Abstract

This paper aimed to analyze the contribution of Journal Ciência & Saúde Coletiva (C&SC) to the construction of the CH field, particularly in its relationships with the Health Policy, understood both as an academic discipline and as a scope of practice. We reviewed papers published between 1996 and 2019 in the C&SC. Titles and abstracts of the 397 documents on health policies were read to measure the magnitude and identify the main themes and theoretical-methodological approaches. Thirty-five documents were selected and read in full among the 142 revised ones to investigate the Journal’s contribution to CH’s construction. The analysis was based on Bourdieu’s sociology. It revealed that C&SC was established as a space for the construction of CH in multiple dimensions, particularly concerning the reflexivity on the field. Specifically, concerning the Health Policy, despite the small percentage of documents on the issue (6.8%), it encompassed the different meanings of this subject for the field. The authors discuss the possible relationships between the characteristics identified and the historical process of incorporating this subject in the various areas of CH.

Key words:
Health policy; Health policies; Public policies; Collective health

Introduction

Health policies have been studied by researchers who consider it as an established discipline in industrialized countries¹1 Walt G, ShiffmanJ, Schneider H, Murray SF, Brugha R, Gilson L. 'Doing' health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan 2008; 23(5):308-317.^,22 Bernier NF, Clavier C. Public health policy research: making the case for a political science approach. Health Promot Int 2011; 26(1):109-116., and by private organizations, called think-tanks, located between the academic, social sciences, the government, and political parties³3 Smith JA. The Idea Brokers: Think Tanks and the Rise of the New Policy Elite. New York: The Free Press; 1991..

In Brazil, this theme was developed mainly within CH, originated in the 1970s, and it also incorporates this dual dimension, which can be understood as a field of knowledge and scope of practice⁴4 Donnangelo MCF. A Pesquisa em Saúde Coletiva no Brasil - a década de 70. In: Abrasco, editor. Ensino da Saúde Pública, Medicina Preventiva e Social no Brasil. Rio de Janeiro: UERJ, OPS, Fiocruz; 1983. p. 19-35.

5 Costa NR. Ciencias Sociales e Salud, consideraciones sobre el nascimiento del campo de la Salud Colectiva em Brasil. Cuadernos Medico Sociales 1992; (62):36-47.^-66 Paim JS, Almeida Filho N. Saúde coletiva: uma "nova saúde pública" ou campo aberto a novos paradigmas? Rev Saude Publica 1998; 32(4):299-316.. Although CH has been investigated under different approaches, there is a reasonable consensus on the appropriateness of using the field approach, in the sense of Bourdieu, to interpret it⁵5 Costa NR. Ciencias Sociales e Salud, consideraciones sobre el nascimiento del campo de la Salud Colectiva em Brasil. Cuadernos Medico Sociales 1992; (62):36-47.^,77 Ribeiro PT. A instituição do campo cientifico da saúde coletiva no Brasil (1975:1978) [dissertação]. Rio de Janeiro: Fiocruz; 1991.

8 Nunes ED. Saúde Coletiva: História de uma idéia e de um conceito. Saúde Soc 1994; 3(2):5-21.

9 Campos GWS. Saúde pública e saúde coletiva: campo e núcleo de saberes e práticas. Cien Saude Colet 2000; 5(2):219-230.

10 Luz MT. Complexidade do Campo da Saúde Coletiva: multidisciplinaridade, interdisciplinaridade, e transdisciplinaridade de saberes e práticas - análise sócio-histórica de uma trajetória paradigmática. Saúde Soc 2009; 18(2):304-311.

11 Bosi MLM. Pesquisa qualitativa em saúde coletiva: panorama e desafios. Cien Saude Colet 2012; 17(3):575-586.

12 Leal MB, Camargo Junior KR. Saúde Coletiva em debate: reflexões acerca de um campo em construção. Interface (Botucatu) 2012; 16(40):53-66.

13 Ianni AMZ, Cristiane S, Barboza R, Alves OSF, Viana SDL, Rocha AT, Rocha AT. Os Congressos Brasileiros de Ciências Sociais e Humanas em Saúde da Abrasco: um campo científico em disputa. Cien Saude Colet 2015; 20(2):503-513.^-1414 Minayo MCS. Disputas científicas que transbordam para o campo da Ética em pesquisa: entrevista com Maria Cecília de Souza Minayo. Cien Saude Colet 2015; 20(9):2693-2696.

The use of this theoretical framework showed that CH, in its emergence, could be considered as a social space to become a field. However, its subsequent development allowed it to be a field in the process of consolidation¹⁵15 Vieira da Silva LM. O Campo da Saúde coletiva. Gênese, transformações e articulações com a reforma sanitária brasileira. Salvador, Rio de Janeiro: Edufba, Fiocruz; 2018., which translates into its institutionalization in several social spheres¹⁶16 Nunes ED. A Revista Ciência & Saúde Coletiva e o processo de institucionalização de um campo de conhecimentos e práticas. Cien Saude Colet 2015; 20(7):1975-1982., particularly in the scientific field, with its graduate courses¹⁷17 Minayo MCS. Pós-graduação em Saúde Coletiva de 1997 a 2007: desafios, avanços e tendências. Cien Saude Colet 2010; 15(4):1897-1907. and its expanded academic production indexed in international databases¹⁸18 Viacava F. Produção científica dos cursos de pós-graduação em Saúde Coletiva no período 1998-2006. Cien Saude Colet 2010; 15(4):1977-1988.^,1919 Packer AL. Indicadores de centralidade nacional da pesquisa comunicada pelos periódicos de Saúde Coletiva editados no Brasil. Cien Saude Colet 2015; 20(7):1983-1995.. On the other hand, the relationship between CH and the Brazilian Health Reform²⁰20 Paim JS. Reforma Sanitária Brasileira: contribuição para a compreensão e crítica. Salvador, Rio de Janeiro: EDUFBA, Fiocruz; 2008. reveals the influence of the political field’s rationality. In this interface, the political and policy analysis appears prominently in CH’s establishment, encompassing all the main subfields, namely, Epidemiology, Social and Human Sciences in Health, although central to the area called Policies, Planning, and Management²¹21 Baptista TW, Azevedo CS, Machado CV, organizadores. Políticas, Planejamento e Gestão em Saúde: abordagens e métodos de pesquisa. Rio de Janeiro: Editora Fiocruz; 2015..

