
Climate changes, as well as demographic
and epidemiological ones which bring demands
for the Unied Health System (SUS) with new,
complex and growing health needs, are happen-
ing parallel to the developments known as the
Fourth Industrial and Technological Revolution,
bringing new analytical and political challenges
for the discussions regarding the relationship
between development and health in a capitalist
context. Biotechnology, articial intelligence,
Big Data, genetic edition, additive manufacture,
nanotechnology, and Internet of ings are ex-
pansion frontlines which aect the health area
in a decisive manner, transforming it into one
of the most dynamic areas in the contemporary
context.
In face of those transformations, Fiocruz ar-
ticulated the project known as “Challenges for
the SUS in the national and global context of
social, economic and technological transforma-
tion - HEIC 4.0” which is dened by research
cooperation in the elds of development, work
and social politics, in the scope of the Health
Economic Industrial Complex (HEIC), seeking
to advance in the production of public policies
which are compromised with economic and so-
cial transformation, with the SUS and with social
and labor rights.
From this perspective, we sought to identify
the prole and the volume of jobs generated by
health activities in Brazil and discuss the main
changes in the universe of work and employ-
ment, in the complex reality brought about by
the technological changes of Revolution 4.0. e
developed methodology provides a contribution
for a new and complex view on health profes-
sionals, since the identication of health workers
includes professionals who are directly and indi-
rectly included into the HEIC.
e identication and understanding of the
progress and limitations regarding the impacts
of new technology in the demand, supply and in
the work of health professionals is fundamental
in order to perceive the potential and the fu-
ture of the complex, focusing on health services,
which are the central element for universal ac-
cess. Technological changes place an increasingly
strong and faster pressure on HEIC, and might
increase asymmetry and contradictions between
the interests of the capital and the real life world,
as it became evident during the COVID-19 pan-
demic1-3.
is landscape brings threats and oppor-
tunities. In a context in which productive and
knowledge asymmetry indicate a segmentation
of services and the polarization of the labor mar-
ket, the many activities connected to healthcare
remain as important generators of qualied work
positions, propelling an actual process of “cre-
ative destruction”. In this sense, two kinds of
movements can be seen in the HEIC labor mar-
ket. At the same time as there is substitution in
some occupations or part of the activities, new
occupations are created, as well as competences,
new training or hiring systems, aecting the vol-
ume and the occupational contents in a decisive
and irreversible manner.
To achieve a universal and integral healthcare
service, humanized and with good quality, incor-
porating the new tools available and the precision
capacity of medicine, is something that requires
an economic and productive base increasingly
more sophisticated, capable of dealing with new
technologies, and also requires well prepared
health professionals. ose professionals must
have new abilities and competencies, and this
requires the training of new professionals or the
incorporation of professionals from other areas
of knowledge, such as the ones related to digital
technologies or to advanced math and engineer-
ing, in order to perform the new tasks and to
make use of the new tools available.
Having the perspective of innovation as a
process of political, economic and social change,
we seek to present in this article the rst results of
the impact of the 4th Industrial Revolution, with
the central objective of identifying and analyzing
which are its potential eects on the universe of
work and labor. We sought to identify and ana-
lyze the potential of the HEIC in terms of gener-
ation of qualied jobs and future jobs, within a
strategy of overcoming the historical inequalities
which dene the socio-occupational structure
of Brazil, considering the country’s production
dependency, and especially, technological de-
pendency, which have kept it in the position of a
mere consumer of technologies and innovations.
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Ciência & Saúde Coletiva, 28(10):2833-2843, 2023
In order to achieve this objective, this article
is organized into this introduction and four sec-
tions. e rst presents the theoretical-political
perspective of the Health Economic-Industrial
Complex. Following lines of investigation which
look into identifying health occupations beyond
conventional approaches4, the second section
presents the methodology for investigating the
labor market in the scope of the HEIC and the
eects of the 4th technological revolution on the
so-called “HEIC 4.0”. Next, we present the results
and discuss the characteristics of the healthcare
labor market organized in three dierent aspects:
i) a new view regarding healthcare professionals
in the HEIC 4.0 labor market; ii) the centrality
of healthcare services in the context of the 4th
technological evolution; iii) the importance of
healthcare professionals in the context of the
technological changes and the pandemic. Final-
ly, the last section, the conclusion, indicates the
importance of developing the HEIC as a key ele-
ment for associating innovation with healthcare,
into a national strategy of generation of good oc-
cupations and of well-being for the entire society.
