Health Promotion

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• Health Promotion
• in Brazil
• Paulo Marchiori Buss
• President of Fiocruz
• Conference at the
• 1st Brazilian Seminar on Health Promotion
  Effectiveness
• Rio de Janeiro, May 10th 2005

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THE LAST 35 YEARS OF HEALTH PROMOTION (1970
2005) - I

• 70s 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 societys 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)

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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

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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)

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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)

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HEALTH PROMOTION HISTORICAL LANDMARKS IN BRAZIL -
I
70s 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)
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HEALTH PROMOTIONHISTORICAL LANDMARKS IN BRAZIL -
II

• 80s
• Fight for Brazils 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.

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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
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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

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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

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HEALTH PROMOTION HISTORICAL LANDMARKS IN BRAZIL -
III

• 90s
• 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

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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
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STRATEGIC PRINCIPLES OF FAMILY HEALTH
ENROLLMENT OF CLIENTELE Precise definition of
covered area TERRITORY DEMARCATION Area mapping,
involving environment and population HEALTH
SITUATION OF THE POPULATION Survey of families
and individuals, generating data for the analysis
of health situation in the area LOCAL
PLANNING Programming activities based on health
risk, prioritizing problem solving
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HEALTH PROMOTION WORK PROCESS CHARACTERISTICS IN
FAMILY HEALTH - I
INTERDISCIPLINARITY Interdisciplinary work,
integrating technical and professional areas of
different educational orientations INVOLVEMENT Par
ticipation 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
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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 INTERSECTORIALI
TY Intersectoral work, linking together social
projects and related sectors oriented to health
promotion STRENGTHENING LOCAL MANAGEMENT Supportin
g strategies to reinforce local management
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FAMILY HEALTH

• Team composition
• Physician
• Nurse
• Nurse auxiliary
• Community health aides
• Dentist
• Dental assistant
• Dental higienist

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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 Program
• Use 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

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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

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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

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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

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HEALTH PROMOTION Examples of federal programs and
actions - V

• Health Promoting Schools
• WHO/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

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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

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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

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