Also, over the past 20 years, a trend towards specialization within CH that translates into the organization of working groups linked to the Brazilian Association of Collective Health (Abrasco) has been observed. Each theme is subjected to a discussion of specific policies, besides epidemiological studies or approaches guided by human and social sciences.

The journals that disseminate Brazilian CH production have been analyzed regarding their contribution to international Public Health²²22 Asnake M. A importância da publicação científica para o desenvolvimento da saúde pública. Cien Saude Colet 2015; 20(7):1972-1973., CH’s institutionalization¹⁶16 Nunes ED. A Revista Ciência & Saúde Coletiva e o processo de institucionalização de um campo de conhecimentos e práticas. Cien Saude Colet 2015; 20(7):1975-1982. and internationalization¹⁹19 Packer AL. Indicadores de centralidade nacional da pesquisa comunicada pelos periódicos de Saúde Coletiva editados no Brasil. Cien Saude Colet 2015; 20(7):1983-1995., and has been the subject of self-analysis by editors¹⁴14 Minayo MCS. Disputas científicas que transbordam para o campo da Ética em pesquisa: entrevista com Maria Cecília de Souza Minayo. Cien Saude Colet 2015; 20(9):2693-2696^,2323 Carvalho MS, Coeli CM, Travassos C. Uma breve história de Cad Saude Publica. Cien Saude Colet 2015; 20(7):2007-2012.

24 Antunes JLF, França Júnior I, Andrade MTD, Barata RCB, Monteiro CA. Desafios editoriais da Rev Saude Publica. Cien Saude Colet 2015; 20(7):1997-2006.

25 Camargo Júnior, KR. Celebrando Ciência e Saúde Coletiva, lembrando da trajetória da Physis. Cien Saude Colet 2015; 20(7):2053-2058.

26 Cyrino AP, Lima EA, Garcia VL, Teixeira RR, Foresti MCPP, Schraiber LB. Um espaço interdisciplinar de comunicação científica na Saúde Coletiva: a Revista Interface (Botucatu). Cien Saude Colet 2015; 20(7):2059-2068.

27 Amarante P, Rizzotto MLF, Costa AM. Memória de um movimento: a Revista Saúde em Debate e a reforma sanitária brasileira. Cien Saude Colet 2015; 20(7):2023-2029.

28 Garcia LP, Duarte E. Epidemiologia e Serviços de Saúde: a trajetória da revista do Sistema Único de Saúde do Brasil. Cien Saude Colet 2015; 20(7):2081-2090.

29 Martins CL, Ribeiro H, Alvarenga AT, Carvalheiro JR. Saúde e Sociedade: parceria e abertura para novas abordagens. Cien Saude Colet 2015; 20(7):2069-2080^-3030 Jackson Filho JM, Algranti E, Saito CA, Garcia EG. Da segurança e medicina do trabalho à Saúde do Trabalhador: história e desafios da Revista Brasileira de Saúde Ocupacional. Cien Saude Colet 2015; 20(7):2041-2051..

The link between Journal Ciência & Saúde Coletiva (C&SC) and Abrasco justifies a specific investigation seeking to identify its contribution to CH’s establishment, particularly concerning health policies, a central aspect of the interface between knowledge and practice. As an object of knowledge, it appears both linked to the social health sciences and the area called Policy, Planning, and Management in Health (PP&GS).

On the other hand, the characterization of the production of papers on health policies in C&SC concerning its magnitude, types of papers, and both theoretical and methodological approaches and the discussion about its relationships with the construction of SC have been neglected. This paper aims to analyze C&SC’s possible contributions to the dissemination of Health Policy scientific and technical production and CH’s establishment.

Methods

Initially, papers that specifically addressed the issue of CH were reviewed, papers and thematic issues focused on the discussion of graduate studies, topics related to the nature of knowledge, and the establishment of CH’s principal underlying fields: Epidemiology, Human and Social Sciences in Health and Health Policy, Planning, and Management. As a result, a review of the works published between 1996 and 2019 was carried out. We searched the Journal’s website with the following Portuguese keywords, only in the title, successively: “campo”, “Saúde Coletiva”; “Pós-graduação” and “Bourdieu”. Two hundred forty-four papers were identified. Only 146 remained after reading the titles and eliminating works that did not address specifically the theme. Abstracts and 35 papers were read in full.

Bourdieu’s sociology guided the analysis of the relationships between the production of papers on policies and CH’s field construction in the Journal. This author affirms that the concept of field is a social micro-cosmos, a network of objective relationships between postures, agents, and institutions, endowed with relative autonomy, which hosts specific struggles that make sense to its members³¹31 Bourdieu P. As regras da arte. Gênese e estrutura do campo literário. Lisboa: Editorial Presença; 1992.. Bourdieu uses the concept of social space either as a synonym for field or as a reference to the global social space, which, in turn, would be underpinned by fields.

Also, as a more delimited social microcosm, inter-fields, where agents from different spheres interact driven by a common interest³²32 Bourdieu P. Sociologie Generale. In: Bourdieu P. Cours au Collège de France, 1981-1983. Paris: Raisons d'agir; 2015. (Vol. 1). p. 440-634.. This author affirms that a field is a theoretical construction that is simultaneously a space of forces and an arena of struggles³¹31 Bourdieu P. As regras da arte. Gênese e estrutura do campo literário. Lisboa: Editorial Presença; 1992.. In this sense, health policies can be analyzed as part of one of CH’s subspaces, namely, the one called Policies, Planning, and Management in Health, which corresponds to one of the poles of this field¹⁵15 Vieira da Silva LM. O Campo da Saúde coletiva. Gênese, transformações e articulações com a reforma sanitária brasileira. Salvador, Rio de Janeiro: Edufba, Fiocruz; 2018.. As an interdisciplinary research theme, its methodological and theoretical approaches can be the subject of disputes between other CH’s subspaces and other fields.

