Inequalities in the provision of medical care for trade and industry workers in the Estado Novo dictatorship. Ana Maria Campos (GHES ISEG, Lisbon) Introduction The geopolitical, economic and social transformations that characterized the post-world War II led to the emergence of a new conception of the state in democratic countries, based on principles of equality and social justice. The improvement of living conditions of the population and the need to fight poverty became an important part of the political agenda of governments, which became responsible for their citizens wellbeing, an idea that was not limited to the satisfaction of the basic needs of individuals but also included equal access to a set of social and civil rights. These priorities, along with the consensus around the legitimacy of states intervention and the opportunities resulting from the exponential economic growth of this period, resulted in a favorable context to the emergence of the Welfare state. In Portugal this phenomenon would have to wait for the advent of democracy in 1974. Nevertheless, during the Estado Novo (1933-1974) we witnessed the implementation of a set of measures, particularly from the mid-40s, designed to improve the living conditions of the population. Social policy in this period was heavily influenced by corporatist ideology and was characterized, primarily, by a duality between social assistance and social security (by that time called Previdência Social 1 ). This paper takes as its subject one of the most peculiar social policies implemented in Portugal during the Estado Novo, the creation in 1946 of a health service designed exclusively for workers of trade, industry and services that were covered by the social security system. First, it is intended to place this event in the set of social policies of the dictatorial regime, whose development had been limited by the implementation of an authoritarian and corporatist regime. In the international context, 1 The expression Previdência Social is usually translated as social security, because it addresses to the insurance schemes that were designed to protect workers and their families against risks of loss of income, but it should be pointed out that the term was far from the concept of social security that will trigger from the 70s. 1
the creation of these medical services is contemporary of the National Health Service Act in England in 1946, one of the most important events of the Welfare state history. Thus, it seems relevant to frame the Portuguese case in the conceptual and theoretical analysis on this topic, seeking to detect similarities that allow us to realize the extent to which these events had influence in this country. It will also be exposed, from a comparative perspective, the major progresses of the social policy obtained during the dictatorship. Lastly, some hypotheses that may explain the delay of the country in this field will be presented, in particular regarding the lack of public health services. 1 Social Policy and Welfare State theoretical framework It s not easy to establish a consensual definition for Welfare state, an expression that contains several variables and presents different nuances meaning that, rather than an abstract definition, it is often analyzed in the shadow of its relationship with political power, industrialization and the development of capitalist economies. The historical context and the principles that led to its institutionalization are common elements in almost every analysis (Baldwin, 1996). The Welfare state has been approached by historiography as a phenomenon that emerges in the post- World War II in highly industrialized and democratic countries. This event consisted in the sophistication of social policies, with the governments seeking to provide their citizens a level of wellbeing that went beyond the satisfaction of basic needs to include a set of social and citizenship rights, shaped by a spirit of equality and social justice. The main factors driving the emergence of the Welfare state were the influence of Keynes theory, boosting states intervention in the economy, and the opportunities created by economic growth, without which the complexity of social policies could hardly withstand. Finally, it is worth noting the influence of the Beveridge Report, published in 1942, to the emergence of a redistributive, comprehensive and universal type of social policy, which moved away both from a market-based system and the conservative and hierarchical bismarckian social security system (Baldwin, 1996, 33 34). Social policy encompasses a wide range of variables, but it is usually attained through: payment of subsidies and social benefits; public facilities and services (e.g., 2
