Abstract

Sea people are culturally differentiated by their way of life intertwined with sea fishing and their social and symbolic production. In northeastern Brazil, these people have been changing their living conditions. The Family Health Strategy (ESF) should strengthen links with different cultures to meet its basic principles. We aimed to reflect on the challenges of the ESF in the context of sea people. We conducted ethnographic research in the community of Redonda, Icapuí, State of Ceará, using dense descriptions constructed through the narratives of small-scale fishers and their families. We analyzed from the theoretical approach of studies in traditional communities. The results are shown in five themes: 1) The family has an extended dimension in communities established with relatives; 2) Fishing life temporalities govern the common acts of the land-sea dyad; 3) The shifts between being “native” and “outsider” create border areas that dialogue with the rituals of belonging; 4) Sea territorialization and the knowledge of experience; 5) The ESF in the arenas of struggles for environmental justice. Here, the production of health is reaffirmed as the production of sea people’s life.

Key words
Culture; Family Health Strategy; Ethnicity and Health

Introduction

Traditional peoples and communities have been characterized by the National Policy for Sustainable Development as groups that are recognized for their differentiated cultures, whose social organization is closely associated with the occupation of territories and natural resources that, in turn, have become indispensable for cultural, social, religious, ancestral, and economic reproduction of these peoples and communities. The spaces occupied by them are called traditional territories¹1 Brasil. Decreto 6.040, de 7 de fevereiro de 2007. Institui a Política Nacional de Desenvolvimento Sustentável dos Povos e Comunidades Tradicionais. Diário Oficial da União 2007; 8 fev..

We are aware of the ambiguities of the term traditional²2 Cunha MC, Almeida MWB. Quem são as populações tradicionais? [Internet]. Site das Unidades de Conservação no Brasil/Instituto Socioambiental; 2010 [acessado 2020 Mar 19]. Disponível em: https://uc.socioambiental.org.
https://uc.socioambiental.org... . However, we use it as a concept of undeniable power and a political strategy by highlighting the social history of communities invisible in their struggles, their relationship with their living environment, and where they found their cultural bases. Also, the development and operationalization of public policies that meet the demands of these populations are a fundamental issue in public health³3 Carneiro FF, Pessoa VM, Teixeira, ACA, organizadores. Campo, Floresta e Águas: práticas e saberes em saúde. Brasília: UNB; 2017.. In these trails, the tensions exposed in the relationship between health and environment, whose live nerve will find its place within the Family Health Strategy (ESF), reach greater severity in the land of environmental conflicts that involve groups using and conferring meanings and taking ownership differently from the territories⁴4 Acselrad H. Conflitos ambientais no Brasil. Rio de Janeiro: Relume Dumará; 2004..

Fishing was a widespread practice among the indigenous people long before Brazilian colonization. This activity contributed to a unique face to the countless regional coastal cultures, among which the following stand out: that of the jangadeiro (raftsman), throughout the northeastern coast of Ceará to the south of Bahia; that of the Caiçara, on the coast between Rio de Janeiro and São Paulo; and the Azorean, on the coast of Santa Catarina and Rio Grande do Sul⁵5 Diegues ACS. A sócio-antropologia das comunidades de pescadores marítimos no Brasil. Etnográfica 1999; 3(2):361-375.. Each place of these sea peoples has a typical cultural feature.

The Brazilian Northeast’s ethnic composition includes diverse communities and traditional peoples formed mainly from indigenous remnants and black slaves who fled the mills and the slave system of the European colonists and transformed free territories into work and living places⁶6 Gomes HCM. Para Onde Sopram os Ventos? Escola, Vida e Cultura dos Povos do Mar [dissertação]. Fortaleza: Universidade Federal do Ceará; 2002.. This is the case of the maritime fishing communities along the coast of Ceará, which, when occupying lands then abandoned, started to have in small-scale fishing a possible subsistence away from the commercial centers of the captaincies⁷7 Lima MC. Comunidades Pesqueiras Marítimas no Ceará: Território, costumes e conflitos [tese]. São Paulo: Universidade de São Paulo; 2002., however, without failing to compose the routes bordering the Jaguaribe River and traveled the path from the hinterland to the sea in the jerky trade⁶6 Gomes HCM. Para Onde Sopram os Ventos? Escola, Vida e Cultura dos Povos do Mar [dissertação]. Fortaleza: Universidade Federal do Ceará; 2002.. We shall call these communities sea people in our text because they have transformed coastal spaces into territories for cultural, social, economic, and symbolic reproduction with very peculiar features⁸8 Diegues ACS. Povos e Mares: Leituras em Sócio-Antropologia Marítima. São Paulo: Nupaub; 1995..

