Abstract

This paper aims to bring reflections and notes for strengthening Brazilian structuring public policies, focusing on Popular Health Education in the Unified Health System (SUS) from the perspectives built in the Observatory of Popular Health Education and the Brazilian Reality. The Observatory is a valuable space for sharing health professionals’ and popular educators’ interpretations and experiences about local and Brazilian realities from the perspective of Popular Health Education. During its two years of activity, the Observatory has gathered summary interpretations of Popular Health Education for the crises that traverse the country’s recent history in a dialogical and participatory way. In a panoramic view, the shared statements point to challenges for valuing the human approach to health promotion, including respecting local and community knowledge and social practices. Moreover, we underscore the importance of social participation in constructing participatory social processes in public health toward citizen autonomy and expanded democratic dynamics in the Brazilian State and its social equipment.

Key words:
Popular Health Education; Collective Health; Social Movements; Community Participation; Information and Communication Technologies

Introduction

This manuscript presents and debates the current challenges for Popular Health Education (PHE) in the Unified Health System (SUS). This opinion article was drafted from constructs collectively produced within the experience of the “Observatory of Popular Health Education and the Brazilian Reality”. Developed two years ago, it is institutionally anchored in the Health Promotion Department of the Medical Sciences Center of the Federal University of Paraíba (UFPB) through the Research and Extension Program “Comprehensive Health Promotion and Nutrition Practices in Primary Care” (PINAB). It is supported by the Popular Extension Research Group (EXTELAR), linked to the Interdisciplinary Center for Research and Extension in Solidarity Economy and Popular Education (NUPLAR) at UFPB.

The reflections and notes presented here intend to contribute to the debate around the current agenda of strengthening and structuring public policies, primarily those aimed at building participatory social processes that value the institutionalization of actions and services characterized by a humanistic approach that promotes the population’s emancipation, and which include and respect local and community knowledge and social practices in the actions of public services.

PHE is a broad and historical field of practices, experiences, and social movements that have accumulated knowledge and spread ideas, methodologies, approaches, and technology relationships between health professionals and the population over the last six decades. The latter - health professionals and the population - effectively point to new possibilities for formatting health services, building them with a dialogical, humanized outlook deeply articulated with listening and inclusion.

The set of civilizational setbacks to which the Brazilian population has been exposed over the last seven years, mainly with several dismantled and unstructured public policies, has also affected PHE experiences, movements, and practices, the initiatives anchored in the health services and management of universities and research and education centers, and those led by social movements and other popular and community groups¹1 Cruz PJSC, Silva MRF, Pulga VL, Machado AMB, Brutscher VJ. Educação Popular em Saúde: concepção para o agir crítico ante os desafios da década de 2020. Rev Ed Pop 2020; ed. esp.:6-28.^,22 Lima LO, Silva MRF, Cruz PJSC, Pekelman R, Pulga VL, Dantas VLA. Perspectivas da Educação Popular em Saúde e de seu Grupo Temático na Associação Brasileira de Saúde Coletiva (ABRASCO). Cien Saude Colet 2020; 25(7):2737-2742.. Despite the setbacks, the Brazilian PHE movement, with its diversity and breadth of practices and groups, has remained active, even in the face of the COVID-19 pandemic.

During the pandemic period, precisely in 2021, PINAB/UFPB started the experience of the Observatory of Popular Health Education and the Brazilian Reality in a remote environment through videoconferences via Google Meet to preserve, promote and facilitate the meeting between the different leaders of PHE practices in a crisis. It aimed to encourage these people to participate in virtual meetings to reflect on the Brazilian situation and the challenges of social and political reality, envisioning, through dialogue, possibilities, alternatives, and strategies for resisting and overcoming challenges, keeping experiences and their potential alive³3 Souza IG, Carvalho LMS, Silva FM, Vasconcelos ACCP, Cruz PJSC. Experiências de extensão em educação popular em saúde no enfrentamento à pandemia da Covid-19 na Atenção Primária à Saúde. Interface (Botucatu) 2022; 26:e210146..

