Collective Health

The subject of humanization of health services and health practices has been object of several researches and publications in Collective Health field because of their importance for constitution of practices and services focused on health care. This study aimed to analyze the concept of humanization, its use and referents, within the production of Collective Health field. Qualitative methodology was chosen, and the empirical part consisted of 98 published articles that were selected from a search in LILACS and SCIELO databases. They were chosen through the keyword ‘health service’ data crossing with ‘violence’, ‘humanization ‘ and ‘dehumanization’ and the keyword ‘work in health’ data crossing with ‘violence’, ‘humanization’ and ‘dehumanization’. In addition to these, the keyword ‘clinical encounter’ was sought separately. This search showed a huge polysemy of the concept of humanization within Collective Health field as well as a great diversity of referents. We took into account the transformations occurring within medical work, and consequently within health work in modernity, and Hannah Arendt's political reflection, mainly on the concepts of ‘authority’, ‘crisis’, ‘birth’, ‘power’, ‘tradition’ and ‘violence’. From this, we sought to enrich the debate and to bring contributions of the Arendtian concepts presenting new conceptual distinctions and possibilities of approach still little explored in Collective Health field.

Negli ultimi vent'anni, i cambiamenti demografici, epidemiologici, culturali e sociali hanno reso necessario ripensare l'organizzazione dei sistemi sanitari, le competenze dei professionisti e la loro formazione. L'esigenza di analizzare le dimensioni soggettive della malattia e l'urgenza di mettere a punto interventi centrati sulle persone nei loro contesti, hanno favorito l'adozione di metodologie di ricerca-intervento mutuati dalle scienze sociali, associate ai quadri teorici delle Cure Primarie di tipo Comprehensive e della Salute Collettiva. Il contributo presenta un'esperienza di ricerca-formazione-intervento italo-brasiliana, multilocale e multisituata, pensata per stimolare studenti di diversi ambiti disciplinari e professionisti sanitari a mettere in campo interventi trasformativi dei servizi e dei percorsi formativi offerti dalle università. Ne emerge quanto la programmazione dei servizi, verticale e standardizzata, risulti ancora lontana dalla soggettività dei singoli territori, un limite che spesso si accompagna alla rigidità dei percorsi formativi universitari. Risulta allora necessario impegnarsi in un continuo "lavoro di scavo" che, forzando i confini istituzionali, miri a modificare le pratiche lavorative e la compartimentalizzazione dei saperi, al fine di ripensare, all'interno dei luoghi stessi della produzione dell'assistenza, interventi prossimi alle persone e ai loro contesti di vita.

Historicity is a key epistemological component of the definition of “science” proposed by authors such as Gaston Bachelard, Georges Canguilhem and Michel Foucault, and partially accepted by the Brazilian Collective Health builders. What we call the “historicity awareness” of Collective Health is the field’s recognition that there is no knowledge of health without history and that its history interferes with its results, with the conceptualization of its objects, its cognitive and technological practices, and the feasibility of its promises of enhancing the quality of life towards an equal society. This helps explain why Humanities in general and History, in particular, are ubiquitous to Health Education, where they are known as Health and Medical Humanities or, as is more usual in Brazil, Human and Social Sciences in Health. They helped to imagine an equitable health care system of which the concrete manifestation, however imperfect, is the Brazilian Unified National Health System, the SUS. Health Humanities, Medical Humanities, and History of Science and Technology are all interdisciplinary fields that challenge historiography and theory of history to look beyond the borders of our normative understanding of the historian’s professional identity – which legitimacy is achieved through specific academic training – to properly evaluate the multiple expressions of society’s relationships and engagements with history and time.

As Gilles Deleuze states in "Bergsonism", a problem always has the solution it deserves in terms of the way in which it is stated. By following this idea and by experimenting with the inventiveness of the thresholds in-between art, philosophy, politics, anthropology, schizoanalysis and agroecology, this composition aims to offer, from a research-creation perspective, new ingredients in order to cook and taste different possibilities regarding the work on the problems of food consumption and food production, which allow us to cultivate a minor understanding of hunger and appetite that lurks the nutritional-biomedical loop, and that not just nourish a fabulation about what else they could be, but also feeds a thinking-moving towards a politics of immediation.

This text looks at the difference between sociology in medicine (collaborator
of health institutions) and the sociology of medicine (independent of health institutions).
If consistent, sociology in medicine should become a sociology of medicine. As an
example, it is shown how the study of the social determinants of health and illness
begins by assuming non-problematically the ontological reality of health and illness,
but ends up problematizing the very concept of health-disease, demonstrating that the
study of health determinants also requires the study of the determinants of the social
construction of disease. The urgent necessity of objectifying collective health itself is
argued. By applying sociological tools we can examine the so-called objective factors
in the determination of health and disease, the socially constructed nature of these
categories of knowledge, and the struggles and power relations that determine whether
or not such categories are viable.