e perspective of the Health
Economic-Industrial Complex (HEIC)
e 1988 Federal Constitution dened an im-
portant expansion of social rights in Brazil, and a
particularly relevant point is the universalization
of access to healthcare provided by the SUS, indi-
cating the importance of developing a universal
and equalitarian system.
e progress in the understanding of the
challenges which are faced by the SUS as a uni-
versal system led to the development of the con-
cept of a Health Economic-Industrial Complex,
which originated from a study initiated by the
Fiocruz in the 2000 decade, which established
an agenda for investigation into the relationships
between health and development in the capitalist
context5,6.
Fundamented in the eld of political eco-
nomics and public health, the HEIC denition
moves away from approaches which deal with
the economic and social dimensions in a sepa-
rate manner, and seeks to overcome the econo-
mist and technical, as well as the isolated health
perspectives focused on well-being. e main
challenge is to identify, in the healthcare area, the
close relationship between the development of an
economic and technological base, the generation
of jobs and the access to social rights in a univer-
sal, equalitarian, and integral manner.
A combination of understandings from four
schools of economic thought comprise the theo-
retical background of the HEIC, used for under-
standing capitalist development: the Marxist, the
Schumpeterian, the Keynesian and the Structur-
alist (with emphasis on the views of Celso Furta-
do). e preservation of the diversity of dierent
conceptions regarding development allowed for
the consolidation of key theoretical and political
aspects: the systemic view regarding economic
space; the dialectical analysis of the development
process; innovation as a process of political and
social change; the generation of asymmetry in
the process of development; the importance of
national sovereignty for reaching sustainability
for the SUS (the academic and political objec-
tive of the construction of the concept); and the
decisive role of the State in the coordination and
guidance of HEIC activities, and in the promo-
tion of development.
From an analytical standpoint, the HEIC
constitutes the economic, institutional and social
space into which there is production and innova-
tion in health3, according to Figure 1.
e HEIC is a systemic space where we can
nd an ample set of industrial activities and ser-
vices, which conform to the competitive and tech-
nological dynamics of markets, and are articulat-
ed into four subsystems: i) activities and sectors
involved in the production of healthcare services,
including hospital and ambulatory services, diag-
nosis and treatment services and services of retail
and distribution of healthcare products; ii) activ-
ities and economic sectors involved in the devel-
opment and production of biological and chem-
ical-synthesis medication, active pharmaceutical
inputs, vaccines, hemoderivatives and reagents for
diagnosis; iii) activities and sectors involved in the
development and production of medical-hospital
equipment, inputs, prosthetics and orthotics, di-
agnostic devices, personal protective equipment;
iv) activities and sectors created in the context of
the 4th technological revolution, involved in the
development and production of services to gen-
erate, process and transform in knowledge, the
data produced by the health sector, reinforcing
the connections between the dierent subsystems.
In this perspective, health is understood as
a citizenship right, and at the same time it is an
economic area, productive and innovative, with
considerable relevance in the current context.
Health services and actions, public or private, are
responsible for 8 million jobs, 10% of the coun-
try’s GDP and ⅓ of the national investment in
research and innovation1,7.
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Gadelha CAG et al.
However, since the 1988 constitutional land-
mark, which established health as a right for ev-
eryone and a responsibility of the State, an uneven
situation can be observed between the expansion
of universal access and the productive and techno-
logical healthcare base, and that has been accentu-
ating the situation of dependency and vulnerabil-
ity faced by the SUS. is scenario is not exclusive
to the health area, but instead a reection of Bra-
zil’s precarious insertion into the globalization
process, since the 1990’s, and of the systemic re-
gression, in economic and social terms, that has
been impacting the country since the 1980’s8,9.
e (dis)association between the produc-
tive structure and social needs, not restricted
to health but having health as its main focus,
became clear during the COVID-19 pandemic.
