Health Promotion, praxis of autonomy and prevention of violence

Elza Machado de Melo Jandira Maciel da Silva Soraya Almeida Belisário Alzira Oliveira Jorge Tarcísio Márcio Magalhães Pinheiro Cristiane de Freitas Cunha Amanda Márcia dos Santos Reinaldo About the authors

HEALTH PROMOTION IS UNDOUBTEDLY ONE OF THE MOST PROMISING strategies for the production of health in today's societies, given its potential in addressing chronic-degenerative diseases11 Tinkham M. Health promotion in the elderly with coronary artery disease. J Vasc Nurs; 2014; 32(4):151-155.

2 Shearer NBC, Fleury J. Ward K, et al. Empowerment Interventions for Older Adults. West J Nurs Res. 2012; 34(1):24-51.
-33 Malta DC, Gosch CS, Buss P, et al. Doenças Crônicas Não Transmissíveis e o suporte das ações intersetoriais no seu enfrentamento. Ciênc. Saúde Colet. 2014; 19(11):4341-4350., violence and accidents44 Butts JA, Roman CG, Bostwick L, et al. Cure Violence: A Public Health Model to Reduce Gun Violence. Annu. Rev. Public Health. 2015. 36:39-53.,55 Melo EM, Melo VH. Promoção de Saúde e Prevenção da Violência. In: Camargos A, Melo VH. Ginecologia Ambulatorial Baseada em Evidência. Belo Horizonte: Coopmed, 2016., and communicable diseases, especially the emerging, re-emerging and neglected diseases66 Rountree MA, Granillo T, Bagwell-Gray M. Promotion of Latina Health: Intersectionality of IPV and Risk for HIV/AIDS. Violence Against Women. 2016; 22(5):545-564.. Finally, in addressing the whole spectrum of morbimortality whose causes are related to the sociocultural, economic, political, and environmental way of life of all people77 World Health Organization. Milestones Health Promotion. Geneva: WHO; 2009.

8 Brasil. Ministério da Saúde. Portaria nº 687 MS/GM, de 30 de março de 2006. Aprova a Política de Promoção da Saúde. Diário Oficial da União. 30 Mar 2006.

9 Sapag JC, Kawachi I. Capital social y promoción de la salud en América Latina. Rev. Saúde Pública. 2007; 41(1):139-149.
-1010 Silva EF, Brito J, Neves MY, et al. A promoção da saúde a partir das situações de trabalho: considerações referenciadas em uma experiência com trabalhadores de escolas públicas. Interface (Botucatu). 2009; 13(30):107-119.. It enjoys worldwide prestige and attention, at least judging by the important initiatives taken towards its development and implementation, such as the Global Health Promotion Conferences: Ottawa, in 1986, which represents the basis for the Health Promotion; Adelaide, in 1988, and the emphasis on intersectorality; Sandsval, in 1991, with the theme of equity; Jackarta, in 1997, the need for expansion with new partners and production of knowledge; Bangkok, in 2005, the proposal to expand social determinants; Nairobi, in 2009, focused on the guidelines for practical action; and Helsinki, in 2013, with the proposal of Health in All Policies1111 Pettersson B. Some bitter-sweet reflections on the Ottawa Charter commemoration cake: a personal discourse from an Ottawa rocker. Health Promot Int. 2011; 26(S2):173-177.. Also in the international arena, the World Health Promotion Conferences, organized triennially by the International Union for the Health Promotion and Education (Uipes) and which constitute important initiatives bringing together professionals, researchers and managers from around the world, to “learn, share, and build the future of Health Promotion and seek equity in health”1212 International Union for Health Promotion and Education. Conferences. [acesso em 2017 nov 11]. Disponível em: http://www.iuhpe.org/index.php/en/conferences.
http://www.iuhpe.org/index.php/en/confer...
. Another example of the recognition given to it is its association with the New Millennium Goals, including combating poverty and inequality and the pursuit of prosperity, well-being, health and education1111 Pettersson B. Some bitter-sweet reflections on the Ottawa Charter commemoration cake: a personal discourse from an Ottawa rocker. Health Promot Int. 2011; 26(S2):173-177.. In Brazil, Health Promotion is intertwined with the advent and development of the Unified Health System (SUS), whether because of the need to reverse the health care model, or because of the need for coherence with health milestones as an expanded model33 Malta DC, Gosch CS, Buss P, et al. Doenças Crônicas Não Transmissíveis e o suporte das ações intersetoriais no seu enfrentamento. Ciênc. Saúde Colet. 2014; 19(11):4341-4350.,1313 Buss PM, Pellegrini Filho A. A Saúde e seus Determinantes Sociais. Physis. 2007; 17(1):77-93., having recently gained reinforcement with the institution, in 2006, of the National Policy for Health Promotion and with its revision in 2014, expanding it1414 Malta DC, Morais Neto OL, Silva MMA, et al. Política Nacional de Promoção da Saúde (PNPS): capítulos de uma caminhada ainda em construção. Ciênc. Saúde Colet. 2016; 21(6):1683-1694..

