Health education and communication as a strategy for well-being and population health in Portugal and Brazil
Abstract
Education and communication strategies can contribute to strengthen public health actions. A critical analysis about education & communication for health as strategies for population well-being was implemented through bibliographical and documental research. Many challenges prevail today the fields of education and health communication. In countries like Brazil or Portugal remnants of the hygienist perspective can hinder, already, the positive outcomes of public policies, especially health policies. Nevertheless the decrease in public health funding, or even reduction in investment both in infrastructure, human resources, and consequently on education and health communication can have a deregulation impact on the overall wellbeing condition of citizens. These are the preliminary steps of a quantitative and qualitative research with descriptive and exploratory dimensions, to be carried out during 2014 and 2015.
Key-words: Health education, communication and health; well-being; health policies; civic society
Introduction
In the 21st century contradictions deepen in society in the endeavour to construct well-being. In one hand the informational, technological revolution, the new discoveries in genetics and molecular engineering and innovations in the areas of humanities, exact and biological sciences proclaimed the dream to be. On the other hand, the growth of social inequality and its consequences especially on the working class or on the hordes of unemployed, declare without a doubt, how far we are from living the dream. Every day we are witness the increase of violence, hunger and human vulnerability in economic, cultural, political, religious and socio-affective contexts.
The recognition of health systems in Portugal and Brazil as a service within the framework of social rights requires the citizen’s specific appropriation of knowledge. For this to be done, an awareness process that it is incumbent upon the State, who has the responsibility for public policies financing and management, needs to be implemented. To this end, it is highlighted the important role of education & communication for health, in the disclosure of the implications of such framework within the civic and civil society.
2 Information was gathered through bibliographical and documental research based on the dialectical method1 to be carried out during the period from 2014 to 2015.
Thus, this article discusses the hindrances that education & communication for health face today in the context of health promotion. (This is
the first step of a larger research to be developed in the postdoctoral course in public health at the Escola Nacional de Saúde Pública da Universidade Nova de Lisboa).
This research proposes a comparative study between Brazil and Portugal, having as central axis the socio-political analysis of coherences and contradictions in the use of health education strategies and/or communication for health.
Education and health communication strategies in Portugal and Brazil
The latter transformations experienced by and in society on re-structuring public policies, within the framework of health, are moulding changes that can be seen in organizations. Consequently the citizen and health professionals articulation/participation is affected.
Active participation in the new re-configurated health care systems and consolidation of these changes in society, are today new challenges that need to be considered. Social representations about the commitment of public policies to promote equity and social justice, are eroding social trust that is needed to sustain the deep changes that are being proposed. Values such as the universality of access to health services and resources, the strengthening of democracy, the social distribution of wealth and the commitment with quality of services provided, are questioned on an everyday basis.
The question over what are the social obligations that need to be fulfilled by the State, versus citizens’ responsibilities and rights, is a debate that prevails thought different social contexts, namely health promotion. Health promotion has become an appetizer to confront the limits of this discussion since it can easily adjust to the blame the victim approach while keeping a politically correct discourse to deal with social and economic constraints. To this end, the participation and interaction of users with the various stages of health systems, health professional attitudes in implementing strategies and actions to ensure the positive participation of citizens in their health
3 care and promotion process, are some of the tips of the iceberg that linger beneath the surface of legislative and regulatory paraphernalia.
Finally the discussion revolves around what is the present and future scope of citizenship as a universal heritage.
Health and wellbeing requires more than services or programs in the context of health care systems that is proposed today. To live well, experience quality of life in decent conditions highlights more than continuous investments in policies such as sanitation, diseased prevention and cure. The need goes beyond and deals with social environments where information and communication strategies play a major role.
A promoção da saúde e a prevenção de doenças têm um papel fundamental na melhoria da qualidade de vida das pessoas e na economia da comunidade. Por isso devem ser encaradas como investimentos e não como custos para a sociedade. Há assim que evoluir de planos de investimentos da saúde exclusivamente dedicados à construção e manutenção de infraestruturas físicas para outros que incluam fortes investimentos na promoção da saúde e na prevenção da doença.(Relatório de Primavera, 2001: 44)
Despite great strides in the area of health, the central issue is to identify to what extent populations in such countries like Brasil or Portugal, have access to knowledge, experience a correct interpretation of the legislative changes in the context of health in order recognize what their rights are today. Are these changes and new regulations perceived has facilitating their health promotion endeavour? How is the civil society perceiving access to health information, programs and services available via SNS and SUS, repectively Serviço Nacional de Saúde in Portugal and Serviço Único de Saúde in Brasil)?