Unlikely what has been suggested by restrictive
views, which place economy and wellbeing in
distinctive elds, the countries with highly pro-
ductive technology and ample access to knowl-
edge were the ones which were able to respond
and be in the frontline in the ght against the
disease, meanwhile many other countries were
le behind in that race and remained dependent
the rst ones.
is situation reects the international divi-
sion of labor, which makes some countries sim-
ple consumers of technology while others dene
the technological standards in place, constituting
a clear center-periphery relationship. As stated
by some economists from the tradition of struc-
turalist thought, with Censo Furtado as the main
reference, the diusion of citizenship rights is
closely related to the development of an econom-
ic base which is compatible with such a challenge.
e condition of technological-productive
dependency of Brazil is associated with the his-
torical standards of development which repro-
duce an economic system which is not articulated
with the national interests, and is centered in the
primary-exporting specialization and in a pro-
ductive structure with little diversication. It is
an economic structure which is incapable of sup-
porting itself and staying ahead in the more tech-
nologically advanced sectors10, directly aecting
the possibilities of generation of good jobs and of
overcoming the compensational character of the
social policies.
Overcoming underdevelopment depends,
necessarily, on understanding such reality and
overcoming old epistemological boundaries
which divide the social, environmental and eco-
nomic universes as distinctive dimensions. In
order to rise against the projects of submitting
society to the interests of the market, which con-
demns the country to remain in a passive and
subordinate position in the international order, a
project is needed, with a social base and a policy
of support, so that the country can overcome its
theoretical insuciency and its structural vul-
nerability.
Figure 1. Morphology of the Health Economic-Industrial Complex in the context of the 4th Industrial and
Technological Revolution.
Source: Gadelha3.
Chemical and Biological
Subsystem
. Vaccines
. Active pharmaceutical inputs
. Medicines
. Hemoderivatives
. Reagents for diagnoses
Mechanical, Electronic, and
Materials Subsystem
. Mechanical equipment
. Electroelectronic equipment
. Prosthetics and orthotics
. Consumables
. Diagnostic devices
Industry
Primary
Health Care Hospitals Outpatient
clinics Diagnostic
services
Retail and
Distribution
Services Subsystem
State: Promotion + Regulation
Information and Connectivity
Subsystem
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Ciência & Saúde Coletiva, 28(10):2833-2843, 2023
Methodology
Based on the theoretical focus of the HEIC, a
methodology was developed for the investiga-
tion of the labor market in the health area, going
beyond the traditional views and representing
progress in the program of studies about health
professionals11. e identication of the workers
includes the ones who work in health services
and also those who work in the production and
commerce of medication, pharmacological mate-
rials an
d medical equipment, as well as all of those
who develop research or teach in the health area,
or are allocated in the private market of health and
insurance plans – this set of activities being de-
nominated “Restrictive HEIC”.
Deepening the pathway taken by Maria Hel-
ena Machado et al.4, the methodology developed
here goes beyond sectors of health that relate di-
rectly with care and medical services. In a comple-
mentary manner, and constituting what is called
“encompassing HEIC” other sectors were consid-
ered, which are indirectly related to the nucleus of
the Complex and have a strong nexus with pre-
vention and promotion of human health, being
those: veterinary and zootechny, sanitation and
hygiene, social security and assistance, physical
conditioning and funeral/burial services.
In face of the challenge of incorporating this
ample perspective, there was a need to identify
those whose occupations are part of the HEIC,
starting, from one hand, by the composition of a
double movement of identication of occupations
and sectors of activity, and on the other hand, by
the combination of data from two primary sources
of information on the labor market, the RAIS and
the PNAD Continuous, which were conducted by
the Ministry of Labor and by the IBGE, respec-
tively. In this phase, the HEIC work market was
analyzed, was characterized (qualitative aspects),
and its performance was analyzed (quantitative as-
pect). We took into consideration previous studies
and sought to advance in terms of systematization
of new concepts, methodologies and information,
and that allowed us to indicate the central charac-
teristics of the HEIC work market and to calculate
the indicators of the occupational structure, based
on occupations and activity sectors, for the years
from 2012 to 2019.