health services, education and social housing); creation of mechanisms for intervention in situations of great instability, in order to reduce social risks like poverty and unemployment. These measures are projected to improve the living conditions of the population and mostly to reduce social inequalities, which is one of the great foundations of the Welfare state. The National Health Service, first introduced in Britain, in 1946, is considered its symbol since it is independent of class, poverty and subsistence conditions (Marshall 1967, 98). Following the proposal of Richard Titmuss (1974) we can find two models of social policy: the residual and the institutional. The first is based on the idea that it is on families and markets that citizens will find the answer to their needs. States intervention occurs only if there are failures in this natural process and should be only temporary. This is a model that moves toward the theory of economic liberalism and that fits the fundamentals of public assistance. In the institutional model, social policy is an integral part of society and should seek to provide citizens with a range of public services, according to their needs. In this formula, we find a higher propensity for universality, equality and redistribution, therefore the institutional model is the one that best embodies the values of the Welfare state. This is due to the existence of a variety of social services where coverage is universal, giving people with lower resources the access to the same services as those who have greater purchasing power. In the residual model we might find services exclusively for the poor like, for example, health services, which may be of lower quality and cause social stigma. Thus, we have two distinct patterns, dominated by opposed concepts with regard to their objectives: selectivity vs. universality; minimum level of living conditions vs. medium or higher standard; private social security vs. state social insurance (Korpi, 1983, 191 193). The Portuguese example is closer to the residual type, although we have to consider the presence of substantial differences resulting from the corporatist orientation of the Estado Novo dictatorship, in which social policy, as well as economic policy, emerged like a third way between socialism and liberalism. Looking at the set of principles that illustrate the Welfare state, we could assume that this phenomenon is not observed in dictatorial countries in which we witness the suppression of civil and political rights, and individual freedom. But that doesn t mean that these countries didn t have a social policy program. Even though, in historiography, social policy is associated with democracy, particularly with the social democratic 3
ideology, in reality this is not a vital requirement and this assumption does not always correspond to reality. Moreover, in his analysis of the three worlds of the Welfare state, Esping-Andersen (1990) concluded that between the liberal, the conservative and the social democratic regime, the last one is precisely the smaller, being practically confined to the Scandinavian countries. According to Therborn (1983) there is some impulsiveness, in the social sciences, in define and associate the emergence of the Welfare state to the mere introduction of a set of social protection measures coupled with the existence of a rhetoric based on the principles of democracy and equality. For this author, an analysis centered on the evolution of the structure of the state - explore what portion is devoted to social policy (e.g. in comparison with defense, administration, justice or public safety), in the set of states activities and priorities, particularly in terms of expenditure and personnel - may lead us to unexpected conclusions. For instance, until 1970, it is hard to identify any country as a Welfare state (cit.by Esping-Andersen, 1990). Therefore, it makes no sense to exclude dictatorships of the the long and complex process that trails the implementation of the Welfare state, especially because we might find similarities with the democratic countries in regard to the motivations and factors that contributed to the development of their social policies. From the perspective of Walter Korpi (1983), political and ideological factors may have less importance, in explaining social policy progress, when compared to demographic, economic and social aspects. However, the political and ideological context of each country will certainly have influence on their choices. For example, in democratic countries, the advent of universal suffrage and the influence of leftist parties were instrumental issues in structuring their social security systems and the creation of mechanisms of redistribution (Lindert 2004). In countries dominated by authoritarian governments, in which we witness the suppression of civil rights, unions and opposition parties, i.e., of all political and social movements that would be more geared to support redistributive measures and social transfers, the outset will be to develop a residual social policy. These countries have a higher tendency to embrace bismarckian insurance schemes, leading to a lower degree of redistribution and equality. This fact relates precisely with the existence of different political motivations between democratic regimes and dictatorships. In the firsts, the main purpose will be, at first glance, the creation of a fair and equitable society, while in the authoritarian ones the reception of social policies will be mostly associated with the need of political legitimacy of these 4