The following Portuguese keywords were used to characterize papers on health policies: políticas, política, políticas de saúde, Sistema Único de Saúde, SUS, Reforma Sanitária, reformas, privado, and financiamento. Of the 806 papers selected, 253 duplicates were discarded, and 553 papers remained. Then, the titles and abstracts were read, and 156 works were discarded, leaving 397 manuscripts (Figure 1).

The included papers were classified according to the following typology of thematic areas and sub-areas³³33 Santos JS, Teixeira CF. Política de saúde no Brasil: produção científica 1988-2014. Saúde debate 2016; 40(108):219-230.: a) political analysis in health; b) health system components; c) analysis of specific health policies. Studies on program evaluation were excluded, and only those whose object was policy evaluation were reviewed.

The studies classified as “Political analysis in health”³⁴34 Paim JS. Pósfacio - Análise política em saúde: um pensamento estratégico para a ação estratégica. In: Federico L. Análise política em saúde: a contribuição do pensamento estratégico. Salvador: EDUFBA; 2015. p. 279-286. investigate the power relationships in health (nature, structure, relationships, distribution, and struggles), and the political process in health and its relationships with the production of political facts, including situational studies. This perspective considers power as a main category, analyzing its appropriation, distribution, and struggle in the sectoral and societal spheres³⁴34 Paim JS. Pósfacio - Análise política em saúde: um pensamento estratégico para a ação estratégica. In: Federico L. Análise política em saúde: a contribuição do pensamento estratégico. Salvador: EDUFBA; 2015. p. 279-286.. The category “Health System Components” includes studies that address the political dynamics around the system’s various constituent elements, such as financing, management, participation, social control, care models, human resources, science, technology, and innovation³³33 Santos JS, Teixeira CF. Política de saúde no Brasil: produção científica 1988-2014. Saúde debate 2016; 40(108):219-230.. The works grouped as “Analysis of specific health policies”, in turn, address with the content of policies as guidelines, plans, and program³⁵35 Teixeira CT, Silveira P, organizadores. Glossário de análise política em Saúde. Salvador: Edufba; 2016., comprising the study of specific policies, such as policies aimed at population groups (women, children, older adults, and workers) or coping with problems (AIDS, dengue, high blood pressure, and tuberculosis).

The methodological approach was also codified according to the nomenclature explained by the author in the summary as case studies, multiple case studies, socio-historical studies, implantation analysis, policy formulation analysis, exploratory analysis, qualitative studies, review articles, essays, unexplained methods and techniques, and others. The code “does not apply” was used for editorials and critiques. When explained in the abstracts, the theoretical references were maintained according to the designation of the authors.

Results and discussion

Health policies in the C&SC

The production on health policies found in the C&SC in the 1996-2019 period totaled 397 works. Most works consist of papers (53.7%), followed by debates (16.6%) and free themes (13.6%) (Table 1). The production found corresponds to 6.8% of 5,871 documents published by the Journal in the period. Comparing the percentage of papers specifically, the Journal published 5,033 works in the period, 213 of which were health policies (4.2%). This small share may be related to editorial choices or the production characteristics of the field.

The thematic analysis revealed that 40.3% of the works address aspects related to the Health System Components, followed by 31.5% classified as Analysis of Specific Health Policies, and 28.2% as Political Analysis in Health (Table 2). This finding differs from the results found by Santos and Teixeira³³33 Santos JS, Teixeira CF. Política de saúde no Brasil: produção científica 1988-2014. Saúde debate 2016; 40(108):219-230., who identified a predominance of studies in the area of Analysis of Specific Health Policies.

However, among the list of specified sub-themes, the largest number of publications found in this research refers to policies aimed at coping with specific problems (23.9%), followed by systems management (13.1%), and SUS construction process (10%). Studies on Political Analysis in Health show an increase in the number of studies on the relationship between public and private (6%), which points to a growing interest in debating the pattern of articulation of these elements within the SUS, and new themes are highlighted, such as financial dominance in health care.

Concerning the analysis of the methodological approach (Table 3), it is noteworthy that most works were classified in the “other” category (24.7%), given the multiplicity of methodological choices. Such studies only describe the use of techniques such as interviews and document analysis, without, however, specifying the research strategy. Some of these studies do not explain the methodology or the techniques used (26.4%). Also noteworthy are the 9.0% of review studies and that 25.4% were classified in the “not applicable” category because they do not require the adoption of a given scientific methodology.

As for the analysis of theoretical references, most publications (61%) do not explain those that would have been used, which confirms the criticism commented in the literature about the “theoretical rarefaction” in the field³⁶36 Schraiber LB, Peduzzi M, Sala A, Nemes MIB, Castanhera ERL, Kon R. Planejamento, gestão e avaliação em saúde: identificando problemas. Cien Saude Colet 1999; 4(2):221-242.. Among those citing a theoretical reference, a profusion of perspectives is observed, and it is not possible to identify a predominant focus.

