Vila Health: Creating a Culture of Evidence

Vila Health: Creating a Culture of Evidence

You continue your work with the EBP intervention Team at St. Anthony Medical Center. Over the last three months, the organization has conducted an evidence-based intervention to address the hospital’s poor patient safety scores. Now, it’s time to review data about the results of the intervention. It’s also time to make recommendations for how the hospital can move forward to creating a culture of evidence.

You have an email from Andrea Branch, the EBP Intervention Team Lead.

EMAIL INBOX

Inbox – (1)

PDSA Cycle Outcomes – First Quarter 2018

From: Andrea Branch, EBP Intervention Team Lead

To: Kayla Stephens

Thank you so much for all of your work on the patient safety intervention. Here is a report on how the intervention went over the past 12 weeks. I pulled data from our tracking system for the first quarter of 2020 for the same indicators with poor performance in 2018 and 2019.

According to the data, it seems like we might be making a difference so far, but you will be the best judge of that. Here are the 2018 and 2019 yearly rates again, and at the bottom you will see the first quarter of 2020 rates:

2018

1. Patient Falls – Expected: 0 Observed: 3

2. Medical Errors causing patient allergic reaction – Expected: 0 Observed: 2

3. Staff member in Emergency Department (ED) needed urgent treatment for concussion = 1

2019

1. Medical Errors causing patient allergic reaction – Expected: 0 Observed: 4

2. Staff member in Emergency Department needed urgent treatment for lacerations = 1

3. Nurse on critical care unit slipped and broke her arm = 1

2020

1. Patient Falls – Expected: 0 Observed: 0

2. Medical Errors causing allergic reaction – Expected: 0 Observed: 1

I also wanted to mention that the EBP Intervention Team seems to think that staff members like the new Incident Reporting (IR) system.

Also, they heard about a couple of incidents where water was spilled in the ICU, and one of the nurses reported each of these incidents immediately. She said it was about time we had an IR system where we could see possible immediate results and make positive changes to the safety of our environment.

I also heard that the Lead Nurse in ICU had two huddles with all staff in the unit, including Environmental Services staff, on the importance of preventing slips and falls for both staff and patients and ensuring the floors in rooms and stations are clean and any spills are taken care of immediately. The Environmental Services staff members mentioned it to their supervisors and I guess their department will be adding one more round during the evening hours to help ensure floors are clean and not slippery for anyone. The Lead Nurse was even thinking about creating an educational poster on preventing falls to put up on the wall in the break room as a reminder.

Anyway, that is just what I heard. Maybe if there is another formal town hall or something like that we can all talk about everyone’s experiences and get some input on how it’s going for everyone with the implementation of the intervention using PDSA cycles.

I suggest you speak with Emilio Ramirez, the PDSA Team Director, to ask questions and gain insight on how you might write your final report and create a culture of evidence at St. Anthony Medical Center.

Again, thanks for all of your hard work.

Sincerely,

Andrea

St. Anthony Medical Center

You meet with Emilio Ramirez, the PDSA Team Director, to discuss your next steps, including how to move forward with building a culture of evidence at the hospital.

 

 

What questions do I need to be asking myself as I complete my final report?

Emilio: That’s an excellent question. One important question you should yourself is, “When do I want another report?” What kind of time frame is needed to ensure that you have the data you need. Another important question is, “How are we going to sustain this?” Going forward, do you have a plan to obtain continued buy-in by stakeholders, as well as the resources you need to continue with the intervention?

EMAIL INBOX

Inbox – (1)

Final report

From: Jackie Sandoval, CNO

To: Kayla Stephens

I am aware of the success of the evidence-based intervention with the PDSA cycle team and with the nursing staff. This is great news! Now we need to spread this optimism about EBP throughout the organization.

As you write your final report and make recommendations to foster engagement by various stakeholders in the organization to create and sustain a culture of evidence. Please address the following:

· Differing opinions that existed within the medical staff.

· Organizational culture.

· Leadership strategies.

· Communication planning to share the results with stakeholders across the organization.

Thank you for all your hard work!

– Jackie

Topic: Reduce asthma deaths

Topic: Reduce asthma deaths — RD‑01, https://health.gov/healthypeople/objectives-and-data/browse-objectives/respiratory-disease/reduce-asthma-deaths-rd-01

– 7 peer-reviewed published scientific articles within the prior 15 years, with at least 3 of these studies published within the prior 5 years that are analytic (causal designs) about a specific environmental population health problem or issue, using the matrix method for performing a literature review.

– write a 1-2 paragraph, a brief narrative synthesis of the findings. Primary studies will be entered into the provided matrix document and dissected according to major components of scientific research

– The following criteria are required: I. Basic literature search information (10 points): 1. A statement of the exact Environmental Health problem or issue in a specific population that was searched in the literature review. II. Matrix Tables (45 points): 1.Matrixes must contain a minimum of seven column headings, with the following titles and information: a “references” column that contains a reference for each study including the Author (s) name, article title, journal name, volume and page numbers; (2) a column containing the year of article publication listed by the oldest published studies first; (3) a column containing the type of study design; (4); a column containing the recruitment process with the final number enrolled; (5) a column containing the major statistical results; (6) a column containing study limitations, (i.e., potential sources of bias); and (7) a column containing implications for population health (See matrix template for assignment usage)

– The matrix will be accompanied by an approximate 250 word or 1-2 paragraph, a written summary that will discuss the major collective findings across the literature that were dissected and synthesized through your literature review using the Matrix as a tool.

