Abstract

This article aims to understand professional insertion and the identity as sanitarist based on the experience of Collective Health alumni from UFMT-Brazil. The Sociology of Professions, based on Claude Dubar, was used to identify the meanings of professionalization according to the nuances of training and practices in the construction of “being a sanitarist.” Using qualitative research, 12 alumni working in Collective Health were interviewed, treated by thematic analysis. One topic focused on the profile, the forms/strategies of professional insertion such as invitations, indications, progression/relocation in the institutions where they already worked, approvals in postgraduate notices and selections with contract. The activities varied in commissioned positions, temporary contracts, statutory, and scholarship holders. Another topic addressed the identity perceptions built in the world of work in the public health network, highlighting the political-social component with a critical role, expressing the commitment of Collective Health to social transformation, improvement of the population’s life and health as a citizenship right and duty of State. The professional identity is built procedurally and the insertion in the work occurs through the mobilization of agents, leaving the engagement in the struggle for recognition guided by the Brazilian Sanitary Reform values and a solidary, fair, and democratic society.

Keywords:
Collective Health; Professional identity; Professional education

Introduction

Collective Health is an interdisciplinary field of knowledge and practices in which professionals with degrees in the health area, in other areas, and with specific postgraduate training work. The hallmark of training in this field is understanding health and its social determinants, practices oriented primarily toward health promotion, prevention, and care for diseases and injuries, having as their object not only the individual but also social groups, the community (Bosi; Paim, 2010BOSI, M. L. M.; PAIM, J. S. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 3, p. 2029-2038, 2010. DOI: https://doi.org/10.1590/S1413-81232010000400017
https://doi.org/10.1590/S1413-8123201000... ).

Collective Health is also considered an ideological movement committed to social transformation by articulating scientific paradigms to approach the health-disease-care object, respecting its historicity and integrality (Paim; Almeida-Filho, 2014). In this sense, the significant participation of Collective Health in the movement toward health reform (Reforma Sanitária Brazileira - RSB) and the implementation of the Brazilian National Health System (SUS) stands out-facts that drove the reconfiguration of health practices and the labor market in Brazil, with repercussions on professional training in health. Furthermore, in implementing the SUS, the strategy of reorienting the care model (starting in the mid-1990s) with an emphasis on health promotion and comprehensiveness of actions increasingly demanded professionals with a profile in Collective Health. In this scenario, undergraduate training could quickly fill the gap of educational institutions in constituting subjects suitable and sufficient for this new reality (Bosi; Paim, 2009, ²⁰¹⁰BOSI, M. L. M.; PAIM, J. S. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 3, p. 2029-2038, 2010. DOI: https://doi.org/10.1590/S1413-81232010000400017
https://doi.org/10.1590/S1413-8123201000... ). This means that “the creation of the undergraduate course, more than a new profession, is about a new strategy for professionalization in health” (Bosi; Paim, 2010BOSI, M. L. M.; PAIM, J. S. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 3, p. 2029-2038, 2010. DOI: https://doi.org/10.1590/S1413-81232010000400017
https://doi.org/10.1590/S1413-8123201000... , p. 2034, free translation), i.e., it combines the construction of identity (graduate sanitarist) with the stage of development of the field of Collective Health.

Thus, implementing the Undergraduate Courses in Collective Health (CGSC) began in 2008, favored by the Support Program for Restructuring and Expansion Plans of Federal Universities/REUNI (Mendonça & Castro, 2023MENDONÇA, P. B. S.; CASTRO, J. L. O ensino na graduação em Saúde Coletiva: o que dizem os projetos pedagógicos. Ciência & Saúde Coletiva, Rio de Janeiro, v. 28, n. 6, p. 1729-1742, 2023.). Currently, 24 CGSCs are implemented in all regions of Brazil.

