Objective: to investigate the knowledge of managers and health professionals, social workers and education professionals regarding the principal barriers to universal health coverage and universal access to health on the part of the extremely poor population; and to point to the contributions made by nursing for the promotion of this right. Method: a qualitative study whose reference was, for ensuring the right to health, the reorientation of the Brazilian Unified Health System (SUS) towards universal coverage and access in these territories. Interviews were held with 27 members of the multi-professional team of a municipality with high social vulnerability. The data were worked on using thematic content analysis. Results: the following were ascertained as the principal barriers to universal health coverage and access to health: failures in the expansion and strengthening of the services; absence of diagnosis of the priority demands; shortage of technology, equipment, and material and human resources; poor local infrastructure; and actions with low resolutive power and absence of interdepartmental policies. Within the multi-professional team, nursing acts in the SUS in unique health actions and social practices in these territories, presenting an in-depth perspective on this harsh reality, being able to contribute with indispensable support for confronting these disparities in universal health coverage and universal access to health. Conclusion: nursing's in-depth understanding regarding these barriers is essential for encouraging the processes reorienting the SUS, geared towards equality in the right to health.
Realizou-se análise do conteúdo das leishmanioses em livros didáticos de ciências e biologia, indicados pelo Programa Nacional do Livro Didático - PNLD/2008 e PNLEM/2009. Os critérios de análise reportaram aos seguintes temas: compromisso social, relação entre saúde e ambiente, qualidade científica, correção dos conceitos e ilustrações. Foram analisados sete dos 13 livros de ciências indicados pelo PNLD/2008 e todos os nove livros de biologia do PNLEM/2009; esses foram adotados em escolas públicas brasileiras no período letivo de 2008 a 2011. Todos os livros apresentaram incorreções científicas, linguagem descontextualizada e lacunas de informação, desfavorecendo a construção do conhecimento e não estabelecendo relações com aspectos históricos, socioculturais e econômicos associados às doenças. Tais constatações, somadas a achados semelhantes na literatura, levam à proposição de que o tema saúde deveria ter tratamento em separado, constituindo-se como volume específico, considerando a sua transversalidade e potencial para estabelecer diálogos para uma formação cidadã.
RESUMO:As leishmanioses têm alta prevalência no Brasil e, particularmente, em Divinópolis, Minas Gerais. O desconhecimento das enfermidades favorece sua disseminação. Por isso, este artigo apresenta uma investigação sobre a percepção de práticas educativas realizadas por professores de Ciências e Biologia do ensino básico quanto ao tema leishmaniose. Foram entrevistados dez docentes, e empregou-se o critério de saturação e a análise de conteúdo. Os resultados demonstraram que os professores atribuem pouca importância às leishmanioses, abordam o conteúdo junto aos alunos superficialmente por considerarem-se despreparados. Apontaram, na região, várias situações de risco para as enfermidades e a inexistência de políticas públicas para preveni-las. O contexto da educação em saúde nas escolas dificulta a adoção de ações profiláticas. São discutidas alternativas para trabalhar o tema nas escolas, integrando ensino de ciências e saúde. Palavras-chave: Leishmanioses. Percepção. Educação em saúde. Professores de Ciências e Biologia.
Health is part of the Sustainable Development Agenda adopted by the United Nations and local communities have an important role in the definition of their own development needs and in the discussion of the post-2015 Sustainable Development Goals. A field survey using a validated questionnaire was applied to 336 extremely poor households in a Brazilian municipality. The survey was a cross-sectional and observational study and included interviews with healthcare professionals and social workers. Drug/ alcohol abuse was pointed as the major problem to obtain improvements in quality of life. The prevalence of disability was 14%. A reduction in rates of deaths caused by crimes and prevention of disabilities should be included as health targets under the SDGs.Keywords: health promotion; sustainable development; quality of life; social determinants of health; poverty. ResumoA saúde integra a Agenda de Desenvolvimento Sustentável da Organização das Nações Unidas. As comunidades locais têm importante papel na definição de suas necessidades para o desenvolvimento e na discussão dos Objetivos de Desenvolvimen to Sustentável pós-2015. Realizou-se uma pesquisa exploratória empregando um questionário validado em amostra de 336 domicílios caracterizados como extrema pobreza em um município brasileiro. Essa pesquisa compreendeu um estudo observacional, transversal, e a realização de entrevistas com profissionais de saúde e assistência social. O abuso de drogas e álcool foi identificado como o maior problema para obter melhorias na qualidade de vida. A prevalência por incapacidades foi 14%. A redução das taxas de óbito por crimes e a prevenção de incapacidades deveriam ser incluídas como alvo desses objetivos.Palavras-chave: promoção da saúde; desenvolvimento sustentável; qualidade de vida; determinantes sociais da saúde; pobreza.Viviane H. França, Ulisses E. C. Confalonieri
Background Tackling poverty requires reconsideration of quantitative factors related to “who” is poor and by “how much” and qualitative factors addressing “what poverty means in these individuals’ lives”. Greater understanding is required concerning the types of access actually used by families in poverty in attempts to meet their basic needs. Poverty must be addressed based on the question: “Inequality of what?” It is in reflecting on the realities of such groups when their basic needs are not met that public policies can be improved and implemented with legitimate priorities. Objective: Describe coverage and access to public health, education and social assistance services and the related effects on the quality of life of families in extreme poverty. Methods An exploratory mixed methods study was conducted applying Amartya Sen’s “Basic Capability Equality” framework, with: 1) 27 interviews with managers and professionals from public services serving territories with extreme poverty; 2) Survey with a systematic proportionate stratified sample of 336 heads of households in extreme poverty from a total 2605 families. The resulting data was analyzed with thematic content analysis and descriptive statistics, respectively. Results The managers and professionals described the lives of families in extreme poverty with phrases such as, “ These people suffer. Sadness weighs on their lives! ” and “ Depression is the most common illness ”. Their precarious circumstances and inadequate access were cited as causes. Quality of life was considered bad or very bad by 41.4% of heads of households. A total income of less than one-third of the minimum wage was received by 56.9% of the sample. One or more people were unemployed in the family in 55.8% of cases. For 53.3% of heads of households, public services “ did not meet any or few of their needs”. The main social determinants of health were described as: alcohol and drugs (68.8%); lack of good health care (60.7%); and absence of income/work (37.5%). The following were identified as solutions to improve their quality of life: (1) health (40.5%); (2) education (37.8%); and (3) employment (44.6%). Conclusions The social determinants of poverty and health must be addressed jointly through intersectoral public policies and egalitarian mechanisms that promote investment in social protection.
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