regimes and with social pacification purposes. In the analysis of the Portuguese situation, the political question is particularly relevant for understanding the social policies that were established, due to the authoritarian and corporatist nature of the Estado Novo. During its existence, Salazar s regime faced the urgent need to enhance the living conditions of the population, especially health conditions, and at the same time wanted to prove the superiority and effectiveness of their solutions at nationally and internationally. The idea that social policies can be developed in diverse political contexts and get different configurations led some authors (Rhodes 1997; Ferrera 1996) to consider the existence of a specific model for the south European countries - Italy, Spain, Greece and Portugal. These countries have similarities in what concerns their institutional structures, as well as a lower level of industrialization and economic development when compared to northern Europe. In addition, historically, they experienced periods of dictatorship, which have contributed to their economic and welfare underdevelopment and also to the presence of great social inequalities. These conditions explain the delay of the southern European countries, whose social policy is characterized by the fragmentation of their systems; the corporatist tradition observed in health protections and national health services; the low reimbursement from the state, reflected in low social spending; the presence of a welfare mix, combining state, family, church and charity; and finally, the prevalence of patronage and transfer benefits to large corporate groups (Rhodes 1997, 6 8). In general, these countries strategies are rooted in the corporatist and conservative traditions of continental Europe, but, with the exception of Italy, its development was slower and narrower (Esping-Andersen 1993, 599). 2 Social policy and health care in times of dictatorship In Portugal, although there was no Welfare state until the 1974 revolution came off (Barreto 1996; Lucena 1976; Maia 1985; Rodrigues 1999), before that event we witnessed an increase of measures designed for the protection of workers and their families against the so-called social risks. After a failed attempt to implement a 5
mandatory social insurance scheme still in the I República (First Republic, 1910-1926) (Cardoso and Rocha 2009; Pereira 1999), in the Estado Novo regime we observe the development of a social policy project, inseparable from labor regulation (Patriarca 1995), based on the subsidiary role of the state and on a duality between Social Assistance and Previdência Social (Cardoso and Rocha 2003; Pimentel 1999). Social assistance, based on the principles of charity, was intended to provide support to the poorest people, while the previdência was reserved for the protection of workers, particularly in trade, industry and services sectors, through a system of social insurance. This twofold social policy system implied different goals and different categories of recipients and was applied to social sectors, like health. This was, probably, the main feature of the social model projected by Salazar s government. Social policy and, more particularly, the pension system, which was configured in this period, received influence of corporatist ideology that goes along with the institutionalization of the Estado Novo. Corporatism imposed the submission of the individual to the superior interests of the nation, which would allow the preservation of stability and social order. Its implementation would lead to full cooperation and harmony between capital and labor, within an idealized conception of self-governing economy. In this context, the state would only be a promoter and supervisor of social welfare activities, especially necessary in the areas of health protection, unemployment and family support (Cardoso 2012, 102 106). Social welfare thus emerges as a clear intention to demonstrate the ability of corporatism to find solutions to the problems of the country in the fields of assistance and protection to the poor and in the resolution of instability situations that affected workers within a spirit of cooperation between the different social groups (Cardoso and Rocha 2003, 120). The foundations of the Previdência Social came from two fundamental texts. First, the Estatuto do Trabalho Nacional 2, published in 1933, which contained an article devoted to welfare, projecting the existence of insurance funds designed to protect workers in case of sickness, disability, old age and involuntary unemployment. Each professional activity should have its own welfare institution, and its creation and conditions should depend of the negotiation of collective labor conventions between employers and workers, who would be also responsible for the contributions to their funds. The state had no financial contribution, being its only responsibility the 2 Act inspired by the Italian Carta del Lavoro (1927) laying the foundation of the Portuguese corporatist system. 6
