Hello! In the last class, we went over some basic assumptions, some basic premises that we need to consider in intervention strategies on mental health and work. In this class, we're going to talk specifically about strategies within the logic of prevention and health promotion.
First, we need to define what health promotion is. Do you know this term? Have you heard it somewhere before?
We have considered so far that health has several determinants, including work. So, acting within the logic of health promotion means acting on these health determinants, reaffirming that health is not merely the absence of disease. Brazil has a National Health Promotion Policy that proposes interventions in three thematic axes, with a focus on people's quality of life.
In one of these axes, we can observe that working conditions and relations are contemplated there. So, what does this mean within the logic of health promotion? That promoting health is to intervene in working conditions and relations, the improvement of work environments, the reduction of occupational illnesses and accidents at work and in humanized health services.
And who can act and contribute to promote the mental health of workers? Is it just the employer? Or the worker?
We can see here in this diagram that there are several institutions that play an important role in promoting health at work, such as unions, the Department of Labor Inspection, the Public Ministry of Labor, the CIPAS - Commissions for Accident Prevention, The SUS, the occupational medical services of private companies, and workers and employers So, as we have seen so far, It is important that this effort, these interventions in mental health be collective, especially when we are talking about health promotion, when we want to intervene in the determinants. We want to work before an illness process takes place. It is important that this work be a collective effort and involve this range of actors.
So far, we have talked about what we understand as health promotion, which means intervening in these determinants of the health-illness process, including work. And what do we understand by prevention? In a broad sense, we can say that it includes all the measures, including specific therapies that limit either the emergence of illnesses or their progression.
To talk a little more about prevention, we will use a model which indicates that there are three levels of prevention: the primary, the secondary and the tertiary. What do we consider primary prevention? The actions we take to remove the causes and risk factors of an individual or collective health problem before the appearance of a clinical condition.
So, here, in this primary prevention, we are acting before the disease emerges, before the illness process occurs, acting on the risk factors that lead to the appearance of a certain illness. At work, we can say that an example of primary prevention is the focus on interventions on factors that cause illness at work, on those psychosocial risk factors, and on the chemical risk factors we saw that may also be related to the illness process. So, the primary intervention, the primary prevention, will act before the illness, before the disease appears.
In secondary prevention, we are thinking about actions that will help detect a health problem at an early stage. So, we already have an illness condition, but in the initial process. In that case, for example, we can think of workers that may be in an environment of risk, of high exposure, such as professionals who work shifts, for example, and are constantly exposed to the risk of suffering and illness.
This should be the target of constant screening and tracking measures and early identification of certain issues, such as sleep disorders, for example. In the case of tertiary prevention, we are talking about implementing actions to reduce, in one individual or individuals in a population, the functional impairments arising from an acute or chronic problem. Including rehabilitation.
So, in the case of tertiary prevention, we are talking about acting when a problem has already occurred, including rehabilitation strategies. So, for example, workers who are already harmed by exposure to psychosocial risks and require measures to minimize the effects of this exposure. In this case, it is possible for example, that the worker is absent or on sick leave frequently, or is more introverted.
There may be a drop in performance, and even a concrete verbalization of this suffering, such as burnout, occupational stress, or depression. The task of reinserting these workers who were on leave, may also require tertiary prevention strategies. For all these levels of prevention, from primary, through secondary to tertiary, there are strategies that can be common, such as guaranteeing spaces for speech, collective spaces, spaces for support and social support.
These spaces are important in any of these levels of prevention. But there are specific strategies for each of these levels. In the case of primary prevention, which is when the disease has not yet established itself, it is important that we have clear organizational structures and practices, that we invest in training and development of workers, that we are able to promote changes in the organization of work that minimizes the psychosocial risks that are present in that work organization.
Notice that all these strategies are acting at the primary prevention level. When we think of secondary prevention, we can, for example, make use of strategies like relaxation techniques, adequate professional training to deal with the difficulties that are already present at work, conflict management, we might have a context of conflict where it will be important to make use of some strategy to manage this interpersonal conflict, and the offer of education and training for workers. When we talk about tertiary prevention, some other strategies will also be important, such as effective counseling, listening spaces, referral to specialized services - if I have a worker who is already developing an illness process, this worker will require other intervention measures.
At all these levels of prevention, It is important that the employer or the manager understands the importance of these prevention strategies and ensures that these strategies can be adopted in that work environment. Even if the employer understands and guarantees these strategies take place, it is important to listen to the workers so they can direct, so that these strategies are thought of according to the reality pointed out by the workers. And we will emphasize again: all intervention actions need to be complementary, need to be transversal, and need to be constructed within a collective logic that considers the worker and his understanding of the work process itself.
In the next class we will look at some prevention strategies focusing on the work context. Until the next class!