Sanitarist as a profession, therefore, is new, having as political and institutional milestones: the inclusion of Collective Health graduates in the Brazilian Classification of Occupations in 2017, which legitimizes the insertion and permanence of bachelors in different workspaces, approval of the National Curricular Guidelines for the Undergraduate Course in Collective Health by the Ministry of Education in 2022, fulfilling a role in strengthening curricula in defining the profile of alumni, favoring guidance and insertion of the area in the labor market and consequent consolidation of the course’s identity; regulation of the profession by Law No. 14,725/2023/Brazil, which defines requirements, attributions, competencies, and skills for practicing as a sanitarist.

These milestones are achievements resulting from broad debates and struggles in which the leading role of the Associação Brasileira de Saúde Coletiva (ABRASCO - Brazilian Association of Collective Health) stands out, above all, through the Forum for Undergraduate Studies in Collective Health/FGSC, as well as alumni (mainly, through the representation of the Association of Bachelors in Collective Health) (ABRASCO, 2023ABRASCO - ASSOCIAÇÃO BRASILEIRA DE SAÚDE COLETIVA. Ser sanitarista é transformar o SUS. Associação Brasileira de saúde Coletiva, [s. l.], 2 jan. 2023. Disponível em: Disponível em: https://abrasco.org.br/ser-sanitarista-e-transformar-o-sus/ Acesso em: 20 set. 2024.
https://abrasco.org.br/ser-sanitarista-e... ), among other participating and partner institutions.

In this context, professionalization, seen as a long and complex process of socialization of formal and tacit knowledge that confers specific knowledge and responds to social needs (Bosi, 1996BOSI, M. L. M. Profissionalização e conhecimento: a nutrição em questão. São Paulo: Hucitec; 1996.), is relevant in constructing identity and insertion in the labor market. Socialization refers to a relational, gradual, unfinished, and permanent construction of a symbolic code, implying multidirectional dialogue that requires constant renegotiations according to the temporal order, circumstances, and contexts of action, as well as the person’s life path, allowing for a representation of the world and the identity assumed in it (Dubar, 1997DUBAR, C. A socialização: construção das identidades sociais e profissionais. Tradução. Anette Pierrette R. Botelho e Estela Pinto R. Lamas. Porto: Porto Editora, 1997.). Professionalization, then, involves relationships between identity, education/training, work, and career (Dubar, 2012DUBAR, C. A construção de si pela atividade de trabalho: a socialização profissional. Tradução de Fernanda Machado. Cadernos de Pesquisa, Rio de Janeiro, v. 42, n. 146, p. 351-367, 2012.) which implies:

This understanding introduces the subjective dimension, the mark of experience and intersubjectivity, into the analysis (Dubar, 2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005.), recovering the subject in the professionalization process (Bosi; Paim, 2010BOSI, M. L. M.; PAIM, J. S. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 3, p. 2029-2038, 2010. DOI: https://doi.org/10.1590/S1413-81232010000400017
https://doi.org/10.1590/S1413-8123201000... ). It is, therefore, consistent with the interactionist perspective that contests the functionalist thesis that distinguishes two very different types of work activities: profession and occupation, reserving the quality of the former for a minority of workers organized into “professions,” benefiting from legislation that protects their practice and allows their associations to hold the monopoly on their training and certification (Santos, 2005SANTOS, C. A Construção Social do Conceito de Identidade Profissional. Interacções, [s. l.], v. 5, n. 8. p. 123-144, 2005.). In turn, the sociology of professions from an interactionist perspective redefines professionalization as a general process (and not restricted to certain activities), postulating that every worker wants to be recognized and protected by a statute and that every “occupation” tends to organize itself and fight to become a “profession” (Santos, 2005SANTOS, C. A Construção Social do Conceito de Identidade Profissional. Interacções, [s. l.], v. 5, n. 8. p. 123-144, 2005.). We adhere to this perspective of the Sociology of Professions to approach professional identity by exploring its three intersecting areas highlighted by Dubar (2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005., p. 252): the lived world of work, the socio-professional trajectory with employment movements, and the relationship of workers with the training and work they perform or will perform.

