Information, control and health promotion in the Brazilian context of the pandemic.

This article discusses how preventive and promotional discourses have been incorporated by the Brazilian population in the context of the coronavirus pandemic. It analyzes materials posted on the internet and social after the first case of COVID 19-related death in Brazil that are related health promotion and COVID-19 aimed at orienting society's response to the pandemic. The analysis considers two key factors: the mismanagement of the pandemic by the Brazilian government and infodemic. There is complex use of scientific information with recommendations that focus on what people should do (intervention) and in transforming individuals' behaviors, based on an ideal model of healthy behaviors. Narratives aimed to delegate to the population and specific groups the task of taking care of themselves have been reinforced, removing from the State the responsibility to offer conditions for the population to address the situation. There is a sophistication of strategies that blame individual practices, personal organization and that are disconnected from the collective, especially for those who live in situation of extreme vulnerability. Concomitantly, there are also discourses based on notions of solidarity and renewed social connections, which are empowering and consistent with the practice of health promotion as it attributes meanings to the subjects and their ways of life. We conclude that greatest advocacy in the field of health promotion at this moment is political and could be directed toward reaffirming health promotion principles, supporting permanent mobilization against setbacks in the public sphere and defending a new, democratic, inclusive and collective vision of society.

Percepções dos profissionais de linha de frente da saúde sobre HIV e juventudes / Frontline health professionals' perceptions about HIV and youth

RESUMO A temática do HIV ainda é permeada de estigmas e culpabilização de indivíduos por seus comportamentos. Políticas públicas, incluindo a de HIV/Aids, são baseadas em categorias políticas que geram efeitos simbólicos, reproduzindo ou enfrentando estigmas. A literatura afirma que Trabalhadores da Linha de Frente (TLF) mobilizam valores pessoais e profissionais nas interações com os usuários, que podem incluir categorias sociais ou políticas. Este artigo objetivou compreender como TLF operam tais categorias em contextos institucionais de ambiguidade, bem como analisar se suas percepções com relação às categorias de comportamento de risco e juventude estão em consonância com as políticas públicas. Foram analisadas 8 normativas e entrevistados 42 trabalhadores de 6 serviços de saúde. Os materiais foram codificados, as categorias oficiais foram comparadas, e as práticas, identificadas. As conclusões sugerem que as categorias sociais e políticas têm influência mútua. As categorias políticas ainda são legitimadas por meio de percepções sociais de normalidade e risco, especialmente ao lidar com populações prioritárias. As categorias sociais, operadas na implementação reforçam estigmas e julgamentos morais sobre alguns jovens, como os negros e pobres, as mães solteiras e a comunidade LGBTQIA+. Os serviços especializados utilizam mais as categorias políticas do que os serviços de atenção primária.

ABSTRACT Discussions about HIV are still permeated with stigmas and placing blame on individuals for their behavior. Public policies, including those related to HIV/AIDS, are based on political categories that can generate symbolic effects, either by reproducing or confronting stigmas. The literature points out that frontline health workers (TLF) apply personal and professional values in their interactions with service users, and that these values may be influenced by social or political categories. This article aims to understand how TLF operate such categories in institutional contexts that might be ambiguous, as well to analyze whether TLF's perceptions of categories related to risk behavior and youth are in line with public policies. We analyzed 8 policy documents and interviewed 42 workers from 6 health services. The materials were coded, the official categories were compared and the practices were identified. The findings suggest that social and political categories have mutual influences. Political categories are still legitimized through social perceptions of normalcy and risk, especially as it relates to priority populations. Social categories, which operate in policy implementation, reinforce stigmas and moral judgments about certain young people, such as blacks and the poor, single mothers and those who belong to the LGBTQIA+ community. Specialized services utilize political categories more than primary care services.

Curitiba Statement on Health Promotion and Equity: voices from people concerned with global inequities.