– Example of this matrix method by another student is in the link down below along with the matrix template.

MATRIX ASSIGNMENT TEMPLATE

MATRIX ASSIGNMENT TEMPLATE

Name:

 

Descriptive statement of the Environmental Health issue or problem and specific population that was researched in the literature review dissection and synthesis using the matrix method:

 

 

 

 

 

 

Article ReferencesYear of publicationStudy Design and Aim(s)Recruitment and final number enrolledMajor resultsLimitationsImplications for Population Health
 (List articles from oldest to newest to see improvements / consistencies over time with a glance of the matrix)([A]Study Design: List: Cohort; case control; randomized controlled trial; quazi-experimental; cross sectional; ecological.

[B] Aim(s): Major aim(s) pertaining directly to the EHS you are researching)

Recruitment

process and final number enrolled)

(Major statistical results pertaining to primary aims)(Major sources of potential epidemiological bias)(Major findings pertaining directly to the EHS issue you are researching; can include professional Public Health practice, policy, and research)
(1)      
(2)      
(3)      
(4)      
(5)      
(6)      
(7)      

 

 

Written Narrative of Literature Synthesis: A one to two paragraph synthesis of the major collective findings that pertain directly to the Environmental Health problem / issue researched through the literature review dissection and synthesis. It is recommended to read every column heading vertically from top to bottom and write a brief summary of the findings seen across the literature over time from each heading category including, types of study designs utilized, study populations and recruitment strategies, major results, major epidemiological limitations, and implications for future public health practice, research, and policy.

 

 

 

 

 

 

 

 

 

 

Policy Decisions

Policy Decisions

Program evaluation results can be used to make informed policy decisions that will improve the effectiveness of public health programs and improve the health of the population. Once you can verify a program’s effectiveness, you want to encourage your legislators to push the process to the next stage: translating ideas into legislative policy. How can you use the evaluation results of your intervention program to define and implement your policymaking strategy?

Your Practicum and Systems-Thinking Tools

Your Practicum and Systems-Thinking Tools

You have been exposed to various systems-thinking and building tools used in public health delivery, prevention, evaluation, and measurement, including GIS mapping, statistical software systems such as SPSS, SWOT analysis, GAP analysis, and logic models. Think of a specific example in which your practicum site used a systems-thinking tool to address a public health issue and respond to the following:

  • Describe how the tool allows the practicum site to address a public health issue in the community.
  • Analyze, using the chosen systems-thinking tool, how the practicum site influences the community’s health behaviors to address health disparities or public health concerns.
  • Discuss, based on your knowledge of the public health issues and systems-building tools, whether you would have chosen a different tool to address the issue or used the one selected. Substantiate your response with evidence from the literature.

This paper was written based on the oral presentation in the VI Brazillian Congress of Social and Human Sciences in the Health Field, in 2013.

Saúde Soc. São Paulo, v.24, supl.1, p.201-214, 2015 201

Alan Osmo Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil. E-mail: alan.osmo@usp.br

Lilia Blima Schraiber Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil. E-mail: liliabli@usp.br

The field of Collective Health: definitions and debates on its constitution1

O campo da Saúde Coletiva: definições e debates em sua constituição

Correspondence Lilia Blima Schraiber Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. Av. dr. Arnaldo, 455, 2ºandar. São Paulo, SP, Brasil. CEP:01246-903.

DOI 10.1590/S0104-12902015S01018

1 This paper was written based on the oral presentation in the VI Brazillian Congress of Social and Human Sciences in the Health Field, in 2013.

Abstract At first sight, Collective Health might seem to be multiple and fragmented. Aiming to understand better what defines it as knowledge and activity in society, we made a theoretical review of historical and epistemological considerations developed by researchers who dedicated themselves to character- izing it as a scientific and social field. First, based on this literature, we provide a brief panorama of the emergence of Collective Health in Brazil. It is important to notice that its origins date back to the end of the 1970s, in a context in which Brazil was experiencing a military dictatorship. Collective Health emerges, at that moment, connected with the struggle for democracy and with the Health Reform movement. We show the influences of preventive medicine and social medicine in its constitution. Then, we explore different attempts to delimit it as field of knowledge and practice. We sought to present Collective Health not through one single definition, but taking into account the multiplicity of constructions about it that we found. This allows us to point to an identity of difficult development and that is still under construction. Keywords: Collective Health; Public Health; Social Medicine; Scientific Domains; Knowledge.