Given the above and considering that, since 2010, the Institute of Collective Health of the Federal University of Mato Grosso (ISC-UFMT) has offered the CGSC (evening, 40 places/semester), this text aims to understand professional insertion and identity as a health professional based on the experience of its alumni working in the field of Collective Health. Experience is taken as how concrete subjects experience the world in the existential flow of everyday life, of the set of experiences edited by that marking and touching them, affecting them (Bondía, 2002BONDÍA, J. L. Notas sobre a experiência e o saber de experiência. Revista Brasileira de Educação, Rio de Janeiro, n. 19, p. 20-30, 2002. DOI: https://doi.org/10.1590/S1413-24782002000100003
https://doi.org/10.1590/S1413-2478200200... ). The reports of lived experience (related to, but distinct from, the live experience) present us with striking and significant parts of the experience but not everything that was experienced.

Methodology

This qualitative study values the voice of alumni of the undergraduate course in Collective Health and knowledge through experience with the legitimacy of those who lived/live the process in focus. Thus, in 2019, the ISC/UFMT GSC had 11 completed classes and 93 alumni who were potential interlocutors for this study. Among these alumni, some who worked in the field of Collective Health were identified, and interviews were initiated. Using the snowball technique (Vinuto, 2014VINUTO, J. A amostragem em bola de neve na pesquisa qualitativa: um debate em aberto. Temáticas, Campinas, v. 22, n. 44, p. 203-220, 2014.), the indication of other people in this condition was requested. The total of 12 participants was delimited by the repetition of names added to the saturation of the themes (Fontanella; Ricas; Turato, 2008FONTANELLA, B. J. B; RICAS, J; TURATO, E. R. Amostragem por saturação em pesquisas qualitativas em saúde: construções teóricas. Cadernos de Saúde Pública, Rio de Janeiro, v.24, n.1, p.17-27, 2008.), with whom a comprehensive interview was conducted (Kaufmann, 2013), in a private place from May to August 2019, guided by a thematic script focusing on three items: academic and professional trajectory, identity as a sanitarist and daily work. The interview explored and deepened the following aspects: choice and permanence in the course; contribution of the course and subareas to work in the field; self-concept as a sanitarist and interaction with other professionals; general and specific activities performed; professional expectations.

The interviews were conducted by the first author of this article and were recorded, transcribed, and stored on restricted-access equipment. The data were processed using thematic analysis (Gomes, 1994GOMES, R. Análise de dados de pesquisa qualitativa. In: MINAYO, M. C. S. (org.). Pesquisa Social: teoria, método e criatividade. Petrópolis: Vozes, 1994; 67-80.) to identify core meanings. These core meanings were grouped into themes and analyzed based on the successive socializations that occur with people in their educational and work processes in constructing identity (Dubar, 2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005., ²⁰¹²DUBAR, C. A construção de si pela atividade de trabalho: a socialização profissional. Tradução de Fernanda Machado. Cadernos de Pesquisa, Rio de Janeiro, v. 42, n. 146, p. 351-367, 2012.). The results will be presented in two topics, focusing on the profile of training and insertions in the world of work, followed by the experience of “being a sanitarist.”

The study was approved by the Ethics Committee (Opinion No. 3,193,556/2018), and the participants were identified in the excerpts of their speeches as Entrev. and by random numbering to protect anonymity.

Sanitarists in the world of work: training profile, forms, and insertion strategies

Of the 12 interviewees working in the field of Collective Health, 10 are women, corresponding to the feminized profile in the health area (Wermelinger et al., 2010WERMELINGER, M. et al. A força do trabalho do setor da saúde no Brasil: focalizando a feminização. Revista Divulgação em Saúde para Debate, [s. l.], n. 45, p. 54-70, 2010.), with the age range of 30 to 39 and 40 to 49 years predominating (4 respondents each); 3 in the age range of 20 to 29 years; and one over 50 years old. Table 1 below shows the relevant characteristics of the training and institutional affiliation of the participants because it is where they mobilize the knowledge/skills pertinent to the profession.

Four had another previous degree (01 Biology, 02 Nursing, 01 Data Processing Technology), suggesting familiarity with the academic world. Possible job insertion and training complementation in Collective Health can allow the assumption of functions that value and demand this requirement in public health institutions, therefore meeting the proposal to reorient the dominant care model (Bosi; Paim, 2010BOSI, M. L. M.; PAIM, J. S. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 3, p. 2029-2038, 2010. DOI: https://doi.org/10.1590/S1413-81232010000400017
https://doi.org/10.1590/S1413-8123201000... ).