According to a previous study³⁷37 Esperidião MA. Análise política em saúde: síntese das abordagens teórico-metodológicas. Saúde debate 2018; 42(n. esp. 2):341-360., the analysis of the references identified a heterogeneous set of theoretical approaches and authors mobilized by the papers. Among the theoretical references cited in the reviewed papers (9%), we can identify an affiliation with theories of contemporary sociological matrices (Bourdieu, Habermas, Foucault), Planning in Latin America, political science, medium-range theories, political analysis theoretical models, organization and management theories, and CH authors. However, we can consider that this set of theoretical approaches mobilized in the studies reconfigure four sociological traditions in different periods: a critical or conflict tradition, a rational-utilitarian tradition, a functionalist tradition, and a microinteractionist tradition³⁸38 Collins R. Quatro Tradições Sociológicas. Petrópolis: Vozes; 2009.. Such profuse approaches, mobilized to analyze different objects, show a particular departure from a Marxism-based macro-perspective adopted to address the tensions of the State and society relationship, previously found in the production of research in the early 1990s³³33 Santos JS, Teixeira CF. Política de saúde no Brasil: produção científica 1988-2014. Saúde debate 2016; 40(108):219-230.^,3939 Paim JS, Teixeira CF. Política, planejamento e gestão em saúde: balanço do estado da arte. Rev Saude Publica 2006; 40(n. esp.):73-78.. The different thematic and methodological classifications made in papers of the Journal hinder comparison. Often, papers on policies are analyzed together with the item policy, planning, and management¹⁴14 Minayo MCS. Disputas científicas que transbordam para o campo da Ética em pesquisa: entrevista com Maria Cecília de Souza Minayo. Cien Saude Colet 2015; 20(9):2693-2696^,4040 Loyola MAR. A Saga das Ciências Sociais na área da Saúde Coletiva: elementos para reflexão. Physis 2008; 18(2):251-275..

Health Policy and Collective Health

Space delimitation for analyzing health policies in a journal is not simple, given the different definitions of the term and its multiple intersections with other disciplines and thematic areas. Thus, health policies are referred not only to analyses of state actions related to health problems but various studies on the evaluation of health services, health systems, financing, public-private relationships, among others. Thus, according to the classification obtained in the SciELO/Public Health library, the theme of health policies was classified under a different heading from that of “SUS” and “Planning and management”⁴¹41 Minayo MCS, Gomes R. Significância e métrica do que é produzido pela Ciência & Saúde Coletiva. Cien Saude Colet 2017; 22(2):336-336..

If Abrasco’s first publications were aimed at summarizing their meetings and introducing discussions mainly on human resources training and secondarily on research, C&SC starts by bringing the debate about health policies to the fore. However, before the establishment of Abrasco, the International Association of Health Policy (IAHP) was founded in 1975, in which several Brazilians participated. This association established dialogues with Abrasco and the Latin American Social Medicine Association (Alames)⁴²42 International Association of Health Policy (IAHP). Equity on Health Across The World: Neoliberalism or New Welfare Policies? Perugia: X Conference; 1998..

However, as an academic discipline, Health Policy developed in Brazil differently than the U.S. and Europe. The fact that his seminal production began in the 1970s, together with a political movement for health democratization and the search for Social Medicine references in the 19^th century, may help to understand part of its scientific hardships.

Before the 1970s, the Brazilian Public Health did not include Health Policy as a discipline. It recognized Hospital Administration and Health Administration, later incorporating Health Planning. Possibly, the landmark of this discipline in Brazil is based on a thesis advocated in 1972⁴³43 Donnangelo MCF. Medicina e sociedade: o médico e seu mercado de trabalho. São Paulo: Pioneira; 1975.. In the seminal studies of Cecília Donnangelo⁴³43 Donnangelo MCF. Medicina e sociedade: o médico e seu mercado de trabalho. São Paulo: Pioneira; 1975.^,4444 Donnangelo MCF, Pereira L. Saúde e Sociedade. São Paulo: Duas Cidades; 1976., although Marshall’s⁴⁵45 Marshall TH. Cidadania, Classe Social e Status. Zahar Ed.: Rio de Janeiro: Zahar; 1967. contribution regarding the recognition of civil, political and social rights in Europe in the eighteenth, nineteenth, and twentieth centuries, respectively, is mentioned, the approach developed by the author refers to the dynamics of capitalism, and the class struggles to explain the State’s intervention concerning the right to health.

The Cuenca Meeting on social sciences and health was held that same year (1972), and a study on medical education in Latin America was published by a doctor and sociologist⁴⁶46 Garcia JC. La educación medica em la América Latina. Washington: OPS; 1972. (Publicación científica, 255), in which the author explained a theoretical framework for research. In that decade, some more “classic” texts were produced by economists, sociologists, psychologists, and doctors⁴⁷47 Braga JCDS. A Questão da Saúde no Brasil - Um estudo das políticas sociais em saúde pública e medicina providenciaria no desenvolvimento capitalista. [dissertação]. Campinas: Unicamp; 1978.

48 Luz MT. As instituições médicas no Brasil - instituição e estratégia de hegemonia. Rio de Janeiro: Graal; 1979.

49 Oliveira JA, Teixeira SMF. A (im) previdência social brasileira: 60 anos de história da Previdência Social no Brasil. Petrópolis, Rio de Janeiro: Vozes, Abrasco; 1986.^-5050 Braga JCS, Goes de Paula S. Saúde e Previdência: Estudos de Política Social. São Paulo: Hucitec; 1981., considering social security, health policies, and medical institutions, and a guide for the formulation of health policies⁵¹51 Centro Panamericano de Planificación de la Salud. Formulación de Políticas de Salud. Santiago: OPS: 1975.. Likewise, some books that were widely publicized at the time brought health policy themes to the debate⁵²52 Mello CG. Saúde e Assistência Médica no Brasil. São Paulo: Cebes-Hucitec; 1977.

53 Guimarães R, organizador. Saúde e Medicina no Brasil: contribuição para um debate. Rio de Janeiro: Edições Graal; 1978.^-5454 Berlinger G. Medicina e Política. São Paulo: Cebes-Hucitec; 1978..