Defined as a health approach that incorporates the different social aspects in the explanation and production of health and disease1515 Melo EM, Melo VH. Promoção de Saúde. Autonomia e Mudança. Belo Horizonte: Folium; 2016., Health Promotion has in its scope innumerable formulations, which are inserted in a wide range, comprised between two distinct currents: one that refers, predominantly, to the lifestyle, with a behavioral/individualistic approach; and another that is based on social determinations and falls within the so-called structural approaches. The first one goes back to the multicausal theory of the health /disease process, whose natural history involves risks related to the agent-host-environment triad, which are susceptible to primary prevention1616 Puttini RF, Pereira Junior A, Oliveira LR. Modelos explicativos em saúde coletiva: abordagem biopsicossocial e auto-organização. Physis. 2010; 20(3):753-67.. Structural models, on the other hand, conceive health as well as the behavior of individuals in relation to health as conditioned and/or socially determined phenomena1717 Lieberman L, Golden SD, Earp JA. Structural approaches to health promotion: what do we need to know about policy and environmental change? Health Educ Behav. 2013; 40(5):520-5. in the mode of the socioecological model proposed by Dalhgren and Whitehead, already quite widespread, in which the social determinants of health are organized in a multi-level mandala of social spaces1818 Dahlgren G, Whitehead M. European strategies for tackling social inequities in health: levelling up Part 2. Copenhaguen, Denmark: WHO, 2006.,1919 Bentley M. An ecological public health approach to understanding the relationships between sustainable urban environments, public health and social equity. Health Promot Int. 2014; 29(3):528-37., or the Health in All Policies proposal, which is based on the integration among the different sectors, engendered in the decision-making process itself2020 Baum F, Lawless A, Delany T, et al. Evaluation of health in all policies: concept, theory and application. Health Promot Int. 2014; 29(supl1):i130-42..

Criticism is addressed to both models. In relation to the first, behaviorist/individualist, widely disseminated and hegemonic, the reduction that operates in the role and significance of the dimension of the health/disease process is highlighted77 World Health Organization. Milestones Health Promotion. Geneva: WHO; 2009.,2121 Castiel LD. O acesso aos Campos Elísios: a promoção da saúde ampliada e as tecnologias de melhoramento em busca da longevidade (e da imortalidade). Saúde Soc. 2015; 24(3):1033-46., which is restricted to the individual, permanently torn by the prescriptions of a long life2121 Castiel LD. O acesso aos Campos Elísios: a promoção da saúde ampliada e as tecnologias de melhoramento em busca da longevidade (e da imortalidade). Saúde Soc. 2015; 24(3):1033-46.; therefore, surveillance and control of behavior; of medicalization and of commodification of health, that is, criticism that refers to the linkage of the model to practices of domination, exploitation, and production of profit, governed by the logic of the market, aestheticized by the primacy of supposed individual freedom1515 Melo EM, Melo VH. Promoção de Saúde. Autonomia e Mudança. Belo Horizonte: Folium; 2016.,2121 Castiel LD. O acesso aos Campos Elísios: a promoção da saúde ampliada e as tecnologias de melhoramento em busca da longevidade (e da imortalidade). Saúde Soc. 2015; 24(3):1033-46.. For structural models, it is especially difficult to overcome the complexity that, on the one hand, greatly complicates the processes of effectiveness and ends up reducing the interventions to changes in lifestyle, which are characteristic of the first model1919 Bentley M. An ecological public health approach to understanding the relationships between sustainable urban environments, public health and social equity. Health Promot Int. 2014; 29(3):528-37. and which, on the other hand, impose the central need for linkage to the State and with it the exercise of power and domination over the lives of citizens2222 Weiss D, Lillefjell M, Magnus E. Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level. BMC Public Health. 2016; 16:140..