This article aims to study this process in depth to improve the principles of comprehensiveness, equity, and community participation in the day-to-day running of local health practices.

Popular Health Education and its current role

The words formulated and shared in this manuscript are meant as inputs to the activities of national peers who persist in their journey through Popular Education (PE) and its interface with health.

PHE has been presented as a significant reference in guiding the construction of spaces, initiatives, and concrete experiences for the critical development of social and educational work connected to social reality and the life that pulses in the territories⁴4 Stotz E. Enfoques sobre educação e saúde. In: Rodrigues JAS, Cruz PJSC, organizadores. Educação popular e promoção da saúde na atenção primária: ideias, saberes e experiências. João Pessoa: Editora do CCTA; 2020. p. 27-50., particularly within Primary Health Care (PHC).

In this context, PE mobilizes people to organize themselves in formulating and developing a critical, participatory, and reality-transforming action⁵5 Calado AJF. Educação popular como processo humanizador: quais protagonistas? In: Lins LT, Oliveira VLB, organizadores. Educação popular e movimentos sociais: aspectos multidimensionais na construção do saber. João Pessoa: Editora Universitária/UFPB; 2008. p. 225-242., whether through research, teaching, and social action or through educational and therapeutic groups, projects, listening spaces, and community meetings, social support and solidarity actions, workshops, popular courses and the creation of local organization spaces. Its leading figures are social stakeholders from different places with varying experiences in social movements and popular practices, through students, technicians, university professors, health workers, and other social areas, such as education, the environment, and social assistance⁶6 Brasil. Ministério da Saúde (MS). Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa. Ideias e dicas para o desenvolvimento de processos participativos em Saúde [Internet]. Brasília: MS; 2016 [acessado 2023 jun 28]. Disponível em: https://portalarquivos2.saude.gov.br/ images/pdf/2016/novembro/10/Ideias-Dicas-P-Participativos-2016-10-04-final-final.pdf..

In the actions of these people and their groups, PE is revealed as a set of ethical-political and pedagogical principles that support the shared construction of the social action needed to tackle local social inequalities and unveil alternatives and possibilities for new horizons for life with quality and dignity.

While it is true that PE cannot just call upon itself to mobilize processes of change in the face of injustice, it is also true to say that it is proper from this perspective to mobilize strategies for confronting and overcoming injustice, which necessarily involves a critical reading of the world and life⁷7 Cruz PJSC, Silva MRF, Pulga VL. Educação Popular e Saúde nos processos formativos: desafios e perspectivas. Interface (Botucatu) 2020; 24:e200152..

Thus, we understand that PE is a work-mediated teaching-learning process⁸8 Melo Neto JF. Extensão Popular. 2ª ed. João Pessoa: Editora da UFPB; 2014., understood as a transformative action on social reality for its permanent humanization. PE is an educational approach based on the dialogue of knowledge and practices and people’s active, critical, and purposeful participation in the shared construction of possibilities for overcoming the social problems they experience in everyday life. PE is thus a human action⁹9 Cananéa FAALC. Educação popular e identidade: navegando com a associação artístico-cultural de Cabedelo [tese]. João Pessoa: Universidade Federal da Paraíba; 2015. whose content lies in the reality of the concrete lived and in people’s ways of feeling, thinking, and acting in the concrete world of social reality¹⁰10 Freire P. Pedagogia da autonomia: saberes necessários à prática educativa. 31ª ed. São Paulo: Paz e Terra; 2005., in their quest for autonomy and emancipation.

As Jara Holliday¹¹11 Holliday OJ. Desafíos para la Educación Popular en América Latina hoy. Interface (Botucatu) 2020; 24:e200151. points out, PE is a theory of knowledge with specific assumptions and philosophical bases to guide purposeful, consistent, and socially referenced human action.