This Statement represents the voice of participants in the 22nd IUHPE World Conference on Health Promotion, held in Curitiba, Brazil, in May 2016. The Brazilian political context at that time greatly influenced the drafting of the Curitiba Statement, which was considered by many participants as an opportunity to categorically express that Brazilian democracy was threatened, as well as the danger of fiscal austerity implemented by many governments of the world. The conference organizers also perceived the launching of this Statement as an opportunity to influence the WHO Shanghai Declaration, since it very strongly stated the influence of commercial interests and corporate practices of the market that are harmful to health. The Curitiba Statement gathers 120 suggestions made by conference participants and focuses on how strengthening health promotion and equity can improve people's lives. The 21 recommendations were summarized and resulted in appeals to International Organizations, all levels of Governments, Health Sector, Citizens, Health Professionals and Researchers. Unlike a declaration from government summit that are restricted by governments negotiations from different ideological spectrum, the Curitiba Statement was developed in a free environment to foster professional activism. We reaffirm that the objectives of Health Promotion in the Sustainable Development will only be fully achieved by incorporating these four fundamental principles: democracy, social justice, social mobilization and equity. Health Promotion in the twenty-first century needs new narratives and inputs from professional associations, which can be more assertive and to influencing the official declarations of government.

A construção da intersetorialidade: o caso da Rede Intersetorial Guarulhos Cidade que Protege / The construction of intersectoriality the case of the Intersectoral Network Guarulhos Cidade que Protege ("Guarulhos, the City that Protects")

As sociedades contemporâneas passam por processos de transformação social rápidos e profundos. Essas põe em xeque as teorias, conceitos e modelos considerados eficazes para alavancar o desenvolvimento econômico e social e enfrentar as crises sociais decorrentes das iniquidades sociais. É necessário compreender como se dá a inserção de estratégias como a intersetorialidade e a formação de redes que instigam novas formas de gestão para superar as fragmentações sociais e transformar estruturas institucionais e dinâmicas políticas. A pesquisa realiza um estudo de caso sobre como as práticas intersetoriais e o trabalho em rede estão sendo incorporadas na Rede Intersetorial Guarulhos Cidade que Protege, implementada em Guarulhos, São Paulo, desde 2010 para enfrentar a violência que afeta crianças e jovens. Realizou-se um estudo qualitativo para compreender as concepções e significados da atuação intersetorial e em rede para os atores que a desenvolvem e implementam. Também teve como objetivo compreender a estrutura das redes criadas, identificar fatores que intervêm na produção da intersetorialidade e na formação de rede, quais as condicionam e como estas contribuíram para os resultados da iniciativa. A produção de dados baseou-se em 56 entrevistas semi-estruturadas, selecionando-se os sujeitos pela técnica Bola de Neve, observação, revisão documental e Análise de Redes Sociais. Identificaram-se 90 parceiros e 170 parcerias ativas. As atividades realizadas pelas parcerias incluíram discussão de caso, ações de encaminhamento e seguimento, reorientação de práticas de trabalho, matriciamento, projetos conjuntos, ações em conjunto tendo como grupo alvo as famílias e usuários dos territórios, entre outras. Os resultados indicam que as parcerias seguem a lógica da administração pública e das redes de serviços setoriais existentes, com poucas articulações com a sociedade civil e outros setores. Apontam também as potencialidades do trabalho em rede com a consolidação de estruturas de apoio à intersetorialidade, fortalecimento da capacidade dos atores sociais para o trabalho intersetorial, promoção de novas parcerias, fortalecimento de laços de confiança e relações entre atores sociais e ações direcionadas ao enfrentamento da violência. Constatou-se também a gestão intersetorial limitada pois esta se estabelece em estruturas setoriais e fragmentadas, fragilizando sua capacidade de ação e deliberação e a contribuição que esta poderia oferecer às ações de enfrentamento da violência no município. Coloca-se em dúvida a ideia da intersetorialidade como prática social compartilhada ou modelo de gestão de políticas públicas que promova a autonomia e interdependência dos setores envolvidos. Conclui-se propondo dois marcos analíticos: um para apoiar o planejamento da Rede Intersetorial para o enfrentamento da violência a partir do olhar ampliado ao território e em conexão com órgãos da Rede Municipal de Proteção da Criança e do Adolescente, e outro que sistematiza como a intersetorialidade e as redes podem contribuir para as transformações sociais, políticas e institucionais no contexto da sociedade em rede e informacional.