Thinking about the health of these populations implies subverting the rationale of care models that do not observe the cultural specificities in a country with a continental dimension such as Brazil. It requires, above all, analyzing the historical specificities and internal differences underlying the multiple social realities to contextualize the subjects, considering that the way societies experience their health and disease phenomena reverberates in how they structure their confrontations⁹9 Minayo MCS. Contribuições da Antropologia para pensar a saúde. In: Campos GWS, Minayo MCS, Akerman M, Drumond Júnior M, Carvalho YM, organizadores. Tratado de Saúde Coletiva. São Paulo: Hucitec; 2012. p.189-218..

We know that, by incorporating the essential PHC attributes, such as first contact, longitudinality, comprehensiveness, and care coordination¹⁰10 Starfield B. Atenção Primária: equilíbrio entre necessidade de saúde, serviços e tecnologias. Brasília: UNESCO/MS; 2002., the ESF has enabled a great immersion of health professionals in the farthermost territories since its expansion in the 1990s. Entering these contexts has impelled these professionals to dialogue with multiple knowledge. In this process, it became essential for the ESF to perceive these territories as places of life in motion¹¹11 Santos MA. A Natureza do Espaço: técnica e tempo. Razão e emoção. São Paulo: Hucitec; 1997., where the experiences of individual and collective subjects and their diverse sociocultural relationships, permeated by conflicts and contradictions, are raw material to guide health actions.

Thus, we aim to reflect on the challenges of the ESF in the context of the sea people. We endorsed, therefore, the dialogue that confers a place of subject to the Other and overcomes the condition of silence¹²12 Freire P. Pedagogia da Esperança: um reencontro com a pedagogia do oprimido. Rio de Janeiro: Paz e Terra; 1992. the peripheral populations are subjected to when their lives are made invisible in the face of violent erasure of their cultures in the globalized world.

Affirming the health of sea people indicates the necessary multi-dimensionality of the human subject and its relational aspect, which creates the conditions for producing health, as has been discussed since the First International Conference on Health Promotion and its fertile 1986 Ottawa Charter when health was reaffirmed as a result of living conditions¹³13 Brasil. As Cartas da Promoção da Saúde. Brasília: MS; 2002..

Methods

This is a qualitative study that used ethnography as a dense description¹⁴14 Geertz C. A Interpretação das Culturas. Rio de Janeiro: LTC; 1989., that is, valuing listening to the subjects’ statements in their life contexts, without the researcher exempting himself from his implication and analytical possibility, by capturing plural narratives, which expose the desirous symbolism of culture and the way it gives meaning to experiences, producing the feasibility of social life.

The presence of researchers in the field of study was paramount for the analysis of the narratives as an intersubjective phenomenon, with a deep immersion in the daily lives of the research subjects. The study was conducted in the community of Redonda, in the municipality of Icapuí, in the far east of the Ceará coast, on the borders with Rio Grande do Norte, two hundred kilometers from Fortaleza, within the lower Jaguaribe microregion. We selected this community is because it is recognized regionally for its history of popular struggles in defense of small-scale fishing and fighting predatory fishing, essential characteristics for its self-identification as sea people.

Ethnography was performed for one year in which we operated the following procedures: participant observations, preparation of field diaries, dense descriptions of social situations, interviews with key informants, and survey of genealogies, all carried out in the environment where the subjects live and produce their social relationships, using a voice recording device and notebooks, to capture the understanding of these contexts and their events.

We understand qualitative research as a question epistemology type, meaning that it raises and addresses questions much more than it elaborates foreseen answers, deepens the sayable, and dives into the research practice’s unspeakable process. The critical articulations and designs stem from the intersubjective world that overflows, covering the object accent that sets the researched as a “thing” (not by chance they are “objects of study”, as the subjects of health are “patients”), which results in making, to some extent, the academic texts discourses that conceal their subjects.

Among the informants, we had fishers, shellfish gatherers, older adults, a teacher, a community health worker, a popular artist, and a community leader, ranging from 30 to 78 years. We used codenames (fish names) to identify the participants’ statements.