Another methodological improvement was
the ability to perceive the changes in the HEIC la-
bor market considering the incorporation of new
4.0 technologies, characterizing thus the “HEIC
4.0” work market. Since there are no other such
studies conducted in this eld, a new methodolo-
gy had to be created, beginning with some choices
made by other experts and advancing in the direc-
tion of the specicities of the HEIC and the Bra-
zilian context, in terms of the very structure of the
work market and in terms of the databases avail-
able12. In this sense, the study was developed from
a theoretical-conceptual referential selected about
the denitions of the terms related to HEIC 4.0, to
4.0 technologies (or digital) and to precision med-
icine; as well as about other studies which aimed
at identifying and analyzing the impacts of the
incorporation of those technologies on the entire
work market, being in Brazil, as well as in other
parts of the world. In quantitative terms, data was
gathered about the years 2012-2019, based on the
RAIS CBO (CBO-RAIS), considering that this
base allows for the identication of a wide set of
occupations, and enables us to identify those with
potential connections with new technologies.
Additionally, in this phase the primary sources
of data about the North American work market
were used, the Standard Occupational Classi-
cation (SOC) and the Occupational Information
Network (O*NET) (SOC-O*NET), more com-
plete and updated and through which we can al-
ready identify the occupations, abilities, tasks and
tools which are closely related to 4.0 technologies.
In this phase, we analyzed the incidence of 4.0
technologies on the labor market, seeking to char-
acterize and evaluate the functioning of the HEIC
4.0 labor market.
Aer the denition and application of the two
methodological phases on the databases from
the RAIS and PNAD-Continuous for the period
2012-2019, we were able to prove the importance
of the HEIC labor market, being in terms of its
composition, being in terms of its evolution, or
even in the context of economic crisis. Moreover,
the study shows the reality and the potential in
terms of incidence of 4.0 technologies in the scope
of occupations, analyzed in terms of tasks per-
formed. e period considered, immediately be-
fore the pandemic period, shows the quantity and
diversity, as well as the potential, of the availability
of health professionals in the country before the
economic-health
crisis.
Results and discussion
e HEIC 4.0 work market: a new view
regarding health professionals
Considering the new view proposed here, in
which the healthcare labor market was analyzed
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Gadelha CAG et al.
broadly in methodological and conceptual terms,
the professionals who work in the HEIC and are
absorbed by its segments show its high potential
impact in the Brazilian labor market, in terms of
employing a signicant number of people, as well
as for the quality and diversity of the occupations
it generates.
In 2019, 8.7 million professionals were work-
ing for the HEIC, equivalent to 9.2% of the work-
ing population in Brazil. Moreover, the increase
in HEIC employment was much higher than in
the general labor market, even considering the
context of the economic crisis. Between 2012 and
2019, the variation was positive, 33.9% – with a
31.8% growth in the sector of medical services,
and of 101.7% in the medical care sector. Mean-
while, there was a 6.1% growth in terms of the
general working population, and only 3.9% in
terms of the working population outside the
HEIC. erefore, we highlight the anti-cyclic
performance of the HEIC labor market, and the
fact that a large portion of the jobs created were
of high level, much above the average in the Bra-
zilian labor market11.
Meanwhile, even though it is a space for in-
corporation, the HEIC work market reproduces
the patterns of the Brazilian characteristics of
development, which are dened by inequality in
several aspects. Considering gender inequalities,
the occupational structure of the HEIC shows the
high presence of women, revealing the feminiza-
tion characteristic of the healthcare workforce.
Gender inequalities go in the opposite direction
as what is seen in the general labor market. In
2019, only 44% of those regularly employed were
women, according to data from RAIS; mean-
while, in terms of the HEIC, women were 75.4%
of those employed in the health sector11.
Regarding racial inequalities, blacks (dark
and light-skinned) employed by the HEIC cor-
respond to 44.1%, being that aligned with the
general labor market, in which 45.3% of the em-
ployed population is black. When gender is asso-
ciated with race, we can notice that black women
correspond to 27.8% of that workforce, compared
to only 15.9% of those employed in the general
workforce. In terms of income, most of the HEIC
black workers earn up to 2 minimum salaries
(MS), with more representativeness of women –
64.3% of the black women and 57% of the black
men. In terms of employed white women, most
(51%) are in this income bracket, as well. So, it
is clear that the income of women is lower, being
white or black, and especially in the case of the
latest, in comparison with that of white men. is
is a dening trait of the Brazilian labor market11.