Contemporary societies are undergoing rapid and intense transformations. These challenge current theories, models and concepts that are considered effective to promote economic and social development and to address social crises that arise from social inequities. It is important to understand how strategies such as intersectoriality and network development are incorporated into such context as they promote new management models to address social fragmentation and transform institutional structures and political dynamics. The research conducted a case study on how intersectoral practices and network models are being developed within the Intersectoral Network Guarulhos Cidade que Protege ("Guarulhos, City that Protects"), implemented in the city of Guarulhos, São Paulo, since 2010 to tackle violence that affects children and adolescents. A qualitative study was conducted to understand the conceptualizations and significance of intersectoral action and networking for those who are developing and implementing them. The study also aimed to comprehend the structure of the networks created, which factors intervened in the production of intersectoriality and network development and which ones conditioned them, and how these processes contributed to the initiative´s results. Fifty-six (56) semi-structured interviews were conducted; subjects were selected through the snowball technique. The study also included observation and document analysis. Ninety partners and 170 partnerships were identified. Activities conducted by these partnerships included case discussions, community mapping, referrals and follow-ups, reorientation of work and team practices, joint projects, development of activities with families and users in territories, among others. Results pointed out that partnerships usually followed the logic of the public administration structure and service networks with few partnerships being developed with civil society and others. The data highlight the potential of networks to help consolidate supporting structures for intersectoral action, strengthening the capacity of social actors for intersectoral work, promoting new partnerships, increasing trust, improving relationships among social actors and fostering actions aimed at addressing violence. It also highlighted that intersectoral management was limited given that such arrangements took place within sectoral and fragmented structures, a situation which weakened the capacity of the intersectoral actions undertaken and the contribution that they could make to decreasing violence in the city. The results challenge the assumption that intersectorial collaboration is a socially shared practice or a management model of public policies that promotes autonomy and interdependence among the sectors involved. The study concludes with the proposal of two analytical frameworks: one aimed at supporting better planning for the Intersectoral Network to address violence by considering a greater scope of social actors in the territory and seeking better connections with other entities that conform the Municipal Network for the Protection of Child and Adolescents, and another model that synthesizes how intersectoral action and networks can contribute to social, political and institutional transformations in the context of our network and informational society.

The right to the city and International Urban Agendas: a document analysis. / O direito à cidade e as agendas urbanas internacionais: uma análise documental.

Considering social, economic and demographic issues, living in the city implies inadequate living conditions, social exclusion, inequities and other problems to the population. At the same time, the city is a setting of cultural, social and affective production. As a result, there is a need to reflect on the right to the city and its relationship with promoting the health of its inhabitants. To that effect, urban agendas have been developed to address the city's ambiguity. This paper aims to analyze four of these agendas through the lenses of Health Promotion. A qualitative document review approach was conducted on urban agendas proposed by international organizations and applied to the Brazilian context: Healthy Cities, Sustainable Cities, Smart Cities and Educating Cities. Results indicate some level of effort by the analyzed agendas to assume social participation, intersectoriality and the territory as central to addressing exclusion and inequities. However, more in-depth discussions are required on each of these concepts. We conclude that urban agendas can contribute greatly toward consolidating the right to the city, provided that their underpinning concepts are critically comprehended.