Methodological aspects

This qualitative opinion article¹²12 Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 14ª ed. rev. aprim. São Paulo: Hucitec; 2014. was elaborated in the light of the methodological perspective of the systematization of experiences, under the terms founded by Oscar Jara Holliday¹³13 Holliday OJ. Para sistematizar experiências. 2ª ed. Brasília: Ministério do Meio Ambiente; 2006., who indicates, in his method, that it is fundamental to make explicit the experience to be systematized and the guiding thread (focus) of the systematization. As mentioned above, the experience analyzed occurred at the Observatory of Popular Health Education and the Brazilian Reality, and the systematization focused on the PHE proposals in the Lula government, formulated by the Observatory’s participants during debates at two of its meetings. The systematized meetings were held at the Observatory’s Eighth Meeting on 14/11/2022¹⁴14 Práticas Integrais de Promoção da Saúde e Nutrição na Atenção Básica (PINAB/UFPB). Educação popular em saúde no governo lula: desafios e estratégias [vídeo no Youtube]. 2022 [acessado 2023 out 30]. [2h33min18s]. Disponível em: https://youtu.be/H0P73zYnMyE?si=o1ri1Xjw2GWtLjb5.
https://youtu.be/H0P73zYnMyE?si=o1ri1Xjw... and Ninth Meeting on 19/12/2022¹⁵15 Práticas Integrais de Promoção da Saúde e Nutrição na Atenção Básica (PINAB/UFPB). IX Encontro do Observatório - Construindo propostas para a Educação Popular em Saúde no Governo Lula [vídeo no Youtube]. 2023 [acessado 2023 out 30]. [1h47min29s]. Disponível em: https://youtu.be/EOKaXobxnug?si=L2yQcPdF0YsE5IUC.
https://youtu.be/EOKaXobxnug?si=L2yQcPdF... . These gatherings were attended by 74 people with different health-related backgrounds: health counselors, members of social movements and popular health practices, health workers and managers working in SUS services, and students, professors, and researchers in health and related areas from higher education institutions.

The first meeting included a presentation by Osvaldo Bonetti (popular educator and researcher at Fiocruz) and Eliana Cruz (popular educator and researcher in Collective Health), followed by dialogue and debate, raising questions for reflection, and formulating proposals. There were no initial presentations at the second meeting, so the space was opened primarily for proposals and suggestions for strengthening PHE in the SUS.

The meetings were recorded and posted on YouTube on the PINAB/UFPB channel. The Observatory’s researchers and organizers transcribed the debates to systematize them, then read and analyzed the material to identify relevant proposals. After listing the proposals, the researchers attempted to build summaries that gathered the related themes. After this stage, the proposals were divided into categories didactically and comprehensibly.

As recommended by Jara Holliday¹³13 Holliday OJ. Para sistematizar experiências. 2ª ed. Brasília: Ministério do Meio Ambiente; 2006., our analysis is based on a dialectical methodological approach. The author affirms it is “a way of conceiving reality, approaching it to know it, and acting on it to transform it. It is, thus, a comprehensive way of thinking and living: a philosophy”¹³13 Holliday OJ. Para sistematizar experiências. 2ª ed. Brasília: Ministério do Meio Ambiente; 2006.. He also mentions that this method of analysis involves considering the object from the perspective of a moving reality, historicity, contradictions, and totality in the light of the Marxist approach.

Observatory members’ proposals

The proposals presented in this article derive from discussions by members of the Observatory of Popular Health Education and the Brazilian Reality in collective action with more than a hundred people working in public health in the country. From this perspective, we aimed to emphasize the making of i) the State, which could break with the pre-participatory perspective; ii) public policies, which would deepen humanized healthcare processes; and iii) the perspectives of participatory, democratic, and comprehensive construction of health.