In terms of regional inequalities, the distribu-
tion of those employed by the HEIC follows the
same trend of the labor market in general: 49.5%
of the total working population and 51.2% of the
HEIC workers are in the Southeast region11,13.
Besides the fragility and limitations, the pos-
itive performance of the HEIC labor market is
a result of the combination of other elements,
distinctive in comparison to the labor market in
general.
e rst of those characteristics is the cen-
trality of human work in healthcare, both in
quantitative and qualitative terms, since the work
is constituted be labor intensive activities, even
with the incorporation of new technologies; it is
therefore dicult to expand health services with-
out increasing the level of employment; it has a
growing tendency of expansion and incorpora-
tion of workforce independently of the economic
situation; and the dynamism of the jobs in the
service sector boosts the growth in employment
by other sectors of the complex.
According to the RAIS and the PNADC, in
2019, the composition of the HEIC sectors was:
57.6% of the employed in the area of healthcare
and medical services, 8,5% in commerce, 7.5% in
care, 7.4% in sanitation, 5.5% in social assistance,
3.9% in physical conditioning, 3.3% in produc-
tion and maintenance, 2.0% in veterinary and
zootechny, 1.4% in insurance and health plans,
among others11,13.
e second characteristic reveals that the av-
erage income of the HEIC workers is above the
average income of the labor market. e work-
ing population, according to RAIS, in 2019, had
most of the employed (56.1%) in the income
bracket up to 2 minimum salaries, 31.5% be-
tween 2 MS and 5 MS, and 12.4% in the more
than 5 MS bracket. e segment employed by the
HEIC also has a signicant portion in the brack-
et up to 2 MS, although the percentage is small-
er (50%), and presents larger numbers in other
brackets – 34.8% between 2 MS and 5 MS; 15.2%
more than 5 MS. In the case of healthcare and
services, 48.4% earn up to 2 MS, 36.1% between
2 MS and 5 MS and 15.5% earn more than 5 MS.
On the other hand, 92% of the employed in the
care sector earn up to 2 MS, and 57.5% of the em-
ployed in research and teaching earn more than
5 MS11,13.
e third characteristic is connected to di-
versied qualication in comparison to the labor
market in general. Out of the general working
population, 17.2% have up to Elementary edu-
cation, 55.7% have up to High School education
and 27.0% have incomplete College education or
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Ciência & Saúde Coletiva, 28(10):2833-2843, 2023
more. In comparison, in the segment employed
by the HEIC 7.8% have up to Elementary educa-
tion; 54.9% up to High School Education; 37.3%
have incomplete College education or more
(RAIS, 2019). In healthcare and services, 6.0%
have up to Elementary education, 56.3% have up
to High School education and 37.8% have incom-
plete College education or more. e workers in
the research and teaching area stand out in terms
of education, being that 98.7% have incomplete
College education or more; in the case of care
providers as well, the highest portion (71.9%)
has education up to High School level and only
15.1% have up to Elementary education11,13.
It is important to remember that qualica-
tion and occupational requirements should not
be analyzed only from the schooling perspective,
but also in terms of classication of the kind of
occupation, of the denition of the occupation-
al prole (abilities, competencies, tasks, tools,
among other variables), and the identication of
new modalities and/or new professional quali-
cations required for the work in the healthcare
area, related to the incorporation or presence of
new technology. Such aspects were incorporated
into the methodology developed here13.
e fourth characteristic reveals that the
typical occupations, or nuclear ones, related to
healthcare are regulated and controlled by the
public sphere, by the Ministry of Health and by
the Professional Councils specic to each profes-
sional category. Moreover, HEIC has a relevant
number of occupations which are partially regu-
lated and can be performed by professionals not
necessarily from the health area, aer receiving
specic training in the workplace13.
e h characteristic relates to the fact that
the HEIC has a relevant role in the employment
generation and in terms of formal work contracts,
regardless of the precarization that aects the
professionals in the healthcare area, as a reec-
tion of a structural movement which is present in
the entire Brazilian labor market. According to
the PNADC, in 2019, 42.7% of the employed by
sectors other than HEIC and 41.1% of the general
employed population were in the informal sec-
tor; meanwhile informal employment related to
the HEIC was between 20.3% and 35.4%, more
likely around 20%11,13.
