Analysis of the insertion of nutritionists in Postgraduate Programs in Collective Health: identities, trajectories and position-taking

ABSTRACT

Nutrition began its constitution as an independent profession in the 1930s. It has achieved the status of higher education in 1967. With the emergence of the Collective Health Space in the 1970s, it was verified the construction of an area of Food and Nutrition in Collective Health. Nutritionists integrate this multiprofessional field in its different spheres. To what extent does this insertion correspond to an integration into the Collective Health Space or does it persists as a subspace articulated to it? In order to partially answer this question, the characteristics of nutritionists in the postgraduate programs were analyzed from the Lattes curricula of all those that comprised the permanent framework of courses in 2010. The indicators used were: main area of activity, doctoral area, research lines and publications, among others. Among the 944 professors, 42 were nutritionists (4.4%). Of these, 47.6% indicated Collective Health and 42.9% indicated Nutrition as the first activity area. Nutrition and Food was referred as the first line of research by 40.5%; and Epidemiology by 14.3%. The topic of the thesis was Epidemiology for 42.9%, followed by Evaluation (14.3%) and Social Sciences (11.9%). These findings are indicative that, although nutritionists have a place in the Collective Health Space, their positioning evidences strategies of belonging to the field of origin.

KEYWORDS
Nutritionists; Public health; Health postgraduate programs

RESUMO

A Nutrição iniciou sua constituição como profissão independente na década de 1930. Conquistou estatuto de formação superior em 1967. Com a emergência do Espaço da Saúde Coletiva nos anos 1970, verificou-se a construção do espaço da Alimentação e Nutrição em Saúde Coletiva. Os nutricionistas integram esse campo multiprofissional nos seus diversos âmbitos. Em que medida essa inserção corresponde a uma integração ao Espaço da Saúde Coletiva ou persiste como um subespaço a ele articulado? Visando responder parcialmente esta indagação, foram analisadas características dos nutricionistas nos programas de pós-graduação a partir dos currículos Lattes de todos que compunham o quadro permanente dos cursos em 2010. Os indicadores foram: principal área de atuação, área do doutorado, linhas de pesquisa e publicações, entre outros. Entre os 944 docentes, 42 eram nutricionistas (4,4%). Desses, 47,6% indicaram a Saúde Coletiva e 42,9% a Nutrição como primeira área de atuação. Nutrição e Alimentação foi referida como a primeira linha de pesquisa por 40,5%; e Epidemiologia por 14,3%. O tema da tese foi Epidemiologia para 42,9%, seguido de Avaliação (14,3%) e Ciências Sociais (11,9%). Estes achados são indicativos de que, embora os nutricionistas tenham inserção no Espaço da Saúde Coletiva, suas tomadas de posição evidenciam estratégias de pertencimento ao campo de origem.

PALAVRAS-CHAVE
Nutricionistas; Saúde pública; Programas de pós-graduação em saúde

Introduction

The social process that would lead to the profession of nutritionist arose between the years 1930-1940, during the government of Getúlio Vargas^1,2. Although it has originally been a discipline of Medicine, Nutrition has historically been a relatively independent space. The first regulation of this profession occurred in 1967³; its Council was established in 1978⁴; and, in 1991, a new law extended its guarantees⁵. With the emergence of the Collective Health Space (ESC), in Brazil, in the 1970s⁶, it was started, within it, the construction of a Food and Nutrition space, in view of the multiple interfaces between the two social spaces⁷.

This intersection between Collective Health (CH) and Nutrition occurs mainly in the scope of postgraduate and research. If in the Coordination for the Improvement of Higher Education Personnel (Capes) there is a separation between the committees that evaluate the postgraduate programs of each area, in the National Council for Scientific and Technological Development (CNPq) both are gathered in a single committee.

Furthermore, nutritionists integrated the movement for a Brazilian Sanitary Reform (RSB), whose process is intimately related to the creation of the Brazilian CH as a field of knowledge and practices⁸ or a specific space with a project of becoming a field^6,9. This participation resulted in the creation, in the scope of the Brazilian Association of Collective Health (Abrasco), of a Working Group on Food and Nutrition in Collective Health (GT-ANSC), in July 2008¹⁰, which has played an important role in the discussion of this thematic.

Some studies on nutritional policies show that the thematic of Nutrition has occupied a secondary plan in the ESC. An example is the Fiscal Incentives Program for Workers' Nutrition (Pifat/PAT), which, although it daily reaches more than 16 million people and involves about 19% of the Brazilian nutritionist posts^11,12, is not even part of the National Health Promotion Policy (PNPS) and the National Worker and Worker Health Policy (PNSTT)¹³.