Sharing with these subjects the readings of the sea and the daily life of the community, we gathered what Halbwachs¹⁵15 Halbwachs M. A Memória Coletiva. São Paulo: Revista dos Tribunais; 1990. called collective memory, bringing, from the singular history, social situations with their vivid temporalities in the memory. Remembrance permanently refers the subject to his group since memory consists of a perceptual set traversing people. If the subject’s complexity is involved, it is articulated to the collective experience since people invoke others from their past as guarantors in the conjured up social auditorium.

As in a journey of old travelers, but experiences-recognition, we saw the possibilities of hope and the lacunae parts, composing the route of a path in which each narrator, on the frontier of those who lived a time that, now looking at the present, rebuilds it. In this process, the experience is transformed into the production of knowledge, insofar as, as for Josso¹⁶16 Josso MC. Experiências de Vida e Formação. São Paulo: Cortez; 2004., “experiences reach the status of experience from the moment we do a certain reflective work about what happened and was observed, perceived, and felt”¹⁶16 Josso MC. Experiências de Vida e Formação. São Paulo: Cortez; 2004.(p.48).

Thus, in the concert of the experiences of sea people, we built categories that could bring reflections on the production of health in the place, an exercise in which memory becomes the art of positioning oneself before what is told and recognizes itself as meaning and history asking for continuity¹⁷17 Benjamin W. Obras escolhidas I - Magia, técnica, arte e política. São Paulo: Brasiliense; 1991.. The path of analysis was then woven through the fabric of ethnography itself since it does not aim to present the facts as things but unveil their internal links to allow an interpretation by the researchers¹⁴14 Geertz C. A Interpretação das Culturas. Rio de Janeiro: LTC; 1989..

During the process, the reading of narratives revealed interfaces between the subjects’ social practices and the health production processes, and disease, involving contexts and other subjects, in an actively produced intersubjectivity. We call lighthouses the expressive forms that condensed themes, results of discussions, and studies. The metaphor also alludes to the lights that indicate the arrival to land, coming from the sea, and that light up for the ESF when the needs and proposals of the joint score are elaborated, which affirms the Redonda people’s struggle for health.

We observed the ethical aspects of human research, and our study was approved by the Research Ethics Committee of the Federal University of Ceará.

Results and discussion

We start from an idea of culture not only as the objectification of the daily world, which are separated from how people build the world and give them meaning, but as a human experiential construct, a becoming, and a permanent process of formation¹⁸18 Alves PC. Cultura: múltiplas leituras. Bauru: EDUSC; Salvador: EDUFBA; 2010.. In this light and given the mass of memories and stories of struggles over the territory, we designed lighthouses that can guide the affirmation of health as a common good and as an affirmation of the life of sea people

1^stLighthouse: The concept of family has a broad dimension in communities made up of relatives

Some 2,228 people are currently living in Redonda, according to community health workers’ counting. Most families depend on lobster fishing, the most extensive local economic activity. Other activities are fish catching, small plantations by family farmers, shops, and public services. The local association of small-scale fishers includes 529 fishers, making up the largest small-scale fishing community in Ceará.

However, despite the strong growth of the community, it was essential to reconstruct some aspects of the process of population settlement to understand some practical issues for the Family Health Strategy, as is the concept of family and how it can be mobilized in the context of sea people:

The concept of ethnicity is a socio-political construct, and an ethnic group, according to Barata¹⁹19 Barata RB. Como e por que as desigualdades sociais fazem mal à saúde. Rio de Janeiro: Fiocruz; 2009., is defined under its socio-cultural characteristics. As seen in Ariacó’s statement, the settlement of Redonda led to the establishment of a community built from three family groups: Crispim, Currupio, and Pindu. This bonding between relatives will have its importance in engendering the struggles of the place and strengthening the feeling of belonging to the community of Redonda.

