health promotion in brazil paulo marchiori buss president of fiocruz conference at the 1st brazilian...
TRANSCRIPT
Health Promotion
in Brazil
Paulo Marchiori BussPresident of Fiocruz
Conference at the
1st Brazilian Seminar on Health Promotion Effectiveness
Rio de Janeiro, May 10th 2005
THE LAST 35 YEARS OF
HEALTH PROMOTION (1970 – 2005) - I
• 70’s – Health Systems crisis: Ineffectiveness, inequities and credibility crisis vis-a-vis the demographic-epidemiological transition: ageing, change in nosologic patterns, medicalization, technological development and the boom of costs and expenses.
• New concepts of health-disease-care process, more globalizing, linking health and quality of life.
• Lalonde Report (1974) – Health field: Human biology, environment, lifestyle and health service organization.
“Until now, most of society’s efforts to improve health, and the bulk of direct health expenditures, has been focused on the health care organization. Yet, when we identify the main cause of sickness and death, we find that they are rooted in the other three elements of the concept.” (A New Perspective on the Health of Canadians)
THE LAST 35 YEARS OF
HEALTH PROMOTION (1970 – 2005) - II
• Health for All by the Year 2000 (1977) – 30th World Health Assembly
• International Conference on Primary Health Care (1978)Declaration of Alma Ata
Eight essential points to achieve health for all:• education on prevailing health problems, prevention and control• promotion of food supply and proper nutrition• adequate supply of safe water and basic sanitation• maternal and child health care, including family planning.• immunization against the major infectious diseases• prevention and control of locally endemic diseases • appropriate treatment of common diseases and injuries• provision of essential drugs
THE LAST 35 YEARS OF
HEALTH PROMOTION (1970 – 2005) - III
• 1986 – Ottawa Charter for Health Promotion 1st International Conference on Health Promotion (Canada)
• 1988 – Adelaide Recommendations on Healthy Public Policy 2nd International Conference on Health Promotion (Australia)
• 1991 – Sundsvall Statement on Supportive Environments for Health 3rd International Conference on Health Promotion (Sweden)
• 1993 – Caribbean Charter for Health Promotion
1st Caribbean Conference of Health Promotion (Trinidad y Tobago)
• 1997 – The Jakarta Declaration on Health Promotion into the 21st Century
4th International Conference on Health Promotion (Jakarta)
• 2000 – 5th Global Health Promotion Conference (Mexico)
THE LAST 35 YEARS OF
HEALTH PROMOTION (1970 – 2005) - IV
THE UN “PREPARES” THE WORLD FOR THE 21st CENTURY
• 1990 – UN World Summit for Children (New York)
• 1992 – UN Conference on Environment and Development (Rio de Janeiro)
• 1993 – UN World Conference on Human Rights (Vienna)
• 1994 – International Conference on Population and Development (Cairo)
• 1995 – UN 4th World Conference on Women (Beijing)
• 1995 – World Summit for Social Development (Copenhagen)
• 1996 – Second UN Conference on Human Settlements (Habitat II) (Istanbul)
• 1996 – World Food Summit (Roma)
• 2004 – Millenium Development Goals ( U.N. - New York)
HEALTH PROMOTION
HISTORICAL LANDMARKS IN BRAZIL - I
70’s
Criticism on assistance-based model (focused solely on medical care and hospitals)
Social Medicine and the emergence of social sciences in the analysis of problems and health interventions
O Dilema Preventivista (The Preventivist Dilemma) (Sérgio Arouca, 1975)Community Projects and primary care (Montes Claros and Niterói)
ENSP renewal: PESES-PEPPE [Program for Social and Economic Studies & Program for Population Studies and Epidemiological Research].
CEBES [Brazilian Center of Health Studies] (1976)
ABRASCO [Brazilian Association of Graduation in Collective Health] (1979)
HEALTH PROMOTION
HISTORICAL LANDMARKS IN BRAZIL - II
80’s
Fight for Brazil’s redemocratization: 1985, New Republic
Sanitary Reform Movement
1986 – VIII National Health Conference: extensive participation of public health and of community.