regulation and supervision of the institutions. In 1935, the Law n. 1884 was published, defining four categories of social welfare institutions. In the first category we find the welfare funds of corporatist institutions, which included the Caixas Sindicais de Previdência, welfare institutions for workers in the sectors of trade, industry and services. In its bylaw, these institutions were described as the "most perfect and most comprehensive type of corporatist welfare institutions", linking the principles of social security with the economic conditions of each activity in a spirit of "solidarity of interests". This conception moved away both from the "abstraction of the class struggle" and the "Welfare state socialist utopia". Thus confirming the "higher level of corporatist solutions" and the rejection of "rigid and equal formulas for the entire population", i.e., the doctrinal basis of Salazar social policy. The sickness protection for the beneficiaries of the Previdência Social began to be shaped in this period. The 1935 legislation determined that, along with sickness allowance, social welfare institutions would be responsible for providing medical care. To do so, they would have to organize their own medical services or make agreements with doctors and private clinics. Since, initially, the shape of this medical care was not well defined, there was a proliferation of schemes that could include medical specialties or be confined to general practitioners, depending on the financial capacities of each institution. Aware of the problems that resulted from this lack of regulation and also having in mind the benefits that could arise from the coordination between the different institutions, the government created in 1946 a federation called Serviços Médico-Sociais (Social-Medical Services) in order to organize, coordinate and supervise the medical services of the federated institutions. It should be pointed out that the integration in the federation was not mandatory, meaning that each welfare institution could decide according to their best interests. This event culminated in the publication of a decree, in 1950, aimed at regulating the medical scheme included in the sickness insurance. As emphasized in the preamble of this document, unlike cash allowances, that depended on wages, in healthcare benefits this diversity wasn t logical. The goal was that welfare recipients could benefit from a wide range of services, from general practice to medical specialties, surgery and hospitalization, regardless of the welfare institutions to what they belonged and the place where assistance was provided (clinical services of welfare institutions, arrangements with private clinics or assistance institutions). In addition to this attempt to standardize medical assistance, it should be underlined the presence of a 7
more modern concept regarding the benefits that could result from the improvement of workers health and living conditions. We also find new issues, such as the recovery of working capacity for sick beneficiaries, the need to extend health protection to the workers families and also the importance of preventive actions. These ideas are connected with the perception of greater efficiency and savings in subsidy payments that would be achieved with the reduction of disease. The creation of the social-medical services led to a considerable development of welfare medical assistance in terms of human and material resources, population covered, number of occurrences and spending (Table 1). Table 1 1946 1957 Clinical Services Medical Delegations 3 6 78 400 Covered Population Beneficiaries Family 19 230 16 097 3 133 1 152 946 545 528 607 418 Doctors Nurses Administrative staff 90 56 43 1 287 748 603 Consultations Nursing 26 905 39 596 2 637 686 5 120 838 Clinical analisys Radiographs Childbirths 4 217 1 592 28 157 930 59 215 4 343 Source: «Serviços Médicos-Sociais Federação de Caixas de Previdência», 1958. However, one must keep in mind that this type of assistance was accessible only to a small percentage of the Portuguese population (table 2). Those who did not benefit from the medical welfare protection could only rely on the social assistance institutions. The problem was that, in this kind of assistance, health was not a right, it was not universal nor was its provision equitable, not when compared to the social welfare medical services. 8
