ABSTRACT

This article reflects on youth participation in the PSE, through the conceptual and operational analysis of the idea of participation in its technical and normative frameworks. It also questions whether the PSE maintains, reduces, or improves youth participation, when comparing it to the Health and Prevention in Schools Project, a precursor of the program. The school, a place that contributes to the formation of the individual, according to guidelines established by law, must promote these spaces for participation, strengthening students in a perspective of recognition of the importance of involving this public in discussions of healthy lifestyles, considering that the PSE works from the perspective of Health Promotion. From the qualitative discussion, carried out through documental and bibliographic analysis, as well as the literature review, it was identified that youth participation was one of the pillars of the SPE, a project whose actions were incorporated into the PSE, but which lost strength by not being promoted within the scope of the Program’s legal instruments. The qualification of dialogue among all members of the school community, including one of the Program’s largest target audiences, the youth, strengthens the recognition of the territory as a central actor in the implementation of social policies.

KEYWORDS
Community participation; ADOLEC; School health services

Introduction

The School Health Program (PSE), created by Decree No. 6,286/2007, is the first intersectoral federal policy to seek the articulation of health and education aimed at children and adolescents in the basic and public education network in Brazil. The Program supports the process of strengthening the relationship between education and health networks, following experiences such as the proposal for Health Promoting Schools by the Pan American Health Organization (PAHO) in 1995, the Health and Prevention in Schools Project (SPE), as of 2003, and the creation of the Education and Health Intersectoral Chamber (Portaria Interministerial nº 749, of May 13, 2005).

Over its 15 years of implementation, many adjustments were necessary to make it easier for both the school community and health and education professionals to understand the importance of the intersectoral approach proposed by the program. The recognition of the potential of the school and the territory where it belongs as spaces in which life happens and also in which the health-disease process takes place is a permanent challenge that dialogues with the different organizational cultures, the real conditions of implementation of the PSE in the territory and with the actors’ perception of how they can relate health promotion and education in favor of improving health conditions, the quality of education and the integral development of children and adolescents.

Here, the extent to which the PSE incorporates youth participation in its design and implementation will be analyzed, as well as the conceptual and operational presence of the idea of adolescent and youth participation in the PSE being discussed, by verifying whether the PSE maintains, reduces or improves the youth participation. The comparison with the SPE is due to the fact that the project, precursor of the PSE, lost space on the government agenda with the creation and institutionalization of the program in 2007.

PSE, a program to promote health in schools

The record of health education actions in the school space dates back to the mid-19th century in Brazil, proposing the idea of ‘school health’ in the hygienist perspective. Such an approach proposed interventions in school architecture and furniture, in the regulation and nutritional guidance of school meals, in the performance of anthropometric tests and in the possible detection of diseases or deficiencies in the school population¹1 Monteiro PHN, Bizzo N. A saúde na escola: análise dos documentos de referência nos quarenta anos de obrigatoriedade dos programas de saúde, 1971-2011. Revista História, Ciências, Saúde. 2015 [acesso em 2022 jan 2]; 22(2):411-427. Disponível em: https://www.scielo.br/j/hcsm/a/pd6KN8hjtZQ5fcs5Yxkr47L/?format=pdf&lang=pt.
https://www.scielo.br/j/hcsm/a/pd6KN8hjt... , ²2 Mohr A, Schall V. Rumos da educação em saúde no Brasil e sua relação com a Educação Ambiental. Cad. Saúde Pública. 1992; 8(2):199-203., ³3 Marcondes RS. Educação em Saúde na Escola. Rev. Saúde públ. 1972; 6:89-96.. These ideas developed and disseminated, reaching their apex in the 1950s, when the school played the role of a ‘therapeutic agent’, including the biological explanation of diseases, however disconnected from a school program²2 Mohr A, Schall V. Rumos da educação em saúde no Brasil e sua relação com a Educação Ambiental. Cad. Saúde Pública. 1992; 8(2):199-203.. In the 1970s, with the publication of the Education Guidelines and Bases Law (LDB), Law No. 5,692/71, health issues were compulsory included in school curricula, through ‘health programs’ that formalized the power of the State in the field of formation and control of individual behaviors and habits advocated by the hygienist approach already in force, reminiscent of ‘school health’¹1 Monteiro PHN, Bizzo N. A saúde na escola: análise dos documentos de referência nos quarenta anos de obrigatoriedade dos programas de saúde, 1971-2011. Revista História, Ciências, Saúde. 2015 [acesso em 2022 jan 2]; 22(2):411-427. Disponível em: https://www.scielo.br/j/hcsm/a/pd6KN8hjtZQ5fcs5Yxkr47L/?format=pdf&lang=pt.
https://www.scielo.br/j/hcsm/a/pd6KN8hjt... . It is worth pointing out that all these health experiences at school obeyed sectoral logics at the political, technical and administrative levels, characterized by discontinuity, by isolation and without the articulation between professionals from health and education fields.