Similarly, six interviewees had postgraduate degrees, which presupposes the need to deepen specific knowledge/Collective Health but also allows for career progression; an alternative or strategy for remaining in the field, increasing employability or, as Silva, Domingues, Rocha (2017SILVA, V. C.; DOMINGUES, H. S.; ROCHA, C. M. F. Desafios e possibilidades da inserção profissional de bacharéis em Saúde Coletiva. Revista Insepe, Belo Horizonte, v. 2, n. 2, p. 14-34, 2017.) said, circumventing the reality of limited opportunities for insertion in the labor market. This exposes what has already been found about the insecurity and fragility of the type of employment relationship and the adequacy of remuneration, which may lead to the incorporation of these professionals with precarious work relationships (Lorena et al., 2016LORENA, A. G. et al. Graduação em saúde coletiva no Brasil: onde estão atuando os egressos dessa formação? Saúde e Sociedade, São Paulo, v. 25, n. 2, p. 369-380, 2016.; Silva, Pinto, Teixeira, 2018SILVA, V. O.; PINTO, I. C. M.; TEIXEIRA, C. F. S. Identidade profissional e movimentos de emprego de egressos dos cursos de graduação em Saúde Coletiva. Saúde Debate, Rio de Janeiro, v. 42, p. 799-808, 2018. DOI: https://doi.org/10.1590/0103-1104201811901
https://doi.org/10.1590/0103-11042018119... ).

Nevertheless, postgraduate training (especially specialization and residency) allows quick and localized responses to institutional/service technical demands, sometimes filling gaps or insufficiency in the undergraduate degree. Let us look at the search for postgraduate degrees.

Regarding institutional affiliation, five are scholarship holders (postgraduate studies); four have tenure in public/statutory services, three of whom passed civil service examinations before graduating in Collective Health; three are hired higher education professionals, and one of them has a higher education teaching position in a private institution. At the time of the study, the possibilities in civil service examinations for these participants for the position of Higher Education Professional of the SUS (with and without specialization) were given by the profile of the first degree or by the requirement of specialization in Public Health, given that only in 2022 was there the first notice from the municipal health department in the capital/Mato Grosso with vacancies for graduated sanitarists. The alumni interviewed work in units linked to the SUS, with the public sector predominating as the large employer, i.e., they are salaried. As Diniz (2001DINIZ, M. Os donos do saber: profissões e monopólios profissionais. Rio de Janeiro: Revan, 2001.) reminds us, few professions were born autonomous but rather salaried within organizations, subject to controls, rules, and routines.

The predominant activities performed are health management in positions/functions in the public sector, the residency’s theoretical and practical activities, research in Collective Health (master’s degree), and one case of teaching.

In general, in the personal trajectory, after the undergraduate education, the specific moment of professional life follows: from student to employee, but also unemployed, looking for a job, employed, continuing the postgraduate education in service or not. Considering that identity is “the result at once stable and provisional, individual and collective, subjective and objective, biographical and structural, of the various processes of socialization” (Dubar, 2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005., p. 136, free translation), it is necessary to consider that such construction occurs in the world of everyday life, inscribed in the experience, in the professional case, through insertion in the world of work. This insertion promotes the contours in the constitution of the professional identity when the alumni become members of a professional segment, internalizing and mobilizing knowledge and specific practices of the profession as an experience of appropriation, forging the identity for themselves in loco, directly learning from work and in personal/professional and institutional interactions (Dubar, 1997DUBAR, C. A socialização: construção das identidades sociais e profissionais. Tradução. Anette Pierrette R. Botelho e Estela Pinto R. Lamas. Porto: Porto Editora, 1997., ²⁰⁰⁵DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005.).