Primeira compilação dos trabalhos do projeto "Boas Práticas de Enfrentamento à COVID-19 com Comunidades e Populações Vulnerabilizadas do Nordeste (RN, PB, CE)", escrito em coautoria com lideranças, estudantes e artistas populares e organizado por Ana Gretel Echazú Böschemeier, Breno da Silva Carvalho, Karlla Christine Araújo Souza, Maria Betânia Ribeiro Torres e Maria Teresa Nobre, foi publicado pela Editora Áporo com o selo de Edições UERN dentro da Chamada MCTIC/CNPq/FNDCT/MS/SCTIE/Decit Nº 07/2020 - Pesquisas para enfrentamento da COVID-19, suas consequências e outras síndromes respiratórias agudas graves

Work is a central concept to understand social metabolism. Human work is the process that getting the social metabolism that creates those goods necessary for to life. The industrial revolution laid the foundation for an insurmountable contradiction between capitalism and environmental sustainability. The advance of market power over the use of natural resources to sustain globalized lifestyles is responsible for various manifestations of the ecological crisis. As in the rest of the world, in Latin America this type of economic growth has a negative impact on ecosystems in general and on biodiversity in particular. A productive structure that is extractive and intensive of natural resources that not only show its unsustainability, but also its incapability to produce development and well-being. The current COVID-19 pandemic highlights the economic system's vulnerabilities on an unsuspected scale. The SDG issued in 2015, acknowledges the ecological crisis and recognition the impo...

Collective health is a paradigm with a long history in Latin America.
Similarly, collective mental health has had an interesting development in certain
Latin American countries, even acting to stimulate psychiatric reform. However, both
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because of a hegemonic global-scale epistemology that, by imposing a naturalized
model of truth, denies other forms of knowledge the opportunity to question not only
already-established disease categories, treatment protocols and health policies, but the
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a form of knowledge and a social relation in itself, to broaden the space available for
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ethnographic point of view allows us to rethink that which is already accepted, creating
permeability in entrenched practices and opening up surprising new possibilities.
KEY WORDS Medical Anthropology; Ethnography; Collective Health; Epistemology;
Europe.

A decade ago, a number of English-speaking authors focused mainly on the analysis and intervention of processes of social determination of health of migrants devel- oped the concept of structural vulnerability as a way to combat individualism, biologism, the invisibilization of processes of structural determination and the blaming of victims. As part of the historical contributions of social medicine, the current developments of the structural vulnerability approach have been disconnected from the discussions of the collective health movement and Latin American social medicine in general, among other reasons due to linguistic barriers associated with the scarcity of publications in Spanish. The present interview, conducted with two of the primary representatives of the structural vulnerability approach, investigates its historical origins and seeks to explore the specific contributions that are being made today, as a way to bring them closer to Spanish-speaking readers and so enable dialogue with the proposals of Latin American social medicine.

The main proposal to set up an articulated mode of operation of health services has been the concept of network, which has been appropriated in different ways in the field of public health, as it is used in other disciplinary fields or even taking it from common sense. Amid the diversity of uses and concepts, we recognize the need for rigorous conceptual demarcation about networks in the field of health. Such concern aims to preserve the strategic potential of this concept in the research and planning in the field, overcoming uncertainties and distortions still observed in its discourse-analytic circulation in public health. To this end, we will introduce the current uses of network in different disciplinary fields, emphasizing dialogues with the field of public health. With this, we intend to stimulate discussions about the development of empirical dimensions and analytical models that may allow us to understand the processes produced within and around health networks.

The aim of the study was to describe local knowledge about the use of medicinal plants cited by study participants, as well as to examine how phytotherapy serves as an important strategy of integrative and complementary practice in coping with health problems. The research is characterized as an exploratory study of the descriptive type. Non-probabilistic snowball sampling generated a sample of one hundred and ten participants (n = 110). The study instruments were semi-structured interviews and questionnaires. The data collected were analyzed using Microsoft Excel 2007 and summarized with descriptive statistical methods. The study informants presented knowledge of 77 species and 46 plant families, showing the rich variety of medicinal flora present in the Northern Brazilian Amazon. Among the respondents, elderly women had the most diversified knowledge. Preserving this knowledge is essential and can help in the implementation of public health policies. The results showed high richness of the medicinal flora present in Northern Brazilian Amazon.