The discussion of health beyond the absence of disease, in the hygienist and biologist logics, gained strength from the second half of the 20th century, when the understanding that the complete well-being of the population includes the individual and the community, the multisectoral involvement and local, regional and national actions⁴4 Ferretti CJ, Zibas DML, Tartuce GLBP. Protagonismo juvenil na literatura especializada e na reforma do ensino médio. Cad. Pesquisa. 2004; 34(122):411-423.. In this sense, from the 1980s, the International Conferences on Health Promotion, the Sanitary Reform movement in Brazil, and the promulgation of the Federal Constitution of 1988, which considers education and health as universal social rights, outline a new path for health actions at school, by proposing an intrinsic relationship between the development of the health theme in the classroom and a perspective of building citizenship, which denotes the understanding of health not only as a set of habits to be developed, but from the idea of the right to be continuously exercised and given new meaning¹1 Monteiro PHN, Bizzo N. A saúde na escola: análise dos documentos de referência nos quarenta anos de obrigatoriedade dos programas de saúde, 1971-2011. Revista História, Ciências, Saúde. 2015 [acesso em 2022 jan 2]; 22(2):411-427. Disponível em: https://www.scielo.br/j/hcsm/a/pd6KN8hjtZQ5fcs5Yxkr47L/?format=pdf&lang=pt.
https://www.scielo.br/j/hcsm/a/pd6KN8hjt... .

Health promotion emerges as a combination of the various health determinants, being more effectively incorporated after Law No. 8,080/90⁴4 Ferretti CJ, Zibas DML, Tartuce GLBP. Protagonismo juvenil na literatura especializada e na reforma do ensino médio. Cad. Pesquisa. 2004; 34(122):411-423.. When describing, in the constitution of the Unified Health System (SUS), the principles that govern health, among them, the principle of integrality by promotion, protection and recovery, we moved towards the understanding of health promotion as one of the pillars of health in Brazil⁵5 Albuquerque PC, Stotz EN. Popular education in primary care: in search of comprehensive health care. Interface, Comunic., Saúde, Educ. 2014; 8(15):259-274..

Thus, as a result of the evolution of the SUS and the strengthening of the debate on health promotion in Brazil, in 2006, the National Health Promotion Policy (PNPS)⁶6 Brasil. Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Saúde na escola. Brasília, DF: MS; 2009. Série B. Textos Básicos de Saúde, Cadernos de Atenção Básica; n. 24.,⁷7 Czeresnia D. Conceito de saúde e a diferença entre prevenção e promoção. In: Czeresnia D, Freitas CM, organizadores. Promoção da saúde: conceitos, reflexões, tendências. 2. ed. Rio de Janeiro: Fiocruz; 2012. was approved, with its principles: autonomy, equity, territoriality, social participation, sustainability, integrality, intersectionality and empowerment.

The current PNPS defines as health promotion:

The concept of promotion must be related to the strengthening of individual and collective capacity to deal with the diversity of health conditions. Promotion goes beyond technical and regulatory issues and highlights the importance of strengthening health, through building the capacity to choose and use knowledge⁸8 Cruz DKA. Da promoção à prevenção: o processo de formulação da Política Nacional de Promoção da Saúde no período de 2003 a 2006. [dissertação]. Recife: Fundação Oswaldo Cruz, 2010. 116 p. [acesso em 2022 mar 12]. Disponível em: https://www.arca.fiocruz.br/bitstream/icict/35679/1/347.pdf.
https://www.arca.fiocruz.br/bitstream/ic... . In this sense, the health and education sectors are one of the main partners in the health promotion process. Furthermore, health units and schools are seen as spaces that contribute to the construction of personal values, beliefs, concepts and different ways of knowing the world.

In schools, issues related to health and related to education and not problematized or resolved by the school seem to have health services as the only alternative. These issues arise in classrooms with different representations: by teachers, students, family members, who express their concerns about better health conditions and quality of life⁹9 Schall V. Educação em saúde no contexto escolar brasileiro: influências sócio-históricas e tendências atuais. In: Monteiro S, Pimenta D, organizadores. Ciência, Saúde e Educação: o legado de Virgína Schall. Rio de Janeiro: Fiocruz; 2018..

In addition, they raise the issue of the medicalization of life and the importance of shared promotional work.

Intersectionality and participation are pillars for a policy that considers the actors involved as protagonists in the individual transformation and the of environment in which they act. When considering symbolic, social and cultural capital, health promotion understands the involvement of people and their knowledge in the discussion of healthy lifestyles, so that other knowledge beyond educational diplomas can have a voice and legitimacy¹⁰10 Bourdieu P. What makes a social class? On the theoretical and practical existence of groups. Berkeley Journal 01 Sociology. 1987; 32:1-49., ¹¹11 Aguiar N, organizador. Desigualdades sociais, redes de sociabilidade e participação política. Belo Horizonte: UFMG; 2007., ²2 Mohr A, Schall V. Rumos da educação em saúde no Brasil e sua relação com a Educação Ambiental. Cad. Saúde Pública. 1992; 8(2):199-203..