Regarding the relations between Nutrition and Post-Graduation in Collective Health, despite the existence of studies on the characteristics of post-graduation in the Nutrition sub-area^14-17, the inclusion of nutritionists in the Postgraduate Programs in Collective Health (PPGSC) has been little investigated.

Thus, some questions have emerged: how do the teachers of the PPGSC, graduated in Nutrition, integrate CH? What is the profile of the nutritionists who make up the PPGSC? Are they constituting a specific subspace within the CH or do they keep identity with Nutrition?

With the purpose of contributing to fill some of these gaps, the present study describes the main characteristics of the nutritionist teachers of the PPGSC.

Methodology

Guided by the theory of social world of Pierre Bourdieu, a cross-sectional study was carried out on the main characteristics of all the teaching nutritionists of the 55 PPGSCs who were submitted to the Capes evaluation (2007-2009). This study was part of a project that investigated the ESC and the 944 teachers who worked in the PPGSC in 2010^6,18,19. This insertion made it possible to compare the characteristics of graduates in Nutrition with those from other professions.

The data sources were the Lattes curricula of the 42 nutritionists who made up the permanent teacher board of the Postgraduate Programs in Public Health, in 2010.

The agents, teachers of the PPGSC with graduation in Nutrition, were analyzed from the following characteristics and indicators: professional trajectory and position in the ESC (institution, function and positions held); position-taking in relation to research lines and area of action (epidemiology, planning or social sciences).

For purposes of analysis, the concepts of field, social space, capital, trajectory and positioning were used²⁰. Field was understood as a field of forces and struggles with relative autonomy to transform these relations of forces and establish the legitimate rules disputes within it. A specific social space can be considered as a space of relations between agents located in different fields, but having common interests, related to the issues at stake^21-23. It is, therefore, a more flexible notion, which can be either a field itself, or a microcosm within it, or even an inter-fields space²¹. Capital is a kind of asset, a social energy that allows its bearer to compete and fight according to the specific and authentic rules of each particular space²⁴. And the distribution of agents in the social space is given by the structure and volume of different capitals, such as cultural, economic, and political capitals⁶. The analysis of the trajectory allows to identify the successive positions occupied by the agents in a certain social space, in a determined time. And the relationship between the position occupied and the trajectory make it possible to identify the positioning, which helps, in turn, the understanding of the structure of the field and the issues that are at stake²¹.

The 'Collective Health Space' project, which houses this study, was approved by the Committee on Ethics in Research of the Institute of Collective Health of the Federal University of Bahia (UFBA) under opinion 054/07/CEP/ISCFR167674.

Results and discussion

The position of nutritionists in the scientific subspace of Collective Health

In 2009, there were 944 permanent teachers in the PPGSC. Although the proportion of teaching nutritionists was small, corresponding to 4.4% of the total, it was the third largest presence. There was a dominance of teachers graduated in Medicine n=425 (45%), followed by Nursing n=62 (6.6%), Nutrition n=42 (4.4%), Psychology n=34 (3.6%) and Dentistry n=30 (3.3%) (table 1).

Table 1
Teachers of the Postgraduate Programs in Collective Health (n and %), according to area of graduation

	N	%
Medicine	425	45
Nursing	62	6.6
Nutrition	42	4.4
Applied Social Sciences	35	3.7
Psychology	34	3.6
Dentistry	30	3.2
Pharmacy	23	2.4
Health Sciences	18	1.9
Social Service	10	1.1
Human Sciences	9	1
Economy	9	1
Medical Statistics	9	1
Philosophy	9	1
Law	8	0.8
History	8	0.8
Education	5	0.5
Sociology	5	0.5
Administration	4	0.4
Physical Education	4	0.4
Physiotherapy and Occupational Therapy	3	0.3
Geography	3	0.3
Political Science	2	0.2
Communication	2	0.2
Architecture and Urbanism	1	0.1
Other Medical Specialties	1	0.1
Others	164	17.4
No information	19	2
Total	944	100

Source: Own elaboration based on the Lattes curriculum (CNPq), 2010.

In view of a relatively recent field under construction, identity with CH is still a question at stake in this social space. In the same way, the nutritionists who participate in it are practically divided between desiring recognition as belonging to the field and protecting their identity as nutritionists. This ambivalence can be observed in the analysis of the indication made in Lattes about which would be the first area of action. The CH professors, in the majority, 518 (54.9%), indicated as CH their first area of activity. Nutritionists indicated, in almost equal proportions, with a discrete difference, CH n=20 (47.6%), followed by Nutrition n=18 (42.9%) (table 2).