Regarding the professional insertion paths of the interlocutors, they occurred through invitations, recommendations, and previous work in the sector in which they worked and approval in selection processes/civil service examinations (due to prior training), as in the findings of Silva, Pinto, Teixeira (2018SILVA, V. O.; PINTO, I. C. M.; TEIXEIRA, C. F. S. Identidade profissional e movimentos de emprego de egressos dos cursos de graduação em Saúde Coletiva. Saúde Debate, Rio de Janeiro, v. 42, p. 799-808, 2018. DOI: https://doi.org/10.1590/0103-1104201811901
https://doi.org/10.1590/0103-11042018119... ). It is, therefore, a field of possibilities, that is, a list of alternatives presented to individuals based on broader socio-historical processes throughout each trajectory (Velho, 2003VELHO, G. Projeto e metamorfose: antropologia das sociedades complexas. 3. ed. Rio de Janeiro: Jorge Zahar, 2003.), in this case, providing the opportunity to work as a sanitarist. In other words, they are opportunities for choices, in alternatives demarcated historically and conjuncturally.

In this sense, good performance in curricular internships can be one of these opportunities to demonstrate the skills and abilities acquired through training (Bezerra et al., 2013aBEZERRA, A. P. S. et al. A percepção do graduando em Saúde Coletiva sobre o estágio supervisionado. Tempus, Brasília, DF, v. 7, n. 3, p. 115-127, 2013a.; Lorena et al., 2016LORENA, A. G. et al. Graduação em saúde coletiva no Brasil: onde estão atuando os egressos dessa formação? Saúde e Sociedade, São Paulo, v. 25, n. 2, p. 369-380, 2016.), highlighting the need for that professional profile that can make a difference, in the management of the health system. Internships can reflect academic training and a projection of oneself for future professional performance in the constitution of identity (Dubar, 2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005.). In this space of theoretical-practical articulation, students glimpse the gaps and potentialities of the pedagogical process, making them think about the profession and the consequences of daily health actions (Pereira & Carneiro, 2019PEREIRA, E. L.; CARNEIRO, R. O que podem nos contar os estágios supervisionados em/sobre saúde coletiva? Saúde e Sociedade , São Paulo, v. 28, n. 2, p. 53-66, 2019.), forging credibility for a promising performance in the institution.

Many skills and competencies are developed during the internship, such as recognition, explanations, proposals for problem-solving, participation in decision-making processes, and proactive attitudes (Viana; Souza, 2018VIANA, J.L; SOUZA, E.C.F. Os novos sanitaristas no mundo do trabalho: um estudo com graduados em Saúde Coletiva. Trabalho, Educação e Saúde, Rio de Janeiro, v. 16, n. 3, p. 1261-1285, 2018.). It is through practice that the skills of a given profession are integrated (Bezerra et al., 2013aBEZERRA, A. P. S. et al. A percepção do graduando em Saúde Coletiva sobre o estágio supervisionado. Tempus, Brasília, DF, v. 7, n. 3, p. 115-127, 2013a.; Silva; Ventura; Ferreira, 2013SILVA N. E. K.; VENTURA M.; FERREIRA J. Graduação em Saúde Coletiva e o processo de construção de cenários práticos. Tempus , Brasília, DF, v. 7, n. 3, p. 91-101, 2013.). The specific knowledge and languages of the profession and the dialogue with action allow the capacity for action, directly confronting problems. In other words, the methodology of learning by doing and thinking allows the individual to build personal ways of knowing and acting, making a difference in their insertion into the labor market (Caires; Almeida, 2000CAIRES, S; ALMEIDA, L. S. A experiência de estágio académico: Oportunidades de formação e desenvolvimento do estudante. Psicologia, Lisboa, v. 14, n. 2, p. 235-250, 2000.).