This transformation in which the subject is the protagonist, that is, he wants to act and change his social environment more than being determined by it, takes place in a space that is not necessarily the geographical space. It is not possible to understand the territory ignoring the political and economic relations that are established in the capitalist model of production¹³13 Santos M. O retorno do Território. In: Santos M. Território: Globalização e Fragmentação. 4. ed. São Paulo: Hucitec: Anpur; 1998. p. 15-20.. Such an understanding is important to think of the school as a strategic space to form conscientious and responsible citizens for their choices and behaviors, being a primordial device for health promotion actions.

Youth and school participation: What are we talking about?

The definition of adolescence and youth is somewhat complex when one understands that there is no uniqueness. The central question for the sociology of youth is that of

As the speed of changes that occur in the spheres of production and reproduction of social life is characteristic of contemporary society, young people are key actors in these processes and interact with them, sometimes as protagonists and beneficiaries of changes and, at other times, suffering the losses of ‘modernization’ processes, producing new contradictions and social inequalities¹⁵15 Baquero M. Construindo uma outra Sociedade: o capital social na estruturação de uma cultura política participativa no Brasil. Rev. Sociol. Polít. 2003; 21:83-108..

In the context of social inequalities in Brazilian society, understanding how and why young Brazilians participate in societal construction and decision-making calls into question the way in which each one recognizes himself as a member of this very unequal set and how they see themselves involved in their destinies¹⁶16 Castro LR. Participação Política e Juventude: do malestar à responsabilização frente ao destino comum. Rev. Sociol. Polít. 2008; 16(30):253-268..

The feeling of belonging to the collectivity depends on the recognition and action that moves each individual in the construction of social bonds. Belonging and accountability are intertwined and constitute primordial subjective aspects in the process of assuming oneself as a member of a society, whatever it may be¹⁷17 Bourdieu P. Razões Práticas: Sobre a Teoria da Ação. 11. ed. Campinas: Papirus; 2011..

Thus, participation and empowerment are directly linked to the exercise of citizenship and human rights, as well as the recognition of oneself in the social dimension. Recognition that drives the individual to act in social spaces.

From a subjective perspective, participation denotes the way in which each individual seeks to link itself to the collectivity and launch himself into spaces of speech and action in order to assert as its members¹⁷17 Bourdieu P. Razões Práticas: Sobre a Teoria da Ação. 11. ed. Campinas: Papirus; 2011.. From the perspective of cultural, social and symbolic capital, historical and cultural identities guide the construction of social bonds. The way a young person positions himself in the social macrocosm is related to his history and cultural capital, which is in the structuring of the subjective experience, in interaction with the norms and possible resources in force.

The spaces and stimuli for exercising and learning to participate, as well as the relationship that young people have with time, are variables that interfere with their effective involvement in social and political spheres. Despite the adverse conditions, the public school can still be considered as a space for carrying out collective activities for poor youth, enabling some level of youth participation based on their social condition¹⁸18 Weller W. Orientações coletivas e a construção da identidade negra em grupos juvenis na periferia de São Paulo. In: Anais do VI Encontro Nacional de História Oral; 2002 abr 28-30; São Paulo; São Paulo: USP; 2002..

In this sense, it is worth considering the expression ‘youth protagonism’, which focuses on the active participation of young people, and which assumes the idea of centrality in health promotion programs for adolescents and young people¹⁹19 Carta de Otawa. In: Brasil. Ministério da Saúde, Secretaria de Políticas de Saúde. Projeto Promoção da Saúde. As cartas da promoção da saúde. Brasília, DF: MS; 2002. [acesso em 2022 mar 12]. Disponível em:http://bvsms.saude.gov.br/bvs/publicacoes/cartas_promocao.pdf.
http://bvsms.saude.gov.br/bvs/publicacoe... . Youth protagonism, linked to the notion of ‘empowerment’ of young people, has gained importance in the discourse of multilateral and international cooperation organizations, having been developed by educators who work with young people who live in popular spaces in Latin America²⁰20 Costa CMA, Tavares MFL, Luiza VL. Escolas Promotoras da Saúde na América Latina: Uma Revisão do Período 1996-2009. Rev Bras Promoç Saúde. 2013; 26(1):117-127..

The word protagonism comes from the Greek proto, which means ‘the first’, and agon, which means struggle; therefore, the protagonist is the fighter, the main character. In novels or plays, the protagonist is the most important character and from which the plot of the story starts. For the Aurélio dictionary, a protagonist is one who plays or occupies the first place in an event²¹21 Malta DC, Castro AM. Avanços e resultados na implementação da Política Nacional de Promoção da Saúde. Bol. técnico SENAC. 2009; 35(2):63-71.. However, the term ‘protagonism’ can be generic in view of societies that are also generic and abstract, since this approach

As it is an expression incorporated by international organizations in the early 2000s, and, in Brazil, a little before that period, by third sector institutions such as the Odebrecht Foundation, and because there is still no unanimity among authors and organizations²²22 Bressan A. A participação juvenil no Projeto Saúde e Prevenção nas Escolas: contribuições da análise documental para a identificação de estratégias de promoção da saúde. [dissertação]. Rio de Janeiro: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2011. 234 f. [acesso em 2022 abr 5]. Disponível em: https://www.arca.fiocruz.br/bitstream/icict/24303/1/aline_bressan_ensp_mest_2011.pdf.
https://www.arca.fiocruz.br/bitstream/ic... , we will adopt the term ‘youth participation’ to address the process in which adolescents and young people participate socially in public policies.