Table 2
Nutritionist teachers of the Postgraduate Programs in Public Health (n and %), according to the area of activity

	N	%
Collective Health	20	47.6
Nutrition	18	42.9
Medicine	1	2.4
Anthropology	1	2.4
Others	1	2.4
No information	1	2.4
Total	42	100

Source: Own elaboration based on the Lattes curriculum (CNPq), 2010.

A dual performance can be observed by nutritionists, whether in the academic career - being stronger in CH - or by strengthening the profession of nutritionist, while trying to preserve their identity. In this way, it is observed the same phenomenon that happened in the first area of action with the classification of the area of the doctoral thesis by the teachers. CH predominated among teachers of PPGSC, although with a percentage of 42.6%, which shows that the majority classified the area of their thesis as out of CH. Nutritionists classified them in almost equal proportions, both in CH (38.1%) and in Nutrition (35.7%) (table 3).

Table 3
Nutritionist teachers of the Postgraduate Programs in Collective Health (n and %), according to area of the doctoral thesis

	N	%
Collective Health	16	38.1
Nutrition	15	35.7
Medicine	2	4.8
Social Sciences	2	4.8
Others	1	2.4
No Information	6	14.3
Total	42	100

Source: Own elaboration based on the Lattes curriculum (CNPq), 2010.

About the subarea of the doctoral thesis, the majority classified as public health (16.4%), followed by epidemiology (16%) and medical clinic (4%). Among the nutritionist teachers, most classified as nutritional analysis of the population (19%), followed by epidemiology (16.7%) and public health (11.9%).

These data may indicate that the insertion of teachers graduated in Nutrition into CH occurs ambivalently, which also suggests a strong influence of the space of origin (Nutrition). This fact was also verified by reference to PPGSC teachers, graduated in other health professions, such as Dentistry²⁵ or other health professions¹⁹. There is a predominance of epidemiology and related areas, as in the area known as 'nutritional analysis of the population'. In the latter case, the emphasis on the object rather than on the method may be related to this double insertion movement and the search for delimitation of a specific space.

Nutritionists are distributed in the scientific subfield of CH in a proportionally equivalent way to the other researchers and their presence in this field. The proportion of scholarship holder nutritionists in CNPq, an indicator of high scientific capital, was very close to that of the total number of professors from other graduations. In relation to the latter, of the 944 teachers, 244 (25.8%) had a study grant. In relation to nutritionists, the proportion was almost equivalent: 23.8% (out of 42 teachers, 10 had a productivity study grant). However, a considerable number of agents (76.2%) were not a scholarship holder in productivity. This fact has been related to the historical freezing of the number of study grants, due to the existence of several researchers that meet the criteria of the productivity study grants, but they do not have their requests received due to lack of CNPq resources.

Nutrition teachers had updated their Lattes curricula in less than 30 days, which is shorter than that of all the PPGSC faculty members who did the update in up to 90 days. This fact reveals the importance given by these teachers to the platform, characterized as a relevant instrument for the scientific field.

The post-doctorate is not yet a predominant activity in ESC, since almost 70% of its agents have not done it yet; the same is observed when it comes to nutritionists. While in CH n=300 (31.8%) of teachers already have it, among nutritionists, this percentage drops a bit, going to n=11 (26.2%).

In relation to the doctoral programs, both for CH and for nutritionists, the universities of the Southeast presented a greater number of teachers. In CH, the University of São Paulo (USP) Public Health n=117 (22.7%), the Oswaldo Cruz Foundation (Fiocruz) Public Health n=103 (20%), the State University of Rio de (UERJ) n=57 (11%), followed by the programs of the State University of Campinas (Unicamp) and the Institute of Collective Health/Federal University of Bahia (ISC/UFBA), with n=37 (7.2%) and n=27 (5.2%), respectively. In the case of nutritionists, most of them outstand in USP Public Health n=11 (26.2%), Uerj Collective Health n=7 (16.7%) and Unicamp Collective Health n=3 (7.1%), followed by programs of UFBA Collective Health and USP Nutrition in Public Health, both corresponded to a n=2 (4.8%) (table 4).

Table 4
Nutritionist teachers of the Postgraduate Programs in Collective Health (n and %), according to theme of the doctoral thesis

	N	%
Epidemiology	18	42.9
Evaluation	6	14.3
Social Sciences in Health	5	11.9
Basic Area	4	9.5
Clinical Epidemiology	3	7.1
Social Sciences	2	4.8
Clinical	2	4.8
Management	1	2.4
Others	1	2.4
Total	42	100

Source: Own elaboration based on the Lattes curriculum (CNPq), 2010.

