Abstract

This is a theoretical essay about the development of the concept of solidarity, a word used in the regulatory framework and in political proposals to reorient the Brazilian Unified Health System (SUS). The methodology consisted of mapping authors addressing human action aspects related to this theme from Durkheim’s tradition, linking them to his followers, like Marcel Mauss and authors from the “anti-utilitarianism” movement in social sciences. Solidarity is one way to express a “gift” and appears as a multidimensional action, where duty and freedom, instrumental interest and disinterest interpose and interlace. The planning and execution of sanitary surveillance (VISA) actions requires comprehension of organizational forms and solidary relationship management among agents involved in health risk control, transcending the strongly normative aspect of the prevailing supervision actions. The development of associative actions involving sanitary surveillance professionals, economic agents and consumers, aiming to share the responsibilities in the health risk control of products, services and environments subjected to Sanitary Surveillance action is suggested.

Sociology; Healthcare Planning and Management; Sanitary Surveillance; Health risk management

Introduction

Modern man suffers from the transformations that have occurred throughout the twentieth century, namely: advances in science and technology, which increase exponentially with the development of the information society; the gradual and unsustainable growth of consumption; individualism and “liquid” relationships, where ties are placed in the background in interpersonal relationships; the emergence of a society of risks inherent to the modernization process, both in the environmental perspective and in changing ways of life, such as changes in the labor market, especially with the introduction of women¹1. Beck U. Sociedade de risco: rumo a uma outra modernidade. São Paulo: Ed. 34; 2010.

2. Bauman Z. Amor líquido: sobre a fragilidade das relações humanas. Rio de Janeiro: Jorge Zahar; 1994.

3. Bauman Z. Ética pós-moderna. São Paulo: Paulus; 1997.

4. Bauman Z. O mal-estar da pós-modernidade. Rio de Janeiro: Jorge Zahar; 1998.

5. Bauman Z. Modernidade Líquida. Rio de Janeiro: Jorge Zahar; 2001.^-66. Giddens A. As consequências da modernidade. São Paulo: Editora da Unesp; 1991..

However, this process did not extinguish “the fundamental human need for an impulse of affection and spontaneity in relationships with others”⁷7. Elias N. A sociedade dos indivíduos. Rio de Janeiro: Jorge Zahar; 1994., which calls into question the very concept of solidarity, contrasting with the hegemony of rational-utilitarian thought and the neoliberal doctrine.

Some studies explain current ways of solidarity: Salazar⁸8. Salazar CRS. Gestão do voluntariado e dádiva: reflexões à luz do caso Obras Sociais Irmã Dulce – OSID [dissertação]. Salvador: Universidade Federal da Bahia; 2004. discusses the management of volunteer work at the Irmã Dulce Social Works (OSID), seeking to understand the importance of professional management, with a consequent weakening of voluntary work, based on humanitarian action, considering the importance of keeping ties between volunteers and other institutional stakeholders. Costa⁹9. Costa JRF. Sociedade civil, humanitarismo e utilitarismo: um estudo empírico sobre os padrões de solidariedade das ONGs da RMR [dissertação]. Recife: Universidade Federal de Pernambuco; 2004. studied patterns of solidarity in NGOs in the Metropolitan Region of Recife, finding that they structured their work in networks centered on sociability processes. Tobar and Pardo¹⁰10. Tobar F, Pardo CF. Organizaciones solidarias: gestión e innnovación en el tercer setor. Buenos Aires: Lugar Editorial; 2001. reflect on management in Third Sector organizations, identifying solidarity, addressing innovations and challenges. França Filho¹¹11. França Filho GC. Teoria e prática em economia solidária: problemática, desafios e vocação. Civitas 2007; 7(1):155-174. discusses the concept of solidary economy with a focus on the various realms it currently assumes: in universities, as a field of studies, and in civil society, through social movements and public policies that have been implemented in Brazil.

In health organizations, the establishment of the Pact for Health carried out by SUS managers and approved by the National Health Council in 2006¹²12. Brasil. Ministério da Saúde (MS). Portaria GM/MS 399 de 22 de fevereiro de 2006. Divulga o Pacto pela Saúde 2006 – Consolidação do SUS e aprova as diretrizes operacionais do referido Pacto. 2006. Diário Oficial da União 2006; 22 fev. proposes that the SUS building process include the organization of a “solidary and regionalized network of actions and services that qualify the management process”¹³13. Brasil. Ministério da Saúde (MS). Pactos pela vida, em Defesa do SUS e de gestão. Brasília: CONASS, CONASEMS; 2006.. Decree N° 7.508/2011¹⁴14. Brasil. Decreto 7.508, de 28 de junho de 2011. Regulamenta a Lei nº 8.080, de 19 de setembro de 1990, para dispor sobre a organização do Sistema Único de Saúde - SUS, o planejamento da saúde, a assistência à saúde e a articulação interfederativa, e dá outras providências. Diário Oficial da União 2011; 29 jun. regulates Law Nº 8.080/90¹⁵15. Brasil. Senado. Lei n.º 8.080 de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes, e dá outras providências. Diário Oficial da União 1990; 19 set. and establishes the Organizational Contract for Public Health Action, understood as a “collaboration agreement signed between federative entities for the purpose of organizing and integrating health actions and services in the regionalized and hierarchical network” for the “integrated implementation of health actions and services”¹⁴14. Brasil. Decreto 7.508, de 28 de junho de 2011. Regulamenta a Lei nº 8.080, de 19 de setembro de 1990, para dispor sobre a organização do Sistema Único de Saúde - SUS, o planejamento da saúde, a assistência à saúde e a articulação interfederativa, e dá outras providências. Diário Oficial da União 2011; 29 jun.. In Bahia, Resolution Nº 249 of 2014¹⁶16. Bahia. Comissão Intergestora Bipartite. Resolução n.º 249 de 2014. Diário Oficial do Estado da Bahia 2014; 31 dez. of the Bipartite Interagency Commission “establishes State and Municipality actions in the organization, implementation and management of the actions of the State Health Surveillance System of the State of Bahia, in a shared, solidary, regionalized and decentralized way”.

