Trabalho, Educação e Saúde - TES (Work, Education and Health) is an open access scientific journal, edited by the Joaquim Venâncio Polytechnic School of Health, from Oswaldo Cruz Foundation.
Editorial
Article
The impacts capitalistic globalization has had on the health professionals' education can be represented by technical, polyvalent, individualistic and competitive training, among other aspects. In this context, the public space, the humanistic dimension, and critical thought are neglected. The purpose of this essay is to propose reflection on the education of health professionals for alienated work in health in the context of neoliberalism and suggests possibilities to break away from this type of training. A thematic agenda presents concepts that are considered fundamental for the organization of critical thought among health professionals. The goal is to point to paths to include health professionals in the construction of another possible world, breaking away from the dehumanizing logic of capital that has individualism and profit as its foundations.
Article
The article analyses the appearance of community health agents as a worker category in a context of labor relation flexibilization, in a double sense: valuing work, greater autonomy, continued education, and social skills as primordial elements in the State's implementation of social services; and the atypical character represented by labor agreements outside of the public servents' stability, a condition for the activity that is carried out, on one hand, and, on the other, a factor of social vulnerability of the worker by the preponderance of outsourcing and informal agreements, among others, which are marked by unstable work ties.
Article
The article seeks to build, based on a memory of the Brazilian Sanitary Reform and on approximations between the scientific areas of Education and Health, a microperception (matter for thought, learning, and getting to know) about the surfacing of a domain of knowledge designated by Health Education and Teaching. This emerging domain would seem to be largely associated to the invention of Collective Health, in the scientific field of health, and to the invention of Social Control in Health, in the field of political intervention in this sector. The new knowledge domain would be characterized by a singular implication of teaching with citizenship, allowing the bridging of the boundaries between education and health via permanent education in health. The teaching and citizenship themes are problematized with explicit help or not (via its readers) from a few philosophers and contemporaneous thinkers such as Michel Foucault, Michel Serres, Gilles Deleuze, Félix Guattari, Francisco Varela, Humberto Maturana, and Ilya Prigogine.
Article
In the globalization process, labor flexibilization and the population's vulnerability tend to increase. The purpose of this study is to analyze the situation of the work market in the Brazilian health sector under the light of vulnerability in the globalization context. A systematic study was carried out based on national and international technical and scientific production. The concepts of vulnerability were used as the theoretical base, as they consider not only issues that are pertinent to the health sector, but also to its relationship with the social structure and superstructure, which can integrate with each other in the framework of this sector's work conditions, which, in turn, can elucidate the formulation of policies that are more human for the workers.
Article
This article proposes a reflection on the transformations that have been taking place in professional training in health, using the health sector and education competencies as a reference in the professionals' ordainment in consonance with the construction of the Single Health System and of its policies from the Family Health Strategy perspective. The text focuses on the progress made in the formulation of the health human resource policy in Brazil with regard to the reorganization of the higher education institutions and opportunities for the reorientation of new pedagogic models to develop health professionals who are knowledgeable of the population's social problems and health, becoming capable of intervening in the sector's reorganization. In this regard, it contributes to the discussions in the health human resource area, offering subsidies to a reflection on professional qualification for the Single Health System/Family Health Strategy.
Article
This article seeks to characterize the different forms of mediation present in the daily work of the community health agent - an innovative element in the functional framework of the Family Health Strategy - , which oscillate between convincement an transformation. It believes that the mediating role the agents have can be of major importance to change the assistential model as it takes-on a transforming character, and sees popular education as a path towards strengthening this type of mediation and to change the assistential model. The study allowed community health agent practices to be known and to point to issues that are considered as fundamental in order for the assistential model to be able to meet the needs and expectations of the population and come closer to the principles of integrality, equity, humanization and popular participation.
Article
This article analyzes the changes the main multilateral agencies made, in the turn of the century, to the public policy approaches in countries where there was 'dependent capitalism,' changes materialized in the 'millennium development policies' (MDP). It is noticeable that new ideological bases, underpinned by Robert Putnam's 'social capital theory,' were introduced in these policies. In the realms of education, it is thought this adjustment process will trigger a new stage of renewal of the human capital ideology, one that increases the attributions of the school and limits the political dimension that inserts pedagogic action. The thesis is that the MDPs are intellectually- and morally-driven function hegemony mechanisms, with concrete actions and goal definitions focused on the tiers of workers who are 'excluded' from the productive process but, none-theless, are still able to produce, aiming to establishing a more intensive process of educating for conformism. The Gramsci categories are used as a base for the analyses.