Strengthening and consolidating Popular Health Education:

Popular Health Education, Guarantee of Rights, and Defense of the SUS:

Popular Health Education, Institutionalization, and Management of the SUS:

Popular Education in Primary Health Care and its support for teams and the dynamization of actions in the territories:

Popular Health Education, Health Work, and Continuing Education:

Popular Health Education, Equity Policies, Social Control, and Participation:

Popular Health Education, Care Practices, and Comprehensiveness:

These proposals were built collectively in remote dialogues through the Observatory. They enable us to recognize the many possibilities for popular health educators and the use of virtual technologies made available for the educational, organizational, and communicative processes proper and necessary for PHE.

Lessons learned, challenges, and prospects for the current agenda

The moments of building the proposals mentioned above recalled the power in forums and spaces when it comes to their shared construction and the ideas and strategies for strengthening PHE in the SUS, which was very much present in the process of building the PNEPS-SUS, from the establishment of the CNEPS, with its dozens of representatives from movements, groups, and technical areas of the Ministry of Health and other Ministries, encompassing regional and national meetings¹⁶16 Pedrosa JIS. A Política Nacional de Educação Popular em Saúde em debate: (re)conhecendo saberes e lutas para a produção da Saúde Coletiva. Interface (Botucatu) 2021; 25:e200190..

This moment restores hope and reestablishes a sense of professional commitment to formulating proposals aligned with the wishes of most of the Brazilian population. Thus, the significant participation of many people from several PHE groups, practices, and movements in the Observatory’s meetings resulted in the proposals listed here, which reveal society’s strength toward rebuilding the structuring public policies and the resilience of so many groups and social movements.

In this sense, in the set of proposals, we should underscore the urgent need to revive the CNEPS insofar as, in the 2009-2016 period, this was precisely one of the significant marks of the PNEPS-SUS as a democratic, public, and open space for participatory construction, follow-up, monitoring, and evaluation of the development of the main actions considered in its operational plan.

Another important dimension that the proposals listed reveal is that PHE and its expressions in the current management of the Ministry of Health need to insist on supporting and encouraging local PHE practices, experiences, and movements, primarily within PHC. The previous experience of implementing the PNEPS-SUS had a great deal of support for projects of national relevance and with a broad scope. However, the dimension of support for local and community practices (while present, primarily through the Victor Valla Popular Health Education Award) needed to be more significant. Aligning this thought with the proposals formulated collectively by the Observatory, we see how much we must effectively guide financial support to incentivize local practices in the capillarity of territories and communities.

To this end, the proposals presented assertively state the centrality of valuing the role of PHE in PHC. We refer here to the misguided way in which many PHC units are managed, acting as emergency care centers, much like the Emergency Care Units (UPA), failing to play an essential role in terms of community approach, health promotion actions, territorialization, health surveillance, health prevention actions, and local social participation. By focusing too much on emergency care, with a centralized medical approach, many Brazilian PHC units have become somehow spaces permeated by disease instead of health, by sadness instead of joy, by hopelessness instead of power, by the fear of death instead of the desire to live longer and better. The PHE has methodologies, dynamics, and strategies to support the actions of professionals and community leaders in collaborating with the construction of PHC units as reference centers for building life and happiness projects⁶6 Brasil. Ministério da Saúde (MS). Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa. Ideias e dicas para o desenvolvimento de processos participativos em Saúde [Internet]. Brasília: MS; 2016 [acessado 2023 jun 28]. Disponível em: https://portalarquivos2.saude.gov.br/ images/pdf/2016/novembro/10/Ideias-Dicas-P-Participativos-2016-10-04-final-final.pdf.. We can, therefore, energize and support PHE experiences in PHC, with groups, actions, and local projects built in a shared way in the territories with the Family Health teams, as is already the case in many places in Brazil¹⁷17 Vasconcelos EM. A construção conjunta do Tratamento Necessário. In: Grupo de Estudos em Educação Popular e Saúde [Internet]. 2009 [acessado 2023 jun 28]. São Paulo: Grupo de Estudos em Educação Popular e Saúde. Disponível em: https://geepsaude.wordpress.com/cadernos-%20de-texto/.
https://geepsaude.wordpress.com/cadernos... ^,1818 Cruz PJSC, Brutscher VJ. Participação popular e Atenção Primária à Saúde no Brasil: fundamentos, desafios e caminhos de construção. In: Mendonça MHM, Matta GC, Gondim R, Giovanella L, editores. Atenção primária à saúde no Brasil: conceitos, práticas e pesquisa. Rio de Janeiro: Fiocruz; 2018. p. 231-264..