Thus, at the macro level, we find solidarity by guiding the agreement and management of health actions among federated entities and between them and society across the SUS. However, what about the relationships established in the daily health practice? It is necessary to search for a conceptual precision of the word “solidarity” for public health management, with a view to its concrete application. Thus, we ask: what moves the subject of a solidary action or causes an organization to establish relationships with other organizations? What does the word mean beyond common sense and what meaning is assigned to the term in normative prescriptions and political-managerial propositions elaborated within the SUS?

To answer these questions, we initially search for the meanings of the word in the dictionary, finding that its definition encompasses the idea of responsibility¹⁷17. Michaelis. Dicionário escolar da língua portuguesa. São Paulo: Melhoramentos; 2002. and presupposes shared attitudes and feelings focused on the interpersonal relationship and can be applied to relationships between groups and even organizations. However, this general definition is not enough to understand the multiple meanings attributed in the academic debate and in the broader sociocultural space. Therefore, the purpose of this paper is to analyze the notion/concept of “solidarity” by tracking this word in the work of social sciences authors and then discuss its meaning and implications regarding the organization and management of health surveillance actions, an important health surveillance component within the SUS.

Tracking the notion/concept of solidarity

We take as a starting point the Social Action Theory elaborated by Max Weber, author who calls us to investigate human conduct, as evidenced in diverse societies. Weber argues that social action is a human behavior, an attitude toward action or abstention; it is related to behavior of the other and must have a regularity, and is motivated by custom, habit or a legitimate order, which is determined by convention or by Law, insofar as the sanction corresponding to the violation is collective disapproval or coercion. Weber points out that social action builds on different beliefs and aspirations and gains subjective meanings for stakeholders, proposing a classification of their types as rational, affective and traditional, interpreting them from the rationalization typical of the contemporary era¹⁸18. Aron R. Max Weber. In: Aron R. As etapas do pensamento sociológico. 7ª ed. São Paulo: Martins Fontes; 2008. p. 725-857. Coleção Tópicos..

On the other hand, Bourdieu reflects on social action related to the concept of capital, understood as “social relationship”, “designating the network of social relationships that is one of the essential riches of the dominant”¹⁹19. Bourdieu P. Bourdieu e a Sociologia. In: Pierre Bourdieu entrevistado por Maria Andréa Loyola. Rio de Janeiro: UERJ; 2002. p. 63-86.. This conception allows the author to identify the various types of capital, in addition to the economic ones, namely, the cultural, symbolic, social and scientific capital of agents acting in different environments or fields¹⁹19. Bourdieu P. Bourdieu e a Sociologia. In: Pierre Bourdieu entrevistado por Maria Andréa Loyola. Rio de Janeiro: UERJ; 2002. p. 63-86.^,2020. Bourdieu P. Le champ scientitifique. In: Ortiz R, organizador, Fernandes F, coordenador. Pierre Bourdieu – Sociologia: São Paulo: Ática; 1983. p. 88-104..

It is interesting to note that, assuming the complexity of social relationships, this author emphasizes that the sociologist cannot be guided by a utilitarian view of social life, following only an economistic rationale, without considering cooperation, solidarity, friendship, love and compassion, realms underpinning social relationships. In this perspective, it is possible to think that the motive of certain actions is not only the prospect of gains from the economic standpoint, including possible other interests that consider, for example, feelings and not only reason. Therefore, subjects may and are sometimes inclined to act in solidarity, not solely in a utilitarian way¹⁹19. Bourdieu P. Bourdieu e a Sociologia. In: Pierre Bourdieu entrevistado por Maria Andréa Loyola. Rio de Janeiro: UERJ; 2002. p. 63-86..

Even in authors linked to the “rational-utilitarian” tradition²¹21. Collins R. Quatro tradições sociológicas. Petrópolis: Vozes; 2009. Coleção Sociologia., there is an attempt to include and explain the need for solidarity within social relationships, although they understand it as part of the rational calculation necessary to solve the problem of social coordination. It is based on the premise that individuals often need each other and require cooperation, because insofar as the division of labor increases, there is a need to create norms to regulate the coordination of the activities underlying the process. Surveillance, rewards and punishments would be thought-out solutions; however, it is possible to invest in the configuration of solidary actions. Solidarity in small groups would be created more easily than in large ones, requiring control specialization so that solidarity occurs in the latter.

According to these authors, these are proposals for rational solutions for the creation of social solidarity, as in the theory of games, although they are not sure that it would solve real-life problems. The “Prisoner’s Dilemma”²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002.^,2323. Srour RH. A ética nas organizações. In: Srour RH. Poder, cultura e ética nas organizações. 13ª ed. Rio de Janeiro: Elsevier; 2005. p.306-366. illustrates this reflection, when the option for a solidary action would be the most reasonable among prisoners placed in different cells, even if they were tempted to assume a selfish option, insofar as they did not know what the other would choose. However, this theory has not been thoroughly examined and there is no way to predict empirically where solidarity might be found the most²¹21. Collins R. Quatro tradições sociológicas. Petrópolis: Vozes; 2009. Coleção Sociologia..