Population 1946 1955 Portugal (Continental) 7 585 143 8 191 913 Covered by Serviços Médico-Sociais 19 230 (2,5%) 875 654 (10,7%) Table 2 Source: «Serviços Médico-Sociais Federação Caixas de Previdência», 1956. The social assistance, whose principles were defined by the publication of the Estatuto da Assistência Social (legal statute), in 1944, was governed by the moral values of charity and benevolence and, as such, its exercise should belong to private entities, while the state had the role of its promoter and coordinator. It must be highlighted the broad conception of social assistance that emerges from this document, whose main feature was the inclusion of welfare and health protection, endorsing the existence of a health protection system exclusively for welfare recipients and another to the general population. This fact was crucial to the organization of health services, which were scattered among welfare and social assistance institutions. This feature differed from the models adopted in most European countries, where health protection encompassed, on the one hand, public health services for all citizens, irrespective of their social or financial condition, and, on the other hand, sickness allowances to protect workers against the risk of loss of income. In the Portuguese model, in addition to the payment of sickness benefits, as has been mentioned, the medical assistance could be provided by public and private social assistance institutions and welfare institutions depending on the social situation of the users. This type of organization had the following consequences: 1) inequality in access to health care between the beneficiaries of assistance and social welfare, the former being the most affected; 2) existence of different medical assistance schemes between welfare recipients; 3) lack of quality of the services in general, due to financial difficulties and problems in the coordination of various health systems. After 1960 there were significant changes in health policies, reflected in an increase in human resources, equipment, services and expenses. Despite the shortcomings in terms of population coverage and equal access it is important to stress out the positive evolution of the main health indicators during Salazar s government, although it was more pronounced from the '70s. Particularly relevant is the decline of Infant Mortality, consequence of improved maternal and child care and increased 9
number of childbirths in health institutions. This progress should not be understood as an exclusive consequence of health measures as complex causes are at stake. But, with no doubt, such policies played an important role in the improvement of populations health (Carreira, 1996, p. 42-43). Finally, one cannot fail to mention the contribution of the reform that was undertaken in 1962 in the Previdência Social, which resulted in the extension of health protection to rural and fisheries workers, as well as their families and helped to improve pre-existent health protection schemes. This event reflected a politic intervention that contributed to the trend of universalization in the health sector. As result of the investment, that started in this period, we find a large increase on social expenditure on health and moreover an increase in its share of the total social expenditure (Table 3) (Pereirinha and Carolo 2009, 17). Table 3 Evolution of social spending by risks (millions of escudos) Years Old age and disability Death Survivor Health and sickness benefits Family allowance Total Social Exp. 1940 26041 5896 32067 3364-67368 1945 26006 12498 56223 8318-103044 1950 51138 18830 81443 140923 335543 627877 1955 533384 21731 100525 162132 499919 1317691 1960 803593 39908 123993 269631 852839 2089963 1965 1592988 89510 148747 888269 1221401 3940915 Source: Pereirinha and Carolo, 2009. 10
Despite these progresses, in the transition to democracy Portugal was still underdeveloped in what concerns health conditions, when compared to other western countries (Campos 2000). The weak intervention of the state in this sector during the dictatorship and the limited expansion of social policy and social security, which range was limited even in the active population, are the main reasons for this underdevelopment. At the same time, the social medical services did not guarantee a universal right to overall health, as it was restricted to the beneficiaries of the welfare system (Carreira 1996, 17). It was only in the 70s, in the governation of Marcelo Caetano, who succeeded to Oliveira Salazar, that the state did actually intervene in the health sector. From this moment on, health care emerged as a right to everyone and the government developed a network of public health centers. However, only after the Revolution of 1974, that deposed the dictatorship, conditions were set for the institutionalization of a universal National Health Service (1979) as enshrined in the 1976 Constitution. 3 Problems and hypothesis In Portugal, during the 41 years of the Salazar regime, despite the previously exposed limitations, the population witnessed the implementation of a set of measures designed to protect against occupational hazards and to improve the health of workers and population in general, which was in line with the trends observed in European countries. There were demographic, economic, social and political motivations justifying state intervention. First, it was absolutely necessary that the country surpassed its underdevelopment in terms of demographic indicators. The high values observed in Infant Mortality (see table 4 below), Maternal Mortality and incidence of infectious diseases, along with lower Life Expectancy vindicated government action in order to overcome these problems. At the same time, given the increase in urban population that occurred during this period, it became essential to prevent social and health problems inseparable from large settlements and exponential urbanization. We also find economic motivations that rose with the industrial development of the country, more evident from the '50s, which justified further investment in labor protection and the improvement of workers health and strength, in order to ensure the highest possible level of 11