We understand that the experience of the Observatory of Popular Health Education and the Brazilian Reality has pointed to a new perspective of building meeting places, dialogues, and exchanges. The Observatory differs from other spaces in that it is managed collectively without the organizational demands that many large movements and collectives require. There is no room for tensions over representation or internal management. The people who visit this space meet to get to know each other, share reflections, socialize inventions, discoveries, and their work potential, learn from the knowledge and work of others, and learn together. Without any demerit whatsoever to the experiences of movements, groups, and organizations with greater complexity and political and organizational tensions, the Observatory experience is a lighter space for articulation and communication insofar as, being an extension project, people participate in a more unpretentious way and detached from other expectations, including from the viewpoint of power struggles. At the Observatory, people meet to get to know each other, recognize each other, learn, relearn, formulate, and perform PHE actions collectively, as well as humanization and recivilization experiences.

From this perspective, we should underscore in this text the unique contributions made by Observatory participants, not just at the two meetings mentioned above but during all 12 that have occurred since May 2021. In the periodic meetings for critical evaluation and participatory planning of our work, we accepted guidance, possibilities, proposals, and new ways to improve what we do. We also aimed to understand and accept criticism about our actions’ limitations. Thus, the Observatory has become a place for PHE leading figures to share their impressions of the challenges of their practices. In the dialogues, we shared ideas and reflections, news, and information in virtual conversation circles with a national reach.

The COVID-19 pandemic has mobilized us to do PE remotely. Without losing sight of the fact that PE requires face-to-face meetings, human interactions, bonds, and connections that only occur in face-to-face human encounters, we recognize how much virtual meetings have enabled dialogue between leading figures from different places and contexts. Moreover, the idea proposed by the Observatory from the outset that face-to-face meetings accompany each remote session has contributed to understanding this remoteness as an essential part of the educational and mobilizing process.

In short, the experience of the Observatory of Popular Health Education and the Brazilian Reality has provided a space for more significant opportunities for meetings between people building PE practices in health services, social movements, and life territories. It provides exchanges, experiences, discoveries, expression of dilemmas, and collective and shared perspectives. Participating in the Observatory also opens up spaces to discuss the current situation and how it affects our practices. Examples of these dynamics include: a) how the processes of eugenics, discussed in one of the Observatory’s sessions, are influencing our practices regarding tackling racism and inequalities; and b) how the escalating food insecurity and the dismantling of public food security policies in Brazil are impacting PHE practices.

Moving considerations

The proposals put forward by the Observatory of Popular Health Education draw attention to the need to expand and strengthen spaces, experiences, movements, and practices that mobilize and qualify people’s social participation in SUS actions and services. The current Brazilian context allows us to deepen a participatory and citizen culture closer to democracy, dialogue, mutual respect, and peace.

We, therefore, have some principles and possibilities for building PHE actions in the SUS based on the specific reality of the population and their ways of feeling, thinking, and acting in health, thinking of health action as work that occurs in social and meaningful communication, and relationships based on exchange, cooperation, and community development. We hope that the PHE and the Observatory’s actions will contribute to supporting experiences and practices in PHC in health surveillance, from an emancipatory perspective, in the planning and management processes of the SUS and the care model’s territorialization activities, and the discussion of financing and social control.

References

Publication Dates

History