Participants in these initiatives founded the Brazilian Center for Health Studies (CEBES) and Abrasco in the same decade. At the state level, the Geisel government established the National Health System⁵⁵55 Brasil. Ministério da Saúde (MS). Relatório da V Conferência Nacional de Saúde. Brasília: MS; 1975. and the National Health Policy as its theme for the Fifth and Sixth National Health Conference (CNS)⁵⁵55 Brasil. Ministério da Saúde (MS). Relatório da V Conferência Nacional de Saúde. Brasília: MS; 1975.^,5656 Brasil. Ministério da Saúde (MS). Relatório da VI Conferência Nacional de Saúde. Brasília: MS; 1977.. However, many of the works produced in the period appeared as contributions for discussion and not scientific products.

This area of studies and knowledge production called Health Policy was recognized as an academic discipline and a sphere of social intervention, and the dimensions of “politics” and “policy” were highlighted, as were some concepts underlying the definitions of health policies⁵⁷57 Paim JS. Políticas de Saúde no Brasil. In: Rouquayrol MZ, Almeida-Filho N, organizadores. Epidemiologia & Saúde. 6ª ed. Rio de Janeiro: MEDSI; 2003. p. 587-603.. The definition of Health Policy was adopted as State action or omission, a social response, in the face of health problems and their determinants, and the production, distribution, and regulation of goods and services³⁹39 Paim JS, Teixeira CF. Política, planejamento e gestão em saúde: balanço do estado da arte. Rev Saude Publica 2006; 40(n. esp.):73-78.^,5858 Paim JS. Saúde e Políticas Públicas. In: Paim JS. Saúde, Política e Reforma Sanitária. Salvador: CEPS-ISC; 2002. p. 383-405.^,5959 Fleury S, Ouverney AM. Política de Saúde: uma política social. In: Giovanella L, Escorel S, Lobato LVC, Noronha JC, Carvalho AI, organizadores. Políticas e Sistema de Saúde no Brasil. Rio de Janeiro: Editora Fiocruz; 2008. p. 23-64.. Finally, Health Policy was admittedly understood as part of a scientific field (Collective Health), as a technique of analysis and policy formulation (policy) and praxis (politics) or political action of social actors⁵⁷57 Paim JS. Políticas de Saúde no Brasil. In: Rouquayrol MZ, Almeida-Filho N, organizadores. Epidemiologia & Saúde. 6ª ed. Rio de Janeiro: MEDSI; 2003. p. 587-603..

The above observations can help us understand certain ambiguities in this disciplinary area by involving objects of analysis, research, and intervention, on the one hand, and the effort of conceptual delimitation and theoretical-methodological construction, on the other. The results obtained by this study can reinforce the recognition of such ambiguities, taking into account the limitations of the various classifications used.

The Journal and the construction of the field

The construction of a field is a complex process that occurs in different areas of social space³¹31 Bourdieu P. As regras da arte. Gênese e estrutura do campo literário. Lisboa: Editorial Presença; 1992., and scientific journals are part of this process. In CH’s specific case, several journals contributed by disseminating academic production, debates on policies, and other products¹⁶16 Nunes ED. A Revista Ciência & Saúde Coletiva e o processo de institucionalização de um campo de conhecimentos e práticas. Cien Saude Colet 2015; 20(7):1975-1982..

In the 1990s, CH’s scientific production was divulged through 12 national journals: The Revista de Saúde Pública of USP, created em 1967; the Revista Brasileira de Saúde Ocupacional, published by Funda centro since 1973; the Revista Baiana de Saúde Pública of State Health Secretariat of Bahia (SESAB), of 1974; the Revista Saúde em Debate, linked to CEBES and created in 1976; the Cadernos de Saúde Pública (CSP) of the ENSP, in 1985; the Cadernos de Saúde Coletiva (CSC) of the UFRJ, in 1987; Physis, linked to the UERJ, in 1991; the Revista Saúde e Sociedade (RSS), of the FSP/USP and the Informe Epidemiológico do SUS (IESUS), both in 1992; the latter was renamed Revista Epidemiologia e Serviços de Saúde (RESS), published by the Ministry of Health; the Revista His tória, Ciências, Saúde - Manguinhos (HCSM), published by the Casa de Oswaldo Cruz, of the Oswal do Cruz Foundation - Fiocruz since 1994; the C&SC, in 1996; and Interface, in 1997.

If, at the time of its creation, RSP claimed its continuity vis-à-vis Hygiene that preceded it⁶⁰60 Paula Souza R. Editorial. Rev Saude Publica 1967; 1(1):1-2., others translate, to some extent, in the inaugural editorials, its relationship with CH’s construction. CSP presents itself as a journal focused on the field of Public Health⁶¹61 Sousa AFG. Editorial. Cad Saude Publica 1985; 1(1):0-0.. On the other hand, Interface is born emphasizing “the search for articulation between the paradigms of biological and social sciences”⁶²62 Apresentação. Interface (Botucatu) 1997; 1(1):5-5.. Revista HCS Manguinhos also highlights that the journal reflects the FIOCRUZ purpose of understanding health as the meeting point between the “... hard sciences and social sciences, laboratory and politics, science and society”⁶³63 Gadelha P. Apresentação. História, Ciências, Saúde-Manguinhos 1994; 1(1):3-3.. Physis and C&SC journals explicitly focus on the novelty of CH, not only incorporating the expression into their titles but theoretically analyzing the differences with Public Health¹⁹19 Packer AL. Indicadores de centralidade nacional da pesquisa comunicada pelos periódicos de Saúde Coletiva editados no Brasil. Cien Saude Colet 2015; 20(7):1983-1995.^,6464 Birman J. A physis da saúde coletiva. Physis 1991; 1:1..