In case of formal work, according to RAIS, in
2019 the number of people hired by CLT norms
represented 79.3%, of the workers, meanwhile
18.0% were employed by the Statutory system. In
the case of HEIC workers, 73.6% were in the CLT
regime and 22.9% in the statutory regime. With-
in that segment, those who work in healthcare
and services, 65.2% were CLT and 31.5% were
statutory11,13.
e sixth characteristic deals with the im-
portance of the public sector in generating HEIC
jobs, especially in the area of health services and
care. In the case of the general working popula-
tion, 19.9% are in the public sector (RAIS, 2019).
In terms of the HEIC, 27.6% are in the public
sector, being that in health services and care, the
number reaches 37.8%11,13.
e seventh characteristic indicates the ca-
pacity of creating new modalities or kinds of
occupation, determined by changes in the so-
ciodemographic prole of the population (pop-
ulation aging and increase in need of workers in
caregiving for the elderly), in terms of the pub-
lic policies of healthcare coverage (expansion of
Family Care teams) and in the incorporation of
technology. is last aspect has two elements: on
one hand, new professionals, who have training
which is not typical of the health area, and are
extremely relevant for the incorporation of new
technologies, are absorbed by the HEIC, such
as engineers, physicists and mathematicians,
among others; on the other hand, new abilities
are required by health professionals. In the rst
case, there is a growth in the presence of occupa-
tions which are not related to health and which
have strong relation with 4.0 technologies. For
example, in 2019, according to RAIS data, more
than 80% of the physicists (nuclear and reactors),
more than 70% of the physicists (condensed mat-
ter), and in varying levels, Statisticians, Technol-
ogists, Engineers, are being absorbed in activities
related to HEIC 4.0. In the second case, the study
sought to identify the incidence of new technol-
ogies on occupational qualication through the
study of the tasks performed by those who work
at the HEIC, and their relationship with the tech-
nological content11,13.
e centrality of healthcare services in the
context of the 4th technological revolution
e 4th technological and industrial revolution
has already produced impacts in the healthcare
labor market. Research data shows that 60% of
the occupation have been or will be strongly af-
fected, considering the tasks which are performed
by health professionals. e occupations with the
most potential for incidence of new 4.0 technol-
ogies were those in the area of production and
maintenance, services and care and research and
teaching, showing a variation of +119.1%. is re-
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Gadelha CAG et al.
sult suggests a changing trend in the labor market
based on the incidence of 4.0 technologies in areas
related to HEIC, with high capacity for generating
jobs, even in situations of economic crisis12.
In this context of transformation, the services
sector stands out by the scale and by its dynamic
components. It corresponds to a universe of 2.8
million jobs in 2019, which had an increase of
nearly 20% (more than 390 thousand employees)
in comparison to 2012, according to RAIS data. It
is the HEIC’s most important employer, and be-
sides presenting a high rate of growth, it was also
the sector which showed the highest incidence,
or at least, potential incidence of 4.0 technologies
on occupations12.
Such a trend was also present in several of its
occupations, being them typical of the segment,
or being those that are not typical of the health
sector and that have already been absorbed, in-
cluding professions which are more similar,
in terms of education, abilities and competen-
cies, of the so-called professionals of the future.
Among the professionals with more potential of
incidence of new technologies, most of the oc-
cupations (50%) and of the number of employed
(70%) are connected to medical care and services.
