Social iniquities in Primary Healthcare and intersectoral action: a descriptive study

Abstract

Objective: To analyze Primary Healthcare with regards to dealing with social inequities through actions targeted at Social Determinants of Health, from the perspective of Family Health Strategy Professionals. Methods: Descriptive study with a qualitative approach. Data were collected through focus groups and analyzed using Habermas’s communicative action theory. Results: There were few intersectoral and assistance organization actions with clinical emphasis; municipal management for intersectoral actions shows a lack of planning and faces challenges; and there is little communication and articulation between the sectors. Final considerations: There are many challenges to be overcome by Primary Health Care to contemplate intersectoral actions targeted at Social Health Determinants, a demand inherent to the possibilities of advancing in the reduction of social and health-related inequalities.

Multisectoral actions in primary health care: A realist synthesis of scoping review

“…The intersectoral coordination and functional sectoral institutional mechanisms can potentially reduce social and health-related inequalities in health and nutrition [ 32 , 37 , 48 , 53 , 59 ]. Intersectoral collaboration can contribute to design resilient health systems through advocacy, sectoral integration, and mobilisation of multisector stakeholders [ 25 , 34 , 48 ].…”

“…Such non-health sector policy decisions influence on the SDoH, while the health sector expects inputs from this sector with shared responsibility for health improvement [ 14 , 48 ]. Improving health outcomes need to address upstream determinants of health (e.g., poverty, income), which require the activities of the health sector and sectors that influence health (e.g., education, housing, water and sanitation, labor, public works, transportation, agriculture, and social justice-based approach) [ 32 , 37 , 42 , 47 , 51 , 53 , 54 ].…”

“…Only health system efforts cannot address health sector problems as they are socially constructed and hierarchically layered organisational systems [ 41 ]. Social participation, MSAs between public health and other sectors, and awareness of the social justice-based approach create enabling environments and enhance access to services targeting marginalised populations [ 25 , 26 , 32 , 37 , 51 , 53 ]. Partnerships with private sector and digital technology could support creating an enabling environment to address other sectors’ collateral impacts on the health sector.…”

“…However, challenges of MSAs of community-based organisation and committees were poor participation, duplication, lack of clarity of responsibilities, limited time and financial support, limited collaboration with the local government, lack of inclusion of marginalised groups, unclear process of involvement and conflict of interests, and variable competence of committee members [ 29 , 40 ]. Implementing MSAs locally was hindered by inadequate community participation and coordination, poor communication and articulation among sectors for integrated planning, and individualised social interventions [ 22 , 37 , 53 ].…”

Care provided to adults with obesity, systemic arterial hypertension, and diabetes mellitus in primary health care in Brazil

“…Em relação à intersetorialidade, ações intersetoriais no âmbito da APS vêm trazendo efeitos positivos para a redução das iniquidades sociais e para as desigualdades em saúde, pois, as desigualdades apresentam impactos diretos nos estados de saúde das pessoas (SOUZA et al, 2020). As DCNTs, por sua vez, se destacam por serem doenças com alto escopo de determinantes sociais não controláveis apenas pelo desejo de mudança, e sim enraizadas em todo um sistema pautado pelas desigualdades em saúde (BROCH et al, 2020).…”