The space of nuclear journals for CH’s construction was thus outlined, housing the different groups that were part of this process: epidemiologists, planners, social scientists, and central institutions in establishing the field: USP, IMS/UERJ, UFRJ, ENSP, and UFBA. The Revista Saúde em Debate was intended to be a space for discussing the relationship between health and the social structure, but also claimed, in the first issue, the identity with some Hygiene and Public Health journals that preceded it⁶⁵65 Editores. Saúde em Debate. Revista do Centro Brasileiro de Estudos em Saúde 1976; 1(1):3-3.. We also had the Revista Baiana de Saúde Pública and IESUS, which, while linked to government agencies, published scientific papers and specialized debates. While the other journals were part of the scientific field or with connections with administrative institutions, the CEBES magazine occupied the political position of criticizing the health system and transmitting proposals for the Brazilian Sanitary Reform.

Explicitly focused on the construction of the CH field, the C&SC was different from the others because it was created within Abrasco, and it explicitly aimed to contribute to the “... dissemination and critical reflection of the history and memory of the field ...”¹⁹19 Packer AL. Indicadores de centralidade nacional da pesquisa comunicada pelos periódicos de Saúde Coletiva editados no Brasil. Cien Saude Colet 2015; 20(7):1983-1995..

The reviewed papers’ analysis allows us to conclude that the Journal opened space for reflexivity on CH. Thus, investigating CH’s meaning, its relationships with Public Health, its specificities, and overlaps with other disciplines were themed¹³13 Ianni AMZ, Cristiane S, Barboza R, Alves OSF, Viana SDL, Rocha AT, Rocha AT. Os Congressos Brasileiros de Ciências Sociais e Humanas em Saúde da Abrasco: um campo científico em disputa. Cien Saude Colet 2015; 20(2):503-513.^,1414 Minayo MCS. Disputas científicas que transbordam para o campo da Ética em pesquisa: entrevista com Maria Cecília de Souza Minayo. Cien Saude Colet 2015; 20(9):2693-2696^,6666 Nunes ED. Editorial. Cien Saude Colet 2000; 5(2):216-217..

Noteworthy is the field’s theoretical/epistemological reflection conveyed by analyses and debates on transdisciplinarity⁶⁷67 Almeida Filho N. Transdisciplinaridade e Saúde Coletiva. Cien Saude Colet 1997; 2(1-2):5-20.

68 Castiel LD. Debate sobre o Artigo de Almeida-Filho: Transdisciplinaridade e Saúde Coletiva. Cien Saude Colet 1997; 2(1-2):27-30.^-6969 Cohn A. Estado e sociedade e as reconfigurações do direito à saúde. Cien Saude Colet 2003; 8(1):9-18.. This discussion is central to CH’s establishment, considering that the tensions related to the delimitation of its specificity and affirmation as a new social space were part of its history. Other themes central to the field’s establishment were taken up, such as the discussion on the right to health⁷⁰70 Debatedores. Cien Saude Colet 2003; 8(1):19-32.^,7171 Minayo MCS. Pós-Graduação em Saúde Coletiva: Um Projeto em Construção. Cien Saude Colet 1997; 2(1-2):53-71., besides the discussion on the very concept of group⁷²72 Guimarães CF, Silva RAN. Notas para a problematização do coletivo no campo da saúde. Cien Saude Colet 2005; 20(3):913-924..

The viewpoint on the meaning of CH, according to which this field can be a synonym for Public Health, possibly related to its incorporation into important institutions and also linked to the movement seeking its internationalization⁷³73 Paim JS. A Reforma Sanitária Brasileira e a Saúde Coletiva: concepções, posições e tomadas de posição de intelectuais fundadores. In: Vieira da Silva LM, organizador. O Campo da Saúde Coletiva. Gênese, transformações e articulações com a Reforma Sanitária Brasileira. Salvador, Rio de Janeiro: Edufba, Fiocruz; 2018.p. 192-221., can be identified in some milestones along this path.

If, in its first issue, C&SC sets itself the objective of contributing to CH’s establishment, four years later, in the issue celebrating 100 years of Public Health, the editorial places SUS as part of the development of institutionalized Public Health¹⁴14 Minayo MCS. Disputas científicas que transbordam para o campo da Ética em pesquisa: entrevista com Maria Cecília de Souza Minayo. Cien Saude Colet 2015; 20(9):2693-2696. Likewise, in the 20-year celebration, references to Public Health predominate¹⁴14 Minayo MCS. Disputas científicas que transbordam para o campo da Ética em pesquisa: entrevista com Maria Cecília de Souza Minayo. Cien Saude Colet 2015; 20(9):2693-2696. Participation in disputes in the scientific field also introduces internationalization as the Journal’s central issue⁷⁴74 Campos GWS, Onocko-Campos RT, del Barrio LR. Políticas e práticas em saúde mental: as evidências em questão. Cien Saude Colet 2003; 18(10):2797-2805..