productivity. The social pacification goals and the need to enshrine the corporatist regime were, respectively, the main social and political motivations. Besides the referred reasons, there were also a set of favorable conditions to the implementation of social policies. Firstly, economic growth that occurred in the '50s, thanks to industrial development. Like in other European countries, this event promoted the progression of the social security system, which main target were the workers in the industrial sector. This was also a period of political and social stability, achieved through the control and repression that the regime implemented all over the nation. Accordingly, there was in the national context a combination of conditions and motivations for the regime to promote the well-being of its population, through improved social insurance schemes and a diversification of social policies. Internationally, we also found a tendency for investment in the living conditions of the population, also through the implementation of a number of social measures. So, how to explain the Portuguese lag that we observe in the social policy sector and, in particular, the lack of investment in a sector as undeveloped as the health one? This issue raises two hypotheses. The first leads us to look for the underdevelopment of the country in this period; while the second leads us to take into account the fact that we are facing a very peculiar dictatorial regime. In the first case we should consider the low level of industrialization, which prevented the development of an extensive social security system and also determined the predominance of low wages, meaning low level of contributions, which explains the problems that the welfare institutions, and their medical services, faced. The second hypothesis is based on dictatorial nature of the Estado Novo, which along with the protection of economic interests of political elites, among other actions, proceeded to ban unions and opposition parties and limited the right to vote. This meant that underprivileged social classes, more willing to support universal social policies, remained powerless. These issues reflected a hierarchical vision of society that arises from the corporatist ideology, based on the aphorism to each his place. At the same time, the state determined for itself a moderate interventionism in the economy and particularly in the welfare organization, giving the institutions the autonomy to decide according to their interests, but respecting existing legislation. In reality, the intervention and the control performed by the state were not as moderate as the regime wanted to make believe. The truth is that the government controlled the welfare institutions and corporative entities, since it was the responsible for appointing their 12
leaders, usually someone close to the regime. Considering this context, we couldn t expect more than a partial and uneven social protection system. Therefore, we can only try to understand how the social policies of the Estado Novo were able to meet the country's problems, who benefited from the social measures that were implemented and, finally, how inequalities have evolved. Infant Mortality Rate, 1935 1970 ( ) Table 4 1935 1940 1945 1950 1955 1960 1965 1970 Portugal 149 126 115 94 90 78 65 58 Germany 99 64 97 35 44 40 34 30 Belgium 85 93 100 53 41 31 24 21 Spain 109 109 85 64 51 36 30 27 France 72 91 114 52 39 27 22 18 Greece 113 98 35 44 40 34 30 Hungary 152 130 169 86 60 48 39 36 Italy 101 103 103 64 51 44 36 29 Yugoslavia 149 132 119 113 88 72 56 UK (E / W) 57 57 46 30 25 22 19 18 Czech Rep. 123 99 137 78 34 24 26 22 Romania 192 188 188 117 78 75 44 49 Source: Mitchel, 1992 13
Conclusion As follows from the historical and theoretical framework, Social Policy and Welfare state are two closely linked concepts. But it should be remembered that the first by itself does not define a kind of state nor even its principles and organization. For this reason, we find countries developing social policy programs without ever becoming a Welfare state, guided by the values of democracy, equality and social justice. Countries dominated by dictatorial regimes are the examples that best illustrate this situation. Thus, the lack of political legitimacy of authoritarian governments should not prevent them from being considered in the analysis of the evolution of European social policy, given the complexity of the issue. In the Portuguese context we find a