History of health: visible, audible, and consequential¹

Twenty-two years ago, in celebration of the 125th anniversary of the American Public Health Association, the historians Elizabeth Fee and Theodore M. Brown wrote an editorial for the American Journal of Public Health in which they drew attention to the ways in which history can contribute to health analyses. Historical research, they said, has the potential to enrich our evaluations of contemporary health initiatives by appraising past actions. They also observed that history can be especially useful in identifying standards, continuities, and discontinuities in the realm of ideas and initiatives in health. In conclusion, the authors wrote, “history may provide new insights into the difficulties of change, whether of social and political realities, attitudes, or behaviors” (Fee, Brown, 1997, p.1763).

More recently, in mid-2014, the question of the value of the history of medicine − or history of health, as it is known in Brazilian historiography − once again came to the fore in a controversy over the contributions of this historiographic field. On the one side, writing in the comment section of the prestigious journal The Lancet, Richard Horton (2014) declared that most medical historians had abandoned any pretense of linking past problems to present ones and transforming these issues into tools for resisting the perverse changes to medicine wrought by market forces today. To his thinking, today’s historians − unlike such pioneers as François Delaport, John Farley, and Roy Porter − are invisible, inaudible, and, as a result, inconsequential.

The medical historian Carsten Timmermann (4 ago. 2014) was quick to reply to Horton’s piece. In the blog Somatosphere, Timmermann lamented his colleague’s observations, arguing that a quick look at his own book shelves was enough to disprove Horton’s allegations; at one glance, Timmermann wrote, he saw works by Jeremy Greene, Ilana Lowy, Robert Aronowitz, and other scholars who draw from the past to invite their readers to think about the present, thus indicating that contemporary medical historians do not merit such a harsh judgment. While rebuffing his colleague’s characterization of historians, Timmermann ended his text by encouraging medical historians to step outside their comfort zones more often and talk to scientists and physicians as well as other audiences. In addition to its social worth, he said, this type of initiative would certainly expand historians’ audience.

With Fee and Brow’s perspective in mind, alongside the expansion, or renewal, of this idea as offered by Timmermann, we can affirm that the history of Brazilian health now finds itself facing broader and even more challenging goals and possibilities, given the country’s current public healthcare system. Beyond endeavoring to understand and evaluate initiatives and contexts in the field of health, a renewed history could also strive to produce knowledge or guidance pertinent to professional practice by shedding light on political, cultural, and professional dynamics.

There are four things to consider here. First, scholarship from the history of health allows us to have a contextual notion of the problems faced by Brazilians and by the country’s public health structure, both of which are socially determined products of specific historical contingencies and should therefore be understood within a web of multiple demands and constraints. Secondly, the history of health affords us the elements needed to critically analyze the practices of healthcare providers, not only as activities of a technical nature but also as activities guided by political, ideological, and cultural as well as personal and moral outlooks. In the third place, the history of health gives us a temporal view of health policies, informing us about their era, about Brazilian society, and about the characteristics and challenges of these policies. Last but not least, history, through its cast of actors, fosters and reinforces institutional identities.

Looked at in this light, the history of health can move beyond the limits of purely erudite or abstract knowledge to serve as a tool for drafting and implementing public policy and for crafting or refining policy and management strategies. It can also help health actors reassess ingrained conducts and practices in their daily healthcare activities.

Making history into this kind of tool, however, means we must reflect on the training of health historians, especially in terms of their contact with the discussions, concepts, references, and methods at work in the field of health itself. Just as Thomas Kuhn (2011, p.151-156) called for science historians to be familiar with the logic of their objects, scholars of the history of health must understand the health field’s present-day agendas so their reflections interface with the concerns of healthcare providers, managers, researchers, and users. This endeavor may also be a way of delineating a space specific to the history of health, within the terrain where more general historiography meets the field of health.

Knowing the pathways already taken in our complex social experience in health, with its concepts, norms, and related policies and practices, is an essential task for historians of health from all disciplinary backgrounds. Along with other journals in history, collective health, and the social sciences, História, Ciências, Saúde − Manguinhos is an outstanding vehicle for this scholarship. And may it remain so. Likewise, the History and Health Observatory at the Casa de Oswaldo Cruz devotes itself to researching topics related to the main health issues affecting the Brazilian public today.²