Also, in this line, analyses and evaluations on the development of graduate programs showed the CH’s consolidation as a relatively autonomous universe, both regarding the formation of specialized human resources and the production of specific knowledge¹⁷17 Minayo MCS. Pós-graduação em Saúde Coletiva de 1997 a 2007: desafios, avanços e tendências. Cien Saude Colet 2010; 15(4):1897-1907.^,7575 Barata R, Santos RV. Pós-graduação em Saúde Coletiva no Brasil: o imprescindível papel da avaliação. Cien Saude Colet 2010; 15(4):1908-1909.^,7676 Luz MT, Mattos R. Dimensões qualitativas na produção científica, tecnológica e na inovação em Saúde Coletiva. Cien Saude Colet 2010; 15(4):1945-1953., despite recognizing their diversity⁷⁷77 Carvalheiro JR. Janus bifronte e a pós-graduação. Cien Saude Colet 2010; 15(4):1910-1913.. The development of graduate programs was analyzed at different times¹⁷17 Minayo MCS. Pós-graduação em Saúde Coletiva de 1997 a 2007: desafios, avanços e tendências. Cien Saude Colet 2010; 15(4):1897-1907.^,7171 Minayo MCS. Pós-Graduação em Saúde Coletiva: Um Projeto em Construção. Cien Saude Colet 1997; 2(1-2):53-71.^,7878 Nunes ED. Saúde Coletiva: Revisitando a sua História e os Cursos de Pós-Graduação. Cien Saude Colet 1996; 1(1):55-69.^,7979 Nunes ED, Ferreto LE, Barros NF. A pós-graduação em Saúde Coletiva no Brasil: trajetória. Cien Saude Colet 2010; 15(4):1923-1934., including the effects of this consolidation in the SUS, in the training of professionals in management and epidemiology, and the translation of knowledge to the practice of health services⁸⁰80 Novaes HMD, Werneck GL, Cesse EAP, Goldbaum M, Minayo, MCS. Pós-Graduação senso estrito em Saúde Coletiva e o Sistema Único de Saúde. Cien Saude Colet 2018; 23(6):2017-2025.. The analysis of the demand for graduate programs in 1996 showed the importance of master’s degrees for the qualification of health services professionals and the doctorate for the training of faculty and researchers⁸¹81 Tanaka ACA. Perfil da Demanda aos Cursos de Pós-Graduação, de 1996, na Área de Saúde Coletiva. Cien Saude Colet 1997; 2(1-2):108-116.. Ten years later, the incorporation of these professionals is mainly into the public sector, at the three levels of government⁸²82 Gomes MHA, Goldenberg P. Retrato quase sem retoques dos egressos dos programas de pós-graduação em Saúde Coletiva, 1998-2007. Cien Saude Colet 2010; 15(4):1989-2005.. Likewise, the creation of undergraduate courses in CH corresponded to an affirmation of the area’s specificity concerning the exercise of a set of practices aimed at health in the population scope⁸³83 Bosi MLM, Paim JS. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação profissional. Cien Saude Colet 2010; 15(4):2029-2038..

The Journal also contributed to the dissemination of CH’s stance over these 25 years, such as the debate on what would be the truth in the scientific field of health where, on the one hand, evidence-based medicine and health, and on the other, qualitative studies⁸⁴84 Minayo MCS. A busca da verdade no campo científico da saúde. Cien Saude Colet 2013; 18(10):2806-2808. are situated. Also, despite the repeated affirmations of the qualitative vs. quantitative debate’s idleness, the Journal stressed the importance of qualitative studies, as a new paradigm in opposition to the so-called biomedical model⁸⁵85 Baixinho CL, Presado MH, Ribeiro J. Investigação qualitativa e transformação da saúde coletiva. Cien Saude Colet 2019; 24(5):1582-1582..

The controversy surrounding the norms of ethics in qualitative research also brought up the opposition between the biomedical and the human and social sciences. In some moments in this discussion, CH does not appear as a transdisciplinary field between medicine and social sciences, but as a multidisciplinary field, and researchers in the human and social sciences turn to forums in this area, and not of CH, to advocate the specificity of this subfield¹⁴14 Minayo MCS. Disputas científicas que transbordam para o campo da Ética em pesquisa: entrevista com Maria Cecília de Souza Minayo. Cien Saude Colet 2015; 20(9):2693-2696^,8686 Guerriero ICZ, Bosi MLM. Ética em pesquisa na dinâmica do campo científico: desafios na construção de diretrizes para ciências humanas e sociais. Cien Saude Colet 2015; 20(9):2615-2624.. It also hosted discussions and analyses on CH’s three constitutive subfields: Epidemiology and its development in Latin America⁸⁷87 Barata RB, Barreto ML. Algumas Questões sobre o Desenvolvimento da Epidemiologia na América Latina. Cien Saude Colet 1996; 1(1):70-79.^,8888 Turci SRB, Guilam MCR, Câmara MCC. Epidemiologia e Saúde Coletiva: tendências da produção epidemiológica brasileira quanto ao volume, indexação e áreas de investigação - 2001 a 2006. Cien Saude Colet 2010; 15(4):1967-1976., the Social Sciences in Health¹⁶16 Nunes ED. A Revista Ciência & Saúde Coletiva e o processo de institucionalização de um campo de conhecimentos e práticas. Cien Saude Colet 2015; 20(7):1975-1982.^,3636 Schraiber LB, Peduzzi M, Sala A, Nemes MIB, Castanhera ERL, Kon R. Planejamento, gestão e avaliação em saúde: identificando problemas. Cien Saude Colet 1999; 4(2):221-242., and Planning, Management, and Evaluation in Health⁸⁹89 Levcovitz E, Lima LD, Machado CV. Política de saúde nos anos 90: relações intergovernamentais e o papel das Normas Operacionais Básicas. Cien Saude Colet 2001; 6(2):269-291..

