Determinantes sociais da saude e o Programa Saude da Familia no municipio de Sao Paulo

Abstract

OBJECTIVE:To analyze the current status of the interventions related to social determinants of health conducted in the context of the brazilian family health program. METHODS:A case study using a mixed method approach based on a sequential explanatory strategy with 171 unit managers in the Family Health Care Program in the municipality of Sao Paulo, SP, Southeastern Brazil, in 2005/2006. Self-administered questionnaires were applied and semi-structured interviews and focus groups were conducted with a purposive sample of professionals involved in initiatives related to social determinants of health. Quantitative data were analyzed using descriptive statistics, multiple correspondence analysis, cluster analysis and correlation tests. Qualitative data were analyzed through content analysis and the creation of thematic categories. RESULTS:Despite the concentration of activities directed at disease care, the Family Health Care Program carries out various activities related to the social determination of health, encompassing the entire spectrum of health promotion approaches (biological, behavioral, psychological, social and structural) and all major social determinants of health described in the literature. There was a significant difference related to the scope of the determinants being worked on in the units according to the area of the city. The description of the activities revealed the fragility of the initiatives and a disconnection with the organizational structure of the Family Health Care Program. CONCLUSIONS:The quantity and variety of initiatives related to social determinants of health attests to the program's potential to deal with the social determination of health. On the other hand, the fluidity of objectives and the 'out of the ordinary/extraordinary' characterization of the described initiatives raises concern about its sustainability as an integral part of the program's current operational model.

Iniquidades sociais e intersetorialidade: desafio à atenção primária à saúde

“…The results showed that, according to the variables, 40% of the studies dealt with intersectorial actions of governmental level involving initiatives of the federal government; 22,24 20% dealt only with local intersectoral actions involving civil society 23 and 40% involved actions of the two types. 25,26 Regarding the theoretical references, 40% involved actions to reduce health inequities based only on the WHO framework, 22.25 , 20%, in the Social Capital benchmark, 23 20% in the WHO reference frameworks and the Course of Life 24 and 20%, in the references of WHO and the Social Capital.…”

“…The results showed that, according to the variables, 40% of the studies dealt with intersectorial actions of governmental level involving initiatives of the federal government; 22,24 20% dealt only with local intersectoral actions involving civil society 23 and 40% involved actions of the two types. 25,26 Regarding the theoretical references, 40% involved actions to reduce health inequities based only on the WHO framework, 22.25 , 20%, in the Social Capital benchmark, 23 20% in the WHO reference frameworks and the Course of Life 24 and 20%, in the references of WHO and the Social Capital. 26 Regarding health outcomes, intersectoral actions at the PHC level and with a focus on SDH, described by the reviewed articles, showed the following results: increased access to health services and education; increase in prenatal visits from 49% to 61%; increased immunization and reduction of child malnutrition; reduction of infant mortality below five years; increased income for families in extreme poverty and extension of the social and financial protection network.…”

“…Regarding the issue of intersectoriality, although the articles show that there is a polysemy on the conceptual basis of intersectoriality, two types can be outlined that have marked a prevalence of the implemented actions: intersectoral action whose initiative, implementation and management departs and remains as government action from the federal level; and another modality that are local intersectoral actions, with initiatives of municipal or even federal governments, but involving participation and civil society organizations and are developed with local territorial base. [22][23][24][25][26] Although governmental intersectoral actions constituted a significant part of the studies (40%), there is a tendency (40% reflect the two types AIG and AIPS) to a concept that defines intersectoral work, emphasizing the interface between governments and civil society, as well as the reciprocity and crosscutting of the sectors towards co-participation and effective sharing of planning and management in the production of intersectoral projects and actions. There is also a tendency to overcome conceptual interpretations that delineate intersectoriality as a multisectoral enterprise through a serial logic, that is, a logic of summation of consecutive efforts without synergy.…”

“…The results showed that there was an increase in family income and poverty reduction, greater access to health and education services, extension of social protection, increase of social capital and empowerment of groups and communities, reduction of violence, environmental improvements and improvement of conditions of health. One study 24 in particular shows that comparatively the municipalities that joined the WHO /PAHO/UN agenda 21, that is, the implementation of intersectoral actions aimed at the social determinants of health, with an environmental focus, presented better levels of equity and living conditions than others who did not.…”

Promoção da saúde e a reorientação dos serviços de saúde no município de Fortaleza: a hipertensão arterial como analisador

“…Os dados obtidos foram descritos e analisados sob a perspectiva da promoção da saúde e apresentados de forma a subsidiar a discussão e aprofundar as temáticas referentes ao objeto de estudo. Fase sistemática de coleta de dados A segunda fase da coleta de dados foi feita através da busca de fonte de dados primários, com aplicação de questionários auto preenchidos, complementada pelo uso de dados secundários, como a análise de consolidados mensais do atendimento ao Diabetes Mellitus e à Hipertensão Arterial.Identificamos as ações previstas e as ações implementadas na perspectiva da Promoção da Saúde no nível da atenção básica no município de Fortaleza: quem faz ou não faz; quais facilidades e dificuldades; parcerias estabelecidas; organização das ações; visão da Promoção da Saúde; avaliação e acompanhamento.Atividades que objetivam estimular membros da comunidade a se ajudarem mutuamente no enfrentamento de problemas individuais; (C4) Atividades em conjunto com a comunidade que objetivam a melhora da saúde e qualidade de vida dos membros da comunidade e/ou resolução de problemas locais; e (C5) Atividades que objetivam a elaboração e/ou mobilização por políticas públicas que interfiram na saúde e/ou qualidade de vida da população (DOWBOR, 2008). Um dos objetivos da ACM é realizar uma tipologia dos indivíduos, baseada nas semelhanças e diferenças dos mesmos.…”