Considerando as problemáticas sociais, econômicas e demográficas, viver na cidade implica condições inadequadas de moradia, exclusão social, iniquidades e outros agravos à população. Simultaneamente, a cidade também é cenário das produções culturais, sociais e afetivas. Cresceu, então, a necessidade de refletir sobre o direito à cidade e a relação com a promoção da saúde de seus habitantes. Para contribuir, agendas urbanas foram construídas pensando nesta ambiguidade da cidade. Objetiva-se analisar quatro destas agendas à luz do referencial da Promoção da Saúde. Foi realizada uma pesquisa documental de abordagem qualitativa de agendas urbanas propostas por organismos internacionais e adotadas em contexto brasileiro: Cidades Saudáveis, Cidades Sustentáveis, Cidades Inteligentes e Cidades Educadoras. Os resultados mostram que há empenho, em maior ou menor grau, por parte das agendas analisadas, em assumir a participação social, a intersetorialidade e o território como fundamentais no enfrentamento das exclusões e iniquidades, mas há falta de debates aprofundados sobre cada um destes conceitos. Conclui-se que as agendas urbanas podem ser importante aporte na consolidação do direito à cidade, desde que haja a compreensão crítica dos conceitos que as sustentam.

O direito à cidade e as agendas urbanas internacionais: uma análise documental / The right to the city and International Urban Agendas: a document analysis

Resumo Considerando as problemáticas sociais, econômicas e demográficas, viver na cidade implica condições inadequadas de moradia, exclusão social, iniquidades e outros agravos à população. Simultaneamente, a cidade também é cenário das produções culturais, sociais e afetivas. Cresceu, então, a necessidade de refletir sobre o direito à cidade e a relação com a promoção da saúde de seus habitantes. Para contribuir, agendas urbanas foram construídas pensando nesta ambiguidade da cidade. Objetiva-se analisar quatro destas agendas à luz do referencial da Promoção da Saúde. Foi realizada uma pesquisa documental de abordagem qualitativa de agendas urbanas propostas por organismos internacionais e adotadas em contexto brasileiro: Cidades Saudáveis, Cidades Sustentáveis, Cidades Inteligentes e Cidades Educadoras. Os resultados mostram que há empenho, em maior ou menor grau, por parte das agendas analisadas, em assumir a participação social, a intersetorialidade e o território como fundamentais no enfrentamento das exclusões e iniquidades, mas há falta de debates aprofundados sobre cada um destes conceitos. Conclui-se que as agendas urbanas podem ser importante aporte na consolidação do direito à cidade, desde que haja a compreensão crítica dos conceitos que as sustentam.

Abstract Considering social, economic and demographic issues, living in the city implies inadequate living conditions, social exclusion, inequities and other problems to the population. At the same time, the city is a setting of cultural, social and affective production. As a result, there is a need to reflect on the right to the city and its relationship with promoting the health of its inhabitants. To that effect, urban agendas have been developed to address the city's ambiguity. This paper aims to analyze four of these agendas through the lenses of Health Promotion. A qualitative document review approach was conducted on urban agendas proposed by international organizations and applied to the Brazilian context: Healthy Cities, Sustainable Cities, Smart Cities and Educating Cities. Results indicate some level of effort by the analyzed agendas to assume social participation, intersectoriality and the territory as central to addressing exclusion and inequities. However, more in-depth discussions are required on each of these concepts. We conclude that urban agendas can contribute greatly toward consolidating the right to the city, provided that their underpinning concepts are critically comprehended.

A contribuição do CEPEDOC para a construção da Política de Promoção da Saúde no Brasil / The contribution of CEPEDOC to the development of the Brazilian Health Promotion Policy

Resumo A Política Nacional de Promoção da Saúde (PNPS), institucionalizada no Sistema Único de Saúde em 2006, e revista em 2014, contou com a contribuição de vários núcleos existentes no país, entre eles o Centro de Estudos, Pesquisa e Documentação em Promoção da Saúde e Cidades Saudáveis (CEPEDOC), uma Organização não Governamental ligada à Faculdade de Saúde Pública da Universidade de São Paulo, hoje Centro Colaborador da Organização Mundial de Saúde. Esta colaboração iniciou-se antes da Política ser institucionalizada: houve participação na criação de subsídios teóricos e práticos que justificassem a sua existência e participação na mobilização e advocacia para sua criação. O objetivo deste artigo é demonstrar a participação independente do CEPEDOC, como uma ONG, na aplicação e revisão das teorias e princípios da Promoção da Saúde através projetos realizados, das produções científicas resultantes e dos relatos da participação em mobilizações que contribuíram para efetivação da PNPS como política e prática importante para a produção social da saúde com equidade.

