MOOCS Saúde Mental Relacionada ao Trabalho - 04 - O trabalho como um dos determinantes do processo

Hello, my name is Roberta Mello Vello Poldi, I am a master and specialist in work and collective health. I have been working at SUS (the Brazilian National Public Health System) for 18 years, and as a work surveillance coordinator for the city of Vitória for 10 years. I'm here to give continuity to module 1, which is the “Health-illness Process - Reflecting on the Relationship Between Social Organization and Health.

” Briefly reviewing: in the previous classes we were introduced to some explanatory models of the “Health-illness Process and its Relation to Social Context. ” We articulated the concept of health with the production of mental health and madness. And now, we will initially talk about work as one of the determinants of the health-disease process.

When we talk about an expanded concept of health, and Elzimar spoke a lot about this in the previous classes, we are referring to the notion of health as a citizen's right and duty of the State. Therefore, when we think about this expanded concept of health, we realize that several factors interfere with and influence the health of individuals and population groups. What factors are these?

Have you stopped to think about it? What determines people’s health? We could say there are two major groups: one more individual, related to age, genetic heritage, and gender.

For example, it is easy to compare a group of young people with a group of elderly people. We naturally understand that these groups of people have different health conditions. These are natural inequalities.

However, there is another group, the Social Determinants of Health (SDH). But what are these Social Determinants of Health? There is no consensus.

There are several definitions. Some more detailed and others with a lesser degree of detail. According to the World Health Organization, SDH are the social conditions in which people live and work.

In Brazil, in 2006, a presidential decree created the National Commission on Social Determinants of Health, with the objective, among other things, of disseminating information and knowledge on this topic. According to this commission, SDH are socioeconomic, cultural, and environmental characteristics of a society that influence the living and working conditions of all its members. Several models have been proposed to study Social Determinants, and the relationship between the various factors studied.

Currently, one of the most widespread models in Brazil is the Dahlgren-Whitehead model of health determinants, which includes the SDH arranged into five different layers, more specifically. As a supplementary reading for this module, I suggest the text by Buss and Pellegrini Filho, 2007, which is widely consulted when talking about the Social Determinants of Health. According to these authors, people’s characteristics of age, gender, and genetic factors are at the base of the model, all of which influence their health conditions.

The next layer represents individual behaviors and lifestyles, such as smoking, choosing a healthy diet, or exercising. This layer is situated on the threshold between individual factors and the Social Determinants of Health, as behaviors often understood to be of individual responsibility are also strongly conditioned by determining factors such as information, peer pressure, and, above all, the possibility of access. For example, I may know that a healthy diet is important, but not be able to afford it because this kind of food is too expensive.

I may know that physical exercise is important, but live in an area with no facilities that favor this kind of practice. But then one might say: “well, you could go for a walk on the street. ” Forgetting to think that it might be a dangerous location and I would be putting myself at risk.

So, we need to consider that different people have different possibilities of choice. The next layer highlights the influence of community support networks, whose greater or lesser wealth expresses the level of social cohesion, which as we have seen, is of paramount importance for the health of society as a whole. The next level represents factors related to living and working conditions, the availability of food, and access to specific environments and services, such as health and education.

This indicates that socially disadvantaged people are more at risk due to more vulnerable housing conditions, less access to services, and exposure to more dangerous or stressful working conditions. Finally, at the last level are the macro determinants related to the economic, cultural, and environmental conditions of society, which have a strong influence over the other layers. The SDH are responsible for producing health iniquities.

They are the product of human action; therefore, they can also be transformed by human action through public policies, and this justifies the importance of studying them. We are referring to a network of determinants that overlap all the time, however, in this course we are going to shed light on one of these determinants in particular; Work. Either through its existence/performance, or its absence/unemployment.

It is precisely this perspective on work and the conditions in which it is performed that is key to better understanding this course. If this is clear to you, it will be easier to understand the subsequent lessons. Work is not a priori something negative or positive for mental health.

What indicates whether work will become a promoter of health and pleasure or a promoter of suffering and illness are the conditions and how it is carried out, as well as the significance it assumes in the life of each individual. If we look at the following images, in which people are smiling, we have the impression of a collaborative and healthy work environment, and they give us the idea of work with a positive significance. On the other hand, how do we feel when looking at these other images?

These are just some of the many images available on the internet when we search for “working conditions in the production of charcoal. ” But there are countless others as bad or even worse than these of other production cycles. Do these seem like healthy environments, or do they pose a health risk?

Pause and think about it. Do you think that working in these places under these conditions can generate some kind of illness? And the time to which these people are exposed to that risk while working?

Whether daily hours or longer periods, does that influence or interfere with this possibility? Reflecting on the Social Determinants of Health and seeing these images, I believe it becomes easier to understand that illness is not distributed equally in populations and that some people are indeed more likely to get sick and die earlier than others. To understand the relationship between work and health, it is necessary to base oneself on the individual's experience, and this is a very dear principle for those who work and advocate for workers' health rights.

The workers are the ones who do the work and they are the ones from whom the work is demanded. And they are the ones who know the conditions they have to carry it out. Therefore, if the intention is to know how work is making workers sick, it is necessary to listen to them and allow them to talk about their work.

They need to report how they are experiencing this work, and how they manage to respond or not to the demands imposed on them. On the other hand, and no less important, is the need to understand how companies and managers are or are not providing conditions for workers to do what is demanded of them. In practice, understanding this ailment process is not so simple, since it is also necessary to consider that workers do not react nor are affected in the same ways, even when experiencing similar issues.

This is especially important when we refer to suffering and mental illness. It is necessary to analyze the established demands and the means available so that the work can be taken on and carried out. These demands include both physical, emotional, and cognitive aspects.

Let me give you some examples to clarify. Physical aspects: the workload; intensity and pace, which machines or even peer pressure can determine. This is very common in goal-oriented jobs.

Emotional aspects: the strain of dealing with people; contact with suffering; the need to hide emotions; the need to calm people down; fear while performing the work. Cognitive aspects: the complexity of the work; having to think of several things at once; having to learn new things all the time; exerting a high degree of concentration; the need to follow strict rules. The means, in turn, encompass not only elements of the physical environment, which are still important but also other types of resources and capabilities that are necessary for the worker.

Among these are: adequate physical environment, which includes light, temperature, absence of noise, and adequate equipment. Qualification: content and training time; the acquisition, development, and improvement of knowledge; the process and organization of work; the social and supportive relationship of management and colleagues; the relationship of effort and recognition. These are some of the means among others we could mention.

It is important to understand that the relationship between demands and means needs to be analyzed within a temporal dimension. Workers can experience a great imbalance between demands and means, and be able to face them for a certain period without consequences for their health. However, if this imbalance is prolonged, it could lead to illness.

In short, we can say that when there is a constant and prolonged between the pressures and demands of work and the capacities and resources on the part of workers to respond, this imbalance can lead to suffering and mental illness in many cases. Therefore, to think about health promotion in the work environment is to think about this balance and the significance that work has for the worker. To sum up, this was one of the initial approaches to the notion of work as one of the determining health factors.

It was not our intention to exhaust this subject here, as in the other modules we will delve further into these issues. We will go into the world of work, highlighting its transformations, the factors that can facilitate illness, and the factors that can generate health. So, take a deep breath and stay with us because we will do this together.

See you later!