Review
Resenha
Ensaio
The purpose of this article is to highlight the importance of the analysis of the political, social, and economic context to confirm the conceptual framework as the base for the development of the qualification programs for health professionals. The analysis is defined in four moments. The first, ever since the end of the 19th century through the early 20th century, was characterized by being 'physician-centric'. The second, in which the medical administration and data and statistics registration were included, the medical practice gained new dimensions that allowed it to turn into a social, rather than an individual practice. In the third, with the transference of the hospital organization from Europe to America and the incorporation of modern technology, hospitals became part of a medical and social organization with the mission of allowing for medial and sanitary assistance. A fourth took place in the midst of a contradiction between what had progressed in the development of the health systems, with the acknowledgement of the universal rights to health and citizen participation as the subject and object of the care, and the appearance of the neoliberal globalizing trend, which considered the complex process of health care as merchandise.
Debate
How can those who formulate policies deal with the aspiration of producing a universal health context in a context of fiscal restrictions of the State? There seems to be a contradiction between the redistributive model the Brazilian Constitution predicates and the level of public expenditure with health. In this scenario, increasing financial resources is a precondition in order to deny the 'non-universal' and 'non-decentralized' SUS, so it will not deny itself as a social right. Such as the model of decentralization professed by SUS ideologues, a system that suffered from the scarcity of resources, most of the management problems result from the chronic funding crisis, and adopting efficiency measures cannot serve as the base to cut the SUS' level of financial or organizational resources. On the contrary: improved efficiency can, in fact, mean and require increased spending.
Debate
The article deals with the relationships between fiscal federalism and the decentralized funding of the Single Health System (SUS), from 1990 to the early 2000's, and singles out the problems of the Brazilian tax system, which is unable to compensate for fiscal unbalance among the different spheres of the government.
Debate
This comment is inspired in the article written by Luciana Dias de Lima regarding the relationships between fiscal federalism and the process of decentralization of the Single Health System. It highlights and expands issues regarding the transformations that have taken place in the intergovernmental relationships and the changes in public institutionality that marked the period the author analyzed. The comment calls the reader's attention to the potential deconstruction of the federative relationships of the Single Health System described and analyzed in the text proposed for, if the Executive's new tax reform, which is currently proceduring, is approved.
Debate
The article seeks to dialogue with the discoveries presented by Luciana Dias de Lima in her article about fiscal federalism and decentralized funding of health in Brazil by presenting partial, unpublished results of a study carried out between 2006 and 2008 regarding basic care funding strategies in cities with more than 100,000 inhabitants in the State of São Paulo. The study involved two interrelated modules: secondary data collection and analysis, seeking to relate health funding indices on the local plan to basic care performance levels, and semi-structured interviews with health managers of selected cities. The results show, on one token, that the different basic care models that exist in the cities, as well as the differentiated levels of efficacy and effectiveness of the municipal health systems, are related to the health funding and expenditure standard in these cities; and, on the other, that there are several aspects that tend to play decisive roles in the availability of financial resources for the development of basic care, including committing resources with medium-complexity and high-complexity services and the city's political alignment with the remaining spheres of government.
Interview
Nelson Rodrigues dos Santos made a long testimonial, in December 2005, to the Health Technician Observatory of the Joaquim Venâncio Polytechnic School of Health (Fiocruz). The goal was to record the trajectory of a historical leader, both in the fight for democracy and in the sanitary reform in a project developed by the Observatory about the memory of professional education for health in Brazil. It focused on the 1980's and 1990's, which witnessed moments of great political tension in the country, as represented by re-democratization, sanitary reform, the National Constituent Assembly, and the neoliberal turn in the health policies. In this interview, a revised and updated synthesis of that testimonial, "Nelsão," as he is called by his friends, talks about his background and about the choice he made for Collective Health, discusses themes related to the Brazilian health sector in the past few decades, ranging from the genesis of the SUS to the victories and defeats of the public policies in the social area. A graduate in medicine and holding a doctoral in preventive medicine from the University of São Paulo, respectively in 1961 and 1967, he was a full professor of Collective Health at the Federal University of Londrina and a Consultant for Opas/OMS. Nelsão is currently a collaborating professor at the State University of Campinas and the president of the Applied Sanitary Law Institute (Instituto de Direito Sanitário Aplicado, Idisa).
Experience Report
The text describes a group experience in education in health carried out in a family health unit in Joinville, state of Santa Catarina, in which an attempt was made to cover issues that were relevant to that population's health. The approach was experienced by five students and an undergraduate professor of Nursing from the Associação Educacional Luterana Bom Jesus/Ielusc, in 2005. Education in health in groups allowed us to put the teaching acquired in the Collective Health III class into practice. The activity focused mainly on getting all of the professionals, the students and the users of the health system present there involved and participating with their knowledge and experience. We approached issues related to diabetes mellitus and systemic arterial hypertension, with emphasis on diet. During the activity, we sought to adapt the materials and the language to the users' reality. The activity began with speeches made by the participants to discuss changes in habit to improve quality of life. As reflections, we believe that working with preestablished popular knowledge and culture requires caution, persistence, patience, and professional motivation; respecting them and, above all, developing listening skills. To us, the opportunity was to learn and to teach.