Reinforcing principles on health promotion (without this particular label) and the social determination of the health and disease process as well as its intersectoral relations (again, without this label).
1986-1988 – New constitution developed with extensive participation of the
school of thought and political action of the Sanitary Reform Movement.
In 1988, the Federal Constitution was rectified with the health promotion approach.
HEALTH PROMOTION
FEDERAL CONSTITUTION - THE SUS ACT
Ottawa Charter: 1986; VIII National Health Conference: 1986; Federal Constitution: 1988; SUS Acts (8.080 e 8.142): 1990
Article 196: “Health is a right of all and a duty of the State and shall be guaranteed by means of social and economic policies aimed at reducing the risk of illness and other hazards and at the universal and equal access to actions and services for its promotion, protection and recovery”
Act 8.080 (article 2): “Health determinants are, among others, food, basic sanitation, the environment, labor, income, education, transportation, leisure and the access to consumer goods and social services; the health levels of the population reflect the social and economic organization of the country.” (§ 3)
Among the directives are (article 198):Comprehensive health care Community participation
FEDERAL CONSTITUTION - THE SUS ACT
• Universal Access
• Gratuity
• Comprehensiveness: promotion, prevention, care and reabilitation; pharmaceutic assistance
• Descentralization
• Unified direction in each sphere of government
• Social Control
• Public Financing
• Complementary participation of the private iniciative: mix public/private for the delivery of services
• Regulation: ANVISA; ANS
SUS – SOCIAL CONTROL
• National, State and Municipal Health Councils
• Equal Composition: State – Society
• Approval of Health Policies and Plans
• Regular funcioning with varied effectivity
• National Conferences
• National and other levels: every 4 years, also with equal composition
HEALTH PROMOTION
HISTORICAL LANDMARKS IN BRAZIL - III
90’s
• Development of Health Councils at municipal, state and federal levels: formal social control; equal number of members(State and civilian); intersectorial representation
• 1992 – Earth Summit (Rio 92): Agenda 21
• 1995 – National Health and Environment Plan in Sustainable Development, following Pan-American Conference on the subject. Plan was not carried out.
• 1995 – Community Health Aides Program; Family Health Program
• 1998 – Agreement btw ENSP/FIOCRUZ - ABRASCO - CPHA/CIDA
ORGANIZATION OF HEALTH SERVICE
“Family Health” is a strategy for organization and strengthening of basic care as the level of care in
the Unified Health System (SUS)
It aims at strengthening care by expanding access, qualifying and reorienting health
practices based on Health Promotion
STRATEGIC PRINCIPLES
OF FAMILY HEALTH
ENROLLMENT OF CLIENTELEPrecise definition of covered area
TERRITORY DEMARCATIONArea mapping, involving environment and population
HEALTH SITUATION OF THE POPULATIONSurvey of families and individuals, generating data for the
analysis of health situation in the area
LOCAL PLANNINGProgramming activities based on health risk,
prioritizing problem solving
HEALTH PROMOTION
WORK PROCESS CHARACTERISTICS IN FAMILY HEALTH - I
INTERDISCIPLINARITY
Interdisciplinary work, integrating technical and professional areas of different educational orientations
INVOLVEMENT
Participation on the social dynamics of assisted families and of the community itself
CULTURAL COMPETENCE
Valuing different knowledge and practices on a comprehensive and resolutive approach, leading to trust, with ethics, commitment and
respect
HEALTH PROMOTION
WORK PROCESS CHARACTERISTICS IN FAMILY HEALTH - II
COMPREHENSIVINESS
Integral, continuous and organized care to the enrolled clientele, assuring access to complementary resources
SOCIAL PARTICIPATION
Community involvement in the planning, execution and evaluation
INTERSECTORIALITY
Intersectoral work, linking together social projects and related sectors oriented to health promotion
STRENGTHENING LOCAL MANAGEMENT
Supporting strategies to reinforce local management
FAMILY HEALTH
Team composition:•Physician
•Nurse•Nurse auxiliary
•Community health aides•Dentist
•Dental assistant•Dental higienist
HEALTH PROMOTION
Examples of federal programs and actions - I
• Family Health Strategy in Basic Care Reorganization of basic care, entrusting new families to multi-professional
teams and taking comprehensive actions on promotion, prevention and care
• Community Health Agents A part of the Family Health Program; in certain places, they work by
themselves, taking actions on promotion and prevention
• Family Stipend Program and Minimum Income ProgramUse of federal resources to increase family income in order to provide better access to food and to improve families’ health and nutrition conditions, as well as basic education
HEALTH PROMOTION
Examples of federal programs and actions - II
•Breastfeeding
•Friendly Postman Action to encourage and promote breastfeeding. Postmen disseminate information door-to-door.