Bringing health policy into effect requires more than the institutionalization of health services or even the ratification of certain regulation or legislation in the field of health.
Atualmente devido às constantes transformações em curso e aos sérios problemas de saúde pública, faz-se necessário a utilização de todos os espaços possíveis para a socialização de informações, visando a prevenção de doenças e a promoção da saúde, e a valorização do indivíduo enquanto agente capaz de ser sujeito do seu processo ensino/aprendizagem/cuidado. Assim, possibilita-se aos sujeitos condições de participar por completo e com total autonomia da vida social, em especial na área da educação.(OLIVEIRA & GUEDES, 2008, 128)
4 services, policy makers and end users of social services (like health services) promoting the socialization of information/knowledge transfer about health policy options. The impact of this in health promotion and disease prevention, taking into consideration the aspirations and demands of the users of health systems is therefore a relevant topic to be considered in the turmoil of changes of society today.
A Educação em Saúde é uma prática social, cujo processo contribui para a formação da consciência crítica das pessoas a respeito de seus problemas de saúde, a partir da sua realidade, e estimula a busca de soluções e organização para a ação individual e coletiva (FUNASA, 2007 p.19).
Health education and communication are identified as areas of physical and symbolic unequal value, which includes not only the instance of discursive production, as exacerbated in health institutions, but also the social conditions of circulation and appropriation of the messages that expresses social change. (ARAUJO E CARDOSO, 2007)
Thus, education and health communication have a important role in promoting access to information and knowledge about health services. In this sense, we cannot be limited to the simple transfer of information, in a technical and mechanical way, with the use of technical terms and jargon of healthcare area.
A prática educativa parte do princípio de respeitar o universo cultural das pessoas e as formas de organização da comunidade, considera que todas as pessoas acumulam experiências, valores, crenças, conhecimentos e são detentoras de um potencial para se organizar e agir (FUNASA, 2007 p.21).
In 1988, the adoption of the Constitution of the Federative Republic of Brazil, set up new context of health for citizens. Among them stands out in Article 196 that health is a right of all Brazilians and a duty of the state, guaranteed social and economic policies aimed at reducing the risk of illness and other hazards and the universal and equitable access to services that can promote health, protection and recovery from illness.
The Serviço Único de Saúde (SUS), was set up to achieve such prerogatives and, proposes health education as one of the strategies to do it. On the basis of the principles and guidelines of health education, the SUS has the potential to promote health by guaranteeing citizens significant living conditions improvement.
5
a) Através de um serviço nacional de saúde universal e geral e, tendo em conta as condições económicas e sociais dos cidadãos, tendencialmente gratuito; b) Pela criação de condições económicas, sociais, culturais e ambientais que garantam, designadamente, a protecção da infância, da juventude e da velhice, e pela melhoria sistemática das condições de vida e de trabalho, bem como pela promoção da cultura física e desportiva, escolar e popular, e ainda pelo desenvolvimento da educação sanitária do povo e de práticas de vida saudável.
Ratification of the Constitution of Portugal, was done with the Lei de Bases da Saúde - no. 48/90, August 24, 1990. Chapter 1, of the general Dispositions, states that:
[..] A protecção da saúde constitui um direito dos indivíduos e da comunidade que se efectiva pela responsabilidade conjunta dos cidadãos, da sociedade e do Estado, em liberdade de procura e de prestação de cuidados, nos termos da Constituição e da lei. [..]O Estado promove e garante o acesso de todos os cidadãos aos cuidados de saúde nos limites dos recursos humanos, técnicos e financeiros disponíveis.[..]
Health policy as a social right mechanism, should guarantee that every citizen can have access to health promotion, prevention and recovery from disease. However, economic, political, social and cultural factors are reinforcing social exclusion, social inequalities and inequities to access such guarantees.