The scope and complexity of the challenges to be faced have shown a new path: the articulation of policies to value possible and necessary sectoral contributions, as well as the participation of civil society, so that this amalgamation of capacities, resources and responsibilities can be produce more effective transformations in the conditions that generate the vulnerability of young populations²³23 Santos LFS, Cardoso TZ, Pereira MCA, et al. A escola como dispositivo social de promoção da saúde. Rev. FSA. 2019; 16(2):149-165.. In the scope of public policies, strengthening youth participation in the management of projects and programs can guarantee some sustainability, which are often weakened, or even disappear, in government transitions¹⁶16 Castro LR. Participação Política e Juventude: do malestar à responsabilização frente ao destino comum. Rev. Sociol. Polít. 2008; 16(30):253-268..

Material and methods

A qualitative and exploratory study was carried out, whose analyzed phenomenon was the role of the federal manager in promoting youth participation in health promotion policies. The methodology used was documental and bibliographic analysis, as well as a literature review. The bibliographic and documental research was based on the gray literature and on the databases of the official government pages: Virtual Health Library (VHL), Latin American and Caribbean Literature on Health Sciences (LILACS) and Google Scholar.

When analyzing ‘how’ the policy entered the agenda, being formulated, decided, implemented and evaluated, it is possible to focus on one or more stages of the policy cycle, bearing in mind that policies are dynamic results, with stages not always clearly distinct and permeated by conflicts, which makes it important to establish power relations, identify concepts and types of policy and establish their rationality²⁴24 Silva CR, Gobbi BC, Simão AA. O uso da Análise de Conteúdo como uma Ferramenta para a Pesquisa Qualitativa: descrição e aplicação do método. Org. Rurais Agroindustriais. 2005; 7(1):70-81..

For this work, descriptive and analytical research was used, whose main objective is the improvement of ideas or the discovery of intuitions. Its planning is, therefore, quite flexible, so that it allows the consideration of the most varied aspects related to the fact studied.

The project and program chosen for this study took into account the health promotion policies in the period following the redemocratization of the country, as well as their importance in the dynamics of transforming the organizational culture of the State.

This project was presented to the Research Ethics Committee of Fundação Oswaldo Cruz (FIOCRUZ) under Opinion No. 3,454,552 and CAAE No. 16566719.3.0000.802, and was approved on July 15, 2019.

Results and discussion

The document and bibliographic analysis was organized in table 1 below, in which we can analyze the context of the development of the SPE and the PSE, as well as know the conceptual bases of these policies and compare the content of the documents referring to these initiatives according to the following dimensions: the degree of formalization and institutionalization, analysis of the main legal and regulatory frameworks; intersectionality; the availability of financial resources, as an indicator of the degree of relevance of the policy; and dissemination and coverage, verifying the public likely to benefit from the programs in question.

Degree of formalization and institutionalization, intersectionality and actors involved

Starting with the formalization and institutionalization aspect, it is observed that the creation of the SPE was not established by any legal framework. Its management, from its idealization in 2003, was divided at the federal level between health and education. At the Ministry of Health, those who followed the agenda were technicians from the Department of Surveillance, Prevention and Control of STIs, HIV/AIDS and Viral Hepatitis of the Health Surveillance Secretariat (SVS); at the Ministry of Education, the project was in the Directorate of Curriculum Conceptions and Guidelines for Basic Education (DECOCEB) of the Basic Education Secretariat (SEB). The project was carried out in partnership with the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the United Nations Educational, Scientific and Cultural Organization (UNESCO).

Unlike the SPE, the PSE was instituted by presidential decree in 2007, initiating a new stage in fostering health promotion in schools, since its proposal encompassed the most diverse actions, including the prevention of diseases and injuries.

What can be seen in the legal frameworks is that, when thinking about the management structure and actions of the PSE, the same management mechanisms of the SPE were proposed, with intersectoral articulation through the Intersectoral Working Groups, but the strong axis of youth participation provided for in the SPE was not included.

Thus, structurally, the PSE incorporates the SPE’s management guidelines with the strengthening of intersectoral relationships and with a scope of actions much larger than what it was. The presence of UN agencies in the PSE is not referenced in the legal frameworks.