O capítulo resgata a trajetória do Grupo Temático de Saúde e Ambiente da Associação Brasileira de Saúde Coletiva-Abrasco, seus desafios junto à área de conhecimento do campo da saúde coletiva e as perspectivas históricas de sua ressignificação diante das crises sociais, políticas, ambientais, econômicas e éticas.

This special issue of Global Public Health will examine contemporary struggles for collective health in Latin America, in order to highlight social movements, activism, and policy efforts mobilizing to inscribe health as a social right in the region. The issue will highlight efforts within the academy, other institutions, and civil society across the region to produce evidence and interventions that lay bare and address class-based and other broad social inequities, as well as the role of social, political, economic, and ideological processes as determinants of health and disease.
In so doing, the issue will also bring to the fore the legacy of long-standing efforts in the region to investigate and address the social and political dimensions of health, those associated with the Latin American Social Medicine and Sanitary Health movements. The issue will thus include a historical framing of the relationship between civil society and health in Latin America. Juxtaposing contemporary struggles for collective health alongside these historical perspectives, the issue is intended to shed light on emerging dimensions between social justice, civil society, and public health, amidst the region’s shifting political-economic and technological landscape.
We invite submissions that would address this theme: (1) by exploring contemporary cases of collective health activism or efforts to forward health research agendas that foreground social, political, economic, and ideological determinants of health; (2) by examining the history and development of Latin American collective health research; or (3) by offering comparative perspectives that contextualize contemporary and historical approaches to health as a social right in Latin America as a research/practice tradition, tracing distinctions and commonalities with approaches to social medicine/social epidemiology elsewhere (in other regions or countries, or potentially globally).

This paper aims at understanding social causality of Tuberculosis in Rio de Janeiro. This is one of the Brazilian states with the highest incidence of this disease. We follow the story of Paulo, a patient who received care at the outpatient clinic for multi-drug resistant Tuberculosis, in Rio de Janeiro. To make sense of his story, we will look at it through the concept of vulnerability in life conditions. Along with Sabroza (2006), we argue that this vulnerability is a collective expression of the economic insertion of a growing segment of Rio’s population in the current technical-scientific-informational capitalism (Santos, 2002 [1979]). Limitations in the health services add directly to vulnerability in life conditions of patients making treatment a hard endeavour. We propose to think and act on Tuberculosis at the collective level of reality, through intersectoral actions. We aim at contributing to the current debates on the social determination of Tuberculosis, to inform actions that can significantly reduce the suffering associated to this and other similarly caused diseases.

La donación de órganos y tejidos es un fenómeno poco estudiado desde perspectivas interpretativas en los campos académicos de la Comunicación, la Psicología y las Ciencias de la Salud. Esta investigación se propuso explorar los significados sociales acerca de este proceso de salud enfermedad atención cuidado, a partir de las contribuciones de la teoría del self social, para así comprender la relación entre el individuo la sociedad que lo sustenta. Con un enfoque cualitativo indagó sobre las normas sociales, los valores, las creencias, las experiencias corporales, las vivencias de muerte y las dinámicas familiares en torno de la cuestión. El estudio fue realizado en la provincia de Córdoba (Argentina) durante el año 2014 y los datos fueron obtenidos a través de entrevistas semiestructuradas, aplicadas a un muestreo no probabilístico. La investigación señala la necesidad de comprender este proceso en clave cultural y comunitaria, promover la apropiación social del conocimiento sobre donación de órganos en sus múltiples dimensiones e incorporar esta problemática en la agenda de la salud colectiva.

IADR Abstract Archives Theoretical approaches in Dental Public Health: What does this mean? Objectives: To identify di erent theoretical approaches in Dental Public Health based on the published literature. Methods: Hermeneutic study that began with a search for secondary sources in electronic databases, combining the MeSH terms: social-determinants, socioeconomic-factors, dental public health, social class, oral-health, oral-condition. Only articles published in English, Portuguese or Spanish, available in full text from the National University of Colombia were included in the analysis. Four researchers read the articles separately and then, consensus meetings were held to identify the underlying theoretical approach of each paper. Results: Forty-six articles met the inclusion criteria, 42 in English. Nineteen came from Brazil, 8 from the UK and 7 from the US. The main theoretical approach used was the social determinants of health (38 articles), followed by psychosocial theory (4), the theory of social/political production of disease (3) and eco-social theory (1). Among those with a social determinants of health perspective (29 empirical and 9 theoretical), 44.7% were from Brazil, followed by 18.4% from the UK. The most studied determinants were: education (8) income (7), race/ethnicity (5) gender (3), social class, occupation, economic status and social-networks (2 each). Conclusions: The literature published on "dental public health" has increased in the last decade and is based on four theoretical approaches: Psychosocial theory: Suggests that di erent psychosocial stressors result in biological e ects. Social production of disease/political economy of illness: Argues that the political and economic institutions are the basis of social inequalities in health. Eco-social theory: Levels interact in a hierarchical manner. Social determinants of health (WHO): Social factors determine biological conditions. We conclude that, in empirical studies, the determinants of education, income, race, gender, and social class/position were the strongest to understand the process of social strati cation. Also, they re ect the unequal distribution of resources and power; thus generating social gradients in oral health.

