Centros de Saúde: ciência e ideologia na reordenação da saúde pública no século XX

Abstract

Os Centros de Saúde surgem nos EUA em torno de 1910, com caráter de assistência social adida a algum serviço médico. Sua separação inicial entre medicina preventiva e curativa foi superada pela medicina integral na década de 1940, quando o discurso dos Centros de Saúde se insere na educação médica. Nos anos 1960 a visão de combate à pobreza daria ensejo à medicina comunitária. No Brasil este ideário foi difundido desde a década de 1920 e fortalecido pela política varguista de construção nacional. Mas foi o Serviço Especial de Saúde Pública o maior responsável por lhe conferir forma prática e conceitual no país.

Referência e contrarreferência no cotidiano da atenção à saúde de Divinópolis-MG, Brasil: o suporte às decisões da atenção primária Reference and counter-reference in everyday health care in Minas Gerais, Brazil: the support to decisions of primary care

“…However, the preventive and corrective attention should focus in the context of the FHS, the length and continuity of care, for the resolution and health equity. 26 The fiery evidence of the population seek the medical care and the lowest interest in preventive actions, or calls to other team members, declare the high demand for medical consultations in everyday services. 22,27 We know that it is possible to live well with spontaneous demand through better organization of care, thus meeting the population's health needs.…”

Pensamento clássico da saúde pública paulista na era dos centros de saúde e educação sanitária

“…There is no need to extend the discussion about the break resulting from the new principles and concepts described years later by the reformists themselves and extensively contextualized in a specifi c review. 23,42 However, some additional characteristics resulting from that new discursive matrix should be pointed out.…”

“…Under the guidance of João de Barros Barreto, a former Johns Hopkins fellow student, the Vargas era created a solid bureaucratic structure in public health in Brazil, strongly oriented to the HC concept and the bureaucratic administration model. 10,23 However, although the revolute context of the break caused by the Pan American public health concepts was already a thing of the past, now the planet was troubled by the capitalist-communism divide. That tension added a certain anguished tone to the conclusion of the Mascarenhas's thesis and the assumption of "Three ways…" for the organization of public health.…”

"É o doutor que vem aí!": guardas sanitários, relações de trabalho e formação de identidade (décadas de 1930 e 1940)

“…In addition to some manuals aimed at their training 8 and the instigating images portraying them in their daily professional routine Mello;Santos, 2002), generally speaking access to these workers is only possible (and this was our case) through the voices of the hierarchically superior actors, the public health doctors, and the agents of public authorities.…”

“…), and in the urban and rural health centers established here during this period. Also in the public health education and sanitation carried out by the Special Public Health Service (SeSP), set up in Brazil at the beginning of the 1940s, which exercised a role of great importance in the implementation of a real "coordinated and integrated network of basic" health care services (Mello;Vianna, 2011Vianna, , p. 1142, it was essential to rely on an 'army' of health auxiliaries. Nevertheless, with the exception of the sanitation visitors and/or educators, and those who exercised subordinate functions in nursing, a certain silence in the historiography of Brazilian health has fallen on these people, always mentioned but little studied in the dimension of health workers with collective interests and identities, professional particularities facing the exercise of the same profession and the possible feeling of belonging to a set of common practices, values, and knowledge.…”