Em meio à complexidade da política pública de saúde e às dificuldades de construção de um sistema nacional de caráter universal em um país heterogêneo e desigual, persistem desafios relacionados ao enfrentamento de problemas estruturais do sistema de saúde brasileiro. Entre eles, destacam-se a fragmentação das políticas, as limitações no financiamento, as distorções nas relações público-privadas e as marcantes desigualdades em saúde. (MACHADO et all, 2009, p. 529)
The question that prevails today in these societies is that it is not possible to guarantee the right to health as it conceived by their respective Constitutions. Segundo Almeida (2010, p. 80) face ao custo crescente dos cuidados de saúde ( 'explosão de custos'), a sustentabilidade do sistema de saúde assume-se, pois. como um dos principais desafios da Saúde Pública Global [em Portugal].
6 In addition, these societies need to be strengthened with spaces of social participation and civic involvement, where the discussions of proposed public policies are re-evaluated. An active citizen participatory bottom-up reflexive undertaking can only promote a congruent movement between social conditions and capabilities and legislative and regulatory bodies entrusted with the social responsibility to fulfil citizens expectations. If used in the right way, education and communication strategies will trigger users of health services to become protagonists of this process. This participatory approach is a key player for societies to succeed while dealing with such conditions that are today structurally over-imposed. Either in the field of health promotion and quality of life, disease prevention or recovery of a simple condition, education and communication strategies have, consequently a leading role.
Citizens should perceive themselves as users of (health) services, who have rights and not recipients of favours granted by the State to whom they belong. Neither health professionals perform charitable or benevolent actions.
A Educação em Saúde utiliza métodos e processos participativos e problematizadores, preconizados e consolidados, buscando práticas inovadoras a partir da realidade num processo dialógico e horizontalizado de construção e reconstrução compartilhada do conhecimento e na ação coletiva para a transformação social. Os profissionais dos serviços, os parceiros e a população são sujeitos (atores), que debruçados sobre a realidade procuram conhecê-la, compreendê-la, desvendá-la e atuar sobre ela para transformá-la.
(Funasa, 2007, p.32)
Through education and communication in health citizens and communities can gain interest to participate actively in decisions making processes aiming
for the improvement of quality of life. Health promotion needs shared management and co-responsibility between various social.
In this perspective, education and health communication complement each other. They contribute to increase health professionals strategies to listen and dialog
Em síntese, o agir em saúde não é um que fazer neutro. O trabalho em saúde como prática social, contém uma dimensão política e ideológica, sempre referidas a um projeto de sociedade,o que implica um comprometimento ético por parte de todos o sujeitos em relação neste campo, sejam eles os grupos sociais usuários da rede de atenção à saúde, os profissionais das equipes de saúde, os gestores (Mehry et alli. 2003 apud FUNASA p. 11).
7 that go beyond the biological dimension of an human being. Social factors, cultural and political contradictions have their way to oppose a health promotion culture.
Through health education and communication, contribution can be made to ensure that citizens are able to identify existing health services, to actively participate in a health system that meets their needs, having as a central point universality of access and equity.
Final Considerations
Health is more than the absence of disease. Investments for health require State articulation between all public policies so that citizens can have the best possible quality of life in an dignified living conditions in society.
To this end, the government needs to bring correct planning, deployment and implementation of public policies, with the premise that actions of health education and communication can foster access to knowledge about health (e.g. policy, services or rights). Such a perspective can strengthen social participation.
It is clear that the field of education and health communication still have many challenges and barriers to overcome, from the remnants of the past when of a practice linked to a the hygienist perspective was prevailing.
Such conceptions are contributing to the maintenance of "educational" practices where the citizen is made accountable for his illness, without taking into account the social context in which they are included, featuring a reductionist intervention of the health-disease process.
The adoption of a fragmented vision by users who seek public health services in Portugal and Brazil, has hindered social development. Such aspects relegated education and health communication to distal tools of health promotion. This is because many professionals still lay on recommendations and requirements related to the sick person. Change from the “sick role”, to a more autonomous and emancipatory role is a cultural change that needs to be done in both countries.
Recognize health as a right, will confirm the reason why the SNS and SUS were brought up. Health education and health communication are tools that can leverage this process.