We realize that the definition of family, in this context, has a broader dimension transcending the notion of nuclear family member, as it incorporates the community dimension and approaches the concept brought by Dias²⁰20 Dias LC. Abordagem familiar. In: Gusso G, Lopes JMC. Tratado de Medicina de Família e Comunidade: princípios, formação e prática. Porto Alegre: ArtMed; 2012. p. 221-232., which refers to a “group of people living together with intense close ties and sharing the feeling of identity and belonging, which will, in some way, influence their lives”²⁰20 Dias LC. Abordagem familiar. In: Gusso G, Lopes JMC. Tratado de Medicina de Família e Comunidade: princípios, formação e prática. Porto Alegre: ArtMed; 2012. p. 221-232.(p.221). The ESF is considered a PHC model focused on the family unit²¹21 Andrade LOM, Barreto ICHC, Goya N, Martins TJ. Estratégia Saúde da Família em Sobral. Sanare Rev Políticas Públicas 2004; 1(5):9-20.. In the case of sea people, it is essential to realize that the family unit transcends the walls of a residence, assuming community proportions, as seen in Redonda.

When collecting genealogies, we asked ourselves: what reconfigurations are necessary for the work of the ESF in contexts where family and community are intertwined in the meshes of an ethnic belonging?

2^ndLighthouse: The temporalities of life in fishing govern the common acts of the land-sea dyad

The inhabitants of communities or fishing villages are linked to times and spaces moved by fishing and work tides or cycles, where nature and sea life are always present:

From Guarajuba’s statement, we can observe that these people organize their lives around environmental characteristics, such as tidal flows and the spawning periods of marine animals, to not separate physical geography from a human and cultural feature typical of the life of the place. Therefore, if social activities are linked to fishing and tidal movements, the observation of this aspect is essential for the planning of actions in these communities, as our narrator well perceives:

Fishing times also define a lot how these people organize themselves. Small-scale lobster fishing does not happen all year. It has a closed season period, as was mentioned before by Guarajuba. At that time, it is forbidden to capture this crustacean to preserve the species in line with its breeding cycle. It is a regulation of fisheries legislation that small-scale fishers must follow, and, in return, they receive unemployment benefits.

The closed season coincides with the rains of the first months of the year, and most families alternate fishing with farming activities, such as small plantations typical of subsistence family farming:

The cyclical temporality governed by the flow of the sea and harvest times governs the lives of these peoples in such a way that it is not possible to produce health in these territories without the proper adaptation of actions to the movement pulsating in everyday life in interaction with the environment and work done in the land-sea dyad. As the fisher puts it: “when we are not at sea, we live in the bushes”.

3^rdLighthouse: The shifts between being “native” and being “outsider” create border areas that dialogue with the rituals of belonging

When observing Redonda’s residents’ conversations in a tent on the beach known as “Boca do povo”, a young girl from the place passed by in a bathing bikini. They commented: “she just wants to be an outsider”. We immediately recorded this expression “to be an outsider” in our notes and started to reflect on its senses and meanings. This way of speaking, used on several occasions in the daily life of the community, implies that there is an implicit understanding of what it means to “be an insider”. There is a set of behaviors, actions, attitudes, and symbols that Redonda recognizes as part of its culture vis-à-vis the others.

The instability and fluidity of sea waters and their resources are strongly related to these peoples’ social practices and ways of life. Maritime anthropology studies²²22 Geistdoerfer A. Anthropologie Maritime: appropriation technique, sociale et symbolique des ressources maritimes. Paris: CNRS; 1989. reinforce that the sociocultural practices of seafarers are marked initially by these natural properties of the sea, which mark the technical, symbolic, social, economic, and ritualistic aspects of these communities.

In this sense, Diegues²³23 Diegues ACS. Ilhas e Mares - simbolismo e imaginário. São Paulo: Hucitec; 1998. speaks of maritime culture or maritime nature to refer to various practices, not only economic, resulting from human interaction with the maritime space. It does not refer to the oceanic world only as a physical entity but as social and symbolic production. He stressed the particularism of what he called “sea people”²⁴24 Diegues ACS. Pescadores, Camponeses e Trabalhadores do Mar. São Paulo: Ática; 1983., his specific way of life marked by different social and cultural practices, such as peasant lives.

The sea is sacred in Redonda’s prayer rite healing rituals. The healer pronounces prayers in which she whispers: “go to the waves of the sacred sea”, giving the ocean the ability to drown out all the ills affecting their lives. In the ritual of this healer, we observed as she turned the child’s head towards the sea in a swinging lullaby-like movement. Her body’s swing reproduced waters’ swings and communion with the marine ecosystem and the belief from her coexistence; she was overwhelmed with power and healing.