We, therefore, believe that technical and political indications for positions of trust or invitations to be hired civil servants do not disqualify the graduated sanitarist. This is because the indications are mediated by the fact that these alumni, in most cases, have demonstrated their potential to employers during their activities with the health system, in practical scenarios (such as internships), being a path in the employment movement (Bezerra et al., 2013aBEZERRA, A. P. S. et al. A percepção do graduando em Saúde Coletiva sobre o estágio supervisionado. Tempus, Brasília, DF, v. 7, n. 3, p. 115-127, 2013a.; Viana; Souza, 2018VIANA, J.L; SOUZA, E.C.F. Os novos sanitaristas no mundo do trabalho: um estudo com graduados em Saúde Coletiva. Trabalho, Educação e Saúde, Rio de Janeiro, v. 16, n. 3, p. 1261-1285, 2018.) in the professionalization process.

The multiplicity of academic experiences of students (during their training) enhances the possibilities of expanding and fulfilling their role in society, providing the opportunity to put their knowledge, thoughts, and actions into practice, making visible the specificity of the work of sanitarist forging bridges and doors of access to the market. Thus, when there is a confrontation with the labor market (and the skills are recognized), status is given to the candidate, and career possibilities (becoming more precise)-reinforce and confirm a professional identity (Dubar, 2012DUBAR, C. A construção de si pela atividade de trabalho: a socialização profissional. Tradução de Fernanda Machado. Cadernos de Pesquisa, Rio de Janeiro, v. 42, n. 146, p. 351-367, 2012.). This conquest of space is notable in the following words.

In the excerpt below, we can see that invitations to management positions in public health services are proliferating, expressing prestige and responsibility for caring for the population on a collective level concerning health services and the SUS. Such repercussions build, reinforce, and strengthen recognition by making visible and propagating the image, role, and potential of the graduated sanitarist (Bezerra et al., 2013bBEZERRA, A. P. S. et al. Quem são os novos sanitaristas e qual seu papel? Tempus , Brasília, DF, v. 7, n. 3, p. 57-62, 2013b.) as a showcase for more than just the individual case, who can achieve and leverage the category towards professionalization. It also configures what Velho (2003VELHO, G. Projeto e metamorfose: antropologia das sociedades complexas. 3. ed. Rio de Janeiro: Jorge Zahar, 2003.) calls metamorphosis for the possibilities in which the person flexes projects in their trajectory, always open and in constant changes and transformations in time and context of insertion. Let us see:

As can be seen, some interviewees already worked in the SUS as Higher Education Professionals in a specific profile from their first degree. However, with the interdisciplinary training provided by Collective Health, they could improve the work they developed, broadening their vision of health, as illustrated in the third and fourth excerpts below.

Therefore, the alumni consider themselves to be inserted in the world of work in Collective Health and the SUS, acting as sanitarists. It is now pertinent to understand what it means to “Be a Sanitarist” based on the knowledge of experience, the mark of what has been lived, intersubjectivity, and their place of speech. This is because such ideas and practices as sanitarists tell us about the identity that, in the daily work routine, feeds back into the professionalization process, as Bosi and Paim (2010BOSI, M. L. M.; PAIM, J. S. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 3, p. 2029-2038, 2010. DOI: https://doi.org/10.1590/S1413-81232010000400017
https://doi.org/10.1590/S1413-8123201000... ) said, which is the following subject.

“Being a Sanitarist”: experience and identity construction

The selected data came mainly from the question in the thematic script: “Do you consider yourself a sanitarist? Why? Tell me about it.” For the analysis, we used basic concepts that Dubar (2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005.) proposed: identity for oneself, acts of belonging, and professional biographical process.

For Dubar (2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005.), “professional self-conception” develops after graduation, when the individual internalizes a new professional image that becomes a significant aspect of their personality until entering the labor market, constituting the professional biographical process. However, in this case, some of our interlocutors were already in the world of work with another degree profile so that the degree would improve, aggregate, and legitimize specific skills and competencies in a continuum that is more than a rupture. This means that these professionals will continue with the duties of their professional profile, with a bonus provided by the new degree, in the manner of postgraduate education, especially the lato sensu. The diploma allows access to an esoteric body of knowledge (Wilensky, 1970WILENSKY, H. L. The Profissionalization of Everyone. In: GRUSKY, O.; MILLER, G. (eds.). The Sociology of Organizations: basic studies. New York: The Free Press, 1970.) in the field of Collective Health that is concentrated in the new undergraduate course and that was sparse, diluted in subjects, fragmented, and localized in the classic courses in the health area and, even, as Bosi and Paim (2010BOSI, M. L. M.; PAIM, J. S. Graduação em Saúde Coletiva: limites e possibilidades como estratégia de formação. Ciência e Saúde Coletiva, Rio de Janeiro, v. 15, n. 3, p. 2029-2038, 2010. DOI: https://doi.org/10.1590/S1413-81232010000400017
https://doi.org/10.1590/S1413-8123201000... ) said, in postgraduate training.