In 2019, the growth in that area was 270.6% in
comparison to 2012, above the general growth in
this sector (+119.1%)12. Table 1 presents the dis-
tribution by sectors, the number of the employed,
their participation, and the 2012-2019 variations,
for the occupations with high index of techno-
logical incidence.
e services and care service sector shows its
importance for the HEIC, given the realization
of the sector’s size, complexity and diversity, as
well as its dynamics and its ability to overow
into other sectors, being the central booster for
employment generation and incorporation of
technology into the HEIC, strongly aligned with
4.0 technologies.
e importance of health professionals in
the context changes brought by technology
and by the pandemic
In face of the profound changes going on,
with the world transforming into what is being
called a “digital society”9, industrial logic be-
comes more radical, reaching the health services,
which become increasingly more impacted by
new technologies. e growth in the sector of
digital services relates to an increasingly robust
industrial and technological base, indicating a
process of “hyper industrialization”, which is ca-
pable of intensifying asymmetries at national and
global levels8.
e industrial base is fundamental in press-
ing for favorable employment dynamics in the
HEIC as a whole, incorporating new technolo-
gies in the production of goods and services. It is
not just a matter of incorporating technologies in
the sense of becoming a consumer-user, but it is
rather, acting progressively more as a developer,
which requires integration of research activities,
development and innovation, in the realm of the
companies, of the universities and labs, being
them public or private.
In the context of the COVID-19 pandemic,
the incorporation of 4.0 technologies and the
qualication of professionals were decisive in the
ght against the disease, from the medical point
of view at rst, and from the prevention point
of view later, when the vaccines arrived in the
marker and were incorporated in the healthcare
systems.
Some of the situations in which that issue was
evident relate to the work of the i) researchers,
from dierent backgrounds and who work in
state of the art labs, in the study of the virus ge-
nome and in the development and technological
incorporation of vaccines (by formalizing a Tech-
nological Request) – which are both actions that
took place in record-breaking time; ii) the epi-
demiologists and their teams, including techno-
logical abilities and tools for the following up of
cases and the identication of mortality proles
and of comorbidities; iii) the health profession-
als conducting dierent redirecting of treatment
and medication which were already available in
search for the most ecient ones for the treat-
ment; iv) of the factories developing medical
equipment and PPEs, vaccines, medication, in-
puts, being those produced with consolidated
technology or with new technologies, among
others. In that sense, the SUS and the founda-
tions, the institutes and the public laboratories
were references, nationally and internationally,
demonstrating the capacity and the potential of
the Brazilian HEIC. During the pandemic, how-
ever, its limitations became evident as well1,7.
e incorporation of 4.0 technologies has
the potential cross-sectional eect on the health
complex occupations, however will impact the
most the occupations related to services and
medical care – in a direct manner, by changing
the tasks performed by the workers, or indirect-
ly, by promoting changes in the routine and the
products and services generated by the work of
those employed in the industrial sectors of the
2841
Ciência & Saúde Coletiva, 28(10):2833-2843, 2023
HEIC. e 4.0 technologies, therefore, have the
potential of transforming substantially the way
in which services and medical care are provided.
However, the technology available should not
be considered in isolation. It is fundamental to
relate technological progress with the strength-
ening of the possibilities and the scope of the ser-
vices of care promotion and prevention in health.
ese services have a high cost and become even
costlier in the absence of early diagnosis, which
does not depend necessarily on high technology,
but can be improved by it.
In terms of the health professionals connect-
ed to the HEIC segment of medical services,
there is a need for expansion, qualication and
renewal, in the sense of incorporating new pro-
fessionals who did not perform functions relat-
ed to healthcare before. is kind of movement
requires the expansion of the scope of the pro-
fessions involved in healthcare services and ac-
tivities, going from community health agents,
to family doctors, from caregivers to physicists,
mathematicians, statisticians, engineers, in a way
that all of the workers perform tasks, develop ac-
tivities and use tools which are more sophisticat-
ed in terms of technology.
e incorporation of new technologies, be-
ing more simple or more advanced, may improve
well being and life quality, and is viable in the
SUS context, and are generating many qualied
jobs, from primary care to high complexity care.
For this reason, it is vital that public policies are
created, capable of strengthening the SUS, and
having as their target the creation of good qual-
ity jobs, aligned with the demands imposed by
the technological changes in eect, and aiming to
provide universal, integral and equitable access
to healthcare.
Conclusion: innovation and care for
generating jobs and well-being
for the whole society
Development which can generate good jobs and
the creation of a social welfare system in a conti-
Table 1. Occupation at HEIC with highest potential of technological incidence 4.0.
