Paim J S, de Almeida Filho N
Instituto de Saúde Coletiva da Universidade Federal da Bahia, Salvador, Brasil.
Rev Saude Publica. 1998 Aug;32(4):299-316. doi: 10.1590/s0034-89101998000400001.
The present essay is an exploratory study of the historical and institutional background of the so-called "crisis in public health", aimed at identifying the new trends and perspectives for the paradigmatic transformation of the health field in the context of the current international panorama of economic and cultural globalization. First, the rhetoric of health is analysed in historical perspective, briefly considering the main elements of the discourse of the ideological movements that historically built the social field of health. Medical Police, Social Medicine and Public Health are included as representative of such movements in 19th century Western Europe. After the Flexnerian turn, these movements were followed by Preventive Medicine, Community Health, Primary Health Care and Health Promotion, which dominated the scene particularly in the second half of the 20th century. The authors also summarise recent concerted PAHO efforts to debate the theory and practice of Public Health in the Americas, vis à vis the emerging demands of the economic, political and social context of Latin American countries. In this regard, the need for a common political agenda is emphasized, with the convergence of three topics-sectorial reform, "Renovation of Health for All" and the "new public health", covering the conceptual, methodological and operative domains. Secondly, a brief systematic account of the conceptual landmarks of the Collective Health movement, as carried through in the two last decades in Latin America, is presented, focusing more particularly on its potential for building up both a domain of transdisciplinary knowledge and a universe of practices. As a field of knowledge, it contributes to the study of health-disease phenomena in populations as a social process, investigating the production and distribution of disease in society as an aspect of social reproduction, and analysing health practices as a labor process integrated into the other social practices. As a universe of practices, Collective Health focuses on its models or action guidelines four objects of intervention: policies (forms of power distribution); practices (behavior modification; culture; institutions; knowledge production; institutional, professional and relational practices); technologies (organization and regulation of productive resources and processes; bodies/environments), and instruments (means of production of interventions). Finally, it is concluded that, although not being in itself a paradigm, Collective Health, as a movement committed to the social transformation of health, presents some possibilities of articulation with new scientific paradigms capable of approaching the health-disease-care object with due regard to its historicity and complexity.
本文是一项对所谓“公共卫生危机”的历史和制度背景的探索性研究，旨在确定在当前经济和文化全球化的国际背景下，卫生领域范式转变的新趋势和新视角。首先，从历史角度分析了卫生的言辞，简要考虑了历史上构建卫生社会领域的思想运动话语的主要要素。19世纪西欧的医学警察、社会医学和公共卫生被视为这些运动的代表。在弗莱克斯纳转变之后，这些运动之后出现了预防医学、社区卫生、初级卫生保健和健康促进，它们在20世纪下半叶尤其占据主导地位。作者还总结了泛美卫生组织最近为就美洲公共卫生的理论和实践进行辩论所做的协同努力，以应对拉丁美洲国家经济、政治和社会背景下新出现的需求。在这方面，强调了制定共同政治议程的必要性，其中三个主题相互融合——部门改革、“全民健康革新”和“新公共卫生”，涵盖概念、方法和操作领域。其次，简要系统地阐述了过去二十年来在拉丁美洲开展的集体卫生运动的概念性里程碑，特别关注其构建跨学科知识领域和实践体系的潜力。作为一个知识领域，它有助于将人群中的健康 - 疾病现象作为一个社会过程进行研究，将疾病在社会中的产生和分布作为社会再生产的一个方面进行调查，并将卫生实践作为融入其他社会实践的劳动过程进行分析。作为一个实践体系，集体卫生将其模式或行动指南聚焦于四个干预对象：政策（权力分配形式）；实践（行为改变；文化；机构；知识生产；机构、专业和关系实践）；技术（生产资源和过程的组织与监管；身体/环境），以及工具（干预措施的生产手段）。最后得出结论，尽管集体卫生本身不是一种范式，但作为致力于卫生社会变革的运动，它展现出与能够在充分考虑其历史性和复杂性的情况下研究健康 - 疾病 - 护理对象的新科学范式相结合的一些可能性。
