Scope and potential of Primary Healthcare in ArgentinaResumen Este

En este artículo se discute la contribución del concepto de gobernanza, articulado con abordajes más tradicionales de análisis de la APS, en un estudio multicéntrico que involucra Argentina, Brasil, Paraguay y Uruguay. Teniendo en cuenta la variabilidad de configuraciones y el contexto de segmentación de los sistemas, se pretende comparar las características de la implantación y desempeño de la APS en cada país, entenderlas a partir de los diversos determinantes y, confrontarlas con los modos de gobernanza. Se presentan los contextos de segmentación en los países, caracterizando los diferentes arreglos de los subsectores público, privado y del seguro social. Se discute el concepto de APS abarcadora y su rol potencial para el reordenamiento de los sistemas de salud apuntando a la equidad en el acceso e integralidad del cuidado. En fin, se definen cinco dimensiones para el estudio de la APS: conducción, financiamiento, recursos, integralidad e intersectorialidad. El análisis de gobernanza explicita las relaciones Estado-sociedad y se propone como una herramienta para comprender las relaciones dinámicas entre estas dimensiones.

Effects of living near people with mental illness in community settings have been researched as part of psychiatric reform evaluation. However, these studies have been carried out mostly in industrialized countries, where social contexts differ from those in which psychiatric reform is now being implemented. To analyze the effects of community life with people with mental illness in the neighborhoods in which they live, in Buenos Aires, Argentina. A questionnaire was administered to randomly-selected neighbors of group homes of a discharge program and an equivalent control area (n = 236). Data was analyzed both quantitatively and qualitatively. Significant differences were found between being a neighbor and having a high degree of acceptance toward people with mental illness. In addition, significant associations were found between neighbors having a high-perceived social cohesion and having a high level of acceptance toward the mentally ill. Living near people with mental illness is associated with better acceptance toward them; these results are congruent with those results found in other cultural contexts.

This paper aims at offering alternative methodological perspectives in health systems research, to produce critical, theoretical knowledge in domains such as health policy and management of health care, organization of disease control, political economy of health and medical practice.We first examined the reasons to believe that worldwide economic agents have driven publicly funded schools of public health to adopt their preferred policies and to orient their priority research topics. We then studied whether this hidden leadership has also contributed to shape research methodologies, which we contrasted with the epistemological consequences of a quest for intellectual independence, that is, the researcher’s quest to critically understand the state of health systems and generalize results of related action-research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research.

Social inclusion is a key component of transformations in mental health care, because it takes into account the benefits of community life for both those with mental illness and the other members of the community. In order to understand the scope of inclusion within mental health, 45 participants of a community center linked to a psychiatric hospital discharge program which explicitly seeks to provide social inclusion were interviewed. The possible changes in social relationships between users and other community members based in their sustained daily interactions in the community center were explored. Results suggest that the building of social bonds, as part of informal support networks, is one of the benefits of attending the community center. Positive changes in ideas regarding people with "mental illness" were also observed, although these ideas seemed to be more connected to the notion of integration than to social inclusion.

The mental health users' movement is a worldwide phenomenon that seeks to resist disempowerment and marginalisation of people living with mental illness. The Latin American Collective Health movement sees the mental health users' movement as an opportunity for power redistribution and for autonomous participation. The present paper aims to analyze the users' movement in Argentina from a Collective Health perspective, by tracing the history of users' movement in the Country. A heterogeneous research team used a qualitative approach to study mental health users' associations in Argentina. The local impact of the Convention on the Rights of Persons with Disabilities and the regulations of Argentina's National Mental Health Law are taken as fundamental milestones. A strong tradition of social activism in Argentina ensured that the mental health care reforms included users' involvement. However, the resulting growth of users' associations after 2006, mainly to promote their participation through institutional channels, has not been followed by a more radical power distribution. Associations dedicated to the self-advocacy include a combination of actors with different motives. Despite the need for users to form alliances with other actors to gain ground, professional power struggles and the historical disempowerment of 'patients' stand as obstacles for users' autonomous participation.

PRESENTATION | APRESENTAÇÃO This article is published in Open Access under the Creative Commons Attribution license, which allows use, distribution, and reproduction in any medium, without restrictions, as long as the original work is correctly cited. WELCOME TO THIS SPECIAL ISSUE OF 'SAÚDE EM DEBATE', focusing on the work of the People's Health Movement (PHM), a global network of health activists and activist organizations working across borders and boundaries to realise the 1978 vision of 'Health for All'. This special issue is an initiative of Brazilian Center for Health Studies (Cebes) and Latin American Social Medicine Association (Alames) as a call for global action for the universal right to health. While there have been some improvements in aggregate health indicators in recent decades, the health gap has widened and the absolute number of people who face catastrophic health expenditures has increased 1,2. As well as widening inequalities, the spectre of hunger, displacement, and conflict arising from global warming and environmental degradation looms large. In some degree these risks arise from the weight of the human footprint on global ecosystems (although the responsibility for this burden is not evenly shared). However, the failures of governance which have enabled these developments and prevented effective action are economic and political. Capitalism, as a global economic system, is facing worsening instability. Underutilised productive capacity contributes to sluggish employment (particularly high wage employment). This holds back consumption expenditure and reduces the incentive to invest. The flight of capital from investment into speculation follows and leads to more bubbles and more crashes. Neoliberalism, the prevailing mode of governance since the 1980s, is directed towards protecting global elites from the consequences of the crisis, through economic policies which actually exacerbate the economic imbalances, drive further ecological degradation and deepen the crisis. PHM works towards the social conditions for good health but in ways which also address the drivers of inequality and environmental degradation; PHM works for universal access to decent health care in ways which also address the political and economic barriers to the necessary institutional reforms. PHM's 'theory of global change' centres on the dynamic of social mobilization; working with communities who are at the frontline of denial and risk; exploring the differing ways in which global economic crisis impacts on health care and living conditions locally. PHM envisions a coming together of health activists across boundaries, borders and differences; facing their different denials and risks but working together to address the global dynamics and forces which are common drivers of those different challenges. This 'convergence' of social movements extends beyond the health sector. PHM understands that comparable issues are being faced in many different sectors; in farming, labour unions, entertainment, environment, gender and i...

En el presente artículo, se problematizan los usos de la noción de dispositivo en el campo de la salud mental. Con este propósito, se realiza un rastreo en fuentes documentales, bibliográficas y testimoniales, a fin de identificar los criterios que recaen sobre dicha utilización. En función de las convergencias y disidencias encontradas, se traza una categorización tentativa de los usos más frecuentes según tres tipos: convencional, teórico y vivencial. Se corrobora la hipótesis de partida, a saber: que en el campo de la salud mental asistimos a una proliferación heterogénea del término “dispositivo”. Se deduce que esto va en detrimento de su potencia como herramienta teórica. Se concluye la pertinencia y la necesidad de un doble trabajo: por una parte, de restitución de algunas dimensiones teóricas del concepto de dispositivo; por otra, de cartografía de los dispositivos del campo de la salud mental.