Faced with that criticism, what is required is the need to link Health Promotion to the exercise of praxis of autonomy of those involved, which is here thought from the Theory of Communicative Action by Habermas, as a condition 'in which social actors are transformed in authors'; and with their multiple voices, which sprout in the endless local spaces, mediate collective and solidarity actions and, at the same time, break the frontiers, gain resonance in the public sphere, engendering the discursive process of formation of opinion and collective will, the place of rational will, therefore, the only one that unifies autonomy and universality2323 Habermas J. Between facts and norms, contributions to a discourse theory of law and democracy. Cambridge: The MIT Press; 1996.,2424 Habermas J. Escritos sobre moralidad y eticidad. Barcelona: Paidós; 1991.. Posing the question like that, what is most important is not knowing which of the two models is adopted, but whether, for whatever they are and whatever actions are taken, they count on the participation of all those involved1515 Melo EM, Melo VH. Promoção de Saúde. Autonomia e Mudança. Belo Horizonte: Folium; 2016..

As a consequence, in this special issue of Saúde em Debate, we have gathered articles related to the two models: on the one hand, mediation of conflicts in labor relations; on the other, the practice of physical activity, participation, intersectorality, care in living networks, but also factors associated with alcohol and tobacco use, still without giving up aspects related to the organization of care and management of health services, primary and specialized care, in which Health Promotion should and can be implemented. We also included theoretical essays and experience reports, which express the effort to think and effect Health Promotion, in a consequent and desirable way, in the molds of its most authentic postulations.

Health Promotion represents one of the priority strategies that the health sector has in its handling of violence, and Habermas' Theory of Communicative Action is once again brought to ground the rapprochement between both, especially the thesis of colonization of the world of life2525 Habermas J. Teoria de la ación comunicativa. Madrid: Taurus; 1987., which is responsible for disturbances and deformations which, for us, constitute the violence that erodes the three pillars of support for the way of life in society, namely, work, environment and citizenship, exactly the ones which it is up to Health Promotion to transform1515 Melo EM, Melo VH. Promoção de Saúde. Autonomia e Mudança. Belo Horizonte: Folium; 2016.. So we have included numerous articles on violence in its multiple faces, violence against women, against adolescents, against the elderly; the issue of agrochemicals, violence in primary care, as well as ways of coping with it, participation, service organization, care delivery, and health professional training.

Reiterating the premises presented, Health Promotion, firmly anchored in the praxis of autonomy of those involved, is the core strategy of the Postgraduate Program in Health Promotion and Prevention of Violence/School of Medicine (FM)/Federal University of Minas Gerais (UFMG) and of the Health and Peace Promotion Nucleus which, together with the journal Saúde em Debate, have taken over the editorial of this issue, whose objective is to contribute to the quality of health practices, which is only possible, in our understanding, if produced in the landmarks of freedom.

