The judicialization of health is discussed as a response to the lack of effectiveness of
public policies, facing criticism related to the lack of legitimacy of judges to allocate
public resources and the financial and political impacts of judicial decisions, among
others. In this context, the structural process is seen as a more adequate approach to deal
with structural health disputes, since the Brazilian procedural system has been showing
concern with the multipolarity and complexity of the conflicts brought to court, in such
a way that their solution conforms to a prospective character and in accordance with
constitutional dictates, in an attempt to overcome an individualistic and linear model of
legal protection. The present text, initially, discusses the differentiation between global,
local and irradiated collective litigation, highlighting the relevance of this distinction for
procedural issues, such as active legitimacy to file collective actions. Then, the focus is
on the collective process as a tool to protect collective disputes, although it is not the
only available option, since the judicialization of individual demands on public policies
can impair the efficiency of the judicial provision, leading to contradictory and
incomplete judgments. The text also explores structural disputes, which arise from
complex violations in bureaucratic structures, public or private, and are often not
completely resolved by simply removing the violation, as they involve multiple poles
with intertwined interests. It is thus noted that there is a need for judicial action to
promote a restructuring of the public entity, for example, which demands time and
continuous monitoring: this is where the so-called structural process comes in, within
which a litigation will be composed structural, aiming at solving a structural problem
and the state of non-compliance brought in judgment, in order to reach, as much as
possible, an ideal state of affairs. In this vein, the present dissertation aims to study the
characteristics of a problem, litigation and structural process, so that, based on these
concepts, the performance of the Procuradoria Geral do Estado do Tocantins is
optimized, in particular the judicial nucleus that takes care of demands involving the
right to health, through the elaboration of a manual that helps in the identification of
structural actions in this area, and suggestions for managing them, in order to enhance
the efficiency of the body's judicial and, also, extrajudicial action, breaking, thus, the
practice of a purely defensive action, in search, therefore, of a constructive action of
effective solutions for the structural problems in the field of public health. It is also
noteworthy that the creation of the Deputy Attorney of the Chamber for the Prevention
and Administrative Resolution of Conflicts is seen as an institutional advance, seeking
mediation and conciliation as alternatives to judicialization. In short, the importance of
the PGE's proactive and strategic performance in facing structural health disputes and
demands related to public policies, seeking more comprehensive and effective solutions
for the systemic problems that affect the effectiveness of these fundamental rights, is
emphasized.
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