REFERÊNCIAS

• FEE, Elizabeth; BROWN, Theodore. Editorial: Why history? American Journal of Public Health, v.87, n.11, p.1763-1764. 1997.
• HORTON, Richard. The moribund body of medical history. The Lancet, v.384, n.9940. Disponível em: https://doi.org/10.1016/S0140-6736(14)61050-3 Acesso em: 21 jan. 2020. 2014.
  » https://doi.org/10.1016/S0140-6736(14)61050-3
• KUHN, Thomas. As relações entre história e história da ciência. In: Kuhn, Thomas. A tensão essencial: estudos selecionados sobre tradição e mudança científica. São Paulo: Editora Unesp. p.145-179. 2011.
• TIMMERMANN, Carsten. Not moribund at all! An historian of medicine’s response to Richard Horton. Somatosphere: Science, Medicine, and Anthropology Disponível em: <http://somatosphere.net/2014/not-moribund-at-all-an-historian-of-medicines-response-to-richard-horton.html Acesso em: 21 jan. 2020. 4 ago. 2014.
  » http://somatosphere.net/2014/not-moribund-at-all-an-historian-of-medicines-response-to-richard-horton.html

• 1
  Note from the science editor: In recent years, the history of health in Brazil and Latin America has evolved into a rich and complex field of research and reflection. Furthermore, this history is fundamental to efforts to defend the need for robust public health systems. The historians at the Casa de Oswaldo Cruz and História, Ciências, Saúde − Manguinhos have played an inarguably vital role in this important field. We have invited one of these historians, who is also an assistant editor at our journal, to provide a brief overview of the story of the history of health and its relevance. At a moment when the collapse of the Brazilian health system makes this field more germane than ever, Carlos Henrique Assunção Paiva offers his thoughts on the topic.
• 2
  The entire team at the History and Health Observatory collaborated in writing this text: Carlos Henrique Assunção Paiva, Luiz Antônio Teixeira, Fernando A. Pires-Alves, José Roberto Franco Reis, Carlos Fidelis Ponte, and Luiz Alves Araújo Neto.

• ERRATUM

  In the “Guest Editor’s Note” (http://dx.doi.org/10.1590/S0104-59702020000100001) published in v.27, n.1 of História, Ciências, Saúde – Manguinhos , the following corrections should be considered:
  • On page 10, footnote 1, where it read: “We have invited one of these historians, who is also an assistant editor at our journal, to provide a brief overview of the story of the history of health and its relevance. At a moment when the collapse of the Brazilian health system makes this field more germane than ever, Carlos Henrique Assunção Paiva offers his thoughts on the topic.”,
  ▶ it should read: “We have invited the Observatório História e Saúde to provide a brief overview of the story of the history of health and its relevance, at a moment when the collapse of the Brazilian health system makes this field more germane than ever.”.
  • On page 11, line 39, where it read: “today.²”,
  ▶ it should read: “today.”.
  • On page 11, footnote 2 should be deleted.
  • On page 12, lines 14-18, where it read:
  “Carlos Henrique Assunção Paivaⁱ
  ⁱAssistant editor; researcher, Casa de Oswaldo Cruz/Fiocruz.
  Rio de Janeiro – RJ – Brasil
  orcid.org/0000-0002-7478-9628
  [e-mail]”,
  ▶ it should read:
  “Carlos Henrique Assunção Paivaⁱ
  ⁱResearcher, Casa de Oswaldo Cruz/Fiocruz.
  Rio de Janeiro – RJ – Brasil
  orcid.org/0000-0002-7478-9628
  [e-mail]
  Luiz Antônio Teixeiraⁱⁱ
  ⁱⁱResearcher, Casa de Oswaldo Cruz/Fiocruz.
  Rio de Janeiro – RJ – Brasil
  orcid.org/0000-0001-8871-0928
  Fernando A. Pires-Alvesⁱⁱⁱ
  ⁱⁱⁱResearcher, Casa de Oswaldo Cruz/Fiocruz.
  Rio de Janeiro – RJ – Brasil
  orcid.org/0000-0002-5091-9539
  José Roberto Franco Reis^iv
  ^ivResearcher, Casa de Oswaldo Cruz/Fiocruz.
  Rio de Janeiro – RJ – Brasil
  orcid.org/0000-0002-1133-2778
  Carlos Fidelis Ponte^v
  ^vResearcher, Casa de Oswaldo Cruz/Fiocruz.
  Rio de Janeiro – RJ – Brasil
  orcid.org/0000-0003-1976-6287
  Luiz Alves Araújo Neto^vi
  ^viResearcher, Casa de Oswaldo Cruz/Fiocruz.
  Rio de Janeiro – RJ – Brasil
  orcid.org/0000-0001-7965-2957”.

Publication Dates

• Publication in this collection
  23 Mar 2020
• Date of issue
  Jan-Mar 2020