 

 

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Resumo A Saúde Coletiva pode, em um primeiro contato, parecer bastante múltipla e fragmentada. Buscando compreender melhor o que a define como conhe- cimento e atuação na sociedade, realizou-se uma recuperação de natureza teórica das considerações históricas e epistemológicas desenvolvidas por pesquisadores dedicados a caracterizá-la como campo científico e social. Primeiro, com base nessa produção bibliográfica, foi feita uma breve caracte- rização da emergência da Saúde Coletiva no Brasil. É de se destacar que suas origens situam-se no final da década de 1970, em um contexto no qual o Brasil estava vivendo uma ditadura militar. A Saúde Coletiva nasce, nesse período, vinculada à luta pela democracia e ao movimento da Reforma Sanitária. Apontam-se as influências do preventivismo e da medicina social em sua constituição. Ao longo deste estudo, foram exploradas distintas tentativas de sua delimitação como campo de saberes e de práticas. Buscou-se apresentar a Saúde Coletiva não com uma definição única, mas considerando a multiplicidade de construções encontradas, o que permite apontar para uma identidade de difícil elaboração e ainda em desenvolvimento. Palavras-chave: Saúde Coletiva; Medicina Social; Domínios Científicos; Conhecimento.

Introduction What instigated the choice of the theme for this study was the perception that, at first sight, Collec- tive Health seems to be multiple and fragmented, both from the theoretical and from the practical points of view. Therefore, aiming to understand it better, a study was carried out, based on the produc- tion in Collective Health in Brazil, in an attempt to answer the following questions: What characterizes and defines Collective Health? What distinguishes it from other fields of knowledge and intervention?

In this preliminary reflection on such issues, we decided to revisit studies that viewed it as a specific field and that were conducted by authors who are considered references in Collective Health, as they participated in the development and implementa- tion of the proposal for a Collective Health in Brazil at the end of the 1970s. These authors are research- ers in the areas of Epidemiology, Human and Social Sciences in Health, and Health Policy, Planning and Management, and have studied the constitution of Collective Health from these distinct fields.

The reference that Collective Health configures a “field” is registered in almost all the publications. In this text, we will maintain this reference following Paim and Almeida Filho (1999, 2000). In their reflec- tions on Collective Health, these authors character- ize it as a “field of knowledge and an specific sphere for practice”: “Collective Health can be considered an interdisciplinary field of knowledge whose ba- sic disciplines are epidemiology, health planning/ management and social sciences in health” (Paim; Almeida Filho, 2000, p. 63).

However, in a recent publication that focuses on Collective Health, this qualification of “field”, which, since the beginning, has been grounded in the con- cept coined by Pierre Bourdieu (1993), is relativized, in view of the fact that Collective Health, sometimes called “area”, sometimes “social space”, has, in its development, a tendency to consolidate as a field (Vieira da Silva; Paim; Schraiber, 2014).

In light of this open question, as a future or consolidated field, what most instigated us was the delimitation of a scientific and practical identity based on its knowledge contents and intervention scopes. Thus, in the above-mentioned revisit to pub-

 

 

Saúde Soc. São Paulo, v.24, supl.1, p.201-214, 2015 203

lications about the construction of Collective Health

in Brazil, we aimed to reveal which areas of expertise

have been mentioned since its origins. Less than a

bibliographic review, therefore, this study aims to

present a rereading of important discussions on the

identity of Collective Health.

This is an effort to clarify what constitutes

the “whole” of Collective Health, in an attempt

to overcome a possible fragmentary view that

has been produced by the diverse disciplines

that compose it, in order to provide a better un-

derstanding of the construction of its identity.

According to Everardo Nunes (2005), this effort

seems to be an important concern in the history

of Collective Health:

Recovering the history and unveiling its internal

composition (epistemé) has been one of the con-

cerns of many studies and analyses that have been

following the very construction of Collective Health

in Brazil. This effort has been present since the

1980s and continues to the present day, with the

aim of providing the elements that configure our

identity and reveal who we are, where we are, what

we do, and the products of our practices (p. 14).

The present paper is divided into two parts. The

first briefly approaches the constitution of Collec-

tive Health in Brazil as presented by authors in the

field. In this part, we emphasize schools of thought

about health-disease processes in collectives as

ways of thinking that are different from that of the

traditional public health and from that based on the

view coined by modern medicine. The way in which

questions of medicine and of public health are ar-

ticulated is the reference to understand the issues

that surround the disciplinary content that the Col-

lective Health proposal has embraced. The second

part explores contrasts among distinct attempts to

define Collective Health. These contrasts are also

present in texts written by authors in the field, who

present different perspectives on the delimitation

of Collective Health, and indicate the existence of a

large multiplicity of schools of thought concerning

its definitions as a field.