In order to obtain conceptual contributions from Sociology and Social Anthropology, we take as a point of departure the understanding of the different aspects and traditions underlying the Social Theory²¹21. Collins R. Quatro tradições sociológicas. Petrópolis: Vozes; 2009. Coleção Sociologia.^,2424. Giddens A, Turner J, organizadores. Teoria Social hoje. São Paulo: UNESP; 1999.. Collins²¹21. Collins R. Quatro tradições sociológicas. Petrópolis: Vozes; 2009. Coleção Sociologia. proposes four great traditions in the field of Sociology: the conflict tradition, derived from Karl Marx, Friedrich Engels and Max Weber; the utilitarian tradition, known as the exchange or rational choice theory; the microinteractionist tradition, whose aspects are pragmatism, symbolic interactionism and phenomenology or ethnomethodology; and the Durkheimian tradition. The latter includes, in addition to its founder, Montesquieu, Auguste Comte and Herbert Spencer, besides Robert Merton and Talcott Parsons, representatives of an organicist and functionalist perspective, concentrating on the macrostructure of society. The lineage of Social Anthropology emphasizes that rituals of social groups produce solidarity and is represented by Marcel Mauss, Lévi-Strauss, Radcliffe-Brown, Erving Goffman and Mary Douglas, among others²¹21. Collins R. Quatro tradições sociológicas. Petrópolis: Vozes; 2009. Coleção Sociologia..

We have opted to retrieve the reflection on solidarity from Durkheim and his followers up to this moment. Next was the work by Marcel Mauss, Jacques Godbout, Alain Caillé and other authors of the M.A.U.S.S. - Mouvement Anti-Utilitariste dans les Sciences Sociales, revealing its importance now.

Solidarity in primary societies

In Durkheim²⁵25. Ortiz R. Durkheim, arquiteto e herói fundador. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 89-122., we found a first study on solidarity, which was his PhD thesis²⁶26. Durkheim E. Da divisão do trabalho social. 3ª ed. São Paulo: Martins Fontes; 2008. Coleção Tópicos., namely, The Division of Labor in Society, 1893, a theme previously discussed by him in one of the courses held at the University of Bordeaux in Paris (1888). Durkheim considers solidarity as a “social fact”, which according to the author’s definition “is any way of doing, fixed or not, capable of exerting on the individual an external coercion: or else, which is general within a given society, at the same time having its own existence, regardless of its individual manifestations”²⁶26. Durkheim E. Da divisão do trabalho social. 3ª ed. São Paulo: Martins Fontes; 2008. Coleção Tópicos.. The study of solidarity belongs, therefore, to the realm of Sociology, and is referred to in Law and customs and can be studied through its impact, because, according to Durkheim, it is a moral phenomenon²⁶26. Durkheim E. Da divisão do trabalho social. 3ª ed. São Paulo: Martins Fontes; 2008. Coleção Tópicos..

This author²⁶26. Durkheim E. Da divisão do trabalho social. 3ª ed. São Paulo: Martins Fontes; 2008. Coleção Tópicos. believes that a collection of individuals could constitute a society through solidarity, namely, the mechanical and organic; and feelings and beliefs common to most of its members. In mechanical solidarity societies, these beliefs and feelings were part of most individual consciousness. Let us look at Raymond Aron’s explanation: “In societies where the differentiation of individuals occurs, each one (…) is free to believe, to want and to act according his/her own preferences. In mechanical solidarity societies, (...) most of existence is guided by social imperatives and prohibitions”²⁷27. Aron R. Émile Durkheim. In: Aron R. As etapas do pensamento sociológico. 7ª ed. São Paulo: Martins Fontes; 2008. p. 456-588. Coleção Tópicos..

Durkheim refers to Law when he differentiates between organic and mechanical solidarity; he considers the Law as restitutive and coercive, respectively, and neglects real Law – the relationship between the individual and things. The advance of organic solidarity would be related to the division and specialization of labor and would correspond to the restitutive Law. In the simplest societies, coercive techniques prevail in coercive Law. Durkheim believed that real Law could only exist if individuals were alone in the world and should not be part of sociological analyses. To consider the individual could lead to anomie, by causing things to gravitate around wills, rather than a direction of common ends²⁵25. Ortiz R. Durkheim, arquiteto e herói fundador. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 89-122.

26. Durkheim E. Da divisão do trabalho social. 3ª ed. São Paulo: Martins Fontes; 2008. Coleção Tópicos.

27. Aron R. Émile Durkheim. In: Aron R. As etapas do pensamento sociológico. 7ª ed. São Paulo: Martins Fontes; 2008. p. 456-588. Coleção Tópicos.^-2828. Ortiz R. Durkheim, um percurso sociológico. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 123-147..

This author was concerned with the study of a new morality – not the religious – and sought to construct a “moral science”, a “moral theory”, however, without considering that science could replace or overcome forces of social cohesion, especially religion. He sought consensus and concentrated on the social bond and the unity that integrates people. Social phenomena would be understood from the standpoint of solidarity and sharing, either between believers, in the case of religion, or between citizens, in the case of lay morality²⁵25. Ortiz R. Durkheim, arquiteto e herói fundador. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 89-122.^,2727. Aron R. Émile Durkheim. In: Aron R. As etapas do pensamento sociológico. 7ª ed. São Paulo: Martins Fontes; 2008. p. 456-588. Coleção Tópicos.^,2828. Ortiz R. Durkheim, um percurso sociológico. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 123-147..

Religion, education and politics would be moral forces capable of organizing society, welding individuals dispersed therein. Moral character would be there in primitive societies, but absent in complex societies. It was a matter of seeking, in the religious universes, ideological elements that approached individuals and social groups, where it would be important to establish an intellectual and moral reform, with education playing an important role, a proposition reaffirmed later by Bourdieu²⁵25. Ortiz R. Durkheim, arquiteto e herói fundador. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 89-122.^,2828. Ortiz R. Durkheim, um percurso sociológico. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 123-147..

