Hello, this is the beginning of the first module of the “Worker’s Health with Emphasis on Mental Health” course. My name is Elzimar Peixoto, I have a master's in psychology and I have worked for the national public health system (SUS) for over 20 years. This first module, which is entitled “Health-illness Process - Reflecting on the Relationship Between Social Organization and Health” has the objective of reflecting on some important aspects related to this theme.
Some of these aspects are; the explanatory models of health-disease processes, and the concept of health and its relation to social contexts. These two topics will be covered in this video. In later videos, we will work with the concept of health, the production of mental health and madness, and the notion of work as one of the determining factors of health.
To begin our conversation, I would like to propose a very simple question. “What is health to you? ” Think, reflect, and write down what comes to your mind as you think about the term “health.
” I’ll give you some time to reflect on this. One, two, three… Here we go, did you maybe think of health as not being sick? As being a gift from God?
As feeling well? Or did you think of it as total well-being? Or even still, did you think of it as having money, a job, leisure, or being in love with life?
Did you think of it as a right and a duty of the state? These are possibilities and concepts that have been built throughout history. So, many of you when thinking about health, probably came up with these ideas.
And it’s no wonder you did because the concept of health is a social construct and over time, we have changed these conceptions. Therefore, they are present in our history and our lives, and will surely help us formulate a concept of health. It is important to recognize the concept of health as a social construct because it is related to how our society has been organized over time and how the concept of health has shifted throughout different periods in history due to social movements.
In order to organize our thinking, we can divide this historical construction into three major cycles for pedagogical purposes. We can think of the religious; biomedical; and health promotion cycles, or an expanded concept of health. I imagine that many of you may think of health as a gift from God, or maybe that health, or the absence of it, disease, has something to do with sin and punishment.
Historically, before the 17th century, this was a very present concept, because we still didn't have the scientific knowledge to understand how diseases occurred and what caused them, so the only possible explanation at that time was to think of illness as a divine interference. The idea of health, then linked to religion and punishment, also applied to those who dedicated themselves to taking care of the sick. This spirit and idea of caretaking were strongly related to guaranteeing a place in heaven, and salvation.
Still, in the 17th century, there were large groups of people who needed assistance. According to Foucault, these were referred to as “the poor. ” Not in the sense that we think of nowadays, but in the 17th-century sense that they were all those people who needed some form of assistance, either because they were sick, or because they had no place to live or food to eat.
This large group together constituted the concept of “poor people. ” From the moment we started to learn more about diseases and became able to identify some of the factors that were indeed causing disease, we began to create tools that enabled us to distinguish, within that great group of people referred to as “the poor”, those who were effectively sick, from those who were there because they needed some kind of support, like food and shelter. The ability to separate those who really needed health assistance from those who were not really sick was only possible because we started identifying some pathogenic agents that effectively caused a disease.
This was important progress. We didn't know much about diseases until we started to identify agents, such as bacteria, bacilli, viruses, etc. , as the causes of some of them.
This was an extremely important aspect of the historical development of society. It allowed us to actually care for and treat those who were sick, and offer other forms of assistance for those who were not. One of the big issues about the causes of diseases during that period was: “Are they caused by a single factor or pathogenic agent, or are there other factors that lead to illness?
” Up until that time, this was still unclear, and although that time period was marked by great progress, there was an emphasis on pathogens as the origins of disease. Thus, diseases were understood to be caused by a single factor, a single cause. It was only later that some scholars started defending a multicausal explanation, in which other factors were contributing to the causation of diseases.
Obviously, this was not that simple. We’re talking about a development of centuries in which this knowledge was being accumulated and the emphasis of the health/disease process was on the cure of a particular disease; the locus of care was the hospital; the logic of care was fragmented and focused on the individual. This model lasted for a long time, linking the concept of health to the absence of disease; “If I am not sick, I am healthy.
” This concept remained for a long time. But then you may think, ok, it makes sense, being healthy is not being sick, ok. What brought about the shift?
What caused us to reflect on this logic and start to think in a different way? Do you have any idea? Can you imagine what great event or historical moment could have been so important for us to reflect on this logic of thinking about health only as the absence of disease?
Again, take a moment to think about it. Well, this great event is related to World War II. After World War II, with Europe in particular destroyed, the holocaust, concentration camps, and all the suffering and violence that society had gone through, a group of ambassadors came together in 1946 to devise a plan to reorganize and recuperate Europe.
And one of the aspects discussed at that event was the issue of health. How was it possible to think that health was just the absence of disease in the aftermath of a war? Can you imagine that?
To believe, in the post-war period, that someone who is ill is only someone who has a clearly identified disease? It didn’t fit, right? Hence, in 1948 a document was produced reinforcing this idea that health is a complete biopsychosocial well-being and not merely the absence of disease.
Look at what a shift, what progress, the perception of health that is constituted from a historical process that is extremely important. This logic of thinking about health not only as the absence of disease but as complete biopsychosocial well-being makes us think and approach the third cycle, which is the cycle of health promotion and the expanded concept of health. Why?
What is well-being for each one of you? What is it for you, watching this video? What is it for your neighbor, friend, and co-worker?
It has a different sense for each person, right? However, in order to move towards the search for this well-being, we need to have some determinants, some conditions that can lead us to this process in the search for Well-Being. Then, an idea of the social determinants of Health emerges, and the idea of an expanded concept of health arises where we need to think about health and its determinants in a much broader way.
So, the definition of total well-being is very subjective and unique to each individual. Each person will define what well-being is for them. For each of you, your friends, neighbors, relatives, and co-workers.
Each individual will have their own understanding of what it is. The idea is that in order to move towards this quest for well-being, which is so singular and subjective, we need some conditions, some basic determinants that will enable us to move in this direction, and it is these minimum conditions that will lead us to this well-being. Here I’m talking about: work, shelter, leisure, food… These are social determinant conditions that can and should be available as a right to all people so that they can progressively build this process in the search for their complete well-being.
This logic of health and the expanded concept of health leads us to think that health is a right of all and a duty of the State. International health conferences on primary health care have ardently defended the proposal that we cannot have health unless we have the minimum conditions for that, and to achieve this, the state needs to guarantee some of these conditions. In Brazil, we come from an extremely important movement that led to the inclusion of the SUS (national public health system) in 1988 in our Constitution stating that health is a right of all and a duty of the state.
A movement in an attempt to have these health determinants recognized and made available to all of us. Our objective here is for you to understand how the concept of health has been constituted over time, that a process is something that is always changing, and that most likely in a few years or decades, we may think about health in a different way. This will not lead us to completely eliminate the idea of health as the absence of disease because this is part of our history and will not simply be abandoned.
It will still be present, but with a different view or emphasis from the moment that we as a society are constituted in different ways. Ok? That's all we have for today.
Cheers!