In the Ministry of Health, the PSE was born in the then Secretariat of Health Care, where, initially, it was linked to the Office of the Department of Primary Care (DAB) and, later, since 2011, within the General Coordination of Food and Nutrition (CGAN), in which it stayed until 2019 for political reasons, since the agenda to promote healthy eating was one of the biggest positive agendas of the Ministry of Health until then, being also articulated with the Ministry of Education and the National Educational Development Fund (FNDE), in which the management identified a force for the convergence of actions. This power was consolidated in such a way that the focus of some PSE actions and campaigns was turned to the theme: the mobilization ‘Health-at-School Week’ (2012, 2013 and 2014) – a campaign that takes place annually with a defined theme by the Ministers and that, until 2015, transferred specific resources to the municipalities that carried it out; the micronutrient fortification action (NutriSUS); and the development of teaching and communication materials.

As of 2019, with the restructuring of the Ministry of Health and the creation of a Department of Health Promotion (DEPROS) in the Secretariat of Primary Health Care (SAPS), the PSE passed through the General Coordination for the Promotion of Physical Activity and Actions (CGPROFI), currently in the Depros Office. The program’s capacity in this management space tends to strengthen its implementation, since the PSE is a health promotion strategy and this strategy is linked to social participation.

Financial resources, dissemination and scope of the SPE and PSE

The SPE was conceived in an intersectoral and extra-governmental way, when the Ministries of Health and Education, in partnership with UNESCO, UNICEF and UNFPA, defined a proposal with a view to transform the contexts of vulnerability that expose adolescents and young people to infection by the HIV virus and AIDS, other sexually transmitted diseases and unplanned pregnancy²⁵25 Brasil. Ministério da Saúde. Diretrizes para implantação do Projeto Saúde e Prevenção nas Escolas/Ministério da Saúde, Secretaria de Vigilância em Saúde. Brasília, DF: Ministério da Saúde; 2006..

To be part of the SPE, the municipality should constitute a Municipal Management Group (GGM), with representatives from health, education and other departments and institutions that develop activities with the adolescent and young population, as well as youth organizations²⁵25 Brasil. Ministério da Saúde. Diretrizes para implantação do Projeto Saúde e Prevenção nas Escolas/Ministério da Saúde, Secretaria de Vigilância em Saúde. Brasília, DF: Ministério da Saúde; 2006..

The SPE did not transfer specific resources for its development. Municipalities were instructed to present the Action Plan to the local Commissions and Chambers in order to guarantee some funds from the Aids Actions and Goals Plan (PAM), so the Action Plans were not submitted for approval by the federal administration²⁵25 Brasil. Ministério da Saúde. Diretrizes para implantação do Projeto Saúde e Prevenção nas Escolas/Ministério da Saúde, Secretaria de Vigilância em Saúde. Brasília, DF: Ministério da Saúde; 2006..

When, at the end of 2007, the PSE was instituted by Interministerial Decree No. 6,286, of December 5, 2007, the United Nations agencies lost their role as official documents do not point to this participation.

Between 2007 and 2012, to join the PSE, municipalities had to send to the Ministry of Health an Expression of Interest in Adherence to the PSE (articulated by the municipal education and health secretaries), by letter and electronically, in a form available online. The elaboration of the PSE project was the responsibility of the Municipal Intersectoral Working Group (GTIM), and, for approval, it was necessary to present it to the Municipal Health Council and the Municipal Education Council, when applicable²⁶26 Ferreira IRC, Vosgerau DSR, Moysés SJ, et al. Diplomas Normativos do Programa Saúde na Escola: análise de conteúdo associada à ferramenta ATLAS TI. Ciênc. Saúde Colet. 2012; 17(12):3385-3398.. During this period, only municipalities with eligible criteria could participate in the program. These criteria were related to the coverage of Family Health Teams, Education Development Index and participation in the Mais Educação Program. These criteria were changed between 2007 and 2012 to increase the participation of municipalities.

As of 2013, a list of essential actions was established, with mandatory agreement by the municipalities, based on the main government plans and projects in force²⁷27 Brasil. Ministério da Saúde; Ministério da Educação. Caderno do Gestor do PSE. Brasília, DF: Ministério da Saúde; 2015. [acesso em 2022 fev 20]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/caderno_gestor_pse.pdf.
http://bvsms.saude.gov.br/bvs/publicacoe... . Essential actions counted for achieving goals and receiving financial incentives. Optional actions, on the other hand, had to be agreed upon by the municipalities and had relevance in changing the state of local vulnerability, but were not counted towards receiving the financial incentive²⁷27 Brasil. Ministério da Saúde; Ministério da Educação. Caderno do Gestor do PSE. Brasília, DF: Ministério da Saúde; 2015. [acesso em 2022 fev 20]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/caderno_gestor_pse.pdf.
http://bvsms.saude.gov.br/bvs/publicacoe... . The year 2013 was the year of universalization of the PSE, that is, all municipalities became eligible to participate in the program and to receive resources for this purpose.

In 2017, the PSE was restructured by Interministerial Ordinance No. 1,055, of April 25, 2017²⁸28 Brasil. Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Caderno de Anotações: Relatos de Experiências da Semana Saúde na Escola. Brasília, DF: Ministério da Saúde; 2017. Documento interno., to increase the adhesion of municipalities and the Federal District, with the optimization of actions and the increase in the value of the financial incentive to be transferred each year of the biennial cycle.

