Embodying 'health citizenship' in health knowledge to fight health inequalities

Abstract

This paper wishes to contribute to the debate around citizen participation in health system decision-making that has been present internationally for the last 30 years. I argue that if we aim to change health inequalities, health professionals and planners need to understand the illness and health service experience of citizens. The concept of 'health citizenship' introduced here refers to health knowledge that integrates the lay knowledge of patients and that this integration is translated into health actions such as clinical communication and the planning of health care, programs, and policy. We illustrate our argument with the two cases: health literacy and the promotion of breastfeeding in a Canadian population living in context of poverty. This paper then concludes by addressing the leadership role, Brazilian graduate nursing schools can play in promoting 'health citizenship' and by doing so, contribute to fi ght health inequalities. Key words: Health citizenship; Health literacy; Breastfeeding; Nursing; Illness meaning. RESUMOEste trabalho pretende contribuir para o debate em torno da participação do cidadão na tomada de decisão do sistema de saúde que está presente no âmbito internacional nos últimos trinta anos. Defende-se que, se pretendem mudar as desigualdades na saúde, os profi ssionais e planejadores da saúde precisam compreender a experiência dos cidadãos com a doença e os serviços de saúde. O conceito de "cidadania em saúde", aqui introduzido, se refere ao conhecimento em saúde que integra o conhecimento leigo de pacientes e que essa integração se traduz em ações de saúde, como comunicação clínica e planejamento de cuidados, programas e políticas de saúde. O argumento é ilustrado com dois casos: o letramento em saúde e a promoção da amamentação materna em uma população canadense que vivem em contexto de pobreza. Em seguida, conclui-se, abordando o papel de liderança que os cursos de pós-graduação em enfermagem no Brasil podem desempenhar na promoção da "cidadania em saúde " e, assim fazendo, contribuir para combater as desigualdades na saúde. Descritores: Cidadania em saúde; Letramento em saúde; Amamentação; Enfermagem; Signifi cado da doença. RESUMENEste trabajo pretende contribuir al debate en torno a la participación ciudadana en la toma de decisiones del sistema de salud que ha estado presente a nivel internacional durante los últimos 30 años. Sostenga-se que, si queremos cambiar las desigualdades en salud, profesionales y planifi cadores de la salud deben comprender la experiencia de los ciudadanos con la enfermedad y los servicios de salud. El concepto de "ciudadanía en salud", aquí introducido, se refi ere al conocimiento de la salud que integra el conocimiento laico de los pacientes y que esta integración se traduce en acciones de salud, tales como la comunicación clínica y la planifi cación del cuidado, programas y políticas de salud. El argumento es ilustrado con dos casos: la educación para la salud y la promoción de la lactancia materna en una población de Canadá que vive en el...

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