set of peculiarities in terms of social policy that distance the country from most European models, including countries also dominated by authoritarian regimes, which makes this an even more interesting example. The purpose of my investigation is not to expose the disadvantages and harms that we already know that resulted from 41 years of authoritarianism, nor do I intend to describe the social inequalities that were in fact flagrant in this period. Also, it makes no sense to focus in the differences between Portugal and more developed countries, like the UK and the Scandinavian countries, in this period, respective to economy and welfare. The distance is well known. In a theoretical perspective, the aim is to place the Portuguese model, with its own path and all its singularities, in the long and complex process that set the implementation of the Welfare state in Europe, which emerges from the end of World War II. As mentioned in the text, in 1946, when in England the National Health Service was implemented, in Portugal the social medical services for welfare recipients, more exactly for workers in industry, commerce and services, were created. Evidently, there is a huge difference between these two events and health models they involved, as well as there are huge differences between the two countries in historical, political and mostly economic conditions. But it is worth noting that with this initiative Portugal took the first step in increasing health care to the population and that despite several limitations the truth is that health conditions, which were extremely precarious before, started improving in the 50 s. The most interesting issue surrounding the organization of the social medical services and the regulation of the medical assistance in the welfare institution is that it really expresses the preference of the Salazar regime for the 14
resolution of the most urgent and immediate needs. We don t find in the initiatives taken in this period an overview of the general health problem and there was no prospect of a long-term intervention, which would result in more efficiency and benefits for society. Probably, this is the truly divisive issue between Portugal and other European countries in respect to social and health protection. Bibliography: Baldwin,, Peter. 1996. Can We Define a European Welfare State Model? In Comparative Welfare Systems: The Scandinavian Model in a Period of Change, by Bent Greve. Houndmills: MacMillan Press. Barreto, António. 1996. A situação social em Portugal : 1960-1995. Lisboa: Instituto de Ciências Sociais - UL. Cardoso, José Luís. 2012. Corporativismo, instituições políticas e desempenho económico. In Corporativismo, fascismos, Estado Novo. Lisboa: Almedina. Cardoso, José Luís, and Manuela Rocha. 2003. Corporativismo e Estado-Providência: 1933-1962. Ler História (45). Cardoso, José Luís, and Maria Manuela Rocha. 2009. O seguro social obrigatório em Portugal (1919-1928) : acção e limites de um Estado previdente. Análise Social (192). Carreira, Henrique Medina. 1996. As políticas sociais em Portugal. Trajectos portugueses 35. Lisboa: Gradiva. Esping-Andersen, Gosta. 1990. Three Worlds of Welfare Capitalism. The Welfare State Reader. Cambridge: Polity Press.. 1993. Orçamentos e democracia: o Estado-Providência em Espanha e Portugal, 1960-1986. Análise Social (122) Ferrera, M. 1996. The Southern Model of Welfare in Social Europe. Journal of European Social Policy 6 (1). KORPI, W. 1983. The Democratic Class Struggle. London: Routledge & Kegan Paul. 15
Lindert, Peter. 2004. Social Spending and Economic Growth Since the Eighteenth Century. 2 vols. Cambridge: Cambridge University Press. Lucena, Manuel de. 1976. A Evolução Do Sistema Corporativo Português. Lisboa: Perspectivas & Realidades. Lucena, Manuel. 2000. Previdência Social. In Dicionário de História de Portugal. Vol. Sup. 9. Porto: Figueirinhas. Maia, Fernando M. 1985. Segurança social em Portugal : evolução e tendências. Caderno 11. Lisboa: Instituto de Estudos para o Desenvolvimento. Marshall, T. H. 1967. Cidadania, Classe Social E Status. Biblioteca de Ciências Sociais. Rio de Janeiro: Zahar. Patriarca, Fátima. 1995. A questão social no salazarismo : 1930-1947=1930-1947. Análise social. Lisboa: Impr. Nac.-Casa da Moeda. Pereira, Miriam Halpern. 1999. As Origens Do Estado Providência Em Portugal: As Novas Fronteiras Entre o Público e o Privado. Ler História (37) Pereirinha, José António, and Daniel Fernando Carolo. 2009. A construção do estadoprovidência em Portugal : evolução da despesa social de 1935 a 2003. WP 36. Lisboa: Gabinete de História Económica e Social. Pimentel, Irene Flunser. 1999. A assistência social e familiar do Estado Novo nos anos 30 e 40. Análise Social (151-152). Rhodes, Martin. 1997. Southern European Welfare States: Between Crisis and Reform. Routledge. Rodrigues, Fernanda. 1999. Assistência social e políticas sociais em Portugal. Lisboa: Departamento Editorial-ISSScoop CPIHTS-Centro Português de História e Investigação em Trabalho Social. 16
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