Also, many rituals and celebrations are carried out amid the productive processes developed in the fishing communities. Let us see the following narratives:

Although biomedicine is currently hegemonic in how health care dictates, it is essential to emphasize that the assimilation of healing rites and knowledge is widespread in the various social spaces underlying the territories of sea people. Valla²⁵25 Valla VV. Apoio Social e Saúde: buscando compreender a fala das classes populares. In: Costa MV. Educação Popular Hoje. São Paulo: Loyola; 1998. p. 151-179. warns that “we must be careful in our interpretations of the actions of the popular classes and their relationship with religion”²⁵25 Valla VV. Apoio Social e Saúde: buscando compreender a fala das classes populares. In: Costa MV. Educação Popular Hoje. São Paulo: Loyola; 1998. p. 151-179.(p.162). Many see these practices as an act of “neediness” without considering that they may turn out to be of “intensity”. Thus, he analyzes: “what can be seen as an attempt to solve a material problem exclusively could well be the result of the desire to live life fully or more intensely”²⁵25 Valla VV. Apoio Social e Saúde: buscando compreender a fala das classes populares. In: Costa MV. Educação Popular Hoje. São Paulo: Loyola; 1998. p. 151-179.(p.162).

Turner²⁶26 Turner V. O Processo Ritual: estrutura e antiestrutura. Petropólis: Vozes; 1974. assigned the ritual a reconstructive role and not only of a pure reflection of social structure, as functionalist anthropologists used to do. Along this path, Linhares²⁷27 Linhares AMB. O tortuoso e doce caminho da sensibilidade: um estudo sobre a arte e educação. Ijuí: Unijuí; 2003. sees the ritual as a creative re-elaboration, a power to found the new within collective life. In her words, rituals are “some action that addresses the symbolic and occurs in social interaction, and the ambivalence of what its intention is with what has been accomplished in daily life manifests in them”²⁷27 Linhares AMB. O tortuoso e doce caminho da sensibilidade: um estudo sobre a arte e educação. Ijuí: Unijuí; 2003.(p.47).

How could the ESF incorporate a therapy that involves spirituality and rituality in the care and healing processes?

4^thLighthouse: Sea territorialization and the knowledge of experience

In addressing small-scale fisheries, sea people mobilize know-how in a community characterized by different collaborations and work partnerships. Exposing small-scale fishing as a human activity that is work and exposes contradictions of the more extensive system, Tupinambá²⁸28 Tupinambá SV. Do tempo da captura à captura do tempo livre - terra e mar: caminhos da sustentabilidade [dissertação]. Fortaleza: Universidade Federal do Ceará; 1999. observes, however, the cooperation between groups and between members of a crew based on the existence of an ethos that allows fishers to cope with daily challenges, among which those that involve risk. She understands that this ethos is a prerequisite for the development of fishing activity and supports community life.

Small-scale fishing mobilizes ancestral knowledge in this solidary group practice. When at sea, small-scale fishers take as a reference for guidance the reliefs that the landscapes before his eyes. This knowledge of navigation and training is passed on from generation to generation. Fishers take the land as a reference and make markings or, in other words, build places on the sea and territorialize, as we can see in the Redonda’s fisher narrative below:

This division and appropriation of space in seas is also established by depth, including the characteristics of underwater relief, water currents, and the types of fish one can find in these places. Maldonado²⁹29 Maldonado SC. Mestres e Mares: espaço e indivisão na pesca marítima. São Paulo: AnnBlume; 1993. realized that, in the absence of visible landmarks or formal terms of possession, the indivisibility of the environment leads fishers to cognitive and territorial development efforts that are specific to them. Thus, using ancient knowledge and shaped by life experience, fishers build territories on the high seas. When demarcating, they realize forms of subjective appropriation of this knowledge and objectively become fishing masters.

For the ESF to dialogue with this clear knowledge from small-scale fishing, it is essential to realize that children, youth, adults, and older adults interact in shared living spaces where learning occurs through the socialization of the culture of these communities³⁰30 Brandão CR. O que é Educação. São Paulo: Brasiliense; 1995.. The learning spaces are diffused in all social environments and, regarding sea people, the school is also the village, where the “knowledge of experience”¹²12 Freire P. Pedagogia da Esperança: um reencontro com a pedagogia do oprimido. Rio de Janeiro: Paz e Terra; 1992. is shared and reproduced for generations. The custom is also made from new claims of rights and assumption of knowledge socialization forms.

