Collective health: a "new public health" or field open to new paradigms?

The present essay is an exploratory study of the historical and institutional background of the so-called "crisis in public health", aimed at identifying the new trends and perspectives for the paradigmatic transformation of the health field in the context of the current international panorama of economic and cultural globalization. First, the rhetoric of health is analysed in historical perspective, briefly considering the main elements of the discourse of the ideological movements that historically built the social field of health. Medical Police, Social Medicine and Public Health are included as representative of such movements in 19th century Western Europe. After the Flexnerian turn, these movements were followed by Preventive Medicine, Community Health, Primary Health Care and Health Promotion, which dominated the scene particularly in the second half of the 20th century. The authors also summarise recent concerted PAHO efforts to debate the theory and practice of Public Health in the Americas, vis à vis the emerging demands of the economic, political and social context of Latin American countries. In this regard, the need for a common political agenda is emphasized , with the convergence of three topics - sectorial reform, "Renovation of Health for All" and the "new public health", covering the conceptual, methodological and operative domains. Secondly, a brief systematic account of the conceptual landmarks of the Collective Health movement, as carried through in the two last decades in Latin America, is presented, focusing more particularly on its potential for building up both a domain of transdisciplinary knowledge and a universe of practices. As a field of knowledge, it contributes to the study of health-disease phenomena in populations as a social process, investigating the production and distribution of disease in society as an aspect of social reproduction, and analysing health practices as a labor process integrated into the other social practices. As a universe of practices, Collective Health focuses on its models or action guidelines four objects of intervention: policies (forms of power distribution); practices (behavior modification; culture; institutions; knowledge production; institutional, professional and relational practices); technologies (organization and regulation of productive resources and processes; bodies/environments), and instruments (means of production of interventions). Finally, it is concluded that, although not being in itself a paradigm, Collective Health, as a movement committed to the social transformation of health, presents some possibilities of articulation with new scientific paradigms capable of approaching the health-disease-care object with due regard to its historicity and complexity.Trata-se de ensaio que apresenta um estudo exploratório da retórica paradigmática da saúde com o objetivo de analisar os principais elementos de discurso dos movimentos ideológicos que historicamente construíram o campo social da saúde, particularmente na segunda metade do século XX. São destacados os esforços empreendidos pela Organização Panamericana da Saúde para debater a teoria e a prática da saúde pública na região das Américas cotejando-os com as demandas emergentes no contexto econômico, político e social dos países latino-americanos. Neste particular, destaca-se a necessidade de construir uma agenda política comum, a partir da confluência de três temáticas - reforma setorial, "Renovação da Saúde para Todos" (RSPT) e "nova saúde pública", contemplando os planos doutrinário, conceitual, metodológico e operativo. Apresenta-se uma breve sistematização do marco conceitual da saúde coletiva, em elaboração na América Latina, situando mais particularmente as suas potencialidades de construção de um conhecimento transdisciplinar. Conclui-se que, apesar de em si não constituir um paradigma, a saúde coletiva, enquanto movimento ideológico comprometido com a transformação social, apresenta possibilidades de articulação com novos paradigmas científicos capazes de abordar o objeto saúde-doença-cuidado respeitando sua historicidade e integralidade