The presence of youth participation in the PSE compared to the SPE: analysis of legal frameworks and initiatives

In order to approach the comparison between the presence of participation as a guiding element of the PSE and the SPE, we analyzed the documents identified by the documentary research on the websites of the Ministries of Health and Education and the partner UN agencies, as well as in the internal folders of the PSE at the Ministry of Health.

The materials in table 2, shown below, were found. With regard to the nature of the documents, the categories were defined based on the content and for whom they were directed, considering the approach of youth participation, taking into account the elements that had something in common.

The survey found only one SPE document on official government pages (Ministry of Health and Ministry of Education). The others are only available on the pages of United Nations partners (UNESCO and UNFPA) and other similar institutions. The PSE materials were all found on the specific page for the program, which is hosted on the Ministry of Health website – https://aps.saude.gov.br/ape/ pse and in the program’s internal folders, to which the researcher had access.

With regard to the nature of the documents, the categories were defined based on the content and for whom they were directed, considering the approach of youth participation, taking into account the elements that had something in common.

Of the four materials found referring to the SPE, one is aimed at management, one aimed only at health and education professionals and two aimed at supporting adolescents and young people in the development of training actions to strengthen youth participation in the project’s themes:

1. The Guidelines for Implementation²⁵25 Brasil. Ministério da Saúde. Diretrizes para implantação do Projeto Saúde e Prevenção nas Escolas/Ministério da Saúde, Secretaria de Vigilância em Saúde. Brasília, DF: Ministério da Saúde; 2006. of the Project and the Training Guide for Health and Education Professionals, even though they do not focus on youth participation, present the issue not in general terms, but as a necessary offer for the management and execution of the project, being included in the responsibilities of the GGM and the State Management Group, as well as appearing as one of the purposes of the project, being contextualized in the presentation and also in the introduction of the Implementation Guidelines.

2. The Guide ‘Health and prevention in schools: guide for the training of health and education professionals’²⁹29 Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde. Saúde e prevenção nas escolas: guia para a formação de profissionais de saúde e de Brasília. Brasília, DF: Ministério da Saúde; 2006. (Série A. Normas e Manuais Técnicos). is a course made up of 7 modules comprising the themes of gender, sexuality, prevention of (Sexually Transmitted Diseases) STDs and AIDS and integrated planning. All workshops are aimed exclusively at health and education professionals. Guidance on the involvement of young people in activities appears, in general, in the presentation and in the introduction, as well as in the comments on suggestions for forwarding the workshops, but the text does not elaborate on when and how this participation can happen. It is a material adapted from a proposal for the training of health and education professionals authored by the nurse Dr. Marina Marcos Valadão, professor and researcher who works in the field of health and popular health education, and who collaborated with consultancy for its creation.

3. The series of issues of the SPE, entitled ‘Adolescents and Young People for Education among Peers’³⁰30 Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de DST, Aids e Hepatites Virais. Adolescentes e Jovens para Educação entre Pares. Saúde e Prevenção nas Escolas, 2010. Fascículos. Brasília, DF: MS; 2010. [acesso em 2022 fev 20]. Disponível em: https://healtheducationresources.unesco.org/library/documents/adolescentes-e-jo-vens-para-educacao-entre-pares-saude-e-preven-cao-nas-escolas.
   https://healtheducationresources.unesco.... , is a material divided into eight notebooks that are based on fostering youth participation by offering methodologies on the topics of alcohol and other drugs, gender, STD prevention, HIV and AIDS, race and ethnicities and sexualities and reproductive health, with specific sections on ‘Adolescence, Youth and Participation’ and ‘Peer Education Methodology’. The focus of these materials are adolescents and young people and their role in the actions that are addressed by the SPE.

4. The ‘Comic Book – Health and Prevention in Schools (HQ SPE)’ Material Set, the HQ ‘SPE: A Guide to Classroom Use’, and the CD with the ‘HQ SPE Challenge’ game can be divided as follows: HQ³¹31 Unesco (BR); Unfpa (BR); Unicef (BR); Brasil. Ministério da Saúde; Ministério da Educação. HQ SPE: Histórias em quadrinhos: Projeto Saúde e Prevenção nas Escolas. Brasília, DF: MS; 2010. is aimed at teenagers and young people, with accessible language that dialogues with the way teenagers and young people communicate with their peers; and the Guide for use in the classroom³²32 Unesco (BR); Unfpa (BR); Unicef (BR); Brasil. Ministério da Saúde; Ministério da Educação. HQ SPE: um guia para utilização em sala de aula. Brasília, DF: MS; 2010. [acesso em 2022 fev 23]. Disponível em: https://unesdoc.unesco.org/ark:/48223/pf0000188264.
   https://unesdoc.unesco.org/ark:/48223/pf... ⁽¹²⁾, which proposes to offer:

Regarding the approach to youth participation, the following documents were found with some approach to the topic:

