A abordagem familiar e comunitária na Saúde da Família: desvelando contradições e construindo mediações críticas

Abstract

This thesis aims to analyze the family and community approach to Family Health in the context of hegemonic dispute between society and health projects in Brazil. Appointed by the Ministry of Health as a strategy to change the care model, the implementation of the Family Health, in a scenario of targeted policies, now requires the formulation of instrumental resources to approach and intervene with the families and the community. The research was guided by the hypothesis that the family approach and community recovery conservative perspectives. To problematize the theme, we take as reference the critical-dialectical method. The apprehension of the research object was made from bibliographical research, with a historic partner analysis from the review of references of Social Theory, Public Health and Collective and Social Service, which deal with themes such as capitalism, health, family, community. We aim to understand how health policy is organized facing the demands of capitalism and how to set up the assistance to the family and the community at different historical moments. In a second stage, we analyze the teaching material of specialized courses in Family Health, provided by the spaces of formation of the UNA-SUS, by electronic means, published between 2009 and 2016, offered by the following universities: UERJ, UNIFESP, UFMG, UFMA, UFMS, UFSC. The analysis of the material was carried out from the recognition of content, data systematization and analysis of results through the axes: conception about health and disease, health policy, work process, health education, family, community and approach instruments. In the historic construction of health policy, the family and the community have been spaces for reproduction of control logics and social adjustment through hygienists practices, campaigners, developmentalists, but also mobilizing the struggle for health as a right. In the hegemonic dispute between projects in the health, the Family Health expressed the transformism of the Health Reform groups, reaffirms SUS rationalization movement and shows the upward trend of the mental approach to the detriment of the social. As can be seen in the content of courses, family and community approach is built from systemic references, functionalist, phenomenological and postmodern, which since the 1970s are questioned under the Brazilian Social Service. In the context of counter-reform it reaffirms the logic of subjectivity of social life, empowerment, transfer of responsibilities, accountability for social protection through care, individualization and consequent culpability by living conditions and health.