Marcel Mauss, nephew and follower of Durkheim, continued his work and studied the primitive societies, called archaic or more precisely primary societies. His famous book Essai sur le don: forme et raison de l’échange dans les sociétés archaïques is considered by Lévi-Strauss, Caillé, Graeber and others as a masterpiece. The author introduced the notion of Total Social Fact: “the social is only real when it is integrated into a system”; with three-dimensional interpretations, it addresses the physical, physiological, psychic and sociological aspects of conducts; it links the social and the individual, the physical (or physiological) and the psychic of another²⁹29. Lévi-Strauss C. Introdução à obra de Marcel Mauss. In: Mauss M. Ensaio sobre a Dádiva. Lisboa: Edições 70; 2008. p. 7-47.. To be understood, facts are things, but things that are part of subjective apprehension. Thus, Mauss expands Durkheim’s concept and influences not only ethnographers, “but also linguists, psychologists, historians of religions and Orientalists” and “a plethora of French researchers”²⁹29. Lévi-Strauss C. Introdução à obra de Marcel Mauss. In: Mauss M. Ensaio sobre a Dádiva. Lisboa: Edições 70; 2008. p. 7-47.

30. Caillé A. Dádiva e associação. In: Martins PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis: Ed. Vozes; 2002. p. 191-205.^-3131. Graeber D. Marcel Mauss e o M.A.U.S.S. In: Martins PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis: Ed. Vozes; 2002. p.19-29..

The essay reveals, through an extensive review of anthropological studies, the importance of giving to those societies, in initial contexts of approximation for later economic exchanges. It is worth noting that the word “gift” is used for the French translation of the word “endowment” (In Portuguese, gift is (1) spontaneous offer; donation; (2) favor; blessing. Endowment is (1) aptitude for something; inclination; talent; (2) blessing, gift given by someone, from the Latin word donum)³²32. Houaiss. Grande Dicionário da língua portuguesa. [acessado 2013 jul 8]. Disponível em: http://houaiss.uol.com.br/busca?palavra=SOLIDARIEDADE
http://houaiss.uol.com.br/busca?palavra=... .

The methodology chosen by Mauss consisted of “a precise comparison method (...) in selected and chosen areas: Polynesia, Melanesia, Northwest America, and some great rights”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008.. Describing the systems studied in their entirety, the author reveals that the establishment of bonds through exchange of gifts preceded trade between those societies, bringing a new way of thinking into economy and morality: “In the Scandinavian civilization, and in many others, exchange and contracts are made in the form of gifts, in theory voluntary, but are in fact obligatorily given and reciprocated”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008..

Mauss’ fundamental question was to unveil the rule for the obligatory retribution of a present: “what force is there in that which is given so that it causes the recipient to reciprocate it?”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008.. He discovers that there is a voluntary and unmotivated, but also forced and interested character, which he called a “system of total services”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008., whose non-retribution would be the cause of wars and rivalries: “there is total provision in that, in fact, it is really all the clan that contracts on behalf of all, for everything that it possesses and for all it does, through its chief”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008.. Mauss came to conclusions about human transactions in societies of that time and those preceding them, and above all, the emergence of the market, currency, contract and sale; and the morality and economy of these transactions in the societies studied, but also the problems posed by what he calls the crisis of law and the crisis of the economy.

The author inaugurates a new way of thinking about economics and social relationships: in order to have economic exchange, primary societies – collectivities and not isolated individuals – created the tie, the bond through the primacy of the latter over mercantile exchange, which he denominated triple obligation (to give, to receive and to reciprocate with gifts), which consisted not only of material goods, but also of courtesies, banquets, rites, women, military services, dances, feasts, fairs; besides necklaces, bracelets, blankets, valuables, among others. They took place during the visits that tribes of those societies did to each other for later exchange of goods. He found that the triple obligation³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008. had some kind of universality.

Mauss even foresaw the application of his findings in the current modernity. Thus, in the conclusions of his Essay ..., he reveals that “it is possible to extend these observations to our own societies. A considerable part of our morality and our own life always remains in the same atmosphere of giving, obligation and at the same time of freedom”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008..

The author³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008. considers that the non-retribution of a gift makes he/she who received it inferior and enumerates forms of gifts in his/her time: in the obligation of retribution to an invitation; in the value of artistic, literary and scientific property beyond the purchase and sale value, but as a collective product, a human betterment; in social security, as a recognition by the State and employers of security against unemployment, illness, old age and death; in the family assistance fund in France and other European countries, as guarantees to workers and their relatives. It considers these facts as a return to law, in this case, corporate law, a “group morality”, the need for society to find the “social cell: in charity, in social service, in solidarity”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008..

Mauss³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008. also warns of the need to return to archaic values, which he calls “noble consumption”: the rich are treasurers of their fellow citizens; greater care with individuals, their health, their education, family, future; good faith, sensitivity, generosity, because: “there are no two wisdoms. Let us adopt, then, as the principle of our life, what has always been a principle and always will be to leave oneself, to give, freely and obligatorily; there is no risk of deception. A Maori proverb says “give as much as you receive and everything will be fine”³³33. Mauss M. Ensaio sobre a dádiva. Lisboa: Edições 70 Ltda; 2008..