1. Health-at-School Week Guide. Campaign held annually since 2012 with the objective of increasing recognition of the actions planned and carried out under the program, in addition to strengthening the integration and articulation between the health and education sectors at the local level. Each year, a theme is chosen by the Ministries of Health and Education. The materials prepared for the 2012 and 2013 mobilizations³³33 Brasil. Ministério da Saúde. Guia de Sugestões de Atividades da Semana Saúde na Escola 2012. Brasília, DF: Ministério da Saúde; 2012. [acesso em 2022 fev 23]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/semana_saude_escola_guia_sug-estao_atividades.pdf.
   https://bvsms.saude.gov.br/bvs/publicaco... ,³⁴34 Brasil. Ministério da Saúde. Guia de Sugestões de Atividades da Semana Saúde na Escola 2013. Brasília, DF: Ministério da Saúde; 2013. [acesso em 2022 fev 23]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/guia_sugestao_atividades_sema-na_saude_escola.pdf.
   http://bvsms.saude.gov.br/bvs/publicacoe... have a chapter on youth participation and protagonism and its importance, with four proposals for workshops to be carried out by health and education professionals, but do not talk about adolescent involvement and of young people in activities. They also have a chapter on sexuality and preventing the use of alcohol and other drugs. The chapters present the theme and contextualize it with actions in schools, and both are part of optional activities. The 2014 material contains the same chapter only on youth participation, without including the topics of sexuality and prevention of alcohol and drug use. It is worth noting that some workshops presented in these devices mentioned the SPE materials as support material.

2. Notebook: experience reports of the Health-at-School week of 2016 and 2017²⁸28 Brasil. Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Caderno de Anotações: Relatos de Experiências da Semana Saúde na Escola. Brasília, DF: Ministério da Saúde; 2017. Documento interno.,³⁵35 Brasil. Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Caderno de Anotações: Relatos de Experiências da Semana Saúde na Escola. Contribuições de troca de experiências de ações de identificação e eliminação dos focos do mosquito Aedes aegypti, associadas a atividades de educação em saúde ambiental para a promoção de ambientes saudáveis, que estão sendo desenvolvidas pelo Brasil afora. Brasília, DF: Ministério da Saúde; 2016. [acesso em 2022 fev 23]. Disponível em: http://189.28.128.100/dab/docs/portaldab/doc-umentos/caderno_anotacoes2016_preliminar.pdf.
   http://189.28.128.100/dab/docs/portaldab... Preliminary Version. In this material – prepared to support the Health-at-School Week of 2016 and 2017 – youth participation appears as a topic in the item ‘Student Participation in the Experience of Schools’. Youth protagonism was also one of the aspects considered in the selection of successful experiences in combating the Aedes aegypti mosquito, theme of the Health-at-School Week in both years. According to experience reports, this strategy was named in different ways: ‘child agent’, ‘young environmental educators’, ‘school environmental health agents’ etc³⁵35 Brasil. Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Caderno de Anotações: Relatos de Experiências da Semana Saúde na Escola. Contribuições de troca de experiências de ações de identificação e eliminação dos focos do mosquito Aedes aegypti, associadas a atividades de educação em saúde ambiental para a promoção de ambientes saudáveis, que estão sendo desenvolvidas pelo Brasil afora. Brasília, DF: Ministério da Saúde; 2016. [acesso em 2022 fev 23]. Disponível em: http://189.28.128.100/dab/docs/portaldab/doc-umentos/caderno_anotacoes2016_preliminar.pdf.
   http://189.28.128.100/dab/docs/portaldab... .

3. Manager’s Notebook, a publication from 2015²⁷27 Brasil. Ministério da Saúde; Ministério da Educação. Caderno do Gestor do PSE. Brasília, DF: Ministério da Saúde; 2015. [acesso em 2022 fev 20]. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/caderno_gestor_pse.pdf.
   http://bvsms.saude.gov.br/bvs/publicacoe... that aims to communicate the program’s guidelines to the manager. The topic ‘youth participation’ appears on page 28, in the chapter on Component III, Training: ‘b) Training of young protagonists for the PSE/SPE – Through the methodology of peer education, the aim is to value young people as a protagonist in the defense of the rights to health’, and there is no discussion, throughout the entire document, about how this should happen in loco.

4. Joint Technical Note No. 564, of April 29, 2014, addressed to the National Youth Secretariat (SNJ), the Secretariat for the Promotion of Racial Equality Policies (Seppir) and the Secretariat for Affirmative Action Policies (SPAA) on the Living Youth Plan. This internal note suggests the incorporation, among other themes, of the discussion of black youth protagonism/empowerment in the planning of PSE actions, however, when mentioning how it would happen, it only suggests that the themes could be worked on in various ways, such as conversation circles, storytelling, dramatizations, study of texts, debate from films, documentaries, among others.

5. Summary of the Thematic Notebook on Social Participation, document dated June 22, 2012, which first topic proposal was about Youth Protagonism and Health at School, and the following topics dealt with Social Participation, Spaces and forms of participation and control by young citizens in the SUS, Social determination and inequities in health and Popular Health Education: other ways of dialoguing and promoting social participation and citizenship. This internal material did not make any progress in his writing; and by rescuing the proposal for the elaboration of thematic materials within the scope of the PSE, with a notebook being prepared for each of the actions of the program, the theme of social participation would not be included as a theme of specific material, but would be transversal to the other materials.