The constitution of the field of Collective Health in Brazil Nunes (1994) situates the origin of the field of Col- lective Health in the 1950s. Vieira-da-Silva, Paim and Schraiber (2014) consider that it dates back to the end of the 1970s, as the benchmark they utilize is the emergence of the term Collective Health in Brazil, and the creation of the civil association that would represent the field: the Associação Brasileira de Pós- Graduação em Saúde Coletiva (Abrasco – Brazilian Association of Postgraduate Programs in Collective Health). However, the authors do not deny the roots that Nunes has pointed in previous periods. Thus, Collective Health consolidated with this name and with its specificities in Brazil. Although the name has not been adopted in other countries, many authors see Collective Health as part of a broader movement in Latin America, as Nunes himself has argued (1994).

Based on a distinction between “project” and “field” of Collective Health, Nunes (1994) proposes that the emergence of this field occurred in three stages: the first, called pre-Collective Health stage, lasted for fifteen years from 1955 onwards, and was marked by the establishment of the preven- tive medicine’s project; the second, which lasted until the end of the 1970s, is called social medicine stage; the third goes from the end of the 1970s to, at least, 1994, when the author wrote the paper Saúde coletiva: história de uma ideia e de um conceito (Collective health: the history of an idea and of a concept). The author considers that the last stage is the period of Collective Health per se. Accord- ing to Nunes (1994, p. 2), “the emergence of these projects reflects, generally speaking, the broader socioeconomic and political-ideological context, as well as the successive crises that are present both in the epistemological level and in the level of health practices and human resources education”.

Paim and Almeida Filho (1999) also point to the importance of context in issues related to field of knowledge. These authors, based on the ideas proposed by Kuhn and Rorty, defend that the con- struction of scientific knowledge is not produced by investigators in an isolated way, in the abstract; rather, it is institutionally organized, within cul-

 

 

204 Saúde Soc. São Paulo, v.24, supl.1, p.201-214, 2015

ture, and immersed in language. Therefore, science would be socially and historically determined. The authors propose that science should be understood as a social practice that has particular principles, is exercised in a process of dialog and negotiation, is targeted at the production of a localized and dated consensus, and is based on a certain solidarity of those who act in the scientific community.

We believe that an important advantage of this periodization is that it highlights preventive medicine and social medicine as approaches to the health-disease process in collectives that can be recognized as the roots of the Collective Health proposal that was developed in Brazil, and which influenced the institutional implementation of the field.

In the sections below, we will characterize these roots so that it is possible to understand the modal- ity of disciplinary and practical proposition that they constituted.

1) Preventive Medicine

According to Paim and Almeida Filho (1998), in the 1940s, some researchers started to diagnose, in the United States, a crisis of a certain medicine that was extremely specialized and fragmented, which caused an increase in costs related to medical prac- tices. In response to this, proposals for changes in medical teaching emerged and incorporated into it an idea of prevention. These proposals were the basis for a reform of the curricula of medicine programs in many North American universities in the 1950s. International health organs adhered to the new doc- trine, which was called Preventive Medicine. Thus, the proposal was internationalized.

Nunes (1994) explains that the emergence of the “preventive project” in Latin America occurred in the second half of the 1950s, in the seminars that were held in Chile and Mexico, sponsored by the Pan American Health Organization (PAHO). The reforms that were defended in these seminars were associ- ated with a pedagogical plan:

The great balance of the period is the inclusion, in the

medicine undergraduate program, of disciplines and

themes associated with epidemiology, behavioural

sciences, health services management, and biosta-

tistics. Thus, when the biologization of teaching was

criticized, as it was grounded on individual, hospital-

centered practices, the aim was not only to introduce

other types of knowledge, but also to provide a more

complete view of the individual (Nunes, 1994, p. 7).

The fact that teaching was based on specializa- tion made medical education become shattered. As a reaction against this, proposals for changes in teaching were made, so that the future doctor could understand the individual as a whole, as it was believed that this would promote a recom- position of the bio-psycho-social dimension that had been fragmented. The social movement that originated Preventive Medicine as a discipline in the curriculum of medical schools was called Comprehensive Medicine, and aimed to recompose specialized practices (Schraiber, 1989). However, the only result was the inclusion of one discipline in the curriculum, even though it pervaded several moments of the doctor’s education. No integrative projects other than the teaching of prevention were incorporated, neither in doctors’ education, nor in their professional exercise in the health services. Schraiber (1989) has argued that these proposals intended to promote a reform of medical practice, but they assumed that this reform would be performed in the sphere of doctors’ education, as if each doctor in his/her practice was the main resource to transform the way of providing care for the population. This way of thinking about the reform of medical practice was well characterized, as a liberal and individualizing reading of social issues that was typical of the North American cul- ture regarding the State’s role in society, by Arouca (2003), in a publication that is considered, today, a bench mark for Collective Health in Brazil (Vieira da Silva; Paim; Schraiber, 2014).

In addition to Preventive Medicine, Community Medicine arrived at Latin America. It emerged, in the 1960s, also in the United States, in a period of intense popular and intellectual mobilization around social issues. Donnangelo and Pereira (1976) have shown that Community Medicine was a response to the low coverage of medical care for the poors, such as communities of migrants or low- income strata of the North American society, and to the low coverage for the elderly – as they were out of the job market, they had no adequate access

 

 

Saúde Soc. São Paulo, v.24, supl.1, p.201-214, 2015 205

to medical services. Diverse intervention models were tested and institutionalized in the form of organized movements in urban communities, aim- ing to reduce social tensions in the ghettos of the main North American cities. In the field of health, there was the implementation of community-based health centers subsidized by the federal govern- ment, which were targeted at performing preven- tive actions and providing primary care to the local population (Paim; Almeida Filho, 1998).