A certain detachment from the experience must also matter to the ESF to operate with incorporation into the public space as a place of production and socialization of transiting knowledge, reaching different temporalities and spaces in permanent dialogues. This understanding is fundamental to the performance of collective health practices, as popular education movements have generally observed the production of knowledge in popular spaces, which will require overcoming banking patterns (characterized by asymmetric practices, where people are not listened to), considering that disease, suffering, and care are perceived as human and shared experiences in these communities, affirmed in the larger complex of the production of social life³¹31 Dantas VMA. Dialogismo e arte na gestão em saúde: A perspectiva popular nas cirandas da vida. Porto Alegre: Rede Unida; 2020..

As Silva³²32 Silva MRF. Linhas de cristalização e de fugas nas trilhas da Estratégia Saúde da Família: uma cartografia da micropolítica [tese]. Fortaleza: Universidade Federal do Ceará; 2012. attested, ESF should engage in an exercise of continuous territorialization as a frequent activation of pulsating life, identifying borderline situations that hinder the production of health in different territories. In this path, the professionals’ “incarceration” in crystallized and paralyzing statements must be deterritorialized to enable new avenues and agency, in which the knowledge provided by the community is articulated to the Family Health work processes.

5^thLighthouse: The ESF in the arenas of struggles for environmental justice

Fishing has undergone profound changes. The rationale of the business-based fishing industry started to be strongly encouraged in Brazil in the mid-twentieth century. In the sixties, the federal government started to grant tax incentives, and several companies were created on the Brazilian coast geared to the international market. In Ceará, for example, several lobster export companies emerged. They peaked in the seventies but underwent a severe financial crisis⁵5 Diegues ACS. A sócio-antropologia das comunidades de pescadores marítimos no Brasil. Etnográfica 1999; 3(2):361-375. due to overfishing that extinguished environmental resources and an economic recession in the country.

The practice of small-scale fishing, which has always used natural propulsion such as sailing or oar, using handmade instruments and boats, and performing family-based work, has been threatened by large-scale industrial fishing. These capitalist interests substantially impacted the intensification of predatory lobster fishing and, consequently, on the scarcity of the species²⁸28 Tupinambá SV. Do tempo da captura à captura do tempo livre - terra e mar: caminhos da sustentabilidade [dissertação]. Fortaleza: Universidade Federal do Ceará; 1999.^,3333 Bezerra CP. Memorial da Redonda: reinvenção e luta na produção da saúde dos povos do mar [dissertação]. Fortaleza: Universidade Federal do Ceará; 2013.^,3434 Bezerra CP, Linhares AMB. Imaginemos Redonda: reflexões sobre sustentabilidade, buscando o ponto de vista da população. In: Matos KSAL. Educação Ambiental e Sustentabilidade IV. Fortaleza: UFC; 2013. p. 228-245..

In this environmental crisis and, specifically, “fishing crisis”, sea people’s struggle was defined around small-scale fishing advocacy. Several resistance movements and social organizations proliferate in the fishing communities, reaffirming the struggle of a people in defense of their territory and their ways of living in it, as in Redonda (Icapuí), Prainha do Canto Verde (Beberibe), and Batoque (Aquiraz)³³33 Bezerra CP. Memorial da Redonda: reinvenção e luta na produção da saúde dos povos do mar [dissertação]. Fortaleza: Universidade Federal do Ceará; 2013.

34 Bezerra CP, Linhares AMB. Imaginemos Redonda: reflexões sobre sustentabilidade, buscando o ponto de vista da população. In: Matos KSAL. Educação Ambiental e Sustentabilidade IV. Fortaleza: UFC; 2013. p. 228-245.^-3535 Céu de Lima M. Pescadoras e pescadores artesanais do Ceará: modo de vida, confrontos e horizontes. Mercator Rev Geo UFC 2006; 5(10):39-54.. Therefore, these scenarios have been the locus of several conflicts, as fisher Cação tells us:

Since then, relationships with the environment have ceased to be relatively sustainable and controlled forms, to become those that involved “outsiders” who did not recognize their rights. The environmental conflict started to position itself, then, as a permanent state of usurping the rights to life of traditional cultures, among them, those of sea people. Although this process is always finding resistance, fishers think that fishing life is going through a “rough patch”, crossed by the lack of an environmental policy that can position itself outside the game of large business investments, which appear as State policy:

The perception of the lobster’s market value seems to have conditioned the shift from a way of life where fishing was used to support the community, and the essentials were exchanged, to another way of living in which trade would be the primary purpose of fishing. Movements of transformation in human relationships and the symbolic sphere began to be outlined along with this change in the value of fish and its form of appropriation.