Solidarity in late modernity

Shifting from the archaic to the modern gift is given in the “introduction of the market in social relationships, as a surrogate for internal relationships, rather than between foreigners (...) the feudal society, rather than the archaic society is found at the origin of the modern gift”³⁴34. Godbout JT. O Espírito da dádiva. Paris: Instituto Piaget, Éditions La Découvert; 1992. Coleção Epistemologia e Sociedade.. One of the characteristics of modernity itself is the entry of the market into social relationships, the expansion of capitalism and the hegemony of liberal thought, beyond state bureaucracy.

The emergence of M.A.U.S.S. and its magazine, Revue du MAUSS – semestrielle, homage to Marcel Mauss, paves the way to the retrieval of non-utilitarian values in Social Sciences and the importance of gift and solidarity in today’s world. Founded in 1981 by a group of French intellectuals dissatisfied with the course of studies in the field of Social Sciences, which placed the hegemonic rational-utilitarian doctrine beyond the behavior of man before the market, but for all human action, M.A.U.S.S. is established after a colloquium on the gift between Alain Caillé and Gerald Berthoud, where it was found “with astonishment that none of the assembled scientists had suspected that generosity or a genuine concern for the well-being of others could be a significant motive of the gift”²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002.^,3131. Graeber D. Marcel Mauss e o M.A.U.S.S. In: Martins PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis: Ed. Vozes; 2002. p.19-29..

Considered a project “at the same time intellectual, ethical and political, scientific and philosophical”³⁵35. Martins PH. Prefácio. In: Martins, PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis, RJ: Vozes; 2002. p. 7-15. of renewal of the Social Sciences in France, and still little disseminated in Brazil, M.A.U.S.S. is characterized by having intellectuals from various disciplines – sociologists, ethnologists, law specialists, historians, political economy and the science of religions – who seek to understand meaningful action, moving away from structuralist abstractionism and creating new alliances within humanism. Its founders theoretically approach intellectuals of the lineage of Claude Lefort, Cornelius Castoriadis; of Edgar Morin’s complex thinking; besides theorists of the solidary economy, like Jean-Louis Laville; of symbolic interactionism, such as Erving Goffman; of Alvin Gouldner’s reflective sociology and Mary Douglas’³⁶36. Godbout JT. Homo donator versus homo economicus. In: Martins PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis: Ed. Vozes; 2002. p. 63-97. cultural anthropology.

Alain Caillé²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002. argues that social sciences and moral and political philosophy are permanently confronted with two paradigms, waging what he considers an “epistemological war”: the utilitarian and the holist.

The dominant utilitarian paradigm represents the American moral and political philosophy and considers the individual as a starting point to explain social totality, stating that human individual action is driven by rationality and selfish interest, also called individualist, contractualist and instrumentalist (paradigm). It is represented by currents of the Rational Action Theory, Game Theory, New Economic History, Neo-institutionalism, Public Choice Theory, Conventionalism, Property Rights Theory, among others²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002..

The holistic paradigm, in turn, seeks to explain individual or collective human action as a manifestation of the social domination over the individual and of the need to reproduce them. That is, there is a social totality that imposes itself and commands human action, always overlapping the individual, represented by the functionalist, culturalist, institutionalist or structuralist²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002. theories.

Caillé²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002. proposes the third paradigm, or gift paradigm to explain human action. In the author’s own words, it is a “truly relational” paradigm, which focuses on overcoming this opposition, through the retrieval and interpretation of the work of Marcel Mauss, a precursor claimed by Lévi-Strauss and Louis Dumont, representatives of structuralism and holism, respectively. The gift paradigm, or third paradigm, believes that “it is not by subjecting themselves to the despotism of the law or taking refuge in each one for himself and deception that human beings will be able to find some peace, security and happiness”²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002.. It aims to analyze the social linkage through interrelations that bind individuals, transforming them into social stakeholders. Human action can be guided not only by utilitarian intentions, but also driven by the desire to do good.

According to this paradigm, human action harbors “material or immaterial calculation and interest, but not only that: there is also obligation, spontaneity, friendship and solidarity, in short, gift”²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002., which performs alliances and weaves ties, with a universality in what Mauss called the “triple obligation”: to give, receive and reciprocate. Mauss affirms that obligation also arises in the gift and, thus, an exhortation to individuation and personal action, demonstrating that freedom triumphs²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002.^,3434. Godbout JT. O Espírito da dádiva. Paris: Instituto Piaget, Éditions La Découvert; 1992. Coleção Epistemologia e Sociedade.. Thus, Mauss had “to enter into a peace treaty between sociological and psychological “imperalisms”²⁸28. Ortiz R. Durkheim, um percurso sociológico. In: Ciências sociais e trabalho intelectual. São Paulo: Olho d’água; 2002. p. 123-147..

Caillé²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002. seeks to make explicit what is understood by gift and establishes two definitions; in the first, the sociological is understood as “any provision of goods or services without guarantee of return”, where the primacy of establishing the social bond exists, which is more important than the donated good; in the second (general definition), he defines it as “any action or service performed without guarantee or certainty of return” (idem), and this fact is underpinned by the realm of gratuity.

On the other hand, Godbout³⁶36. Godbout JT. Homo donator versus homo economicus. In: Martins PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis: Ed. Vozes; 2002. p. 63-97. seeks gift models based on the role of debt, which differentiates the gift from the market: there is no debt settlement in the gift, as it is a primordial characteristic of the relationships with the market. Thus, the gift would have five manifestation models: 1) solidarity, with the circulation of goods and which can be represented by the model established by the State and which is closer to debt; 2) the agonistic gift, between equals, with debt nearing equality and reciprocity playing a fundamental role; 3) the gift between unequal, which is hierarchical, like clientelism relationships; 4) the gift to strangers, without primary bond between donor and receiver; and 5) the gift found in primary bonds, whose mutual debt is positive, which is represented in the manifestations of the gift especially between relatives and friends.