Like in Preventive Medicine, there was, in the Community Medicine proposal, an emphasis on the “behavioural sciences”. In this case, however, knowl- edge of sociocultural and psychosocial processes aimed to “enable the integration of healthcare teams in ‘problematic’ communities, through the identification and cooptation of local social agents and forces for health education programs” (Paim; Almeida Filho, 1998, p. 304).

International organs in the field of health incor- porated, once again, the new ideological movement, community-based and preventive, and translated its doctrine into the needs of different contexts in which it could be applied.

Although Community Medicine and Preventive Medicine emerged in different moments in the United States, they arrived more or less at the same time in Brazil (Donnangelo; Pereira 1976; Schraiber, 1989).

2) Social Medicine

The Social Medicine movement emerged in Latin America at the end of the 1960s and beginning of the 1970s. Its center is the discussion of the appre- ciation of the social dimension as the sphere that determines the emergence of illnesses and health possibilities, in disease prevention and health promotion. Furthermore, the social dimension is the adequate sphere for intervention, beyond and in articulation with medicine as intervention in individual cases (Vieira da Silva; Paim; Schraiber, 2014). Therefore, it is an alternative view to the biomedical reduction in which medical knowledge and practice structured themselves, even though with diverse explorations regarding the meaning of the appreciation of the social sphere. In this sense, the central figure in Latin America, with a strong influence in Brazil, was the Argentinian doctor

and sociologist Juan Cesar Garcia, by means of his work within the PAHO (Garcia, 1985; Nunes, 1983; Vieira da Silva; Paim; Schraiber, 2014). By valuing the presence of the social sphere in health, Garcia, like many Brazilian researchers who participated in the construction of Collective Health, searched for references in a historical-structural approach to the social sphere. Thus, he did not merely assume a segmented presence of the social sphere like the isolated approach to elements of the environment and of the population itself.

On the other hand, many authors refer to Social Medicine based on George Rosen’s studies, and they focus on the movement that emerged in Europe in the middle of the 19th century.

Regarding this, Nunes (1983) says:

This paper written by Rosen has been considered

of fundamental importance to the understanding

of social medicine, and one of the points that it

raises is the question of sanitary problems, which

increase due to the transformations deriving from

the industrialization process (p.19).

Rosen (1983) argues that a central issue in Europe during the 19th century was which political orientation the government should follow in order to increase national power and richness. The industry was considered one of the main means. As a result, work started to be seen by political leaders as an es- sential element to generate national richness. Any loss of productivity caused by illness and death was, at the time, seen as a significant economic problem. This approach implied the idea of a national public intervention in health, which was developed in many directions, depending on the country.

The first place in which the State’s concern for the population’s health problems flourished was in the German states, even before they were unified or underwent the industrialization process, and the idea of medical police emerged for the first time. Ac- cording to Rosen (1983), Polizei, in German (police), derives from the Greek word politeia. The theory and practice of public management came to be known, throughout the 18th century, in the German states, as Polizeiwissenschaft (science of police), and the branch that deals with health management, as Med- izinalpolizei (medical police).

 

 

206 Saúde Soc. São Paulo, v.24, supl.1, p.201-214, 2015

The development of the theory and practice of public administration was intimately related to the interests of the Absolutist State. Therefore, a sys- tematization of managerial thought and behavior was reached and it attributed wellbeing activities to the absolute State. However, the legislator was responsible for determining the greatest wellbeing, so that the State had the power to intervene in the individuals’ matters aiming at the common good. The development and application of the concept of “medical police” was a pioneering attempt to create a methodical and precise examination of health prob- lems from the social point of view. At the beginning and in the middle of the 19th century, it was in France that this type of study developed theoretically. In France, however, the concept of medical police was not broadly accepted (Rosen, 1983).

In the context of the French Revolution, health and wellbeing problems were addressed by the revo- lutionary governments. There was even an attempt to establish a national social assistance system that included medical care. Although it did not advance, some of the ideas and objectives of the period would deeply influence France in the first half of the 19th century. “Ideas of public service and social utility provided the seed from which new ideas germinated concerning the relation among health, medicine and society” (Rosen, 1983, p. 43).

During the first half of the 19th century, there was, in France, a fruitful encounter between so- cial philosophy and medicine. “As a result, French medicine was permeated, to a considerable degree, by the spirit of social change” (Rosen, 1983, p. 46). The contact with the new living conditions deriving from the industrialization process, such as workers’ conditions and the social reality in which they lived, caused the emergence of new ideas in the field of health in its relations to society. The idea of Social Medicine germinated in this scenario. Jules Guérin was one of the first authors to use this term, in 1848.