This third thematic area, which can also be analyzed as a CH subfield¹⁵15 Vieira da Silva LM. O Campo da Saúde coletiva. Gênese, transformações e articulações com a reforma sanitária brasileira. Salvador, Rio de Janeiro: Edufba, Fiocruz; 2018., has had different names over the past 40 years, variations that correspond to the process of construction of the field, and of the SUS. While initially called “Administration and Planning in Health”⁹⁰90 Associação Brasileira de Pós-Graduação em Saúde Coletiva (Abrasco). Ensino da saúde pública, medicina preventiva e social no Brasil. Rio de Janeiro: Abrasco; 1982. or “Planning and Management in Health”⁹¹91 Teixeira CF, Sá MC. Planejamento & Gestão em Saúde: Situação Atual e Perspectivas para a Pesquisa, o Ensino e a Cooperação Técnica na Area. Cien Saude Colet 1996; 1(1):80-103., and later “Planning, Management, and Evaluation in Health”³⁶36 Schraiber LB, Peduzzi M, Sala A, Nemes MIB, Castanhera ERL, Kon R. Planejamento, gestão e avaliação em saúde: identificando problemas. Cien Saude Colet 1999; 4(2):221-242., it has always included the study of health policies among its objects. It was also considered eminently as a “field of practice”⁹²92 Luz MT. A Produção Científica em Saúde Coletiva (1994-1995). Cien Saude Colet 1997; 2(1-2):117-141.. It also made room for themes with a greater or lesser degree of delimitation related to the construction of the SUS that would become Abrasco’s thematic groups. Some of these groups evolved in the construction of their identity and aimed to increase their relative autonomy, as a social subspace within the CH, or even in the interface with other disciplines or professions, such as Collective Oral Health⁹³93 Soares CLM, Paim JS, Chaves SCL, Rossi TRA, Barros SG, Cruz DN. O movimento da Saúde Bucal Coletiva no Brasil. Cien Saude Colet 2017; 22(6):1805-1816.^,9494 Celeste RK, Warmling CM. Produção bibliográfica brasileira da Saúde Bucal Coletiva em periódicos da saúde coletiva e da odontologia. Cien Saude Colet 2014; 19(6):1921-1932., Health, and environment⁹⁵95 Augusto LGS, Tambellini AT, Miranda AC, Carneiro FF, Castro H, Porto MFS, Schütz GE. Desafios para a construção da "Saúde e Ambiente" na perspectiva do seu Grupo Temático da Associação Brasileira de Saúde Coletiva. Cien Saude Colet 2014; 19(10):4081-4089., Health information⁹⁶96 Moraes IHS, Santos SRFR. Informação em Saúde: Os Desafios Continuam. Cien Saude Colet 1998; 3(1):37-51., Evaluation of Health Programs⁹⁷97 Hartz ZMA, Pouvourville G. Avaliação dos Programas de Saúde: A Eficiência em Questão. Cien Saude Colet 1998; 3(1):68-82.. Some called themselves fields, such as Pharmaceutical Care⁹⁸98 Osorio-de-Castro CGS, Oliveira MA, Vasconcelos DMM. Assistência Farmacêutica: um campo em consolidação. Cien Saude Colet 2017; 22(8):2432-2432..

The Journal was also a space for discussing the different viewpoints on health policies. With the main text and the selection of several commentators with sometimes different opinions, the debate format can be considered part of the field’s social construction process. As an example, we can illustrate, with the first issue, where different viewpoints on the Health Reform and Health Policies in the situation can be recovered from that inaugural debate. Three viewpoints on Health Reform gathered around the criticism of neoliberal policies, and the advocating universality and integrality can be learned from those papers: SUS as part of the administrative reform of the State⁹⁹99 Barros E. Política de Saúde no Brasil: a Universalização Tardia como Possibilidade de Construção do Novo. Cien Saude Colet 1996; 1(1):5-17.^,100100 Junqueira LAP. A Descentralização e a Gestão Municipal da Política de Saúde. Cien Saude Colet 1996; 1(1):21-22., the democratic SUS of the Health Reform and the health movement¹⁰¹101 Campos GWS. Papel do Movimento Sanitário na Construção do Novo. Cien Saude Colet 1996; 1 (1):23-25.

102 Paim JS. Políticas de Saúde no Brasil ou Recusando o Apartheid Sanitário. Cien Saude Colet 1996; 1(1):18-20.^-103103 Rodrigues NE. Comentários a: "A Política de Saúde no Brasil a Universalização Tardia como Possiblidade de Construção do Novo". Cien Saude Colet 1996; 1(1):26-27., and one of the viewpoints of social sciences: both as an analysis of health policies¹⁰⁴104 Costa NR. Políticas Sociais e Crise do Estado Relativizando Crenças Cognitivas. Cien Saude Colet 1996; 1(1):28-34. and political analysis of policies and also sociological⁶⁹69 Cohn A. Estado e sociedade e as reconfigurações do direito à saúde. Cien Saude Colet 2003; 8(1):9-18.. The reflection on health policies followed the different situations, like the discussion in the 1990s¹⁰⁵105 Goulart FAA. Esculpindo o SUS a golpes de portaria... - considerações sobre o processo de formulação das NOBs. Cien Saude Colet 2001; 6(2):294-298. that mapped “advances” and “difficulties”. Also noteworthy are the commemorative events in which balances on the SUS performance are presented, such as that concerning the 20 years of the SUS¹⁰⁶106 Vaitsman J, Moreira MR, Costa NR. Editorial. Cien Saude Colet 2009; 14(3):690. and the 30 years of SUS¹⁰⁷107 Paim JS, Temporão JG, Penna GO, Santos NR, Pinto LF. Sistema Único de Saúde: 30 anos de luta!. Cien Saude Colet 2018; 23(6):1704..

Final comments

C&SC established itself as a space for CH’s construction in multiple areas, particularly concerning reflexivity on the field, through the semantic, historical, and sociological analysis of the different meanings and their main characteristics. It also housed theoretical-epistemological-methodological reflection on the establishment of its main subfields and thematic areas. Specifically, regarding health policies, despite the small percentage of specific works on the subject, it encompassed the different meanings to the field: Health Policy as an academic discipline and the debate on health policies. This very delimitation reflects the disputes in the field and the social construction process. It possibly varies depending on the position held by the author and his trajectory within CH.

However, this study has several limitations. Concerning policy analysis, the lack of consensus on thematic classifications hinders comparison with other works. Also, the analysis of the papers’ full content could bring about other elements for the interpretation. Regarding the investigation of the Journal’s contributions to the construction of the field, it is necessary to examine the evolution of the space of the journals that, alongside C&SC, participated in this process. The apprehension of the relationships between C&SC and the establishment of CH would also require seeking to recover the space of the viewpoints on the main contentious issues along this path, the agents and institutions involved in its production, seeking to relate the positions and trajectories to the identified positions and how they were reflected in the papers.

Despite these gaps, the apprehension made here allowed discussing some of the characteristics and the scope of the production on Health Policy in its relationships with CH. The transformations evidenced in the evolution of objects and focus on the theme, from its origins as a sociological object to its unfolding with the contribution of other disciplines alongside theoretical and methodological diversity, may be related to the historical process of incorporating this object in the different areas of the establishment of CH.

References

Publication Dates

History