CBO Sector
No.
occupations
2019
Participation
2019
Absolute
variation
(2012-2019)
Percentage
variation
(2012-2019)
Biomedical doctor Services and care 16,998 60.6% 13.200 347.6%
Maintenance Technician -
Medical-hospital equipment and
instruments
Production and
maintenance
3,443 12.3% 1.656 92.7%
Biotechnologist Research and
teaching
1,954 7.0% 189 10.7%
Neurologist doctor Services and care 1,427 5.1% 339 31.2%
Medical equipment assembler
(assembling materials)
Production and
maintenance
1,297 4.6% -1.432 -52.5%
Biomedical systems technologist Services and care 575 2.1% 414 257.1%
Vivarium technician Research and
teaching
556 2.0% 70 14.4%
Bioengineer Research and
teaching
466 1.7% 354 316.1%
Researcher in human biology Research and
teaching
404 1.4% 112 38.4%
Bioengineering support technician Research and
teaching
329 1.2% -10 -2.9%
Hospital management technologist Services and care 297 1.1% 258 661.5%
Radiotherapist doctor Services and care 126 0.4% 9 7.7%
Geneticist doctor Services and care 111 0.4% 79 246.9%
Geneticist Services and care 46 0.2% -3 -6.1%
Total 28,029 100.0% 15.235 119.1%
Source: Gimenez et al.12, based on RAIS data.
2842
Gadelha CAG et al.
nental-size country requires a strong productive
and technological base, dense and sophisticated,
which can support it. Health is a platform for
technologies of the future, on the boundaries
of knowledge, which are, as research shows, the
base for the generation of good jobs. Services of
medical care and attention depend on a strong
productive base and are being increasingly im-
pacted by new technologies; at the same time,
those are activities which require extensive and
qualied labor, therefore, there is need for atten-
tion regarding health professionals.
Incorporation of technology aimed at collec-
tive and humanized healthcare has the potential
to generate new occupations, demanding new
abilities in the use of new tools, and generat-
ing a professional segment that is increasingly
interdisciplinary and diverse. Public policies
are required, which are able to recognize the
importance of the new technology available to
healthcare professionals, as well as policies for
professional training on a large scale, enabling
the workers to deal with new technology. It is a
matter of promoting a sort of symbiosis between
caring for those who provide care to people, re-
sulting in the generation of qualied employ-
ment and well-being for society as a whole.
e development of the HEIC results in a
frontline for the generation of good jobs in a
short term and for the jobs of the future, and it
may be the key for the country’s development, by
articulating investment and incorporation of new
technologies in the SUS, with the production,
scientic development, income improvement
and employment generation, to production in
the country. Restrictive views, which place econ-
omy and well-being in separate elds, must be
replaced by a systemic and structural view which
recognizes Health as an strategic space, where we
can, simultaneously, have a new model of society,
and which may help Brazil to overcome its tra-
jectory of economic and social regression, by cre-
ating economic dynamism and generating good
jobs and well-being.
Collaborations
All of the authors contributed to the stages of the
creation of the study, data collection and analysis,
the write-up the manuscript, and critical reading.
CAG Gadelha contributed with the theoreti-
cal-conceptual denition of the Health Econom-
ic-Industrial Complex (HEIC), in the elaboration
of the project, and in the critical revision of the
manuscript. DM Gimenez contributed in the
methodology construction and statistical manip-
ulation of data, as well as in the critical revision of
the manuscript. JPM Cajueiro contributed in the
methodological construction, data collection and
statistical manipulation, as well as in the write-up
of the manuscript. JDD Moreira contributed in
the denition of the study’s structure and in the
write-up of the manuscript.
2843
Ciência & Saúde Coletiva, 28(10):2833-2843, 2023
Acknowledgements
is study received nancial support from the
“Desaos para o SUS no contexto nacional e
global de transformações sociais, econômicas
e tecnológicas” Project and from CNPq, CAG
Gadelha’s research and production sponsorship.
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Article submitted 20/12/2022
Approved 01/06/2023
Final version submitted 08/07/2023
Chief editors: Romeu Gomes, Antônio Augusto Moura da
Silva
is is an Open Access article distributed under the terms of the Creative Commons Attribution License
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