Nunes (2007) emphasizes that it was in a revolu- tionary context dating back to the 1840s that many doctors, philosophers and thinkers assumed the social character of medicine and illness. The ideas and proposals that had progressed in France before and during the revolutionary movement of 1848 spread across Germany. Among the main names of

the German movement, which assumed Social Medi- cine instead of Medical Police as its proposal for national intervention, were Neumann and Virchow. Neumann, in 1847 (apud Rosen, 1983, p. 50), states that “medical science is intrinsically and essentially a social science and, as long as this is not recognized in practice, we will not be able to enjoy its benefits and we will have to satisfy ourselves with emptiness and mystification”.

The proponents of the idea of medicine as a social science employed it as a conceptual formulation under which they summarized defined principles:

The first of these principles is that people’s health

is a direct matter of society and society has the

duty of protecting and guaranteeing its members’

health […]. The second, as Neumann noticed, is that

social and economic conditions have an important

and – in many cases – crucial impact on health and

illness and that these relations must be submitted

to scientific investigation […]. The third principle,

which follows the other two logically, is that the

steps taken to promote health and fight against

illness must be both social and medical (Rosen,

1983, p. 51-52).

The influence of this entire formulation on the Brazilian Collective Health can be seen, for example, in the fact that these principles were revisited in Brazil in the VIII Conferência Nacional de Saúde (CNS – 8th National Health Conference), in a reread- ing that was appropriate to the historical context of the 1980s and to the reality of a country in the periphery of the capitalist development. Therefore, these principles, as connections between medicine and the social sphere, will influence the Brazilian Health Reform.

However, the revolutionary process of the 1840s was defeated in Germany and also in France, and due to this, the medical reform movement ended quickly (Rosen, 1983). During the next decades, the broad reform proposal became a limited program. The idea of social medicine reappeared in a meet- ing summoned by the World Health Organization, WHO, in 1952, in Nancy and, later on, in a document released by the PAHO in 1974 (Nunes, 1994).

The end of the 1960s and beginning of the 1970s were extremely fertile years in terms of theoretical

 

 

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discussions about health-society relations. There was a great influence of discussions held by authors in the human sciences, and a bench mark was the lecture that Michel Foucault delivered in 1974, in Rio de Janeiro, about the origins of Social Medicine (Nunes, 2005), in which he re-discussed the signifi- cant content of this term. According to Paim (1992), at this moment, there was, in Brazil and in the rest of Latin America, an important theoretical production that recognized the bonds between health practices and the social totality. In this sense, the contribu- tions from the social sciences to the study of health were fundamental so that we could reach the current degree of systematization of knowledge in the field.

On the proposal of social medicine, Sérgio Arouca states:

Therefore, Social Medicine emerges with two

tendencies; the first […] a movement to modify

medicine connected with the process of change

in society, or […] through its institutional change

[…]; the second is an attempt to redefine the posi-

tion and place of objects inside medicine, to make

conceptual delimitations, to discuss theoretical

frames. In short, it is a movement at the level of

knowledge production that, through a reformu-

lation of the basic questions that enabled the

emergence of Preventive Medicine, tries to define

an object of study in the relations between the

biological and the psychosocial spheres. Social

medicine, by electing these relations as its field of

investigation, tries to establish a science that is

situated on the boundaries of the current sciences

(Arouca, 2003, p. 150).

In the fragment above, Arouca highlights two dimensions of Social Medicine: the formulation of proposals for intervention in social life and in medicine based on the health-society connection, and the proposal for establishing a branch of studies about this specific connection, focusing on illness issues and on issues related to the production of medical assistance and professional practices in the services. In addition to a criticism against a certain kind of medicine – expensive, fragmented and with few results to the population’s health -, there was also a discussion on the amplification of the health service coverage to the population. According to

Nunes (1994), it was the beginning of the crisis of the developmentalist model of public health, which had postulated that one of the effects of economic growth would be the improvement in health condi- tions. This is particularly valid for Brazil at the time. Although the country was undergoing a moment of economic growth, this produced no results to the living conditions of its population.

In the 1970s, there was, in the international scope, an intensification of the discussion about the amplification of health service coverage. The 1977 World Health Assembly launched the slogan “Health for all by the year 2000” (Paim; Almeida Filho, 1998). In Brazil, in a context marked by the strengthening of repressive forces on the part of an authoritarian State, as well as by an increase in social inequalities and a worsening of the living conditions of a large part of the population, a field of knowledge and of innovative practices was gradually built in the area of health.

Nunes (1983), referring to Laurell, argues that critical reflection on medicine and its institutions in Latin American countries at the time can be seen as an answer to four groups of questions: 1) class position explains the distribution of diseases in the population much better than any biological factor; 2) the belief that the population’s health conditions would improve as a result of economic growth proved to be wrong; 3) the development of medical-hospital care did not bring a significant advance in the health indexes of the groups covered by it; and 4) the dis- tribution of health services across different groups and social classes does not depend on technical and scientific considerations, but mainly on political and economic considerations.