This author³⁴34. Godbout JT. O Espírito da dádiva. Paris: Instituto Piaget, Éditions La Découvert; 1992. Coleção Epistemologia e Sociedade. discusses several examples and the possible reasons for current gift concealment: the predominance of utilitarian thought, where confessing the inconsistency or lack of gift is a way of assuming modernity or postmodernity. The author encourages us to think differently, since the gift requires the implicit and the unsaid for its manifestation and acts with non-formulated rules and is often confused with equivalence or exchange.

Godbout points out that, in order to understand the gift’s concealments, we need to understand that there is always a relationship with the economic rationale and we must ask ourselves about the formulation of the initial tie if it does not obey rules that escape us. Moreover, there is also the (mis) understanding that the true gift is free and that gratuitousness is impossible! We would have to conceive gift as a relationship and a symbol, thus, “evaluator of person-to-person relationships, catalyst and indicator of elective affinities”³⁴34. Godbout JT. O Espírito da dádiva. Paris: Instituto Piaget, Éditions La Découvert; 1992. Coleção Epistemologia e Sociedade..

Godbout refers us to the feeling of Marcel Mauss in introducing the Essay on the gift, equivalent to the dominant feeling about the current manifestations of the gift, but concealed by the primacy of utilitarian rational thought in late modern societies³⁴34. Godbout JT. O Espírito da dádiva. Paris: Instituto Piaget, Éditions La Découvert; 1992. Coleção Epistemologia e Sociedade.. The Action Theory in Mauss²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002., or Multidimensional Theory of Action arises to understand that individual or collective action unfolds in four irreducible motifs to one another in theory, linked in practice and organized into two opposing pairs: obligation (coercion) and freedom (spontaneity, creativity); interest (instrumental interest) and disinterest (motivated to do good, solidary).

The practical application of the gift paradigm is addressed through to the logic of the “associative fact” by Caillé³⁵35. Martins PH. Prefácio. In: Martins, PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis, RJ: Vozes; 2002. p. 7-15., where “entering into association is, first and foremost, to make one’s own time and person available; therefore, there is an obvious linkage between the issue of the meaning of gift and that of the statute of associative action”. Therefore, gift is considered the political act par excellence, a paradigm of the politician.

Thus, Mauss discovery could not be seen only in archaic societies, but currently in primary sociability, referring to person-to-person relationship; and secondary sociability, referring to people and roles that other people play, such as the market, law and science. The associative fact “unfolds in the interface of primary and secondary elements (...) allowing the execution of functional tasks by way of personalization or the establishment of alliances on a large scale, alliances appropriate to the larger society”³⁵35. Martins PH. Prefácio. In: Martins, PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis, RJ: Vozes; 2002. p. 7-15..

Caillé³⁵35. Martins PH. Prefácio. In: Martins, PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis, RJ: Vozes; 2002. p. 7-15. also affirms that the associative fact develops in non-profit enterprises, but with common interests, where trust and mutual indebtedness rule and all benefit; it requires more than a formal legal content, since there are a variety of associations, in different places and with different legal frameworks; thus, there are different types of associations: tacit or explicit; sanctioned by law/custom/nothing; with free entry/exit or not; with different purposes and scale; and with different ways of recruiting its members and level of autonomy in relation to other organizations and degree of referentiality; and also consisting of volunteers and/or employees. The associative covenant is established by means of the gift, and there is a link between association and democracy, in secondary public spaces, in the tacit collective pact, in the political level, “but also - and perhaps first and foremost – in daily life, at the core of the primary public spaces occupied by associations”³⁵35. Martins PH. Prefácio. In: Martins, PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis, RJ: Vozes; 2002. p. 7-15..

The author argues that, if in the past solidarity took place at the core of personified solidarity – from man to man – in modernity it is characterized by impersonality, in a functional and redistributive way, as in the welfare state, which goes through a deep crisis. It is necessary, then, to establish new solidarity ways, with men recognizing themselves as members of the same society, looking at each other. Gift, solidarity, association, establishing alliances and democracy go hand in hand: “Solidarity in our societies must begin by taking the democratic requirement seriously (...), democracy is only taken seriously (...) when it favors the proliferation of associations”³⁵35. Martins PH. Prefácio. In: Martins, PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis, RJ: Vozes; 2002. p. 7-15..

In this aspect of association, França Filho and Cunha³⁸38. Martins PH. As redes sociais, o sistema da dádiva e o paradoxo sociológico. In: Martins PH, Fontes B, organizadores. 2ª ed. Redes sociais e saúde: novas possibilidades teóricas. Recife: Ed. Universitária da UFPE, 2008. p. 8-23. discuss the local networks of solidary economy, taking as an example the project called Eco Luzia, in Simões Filho, in the State of Bahia, Brazil. Networks are defined as “an association or coordination of various enterprises and/or initiatives of solidary economy with a view to establishing a proper circuit of economic relationships and exchange of experiences and formative knowledge”³⁸38. Martins PH. As redes sociais, o sistema da dádiva e o paradoxo sociológico. In: Martins PH, Fontes B, organizadores. 2ª ed. Redes sociais e saúde: novas possibilidades teóricas. Recife: Ed. Universitária da UFPE, 2008. p. 8-23., whose main objectives were to provide sustainability to enterprises and initiatives and to empower a territory as to the capacity for self-promotion.

They reveal a “sustainable-solidary conception”, which is committed to solidarity, cooperation and collective actions, considering the structural nature of unemployment and the exclusionary rationale of the capitalist system; they focus on a new economy, emphasizing territorial self-sustainability, seeking to reorganize local economies from the establishment of networks of solidary economy, a “complex and innovative cooperation strategy for the promotion of local development”³⁸38. Martins PH. As redes sociais, o sistema da dádiva e o paradoxo sociológico. In: Martins PH, Fontes B, organizadores. 2ª ed. Redes sociais e saúde: novas possibilidades teóricas. Recife: Ed. Universitária da UFPE, 2008. p. 8-23..