On the themes of the doctoral thesis, epidemiology is individually the most frequent, both for CH and for nutritionists, and the proportion of the latter is even greater. The CH professors, for the most part, classified as epidemiology (28.8%), followed by evaluation (14.3%) and social sciences in health (11.9%). Nutritionists classified as epidemiology n=18 (42.9%), followed by evaluation n=6 (14.3%) and social sciences in health n=5 (11.9%) (table 3).

Regarding the master's degree, most teachers of CH indicated public health as area of knowledge (31.2%), followed by CH (15.5%), Medicine (6.3%) and Preventive Medicine (5.1%), characterizing a more heterogeneous distribution for CH. In relation to nutritionists, there is a predominance, as area of knowledge, of public health (40.5%), followed by Nutrition (9.5%), CH and social sciences (7.1%), with a considerable number of teachers who have completed master's degree in other areas (23.8%). This fact reveals the importance of public health as the identity of PPGSC teachers, both because some consider it as synonymous with CH¹⁸ and by the fact that some important programs preserve the name of Public Health. Also, the dominance of the designation 'Public Health' may be related to the need for international dialogue, due to the fact that equivalent disciplines and areas of knowledge are so named.

Regarding the time and university of completion of the master degree, in the years 1990-2000 (52.1%), the program that alone formed the largest proportion of masters of CH was that of USP (18.5%), followed by those who graduated in universities outside the Country (12.6%). Among nutritionists, the majority n=30 (75%) graduated between 1990-2000, at the USP (26.2%), followed by those who graduated outside the Country (11.9%) and those who graduated in the Federal University of Pernambuco (UFPE) (7.1%) and in the National School of Public Health Sergio Arouca (Ensp/RJ) (7.1%).

In relation to the area of dissertation of the masters, the majority of CH indicated as area the CH (36.8%) and Nutrition (3%). Specifically among nutritionists, the majority (54.8%) indicated Nutrition, followed by CH (26.2%), this being, perhaps, once again, a way for nutritionists to delimit their space, as a position. That is, although they are in ESC, they delimit their membership in a subspace of Nutrition (table 5).

Table 5
Nutritionist teachers of the Postgraduate Programs in Collective Health (n and %), according to the dissertation area of the master's degree

	N	%
Nutrition	23	54.8
Collective Health	11	26.2
Medicine	1	2.4
No information	5	11.9
Do not apply	2	4.8
Total	42	100

Source: Own elaboration based on the Lattes curriculum (CNPq), 2010.

The analysis of sub-areas of the masters indicates that it does not seem to be a relevant topic for CH agents, since a considerable number did not fill this information (18.9%); and, among those who informed, the majority were so dispersed that 21.1% indicated other subareas. Nevertheless, it should be mentioned that most of the teachers indicated public health as subarea n=156 (16.5%), followed by epidemiology n=113 (12%) and medical clinic n=32 (3.4%). For nutritionists, the majority indicated the Nutritional Analysis of Population (26.2%), followed by public health (16.7%) and epidemiology (9.5%). It can be seen that epidemiology appears in both subspaces, however, as previously identified, the delimitation of space for nutritionists becomes clearer when they indicate the nutritional analysis of the population as subarea. This finding reinforces the hypothesis that nutritionists try to establish themselves within CH with their own identification, either as a professional category, a space of belonging or an area of knowledge.

The analysis of master's degree dissertations indicates that the dominant theme is related to epidemiology (28.2%), followed by social sciences (22.5%) and planning and management area (12.8%). Among the nutritionists, the dominant theme is epidemiology (40.5%), followed by evaluation (9.5%) and clinical (9.5%).

In relation to the year of graduation, the majority of the CH graduated between the years 1970 and 1980. Among the nutritionists, the majority graduated in the years 1975 and 1990. That is, the incorporation of nutritionists into space is more recent than other ESC professionals.

Regarding the academic background, it was noticed that there is a similarity, both for nutritionists and for CH professors, regarding the post-doctorate, the doctorate and the graduation year. For the master's degree, many nutritionists graduated between the years 1990 and 2000, characterizing a more recent training in relation to the other agents analyzed.

As far as the academic career is concerned, most nutritionists are Exclusive Dedication (ED), while the data suggest that, for CH, there are a greater number of agents transiting through other subspaces, such as bureaucracy, politics, consulting and clinic.