•Child Friendly Hospital Iniciative Around 230 hospitals throughout the country encouraging and promoting breastfeeding in nursery rooms and among mothers of hospitalized children
•National Policy on Food and Nutrition To include micronutrients: Iron & folic acid in flour; iodine in salt (federal laws)
•Human Milk Bank National Network (IFF/FIOCRUZ) 180 units
HEALTH PROMOTION
Examples of federal programs and actions - III
• Program of Education and Health through Physical Activity and Sport
Action Brazil Centers (“Agita Brasil”)
• National Program of Immunization (PNI)
Vaccines: BCG, Polio, DTP-Hib, MMR, Yellow Fever Vaccine, Influenza
Vaccine (for adults). Future: Rotavirus Vaccine and 7-Pneumococcus
Vaccine
• Program to Humanize Prenatal Care and Childbirth
Improving access to and quality of prenatal care, as well as, assistance to
childbirth and puerperium and newborn, including health promotion
practices; civil registration
HEALTH PROMOTION
Examples of federal programs and actions - IV
•National Program for Cervix Uteri and Breast Cancers Control Education, early diagnosis (Pap smear and breast self-examination) and treatment
•National Program for Smoking Control and Other Cancer Risk Factor Professionals trained in more than 3,000 municipalities in Brazil: schools, corporations and local communities.
Intersectoral actions: Product registry; Sales prohibited for children and adolescents; Publicity restricted in the media;
Regulation of maximum levels of tar, nicotine and CO; Warnings in cigarette packs ;Smoking prohibited in public buildings and aircrafts; Cigarette free schools, work environments and health units
HEALTH PROMOTION
Examples of federal programs and actions - V
• Health Promoting SchoolsWHO/PAHO program: incipient actions throughout the country
• Adolescent Health Program The Adolescent Health Program is aimed at all youths between 10 and 19
years of age and is characterized by its comprehensiveness and focus on prevention and education
• School Health Program Educational videos to be broadcasted on School TV (TV Escola), a TV
channel of the Ministry of Education
• Alcohol Control Advertisement restriction; sales prohibition for under 18
HEALTH PROMOTION
Other actions
• Brazilian Network of Healthy Municipalities
• Healthy communities: Integrated and Sustainable Local Development – DLIS - Manguinhos
• Health-related messages on soap operas
• Social support groups: Alcoholics, obese, smokers, pregnant women, breastfeeders, handicapped
• Traffic Law: extra-sectoral initiative, large impact on morbidity and mortality, safety belt
• Gun Control
HEALTHY PUBLIC POLICIES
PRIORITIES IN RECENT SCENARIOS IN BRAZIL
Morbidity and mortality burdens as well as the present social and economic situation, indicate the best public policies related to health promotion today in Brazil:
• Housing
• Basic Sanitation: water, sewage systems and solid waste • Food safety; food and nutrition policies
• Education: illiteracy; universalization of basic education
• Minimum income through the Family Stipend Program