REFERENCES
8 BRASIL. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Atenção à Saúde.Política Nacional de Promoção da Saúde / Ministério da Saúde, Secretaria de Vigilância em Saúde, Secretaria de Atenção à Saúde. – 3. ed. – Brasília : Ministério da Saúde, 2010.)
BRASIL. Fundação Nacional de Saúde. Diretrizes de educação em saúde visando à promoção da saúde: documento base - documento I/Fundação Nacional de Saúde - Brasília: Funasa, 2007. 70 p. BRASIL. Ministério da Saúde. Caderno de Educação Popular e Saúde. Disponível em: <http://portal.saude.gov.br/portal/arquivos/pdf/caderno_de_educacao_popular_e_saude.pdf>. Acesso em: 15 fev. 2014.
CABRAL, M.V. & SILVA, P.A. O estado da saúde em Portugal: acesso, avaliação e atitudes da população portuguesa - evolução entre 2001 e 2008 e comparações regionais. Lisboa:ICS, 2009. CAMPOS, A.C. & SIMÕES, J. O percurso da saúde: Portugal na Europa. Almedina, Coimbra, 2011.
FREIRE, P. Extensão e Comunicação? 3. ed. Rio de Janeiro: Paz e Terra, 1979.
FREIRE, Paulo. Pedagogia do Oprimido, 17ª Ed. Rio de janeiro, Paz e Terra, 1987.
FUNASA. Educação em Saúde Diretrizes. Disponível em: <http://www.funasa.gov.br/site/wp-content/files_mf/dir_ed_sau.pdf>. Acesso em: 09 fev. 2014.
MACHADO, C.V. et all. Políticas de saúde no Brasil nos anos 2000: a agenda federal de prioridades. Caderno de Saúde Pública. [online].Vol. 27, n.3, PP.521 - 532, 2011.
MOROSINI, Márcia Valéria; FONSECA, Angélica Ferreira; PEREIRA, Isabel Brasil. Educação em saúde. Disponível em: <http://www.epsjv.fiocruz.br/dicionario/verbetes/edusau.html>. Acesso em: 15 fev. 2014.
Observatório Português dos sistemas de saúde.Duas faces da saúde. Relatório de Primavera de
2013. Mar da Palavra, Coimbra, 2013. Disponível em
http://www.observaport.org/sites/observaport.org/files/RelatorioPrimavera2013_0.pdf, acesso em 14 de fevereiro de 2014.
9 PINTO, Joao Bosco. Ação Educativa por meio de um Método Participativo no Setor Saúde. In: Ação participativa: Metodologia/Encontro de experiência de Educação em Saúde da Região Nordeste. Anais. – Série F: Educação e Saúde, 4. Ministério da Saúde.
POLIGNANO, Marcus Vinícius. História das políticas de saúde no Brasil: Uma pequena Revisão. Disponível em: <www.saude.mt.gov.br/arquivo/2226>. Acesso em: 17 fev. 2014.
PORTUGAL. Lei de Bases da Saúde - Lei nº 48/90, de 24 de agosto de 1990. Disponível em
http://dre.pt/pdfgratis/1990/08/19500.PDF. Acesso em 19 de fevereiro de 2014.
PORTUGAL. Lei que cria o Sistema Nacional de Saúde. Lei nº 56/79, de 15 de setembro de 1979. . Disponível em http://www.parlamento.pt/Legislacao/Paginas/Leis_area_saude.aspx. Acesso em 20 de fevereiro de 2014.
PORTUGAL. Constituição da República de Portugal. Disponível em
http://www.parlamento.pt/Legislacao/Paginas/ConstituicaoRepublicaPortuguesa.aspx, acesso em 18 de fevereiro de 2014.
TEIXEIRA, Carmen. Os princípios do Sistema Único de Saúde. Disponível em: <http://www.saude.ba.gov.br/pdf/OS_PRINCIPIOS_DO_SUS.pdf>. Acesso em: 15 fev. 2014.
WACHWICZ, L.A. A dialética na pesquisa em educação. Revista Diálogo Educacional. [online]. V.2, n.3, jan/jun, 2001, ISSN 1981 - 416 X.