The first excerpt below tells us about the self-conception linking “being a sanitarist” to acting (an idea shared by another alumni), i.e., it shows the strength of concrete practice in the field of Collective Health, applying what was learned in the undergraduate course and following the respective values and principles. It refers to what Dubar (2012DUBAR, C. A construção de si pela atividade de trabalho: a socialização profissional. Tradução de Fernanda Machado. Cadernos de Pesquisa, Rio de Janeiro, v. 42, n. 146, p. 351-367, 2012.) calls initiation and identity conversion, when the individual begins to mobilize knowledge in practice, articulating it with theory through insertion in the world of work. While the distinction mentioned above seems to reside in the inseparability of knowing and doing, it makes us wonder whether the “acting,” “work,” and experience of Collective Health mentioned would not be closer to the meaning of activism that is striking in the field and in the training that, in part, was given before the creation of the degree in question. Distinct from contestation (specific actions) and engagement (continuous actions in time and space), activism embraces and transcends both because more than a continuous disposition, it implies sociopolitical ‘dedication,’ comprises ‘personal involvement,’ a trajectory of action and, above all, socialization (Steyer & Cadoná, 2018STEYER, M. R. P; CADONÁ, M. A. O lugar da militância na construção da educação em saúde: análise com base em uma política regional de educação permanente. Trabalho Educação e Saúde, Rio de Janeiro, v. 16, n. 2, p. 453-470, 2018., p. 460). In other words, a whole range of experiences, positions, knowledge, practices, interactions, communications, and activities developed in a given environment, allowing individuals to become subjects (develop needs, capabilities, competence to act, personal qualities, worldviews of a given cause), these latter authors state. Collective Health and the SUS constitute a cause committed to rights and social justice. Let us see.

The following statement about Being a Sanitarist gives us clues that identity is not constructed as if by magic from one moment to the next (just by being trained) but instead in a process where the recognition, appreciation, and confirmation of personal and professional experiences evidence and support the construction of identity itself. Recognition is formed in professional action and communication. These are detailed by the contexts of intervention, by the actors, and by the objects of professional practice so that a significant part of professional identity is generated by experience, i.e., in the concrete exercise of professional training in constant interaction with other professionals and manufactured in the diversity of agreements and disagreements between the virtual identity (proposed or imposed by others) and the real identity, assimilated by the individual (Santos, 2005SANTOS, C. A Construção Social do Conceito de Identidade Profissional. Interacções, [s. l.], v. 5, n. 8. p. 123-144, 2005., p. 132; Dubar, 2012DUBAR, C. A construção de si pela atividade de trabalho: a socialização profissional. Tradução de Fernanda Machado. Cadernos de Pesquisa, Rio de Janeiro, v. 42, n. 146, p. 351-367, 2012.).