This series of thematic notebooks was created for some PSE actions, however, in the search for the issue of social participation or even youth participation, the material refers to that of the SPE.

What is observed is that the theme of social participation – and specifically of youth participation – appears in general lines and as a mention in the PSE materials. In the SPE materials, this issue is widely discussed and encouraged, including offering methodologies.

This reference to the SPE that is used in the PSE documents demonstrates the strong component of youth participation in the old project and is still a way of validating this discussion within the scope of the current program.

Final considerations

Participation can be characterized and understood in numerous ways. Participating can be a more or less active action. According to Bordenave³⁶36 Bordenave JED. O que é participação?. São Paulo: Brasiliense; 1983., it is possible to classify the quality of participation according to the level of importance of the decisions that are shared between the different actors, who are both in the management and in the population that benefits or is harmed by the decisions.

Thus, five levels of importance of decisions are established, which, in the analysis carried out, were understood to be within the scope of management. The formulation of doctrine or policy is the most fundamental level, the definition of objectives and strategies enters the second level and the elaboration of programs and projects is the intermediate level. Subsequently, the allocation of resources (Level 4), the execution of actions (Level 5) and, at the last level, the evaluation of results³⁶36 Bordenave JED. O que é participação?. São Paulo: Brasiliense; 1983..

We can consider that, in terms of management, the SPE complied with all the decision levels foreseen by Bordenave if we consider that the research carried out by UNESCO, a partner in the project, was an evaluative stage that positively guided the SPE’s practices. This would also be complemented by the study carried out by FIOCRUZ³⁷37 Köptche LS, Padrão MRAV, Rocha FG, et al. Reflexões sobre o uso de material para educação entre pares no Programa Saúde na Escola. Com. Ciênc. Saúde. 2017 [acesso em 2022 mar 3]; 28(2):178-187. Disponível em: https://revistaccs.escs.edu.br/index.php/comunica-caoemcienciasdasaude/article/view/219.
https://revistaccs.escs.edu.br/index.php... on the methodology of peer education with a sample in the five regions of the country. This FIOCRUZ survey was carried out within the scope of the PSE, also reflecting the results of the SPE’s action, since the material on which adolescents and young people were trained for validation was the Adolescents’ Guide to Peer Education.

Social participation in the health agenda can be perceived, over time, as a polysemic and flexible idea. It can mean people’s adherence to the guidelines and prescriptions of specialists, in the conduct of choices and ways of living, the way of taking care of oneself and the other, obedience to the ‘call’ for collective actions in favor of a greater good, as in the task forces to clean environmentally degraded areas, controlling vector breeding sites; or even in adherence to vaccination campaigns, cultivating this social or collective conscience, which Durkheim pointed out, at the beginning of the last century, as the league of the social fabric³⁸38 Durkheim E. Educação e Sociologia. 5. ed. Petrópolis: Vozes; 2014.. However, we are talking here about participation in the promotional perspective, which involves the construction of a reflective critical subject, who participates in the elaboration of solutions to problems that he himself can list as important for himself and his community. From the perspective of health promotion, it is necessary to go beyond obedient and instrumental participation, in order to build more horizontal, diverse and dialogic relationships, in which participation is creative, as it shares the co-creation of new perspectives of care and a shared future in the space among young people, health and education professionals.

The limits and outlines of youth participation in the current health promotion policy at school, brought about by the analysis presented here, suggest that participation should be understood as a presupposition to be included in the joint planning between health and education, since – crossing the understanding of health promotion as a process of training the community to act in improving their quality of life and health, including greater participation in the control of this process³⁹39 Nazzari RK. Capital social, cultura e socialização política: a juventude brasileira. In: Baquero M, Cre-monese D, organizadores. Capital social: Teoria e Prática. Unijuí: s.n.; 2006 [acesso em 2019 abr 8]. Disponível em: http://capitalsocialsul.com.br/capitalsocialsul/arquivos/mt/livro%20capital%20social%202006-.pdf#page=123.
http://capitalsocialsul.com.br/capitalso... – should converge in the perspective of recognizing these young students as actors who recognize their needs and can change their environment.

To this end, it is not just a matter of cultivating critical reflexivity in young people, but of investing in the construction of more horizontal power relations and of qualifying the dialogue between all members of the school community (teachers, managers, workers, students and family members), and between these and their various partners, in order to effectively recognize the territory as a central actor in the implementation of social policies in the country.

The possibility of the school, when addressing important health issues for the school community, to become a great sounding board for technical and scientific knowledge, in partnership with science and technology institutions and with those of higher education, is feasible. Health, as a generating theme to problematize the territory, has great potential to re-signify the teaching of physical, biological, social and human sciences, crossing disciplinary limits and contributing to the quality of education and its multiple action on life and health conditions.

References

Publication Dates

History