3) Collective Health in Brazil

Paim and Almeida Filho (1998) have shown the existence of mutual influences between the devel- opment of a project of field of knowledge called Collective Health and the movements in favor of democratization in Brazil, especially that of health reform. This leads us to emphasize the importance of considering the historical context in which Col- lective Health emerged, which was that of a country living under an authoritarian regime. Thus, it is possible to state that the

 

 

208 Saúde Soc. São Paulo, v.24, supl.1, p.201-214, 2015

Alliance of Collective Health with democracy and

human and social rights is due to the historical

fact that the field is gestated in a decade marked

by social turbulences and movements claiming for

changes, in the fight against dictatorship in Brazil

and in favor of social reform (Schraiber, 2008, p. 15).

This social reform includes a health reform in the project of Collective Health. In Brazil, two institutions emerged directly connected with this project: Cebes and Abrasco. The Centro Brasileiro de Estudos de Saúde (Cebes – Brazilian Center for Health Studies) was created in 1976 “discussing the issue of democratization of healthcare and being constituted as an organizer of culture capable of reconstructing healthcare thought” (Paim, 2008, p. 78). According to Paim (2008), Cebes is recognized as the first institutionalized protagonist of the Brazilian health movement, and it has played an important role in the socialization of a critical aca- demic production coming from the then-emerging field of Collective Health.

Two important moments in the creation, in 1979, of the Associação Brasileira de Programas de Pós- Graduação em Saúde Coletiva (Abrasco – Brazilian Association of Postgraduate Programs in Collective Health) – today, Brazilian Association for Collective Health -, were the 1st National Meeting of Postgraduate Studies in Collective Health, and the Sub-Regional Public Health Meeting of the Pan American Health Or- ganization/Associación Latinoamericana de Escuelas de Salud Pública (PAHO/Alesp), both held in 1978. They aimed to redefine the education of personnel for the area of health, and proposed an association that was able to congregate the interests of postgraduate education institutions (Nunes, 1994).

The movement for the Brazilian health reform, which emerged in the middle of the 1970s, aimed to fight for the democratization of healthcare. Paim (2008) argues that it was more than a project of health sector reform – it was a broad project of social reform:

[…] as a social reform centered on the following

constituents: a) democratization of healthcare,

which implies awareness-raising about health

and its determinants and the recognition of the

right to health, inherent in citizenship, in order

to guarantee universal and egalitarian access to

Brazil’s National Healthcare System and social

participation in policy-making and management;

b) democratization of the State and its apparatus,

respecting the federative pact, ensuring the decen-

tralization of the decision-making process and of

social control, and fostering ethics and govern-

ments’ transparency; c) democratization of society,

reaching the spaces of economic organization and

culture, in the production and fair distribution of

richness and knowledge, and in the adoption of a

‘totality of changes’ around a set of public policies

and health practices, and also through an intellec-

tual and moral reform (Paim, 2008, p. 173).

In a scenario of crisis in the health sector in the second half of the 1970s – although the government’s official discourse mentioned a greater opening to the social sphere -, it is possible to say that the adopted measures were very limited, when we look at the determinants of this crisis, which “expressed itself through the low efficiency of medical as- sistance, high costs of the medical-hospital model and low health service coverage compared to the population’s needs” (Paim, 2008, p. 75). In this same period, “there was a rebirth of the social movements, involving the working class, as well as popular sec- tors, intellectuals and professionals of the middle class” (Paim, 2008, p. 77). In the scope of health, these movements connected with one another and became social forces that opposed authoritarian and privatizing health policies.

Concerning the theoretical foundations related to the proposal for a health reform in Brazil, Paim (2008) argues that the health conceptions that were used were developed by its academic branch, that is, by preventive and social medicine departments and public health schools or similar institutions. In the 1970s, the preventive movement had a lot of influence, as it brought the ideas of Comprehensive Medicine. However, as the criticisms against the Preventive Medicine and Community Medicine pro- posals were gradually issued, in Brazil and in other Latin American countries, part of these academic institutions started to be inspired by the Social Medicine that had developed in Europe in the middle of the 19th century (Paim, 2008). Therefore, Collec- tive Health emerged in Brazil as a rupture, based on

 

 

Saúde Soc. São Paulo, v.24, supl.1, p.201-214, 2015 209

the criticism against the movements of preventive medicine, community medicine, and institutional sanitarianism (Paim, 1992).

Two important concepts for the theoretical foundation of the sanitary reform, developed by the academic production in Collective Health, were: social determination of diseases and work process in health. According to Paim (2008), the “understanding that health and illness cannot be explained exclusively by the biological and ecologic

Unit VI Case Study

Unit VI Case Study

 

11% of course grade

 

 

There are several intervention and prevention strategies used to implement policies in environmental health. These policies’ effectiveness are often questioned.

For the Unit VI Case Study, identify an environmental health issue in your community. After selecting the environmental health issue, address the issues below in your case study.

· Explain the background of the environmental health issue.

· Discuss how this issue is affecting the community members.