The interdisciplinary field of Collective Health has, as one of its commitments, the defense and implementation of the Brazilian National Health System (SUS), valuing the need to train qualified professionals to transform practices and to mobilize politically to change care models. As seen below, “being a sanitarist” means, based on gathering knowledge from its constituent areas, extending and broadening the view of health beyond the individual, and understanding the complexity of influences not explained by the biological without excluding the individual. This broad view is based on considering the social inequalities engendered by social, environmental, economic, cultural, ethnic, racial, psychological, and behavioral processes that influence (exposing or protecting) the occurrence, amplification, protection, or mitigation of health problems and injuries and risks to the population (Buss; Pellegrini-Filho, 2007BUSS, P. M.; PELLEGRINI FILHO, A. P. A saúde e seus Determinantes Sociais. Physis: Revista Saúde Coletiva, Rio de Janeiro, v. 17, n. 11. p. 77-93, 2007.); understanding and defending the equality of the right to health and confronting inequities; promoting health and well-being. However, the speech embodies the multiprofessional rancor, prone to fragmentation and juxtaposition of specialized knowledge. It may be more productive to extrapolate to an interprofessional perspective linked to the notion of health teamwork, marked by reflection on professional roles, problem-solving, and negotiation in decision-making processes, based on the construction of knowledge in a dialogical way and with respect for the singularities and differences of the various cores of knowledge and professional practices (Alvarenga et al., 2013ALVARENGA, J. P. O. et al. Multiprofissionalidade e interdisciplinaridade na formação em saúde: vivências de graduandos no estágio regional interprofissional. Revista de Enfermagem, Recife, v.7, n.10, p. 5944-5951, 2013.).

We agree with Dubar (2005DUBAR, C. Socialização: construção das identidades sociais e profissionais. São Paulo: Martins Fontes, 2005.), who believes that identity for oneself is inseparable from identity for the Other and is so in a problematic way; i.e., it is always correlated with the Other and its recognition, but the experience of the Other is never lived directly by the Self. This is because interactions take place in the same shared world and in an intersubjective relational logic in which the constitution of the world, of the things that exist in it (including Self/Other), and of the consciousness that one has of it, occurs “between subjects,” in the collective so that each one can be subject and object in reciprocity (Marsciani, 2014MARSCIANI, F. Subjetividade e intersubjetividade entre semiótica e fenomenologia. Galáxia, São Paulo, n. 28, p. 10-19, 2014., author’s emphasis). Therefore, to affirm what one is a professional (in this case, a Sanitarist), it is also necessary to be informed about what the other people attributes to us to forge an identity.

Ultimately, professional identity is a process, and as such, it is unfinished, relational, always being constructed/deconstructed/reconstructed in a non-linear way through interactions (articulated micro and macrosocial, objective and subjective) and learning, which gains concreteness (material and symbolic) in the articulation of training, projections, experience in the world of work in political and institutional contexts, which legitimize belonging to a given category.

Final considerations

The results revealed diversification in the movements and forms of insertion and action in the world of work based on professional paths and identity dynamics in a field of possibilities. Understanding such trajectories becomes a challenge and an opportunity for the training institution, alumni, students, and professors, as well as for the health system and managers. In the movement to recognize the category for action, it is important to consider that professional identity is built in close relation to public health policy in the different governmental spheres that encompass the construction of the SUS, even though there is a perceived mismatch between the need for the new profile and the institutionalized opportunities for insertion.

It was possible to perceive that the alumni interviewed see themselves as strategic subjects, having the necessary tools for an expanded vision of health, recognizing that the training in Collective Health has enabled them to develop the health work process in their places of work. Those who had a degree prior to Collective Health, already working/linked to the public health system, legitimize that specific training in Collective Health is empowering and provides more efficient responses at work than, strictly speaking, the contribution of the first training that accredited insertion in the public health network. However, if we see the relevance of practice in training in Collective Health, we must consider that some of the alumni already had practice from insertion in the labor market, knowing and moving through the health system, which may have favored the use of the new degree.

The challenges of employability in the professionalization process, as in other professions, reveal the importance of the debate on the need for graduated sanitarist beyond discussions on identity and professional insertion, but increasingly on the joint alignment between the training process and the professional development of this category to carry out work in Collective Health aligned with the SUS as a citizenship right.

As a study limitation, the identity issue was not analyzed with all the alumni (although they were carefully selected and delimited by qualitative research technique), nor the inclusion of alumni (monitoring of alumni). It would be pertinent to look at the repercussions of regulating the profession for future studies. Furthermore, we cannot neglect the current context of the curricularization of extension, which may constitute a promising opportunity for the practices of sanitarists with reflections on the construction of professional identity.

Acknowledgements

To the Coordination for the Improvement of Higher Education Personnel (CAPES) for granting a scholarship to the first author for the master’s degree.

References

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