RESUMO:

Este artigo discute as necessidades e demandas de saúde de homens trans, tema pouco estudado que, com frequência, interpela a construção de práticas de cuidado em saúde para esta população. Foi realizada uma pesquisa qualitativa composta de observação participante e entrevistas semiestruturadas com dez homens trans residentes em Salvador, Bahia, Brasil, em sua maioria negros, heterossexuais e com idades entre 20 e 43 anos. A análise foi baseada na antropologia interpretativa, articulada às críticas do pressuposto da interseccionalidade e da perspectiva decolonial. As necessidades e demandas de saúde dos homens trans são organizadas em três aspectos: a despatologização, a modificação corporal e os atendimentos ambulatoriais. Esses não são universais entre todos os homens trans e podem ser decorrentes de situações que assinalam conflitos e pressões grupais. A ausência do processo transexualizador no estado e as barreiras no acesso à rede de atenção à saúde intensificam o processo de mercantilização das suas demandas de saúde, em especial, as modificações corporais. Conclui-se que a transfobia estrutural faz disparar uma série de questões de saúde, ao mesmo tempo em que limita as possibilidades de obtenção de cuidado. A despatologização das vivências trans constitui o eixo central com base no qual o cuidado deve ser pensado, relacionando-a a mudanças culturais, políticas e sociais que impliquem a construção de uma sociedade não transfóbica e incidam no bem-estar e reconhecimento dos homens trans.

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ABSTRACT:
This article discusses the health needs and demands of trans men, a topic that has received little attention and frequently calls for the development of specific health care practices for this population. A qualitative study was performed, consisting of participant observation and semi-structured interviews with trans men residing in Salvador, Bahia State, Brazil, the majority of whom were black, heterosexual, and 20 to 43 years of age. The analysis was based on interpretative anthropology, linked to critique of the assumption of intersectionality and the decolonial perspective. The health needs and demands of trans men are organized in three aspects: de-pathologization, body modification, and outpatient care. These aspects are not universal among trans men and may result from situations that indicate group conflicts and pressures. The absence of transsexualization process in the state of Bahia and barriers to accessing the health care network intensify the commodification of trans men’s health demands and especially body modifications. The study concludes that structural transphobia triggers a series of health issues, while limiting the possibilities for obtaining care. The de-pathologization of trans experiences constitutes the central basis for conceiving care, relating it to cultural, political, and social changes that involve the construction of a non-transphobic society and foster the well-being and recognition of trans men.

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RESUMEN:
Este artículo discute las necesidades y demandas de salud de hombres transexuales, tema poco estudiado que, con frecuencia, requiere la construcción de prácticas de cuidado de salud para esta población. Se realizó una investigación cualitativa, compuesta de diez hombres transexuales residentes en Salvador, Bahia, Brasil, en su mayoría negros, heterosexuales y con edades entre 20 y 43 años. El análisis se basó en la antropología interpretativa, vinculada a críticas del presupuesto de la interseccionalidad y desde una perspectiva decolonial. Las necesidades y demandas de salud de los hombres transexuales se organizan en torno a tres aspectos: despatologización, modificación corporal y atención ambulatoria. Estos no son universales entre todos los hombres transexuales y pueden derivarse de situaciones que indican conflictos y presiones grupales. La ausencia del proceso transexualizador en el estado y las barreras en el acceso a la red de atención de la salud intensifican el proceso de mercantilización de sus demandas de salud, en especial, las modificaciones corporales. Se concluye que la transfobia estructural dispara una serie de cuestiones de salud, al mismo tiempo que limita las posibilidades de obtención de cuidado. La despatologización de las vivencias trans constituye el eje central, en base al cual se debe pensar el cuidado, relacionándolo con cambios culturales y políticas sociales que impliquen la construcción de una sociedad no transfóbica e incidan en el bienestar y reconocimiento de los hombres transexuales.