Position-taking within the scientific field

Almost 3/4 (73.8%) of nutritionists have an ED contract. In CH, although the ED is the majority, this is in a lower percentage (56.3%). And the regimen of 40 hours is more incident than among nutritionists (31.8% and 21.4%, respectively). These findings may indicate that, while the vast majority of nutritionists follow an exclusively academic career, there is a greater number of CH workers transiting through other subspaces, such as bureaucracy, politics, consulting, and the clinic.

With regard to research lines, a great dispersion is verified. In CH, the most mentioned (epidemiology) is reported by only 14.7% of teachers, followed by policy, planning and management (5.9%). Among the nutritionists, a greater consistency is verified: there is a large proportion of teachers that indicate as main line of research themes related to nutrition and food (40.5%) - a very comprehensive designation -, followed by epidemiology (14.3%) and 'others' (16.7%).

The analysis of the themes of choice of the first research projects for nutritionists shows that epidemiology predominates (47.6%), followed by social sciences in health (14.3%) and evaluation (9.5%). In CH, most of the themes are also about epidemiology (23.1%).

Final considerations

This study provides some evidence on the relationships established between nutritionists and ESC. The postgraduate training in CH, the option to participate in PPGSC and the indication of the CH as the first area of action by a high proportion of nutritionists are indicators of a movement aimed at integrating the latter into the ESC. On the other hand, the persistence of an almost equivalent proportion of teachers who still indicate Nutrition as the first area of activity, who have master's and doctoral degrees in Nutrition programs or in other areas of knowledge, characterizes a second modality of participation, which maintains the identity with the space of Nutrition. A third possibility, in cases where the first and second area of action are CH and/or Nutrition, could express an ambivalent participation, between the identification with CH and the reaffirmation of identity and belonging to Nutrition.

The teachers graduated in Nutrition distribute themselves in the diverse positions of the scientific subfield of the CH, in a proportional way. In the dominant pole, the ratio of research productivity scholarship holders in relation to researchers is relatively equivalent to that of the universe.

Although nutritionists constitute a part of the PPGSC teachers and, in the indication for the first area of action, there is a small predominance of CH, the analysis pointed out that their positioning prioritizes objects linked to Nutrition. In a social space still dominated by doctors and disputed by social scientists, dentists and nurses, among others, nutritionists possibly seek to delimit their subspace by resorting to their identity of origin. It is possible that this ambiguity will eventually affect the provisions for the struggles within the ESC, which may help to understand the lack of prioritization or even the absence of the themes of food and nutrition in the main agenda of the Brazilian CH. On the other hand, the double identity is part of the process of autonomisation of the CH field, where the loss of the professional identity of origin is ambivalent, considering that a new professional identity has not yet been consolidated^18,19.

Regarding the incorporation of nutritionists in this space, it has been perceived that it has occurred in a gradual way, like other professions, such as the medical. When considering the scientific capital, synthesized in the form of productivity scholarship of the CNPq, it is observed that the nutritionists occupy a position proportionally equivalent to the other researchers, demonstrating a certain political force for this subarea, since they have conquered/delimited some scientific spaces inside the CH, as in the case of the creation of GT-ANSC of the Abrasco, which, alongside the WG of Oral Health, has thematic associated with a professional delimitation, with 89.5% of its members being nutritionists²⁶.

The present study presents some limitations, mainly because it was based only on the analysis of Lattes curricula. A better understanding of the relationships between Nutrition and CH requires the execution of investigations that incorporate other sources of data, such as in-depth interviews and documents capable of allowing a more complete analysis of the architecture and dynamics of this social space and of the issues at stake. Although the data refer to the 2006-2009 evaluation, and need to be compared with those of subsequent evaluations, its importance lies in making a first approximation to the subspace of Nutrition within the CH, with a systematic and theoretically oriented and compared approach with the teaching universe of the PPGSC. This study may serve as a baseline for subsequent analysis.

• Financial support: non-existent

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  Costa JB. Perfil dos Docentes com Graduação em Odontologia Pertencentes aos Programas de Pós-Graduação em Saúde Coletiva [dissertação]. Salvador: UFBA/ISC; 2018.
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  Associação Brasileira de Saúde Coletiva. GT Alimentação e Nutrição em Saúde Coletiva. Rio de Janeiro: Abrasco; 2018 [acesso em 2018 jul 1]. Disponível em: https://www.abrasco.org.br/site/gtalimentacaoenutricaoemsaudecoletiva
  » https://www.abrasco.org.br/site/gtalimentacaoenutricaoemsaudecoletiva

Publication Dates

• Publication in this collection
  Oct 2018

History

• Received
  04 July 2018
• Accepted
  19 Sept 2018