Martins³⁹39. Almeida-Filho N. conceito de saúde e a vigilância sanitária: notas para a compreensão de um conjunto organizado de práticas de saúde. In: Costa EA, organizadora. Vigilância Sanitária: desvendando o enigma. Salvador: EDUFBA; 2008. p. 19-43. discusses the need to bring health and sociology disciplines closer, making a synthesis between the thoughts of Durkheim, Mauss and Elias, revealing the possibilities of practical application, from the standpoint of the establishment of social networks and reinforcing the expanded understanding between the social and the individual for solidary social practices in health, emphasizing the need for their reorganization to meet social demands. This is called a systemic, paradoxical and interactive view of community and local life, for new modalities of public policies.

Solidarity as an innovative perspective in the organization and management of health surveillance actions

By bringing the concepts from the field of sociology and social anthropology closer to the field of health, we shall elucidate how the developed theme can be applied to the organization and management of Health Surveillance (Visa) actions, specifically as a political and ethical reference for the education of subjects involved in health risk management. To do so, we return to the initial question: what should move the subject of health practices to perform a solidary action? Or better still: what should an organization do to establish solidary relationships with other organizations?

Health surveillance actions are considered, above all, as health promotion practices and play an important role in the prevention of risks and health protection, controlling possible diseases affecting the population⁴⁰40. Costa EA. Vigilância sanitária: contribuições para o debate no processo de elaboração da Agenda de Prioridades de Pesquisa de Saúde. In: Brasil. Ministério da Saúde (MS). Saúde no Brasil: contribuições para a Agenda de Prioridades de Pesquisa. Brasília: MS; 2004. p. 115-140.. These are actions that include the ethical principle of beneficence and should not be limited to the legal, technical and administrative realms; they have specificities, since they must qualify products, processes, services and environments, including work environments, but that do not dissociate from others in the field of health in the conception of comprehensive care⁴¹41. Souza GS. Vigilância sanitária no sistema local de saúde: o caso do Distrito Sanitário de Pau da Lima - Salvador/Bahia [dissertação]. Salvador: Universidade Federal da Bahia; 2002.^,4242. Costa EA. Vigilância sanitária: proteção e defesa da saúde. São Paulo: Hucitec, Sobravime; 2004..

Risk management and communication are health regulation components and are necessary to the control of risks related to object of health surveillance, which uses specific intervention technologies, such as inspection and oversight; health education programs; monitoring of advertising; healthcare alerts, among others, and acts based on the implementation of healthcare standards, supervising their compliance and punishing regulated sector’s non-compliance. In order to do so, it has “police power”, a right granted to its agents to defend public interest, to the detriment of individual interests⁴¹41. Souza GS. Vigilância sanitária no sistema local de saúde: o caso do Distrito Sanitário de Pau da Lima - Salvador/Bahia [dissertação]. Salvador: Universidade Federal da Bahia; 2002.^,4343. Brasil. Portaria nº 1.052, de 08 de maio de 2007. Aprova e divulga o Plano Diretor de Vigilância Sanitária. Diário Oficial da União 2007; maio 9.^,4444. Leal COBS, Teixeira CF. Redes solidárias em vigilância sanitária: a rede de gerenciamento da comida de rua em Salvador, BA – Brasil. Vigil. sanit. debate 2015; 3(4):20-29.. It is a power that can therefore be punitive and coercive, especially during the surveillance process.

In bringing the concept of solidarity and its operationalization, in particular through the establishment of networks as a strategy for the management of the system and organization of the actions of several objects under the responsibility of health surveillance, we consider that this alternative facilitates the minimization of problems found in the management and organization of its system and favors ways of solidarity, especially if we consider objects that require management of social perspective, which empowers subjects and qualifies processes⁴⁵45. Leal COBS, Teixeira CF. Comida de rua: um estudo crítico e multirreferencial em Salvador, BA – Brasil. Vig Sanit Debate 2014; 2(04):12-22.

46. Leal COBS. A construção de redes solidárias em vigilância sanitária: fundamentos teóricos e alternativas organizacionais [tese]. Salvador: Universidade Federal da Bahia; 2013.^-4747. Castells M. A sociedade em rede: a era da informação: economia, sociedade e cultura. São Paulo: Paz e Terra; 1999.. Thus, the thematic of establishing organizational networks becomes a possibility of a solidary responsibility in health risk management. We could say that setting networks is considered a new health surveillance intervention technology for the management and communication of health risk. Thus, gift, solidarity, association and establishment of alliances through network action is a health surveillance democratic way of organizing its work process as an innovative way of managing and organizing its actions. As such, the first question is answered: what should move the subject of health practices to perform a solidary action is the feeling of responsibility.

In order to do so, it is necessary to foster the capacity of structuring local health surveillance, providing the control of risks related to several objects. In this process, it is imperative to take account of regional and local diversities, political, economic and socio-cultural diversities in Brazilian municipalities. A large communication and coordination capacity is required, which is typical of network action and is embodied in the associative and, therefore, relational form, in the interface between primary sociability – person-to-person – and secondary sociability – people and roles, as we have seen; linking health surveillance and institutions stakeholders whose objects interface with their actions, or health surveillance-regulated stakeholders, or even consumers and representative sectors of objects regulated by health surveillance.