· Examine the current policies in place to address the environmental health issue.

· Discuss the pros and cons of the current policy.

· Analyze the current intervention and prevention strategies used to correct the problem.

· Discuss the pros and cons of the intervention and prevention strategies.

Your case study must be a minimum of three pages in length, not counting the title and reference pages. To support your ideas, use a minimum of two outside sources. Additionally, use a source that focuses on your community (such as a newspaper or journal article).

Remember that all written assignments must be formatted using APA Style, especially in-text citation and references.

Disparity Reduction Plan

Unit IV PowerPoint Presentation

 

8 SLIDES NOT COUNTING TITLE AND REFERENCE PAGES

 

 

11% of course grade

 

Disparity Reduction Plan

 

Create a disparity reduction plan that you could present to both physicians and the hospital administration in your community that focuses on both a specific disparity and demographic(s) affected by that disparity.

 

Location: SAN ANTONIO, TEXAS

 

Using the problem-solving methodology, you will:

· identify the problem,

· discuss the population most affected,

· indicate the root cause of the problem,

· suggest a possible solution to the problem, and

· surmise positive outcomes from this solution based on it being used in other areas.

Use data to support your answer. Present your findings to the physicians and hospital admin in the form of a PowerPoint presentation. Your presentation should consist of at least eight slides, not counting the title and references slides.

PowerPoint Requirements:

· All graphics must be clear.

· All graphics must be cited.

· Include at least four photos.

· Include at least one graphic.

· Include notes so that the information on the slide contains simple bulleted phrases and the notes expand on those bullets with complete sentences – as if you would use them in an oral presentation to the physicians and hospital administration.

 

The following resource can help you with the basics of creating a PowerPoint presentation:

Benefits and Challenges of Generating Community Participation

Unit V Article Critique

 

9% of course grade

 

Using the problem-solving methodology, you will critique one of the articles displayed below. (Full references for these articles can be found in the Required Unit Resources section of the Unit Study Guide.)

 

Benefits and Challenges of Generating Community Participation

Or

Using a Mixed-Methods Approach to Identify Health Concerns in an African American Community

Part 1:

· Assess the critical health issue found in the article.

· Discuss the population most affected.

· Indicate the root cause of the health problem.

· Indicate if there was a possible solution to the problem(s).

· List the outcomes from the researcher’s solution in the article.

 

Part 2:

· Propose an alternative program you feel would be more affective. Provide data to support why you are suggesting this option.

 

Your paper should be at least two pages in length. Adhere to APA Style when constructing this critique, including in-text citations and references for all sources that are used. Please note that no abstract is needed.

Reference

Weathers, B., Barg, F. K., Bowman, M., Briggs, V., Delmoor, E., Kumanyika, S., Johnson, J. C., Purnell, J., Rogers, R., & Halbert, C. H. (2011). Using a mixed-methods approach to identify health concerns in an African American community. American Journal of Public Health, 101(11), 2087–2092. https://link.gale.com/apps/doc/A272076928/ITOF?u=oran95108&sid=ITOF&xid=b04a08b2

Outlining the public health financing process is an intuitive phase. Many public health officials start drafting the program budget along with the planning phase just to have some idea of the funding needed to support such a venture.

Outlining the public health financing process is an intuitive phase. Many public health officials start drafting the program budget along with the planning phase just to have some idea of the funding needed to support such a venture. Later, financial analysts are consulted to form a detailed plan of action and develop multiple financial options and a cohesive financial planning mechanism.

In this assignment, you will continue working on sections for your final project assignment. You will conduct a budget analysis for this assignment.

Using the readings for the week, the South University Online Library, and the Internet, write a 2–3-page budget analysis. Select 2–3 scholarly references on public health program financial plans to use in support of your response. Make sure to include evidence-based information and scholarly references.

Complete the following:

  • Begin by reviewing the assigned reading materials and the information about implementing and monitoring budgets.
  • Next, review the previous assignments you completed on your selected health issue or health disease topic.
  • Develop a cohesive budget to include types of cost analyses. Your budget analysis should be developed using an Excel spreadsheet. Review the readings for this week for examples.
  • Include the following components in your budget analysis:
    1. Selected Categories
    2. Total Budget
    3. Cumulative Expenses
    4. Dollar Variance
    5. Amount Left to Spend
    6. Percent of Unspent
    7. Percent of Variance
  • Be sure to calculate the total expenditures, revenue total, and final budget total.

In a 1-page summary in Word format, provide an overview of your budget that includes a mini-synopsis of the significant points. Approach your budget analysis as a practical application and assume you are going to submit it to public health officials to solicit funding for your health program. For this assignment, you will have two deliverables—the summary in Word format and the Excel spreadsheet with your analysis.

Since Microsoft Word and Excel are interconnected programs, you may embed your Excel spreadsheet in your Word document. The Microsoft Office Word Help Guide/Assistance can provide further information about how to embed or link documents.

Submission Details:

  • Submit one document with both assignments, the overview and the budget, combined in a Microsoft Word