On the other hand, the struggle of Redonda’s fishers was firmly consolidated in defense of the exclusive practice of small-scale fishing in areas delimited by public authorities, and the inspection of compliance with the current legislation, such as the use of sustainable equipment, respect for fishing and preservation and the minimum sizes of the crustacean required for capture: “you cannot catch small lobsters”; “you cannot catch lobsters during the closed season”; “you cannot engage in net or marambaia (toxic baits, such as tires, drums) fishing because they destroy the environment, only manzuás” - they expose their demands.

Thinking about these transformations in fishing was fundamental to understand the collective health of these peoples. How did the fishing crisis reverberate in the living and health conditions of this population? Bearing in mind that the Brazilian public health system is based on the social rights expressed in the 1988 Federal Constitution³⁶36 Sousa MF. A reconstrução da saúde da família no Brasil: diversidade e incompletude. In: Sousa MF, Franco MS, Mendonça AVM. Saúde da Família nos Municípios Brasileiros: os reflexos dos 20 anos no espelho do futuro. Campinas: Saberes; 2014. p. 40-76., how can we build alliances with the struggles of sea people for their fundamental rights?

Traditional communities require a team agenda that focuses on the “environmental justice”³⁷37 Acselrad H, Mello CCA, Bezerra GN. O que é justiça ambiental. Rio de Janeiro: Garamond; 2009. concept, which designates a framework for a future life that overcomes the disproportional environmental risks affecting most impoverished people. The alliance with the struggles of traditional people does not mean that its contradictions are not perceived.

We should remember that traditional cultures do not exist in a mythical “pure state”³⁸38 Diegues ACS. O mito moderno da natureza intocada. São Paulo: Hucitec; 2001. that does not articulate with dominant capitalism or are “natural conservationists”⁵5 Diegues ACS. A sócio-antropologia das comunidades de pescadores marítimos no Brasil. Etnográfica 1999; 3(2):361-375.. On the contrary, like any other culture, these cultures enter into relationships and exchanges in the face of an intercultural and globalized world, in which there are confrontations and intertwining and implies reciprocal negotiation and borrowings³⁹39 Canclini NG. Diferentes, Desiguais e Desconectados: mapas da interculturalidade. Rio de Janeiro: UFRJ; 2009..

However, recognizing the fundamental rights of traditional communities is not based on the “supposed virtually existing identity essence”⁴⁰40 Brasil. Ministério Público Federal (MPF). Territórios de povos e comunidades tradicionais e as unidades de conservação de proteção integral: alternativas para o asseguramento de direitos socioambientais. Brasília: MPF; 2014., immutable identity and consolidated practices, but, above all, on how they are designated, recognized, and organized in the face of globalizing and homogenizing impositions. Producing and promoting Family Health involves occupying spaces with this statement and action, and in the process of this struggle, understanding the formative function of social subjects who assume the production of collective health as an affirmation of those on the coast who make their life at sea.

Final considerations

The institutionality of the right to health in Brazil is inalienable and is an achievement that should be increasingly implemented. Moreover, it is clear that health is produced in all places of social life, and knowledge capable of giving context, concreteness, and dialogism to those of health professionals is expressed in them. We are in a socio-political moment in which the principle of the state, as it associates with that of the market, should be limited by the principle of community⁴¹41 Santos BS. Para um novo senso comum: a ciência, o direito e a política na transição paradigmática. São Paulo: Cortez; 2011., and the ESF has unavoidable responsibility in this process. It is about ensuring diversity, the life forms that, by different contexts, experience the human with other potencies.

Sea peoples are unique cultures in which the recognition of self-identification to the so-called “life at sea” is the legitimate criterion of belonging. Their claim agendas arise in a context of environmental crisis in which the peripheral communities suffer the most from their effects, astonished before their vulnerable conditions of life and, consequently, health.

The rationale of capital rises, without, however, being able to completely offset the rationality of the solidary life of sea people. The transformations experienced by these people occur in the dialectic between adjustment and resistance and have a significant impact on their living conditions. The ESF must pay attention to the lighthouses that clear out how to produce the health of sea people in close harmony with their cultural singularities.

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