In order to achieve this process, it is imperative to radicalize democracy in public institutions, taking the “democratic requirement seriously”³⁵35. Martins PH. Prefácio. In: Martins, PH, organizador. A dádiva entre os modernos: discussão sobre os fundamentos e as regras do social. Petrópolis, RJ: Vozes; 2002. p. 7-15.. An organization becomes solidary when it provides the establishment of networks seeking efficiency in public management, one of its own principles, since networks are horizontal organizational structures that allow broad participation, cooperation, the establishment of ties and linkages with a view to achieving common objectives⁴⁵45. Leal COBS, Teixeira CF. Comida de rua: um estudo crítico e multirreferencial em Salvador, BA – Brasil. Vig Sanit Debate 2014; 2(04):12-22..

It is necessary to qualify subjects that perform healthcare management and practices in the area of health surveillance. Besides training critical subjects vis-à-vis their action, it is essential to understand that human action carries interest, but also a desire to do good, spontaneity and solidarity. It is about sharing powers, qualifying practices from the perspective of an associative action and promoting it in a democratic context; establishing subjects that are aware of their role, in solidarity with issues of acting in health surveillance, but also guided by their own interests and representatives of organizational interests; promoting the involvement of several sectors of the society around the most diverse objects under the responsibility of health surveillance and seeking joint solutions to specific problems; making alliances with the regulated sector, the population, other institutions inside and outside health, acting intersectorally and in an interdisciplinary way. Coordinating, giving of oneself to receive from the other and setting bonds to solve health problems: this is how an organization establishes solidary relationships with other organizations.

It is within this perspective that Leal and Teixeira⁴⁵45. Leal COBS, Teixeira CF. Comida de rua: um estudo crítico e multirreferencial em Salvador, BA – Brasil. Vig Sanit Debate 2014; 2(04):12-22. report the setting of the Street Food Management Network of Salvador as an operational proposal for the solidary management of street food’s health risk. Street food is an object of great complexity that is poorly investigated by health surveillance; it must consider important realms, namely, social, economic, nutritional and cultural realms; it is found throughout the Brazilian territory and is of global importance. Thus, it requires social management of health surveillance, which fosters the development of stakeholders involved for the empowerment of this segment at the local level. However, this rationale can be implemented in any organization⁴⁸48. Cardoso RCV, Santos SMC, Silva EO. Comida de rua e intervenção: estratégias e propostas para o mundo em desenvolvimento. Cien Saude Colet 2009; 14(4):1215-1224..

Because it is a segment of great social vulnerability, street food requires a different look from the regulatory agencies. The studies point out weaknesses in the structuring of this trade, the low priority given by local managers to its qualification, although it is a strong component for the development of the local economy, it has an important cultural realm and evidences food risks as a component of environmental-related and worker-related risks, which are important objects for health surveillance as a component of health surveillance in the SUS⁴⁵45. Leal COBS, Teixeira CF. Comida de rua: um estudo crítico e multirreferencial em Salvador, BA – Brasil. Vig Sanit Debate 2014; 2(04):12-22.

46. Leal COBS. A construção de redes solidárias em vigilância sanitária: fundamentos teóricos e alternativas organizacionais [tese]. Salvador: Universidade Federal da Bahia; 2013.^-4747. Castells M. A sociedade em rede: a era da informação: economia, sociedade e cultura. São Paulo: Paz e Terra; 1999.^,4949. Alexander JC. A importância dos clássicos. In: Giddens A, Turner J, organizadores. Teoria social hoje. São Paulo: UNESP; 1999. p. 23-89..

Final considerations

We have brought conceptual contributions from social theories to explain the understanding of solidary action, considering solidarity as a gift through the description of readings of authors of a chain of thinkers that retrieves the work of Mauss²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002. and creates a poorly disseminated Action Theory by Mauss, especially in health and even less in health surveillance. In the words of Caillé himself, “everything here must be explored empirically and thought theoretically”²²22. Caillé A. Antropologia do dom: o terceiro paradigma. Petrópolis, RJ: Vozes, 2002..

For its implementation, it is worth retrieving values that can guide individuals to act in solidarity; as well as health organizations, so that they work on the choice of values, as we have seen in Max Weber¹⁸18. Aron R. Max Weber. In: Aron R. As etapas do pensamento sociológico. 7ª ed. São Paulo: Martins Fontes; 2008. p. 725-857. Coleção Tópicos.. In the same way, we stress, in Durkheim, the importance of collective consciousness, social cohesion, the search for moral authority, as Mauss affirms, stressing a “group morality”. Thus, the reading of the classics were an important way here to begin to understand the social²¹21. Collins R. Quatro tradições sociológicas. Petrópolis: Vozes; 2009. Coleção Sociologia.^,50.

Quoting Godbout³⁴34. Godbout JT. O Espírito da dádiva. Paris: Instituto Piaget, Éditions La Découvert; 1992. Coleção Epistemologia e Sociedade.: “The value of a tie depends on people’s characteristics, the nature of the bond and a set of variables (...). The more things are isolated from their tie value, the more they become transportable, cold (frozen) pure objects that escape time.”

Thus, and in view of the multiplicity of objects subject to health surveillance action, it is imperative to search for new ways of managing and organizing the work process in which institutional stakeholders seek the establishment of these ties with other stakeholders and/or other institutions, whose objects are health surveillance-related; as well as with sectors of society representative of these objects and the representatives of the health surveillance-regulated sector itself. We recommend that the Action Theory in Mauss serve as a guide in the search for new solidarities for health risk management. We would say that establishing networks would be a viable strategy that is consistent with the proposal of solidarity and we affirm that this can become a new health surveillance management and intervention technology in health surveillance and the Brazilian Unified Health System (SUS).

References

Publication Dates

History