Abstract The Brazilian Health Promotion Pol- icy (PNPS, for its acronym in Portuguese), institutionalized in the National Public Health System in 2006 and revised in 2014, resulted from the contribution of various groups, including the Centro de Estudos, Pesquisa e Documentação em Cidades Saudáveis (CEPEDOC) [Center for Studies, Research and Documentation on Healthy Cities], a non-governmental organization linked to the School of Public Health of the University of Sao Paulo, and currently designated as a WHO Collaborating Center. This collaboration took place since before the institutionalization of the Policy through the participation in the development of the practical and theoretical bases that justified the existence of the policy and the mobilization and advocacy for its creation. This article aims to demonstrate the independent participation of CEPEDOC, as an NGO, in the construction of the PNPS objectives through its projects, scientific production, participation in events and that contributed to the development of the PNPS as a key policy and practice for the social production of health with equity.

Lessons learned from the application of a participatory evaluation methodology to healthy municipalities, cities and communities initiatives in selected countries of the Americas.

Health promotion has made significant strides in the past few decades in the Americas. Creating a healthy and supportive setting, also known as the settings approach, continues to be one of the most widely used health promotion strategies. Interest in evaluating the effectiveness of these strategies has been increasing greatly in the past few years. Participatory evaluation holds great promise for helping to generate this evidence and promote understanding of the factors that affect, positively or negatively, the advances of health promotion in the Region. During 2004-2006, a Participatory Evaluation methodology was introduced into several countries in the Americas through formal trainings conducted by the Pan American Health Organization (PAHO) in collaboration with country partners. This article summarizes the main lessons learned from the application of the participatory evaluation methodology in various countries in Latin America and the Caribbean. Factors affecting the evaluation of the initiatives were identified at multiple levels (individual, community, organizational, political, economic, etc.). Specific issues that were addressed included the political context, turnover of personnel in key institutions, concerns related to the effectiveness of participatory processes, and the existence of strong and sustained leadership at the country level. These factors are intertwined and affect each other in very complex ways, a fact that was reflected in the municipalities' experiences with participatory evaluation. Challenges included the ability to secure resources for the evaluation, the time needed to conclude the process, and working in an intersectoral manner. However, participating municipalities reported that the process of implementing a participatory evaluation and working with various stakeholders had an empowering effect: communities and stakeholders were more willing and interested in participating in health promotion initiatives in a sustained manner; alliances and intersectoral collaboration were strengthened; communication channels were opened; and municipalities were stimulated to review their planning and implementation processes in order to more appropriately incorporate health promotion principles. The article concludes with recommendations to improve the planning and implementation process of participatory evaluation efforts.

Documenting the current state of the healthy municipalities, cities and communities initiative in the americas.

The objective of this study was to document the challenges, achievements, and lessons learned in municipalities where the Healthy Municipalities, Cities and Communities (HMC) strategy has been implemented in the Americas. A general survey was distributed through the HMC online network and through the Pan American Health Organization country offices. Municipalities answered questions regarding the planning, implementation, and evaluation phases of the strategy. Fifty-seven municipalities answered the survey. Ninety-three percent of the municipalities had signed a written agreement of political commitment to the HMC strategy. While 60% of the surveyed municipalities reported having a local health and well being situational analysis, 70% had an HMC Action Plan and only 58% had a follow-up and evaluation plan. The activities in which municipalities are engaged under the banner of the HMC strategy vary greatly in the Americas Region with varying degrees of success. Intersectorial collaboration and evaluation continues to be a challenge for the HMC initiative.

Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce.

Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included.