References

  • 1
    Tinkham M. Health promotion in the elderly with coronary artery disease. J Vasc Nurs; 2014; 32(4):151-155.
  • 2
    Shearer NBC, Fleury J. Ward K, et al. Empowerment Interventions for Older Adults. West J Nurs Res. 2012; 34(1):24-51.
  • 3
    Malta DC, Gosch CS, Buss P, et al. Doenças Crônicas Não Transmissíveis e o suporte das ações intersetoriais no seu enfrentamento. Ciênc. Saúde Colet. 2014; 19(11):4341-4350.
  • 4
    Butts JA, Roman CG, Bostwick L, et al. Cure Violence: A Public Health Model to Reduce Gun Violence. Annu. Rev. Public Health. 2015. 36:39-53.
  • 5
    Melo EM, Melo VH. Promoção de Saúde e Prevenção da Violência. In: Camargos A, Melo VH. Ginecologia Ambulatorial Baseada em Evidência. Belo Horizonte: Coopmed, 2016.
  • 6
    Rountree MA, Granillo T, Bagwell-Gray M. Promotion of Latina Health: Intersectionality of IPV and Risk for HIV/AIDS. Violence Against Women. 2016; 22(5):545-564.
  • 7
    World Health Organization. Milestones Health Promotion. Geneva: WHO; 2009.
  • 8
    Brasil. Ministério da Saúde. Portaria nº 687 MS/GM, de 30 de março de 2006. Aprova a Política de Promoção da Saúde. Diário Oficial da União. 30 Mar 2006.
  • 9
    Sapag JC, Kawachi I. Capital social y promoción de la salud en América Latina. Rev. Saúde Pública. 2007; 41(1):139-149.
  • 10
    Silva EF, Brito J, Neves MY, et al. A promoção da saúde a partir das situações de trabalho: considerações referenciadas em uma experiência com trabalhadores de escolas públicas. Interface (Botucatu). 2009; 13(30):107-119.
  • 11
    Pettersson B. Some bitter-sweet reflections on the Ottawa Charter commemoration cake: a personal discourse from an Ottawa rocker. Health Promot Int. 2011; 26(S2):173-177.
  • 12
    International Union for Health Promotion and Education. Conferences. [acesso em 2017 nov 11]. Disponível em: http://www.iuhpe.org/index.php/en/conferences
    » http://www.iuhpe.org/index.php/en/conferences
  • 13
    Buss PM, Pellegrini Filho A. A Saúde e seus Determinantes Sociais. Physis. 2007; 17(1):77-93.
  • 14
    Malta DC, Morais Neto OL, Silva MMA, et al. Política Nacional de Promoção da Saúde (PNPS): capítulos de uma caminhada ainda em construção. Ciênc. Saúde Colet. 2016; 21(6):1683-1694.
  • 15
    Melo EM, Melo VH. Promoção de Saúde. Autonomia e Mudança. Belo Horizonte: Folium; 2016.
  • 16
    Puttini RF, Pereira Junior A, Oliveira LR. Modelos explicativos em saúde coletiva: abordagem biopsicossocial e auto-organização. Physis. 2010; 20(3):753-67.
  • 17
    Lieberman L, Golden SD, Earp JA. Structural approaches to health promotion: what do we need to know about policy and environmental change? Health Educ Behav. 2013; 40(5):520-5.
  • 18
    Dahlgren G, Whitehead M. European strategies for tackling social inequities in health: levelling up Part 2. Copenhaguen, Denmark: WHO, 2006.
  • 19
    Bentley M. An ecological public health approach to understanding the relationships between sustainable urban environments, public health and social equity. Health Promot Int. 2014; 29(3):528-37.
  • 20
    Baum F, Lawless A, Delany T, et al. Evaluation of health in all policies: concept, theory and application. Health Promot Int. 2014; 29(supl1):i130-42.
  • 21
    Castiel LD. O acesso aos Campos Elísios: a promoção da saúde ampliada e as tecnologias de melhoramento em busca da longevidade (e da imortalidade). Saúde Soc. 2015; 24(3):1033-46.
  • 22
    Weiss D, Lillefjell M, Magnus E. Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level. BMC Public Health. 2016; 16:140.
  • 23
    Habermas J. Between facts and norms, contributions to a discourse theory of law and democracy. Cambridge: The MIT Press; 1996.
  • 24
    Habermas J. Escritos sobre moralidad y eticidad. Barcelona: Paidós; 1991.
  • 25
    Habermas J. Teoria de la ación comunicativa. Madrid: Taurus; 1987.
Centro Brasileiro de Estudos de Saúde RJ - Brazil
E-mail: revista@saudeemdebate.org.br