Vulnerability in health, education and freedom: reflection in the light of Hannah Arendt

Abstract

Objective

reflect on the concept of health vulnerability in light of Hannah Arendt's assumptions on education and freedom.

Method

a theoretical-reflexive study whose results were grouped into two categories: Vulnerability in health as a human condition and Education and freedom of the subject in a vulnerable situation.

Results

vulnerability must be recognized as a feature of the human condition, because its dimensions involve the subject and their health, material, socio-environmental, cultural and legal conditions. When considering vulnerability from a political and awareness-raising perspective, education emerges as a tool to overcome it, for it makes it possible to develop the singularities of the subjects, preparing them for their responsibility to the world; it enables them to overcome alienation; it materializes political learning and decision making. All of this together is crucial to overcome the condition of vulnerability to the inequalities existing in the world and the respect for the subjects' freedom.

Conclusion and implications for practice

arendtian thoughts are related to vulnerability, since awareness, through education, is indispensable to the improvement of the current social and political context. The human being's search for freedom and the encouragement of their actions enable the evolution of the subject in the world.

Keywords:
Education; Nursing; Freedom; Philosophy; Health Vulnerability

Resumo

Objetivo

refletir sobre o conceito de vulnerabilidade em saúde à luz dos pressupostos de educação e liberdade de Hannah Arendt.

Método

estudo teórico-reflexivo cujos resultados foram agrupados em duas categorias: Vulnerabilidade em saúde como condição humana e Educação e liberdade do sujeito em situação de vulnerabilidade.

Resultados

a vulnerabilidade deve ser reconhecida como traço da condição humana, pois suas dimensões envolvem o sujeito e suas condições de saúde, materiais, socioambientais, culturais e jurídicas. Ao considerar a vulnerabilidade na perspectiva política e conscientizadora, a educação emerge como ferramenta para sobrepujá-las, pois possibilita desenvolver as singularidades dos sujeitos, preparando-os para a responsabilidade com o mundo; propicia superar a alienação; concretiza o aprendizado político e a tomada de decisões. Tudo isso reunido é crucial para suplantar a condição de vulnerabilidade frente às desigualdades existentes no mundo e o respeito à liberdade dos sujeitos.

Conclusão e implicações para a prática

pensamentos arendtianos guardam relação com vulnerabilidade, pois a conscientização, por meio da educação, é indispensável ao aprimoramento do atual contexto social e político. A busca do ser humano pela liberdade e o encorajamento de suas ações oportunizam a evolução do sujeito no mundo.

Palavras-chave:
Educação; Enfermagem; Filosofia; Liberdade; Vulnerabilidade em saúde

Resumen

Objetivo

reflexionar sobre el concepto de vulnerabilidad en salud a la luz de los supuestos de educación y libertad de Hannah Arendt.

Método

estudio teórico-reflexivo cuyos resultados se agruparon en dos categorías: Vulnerabilidad en salud como condición humana y Educación y libertad del sujeto en situación de vulnerabilidad.

Resultados

la vulnerabilidad debe ser reconocida como un rasgo de la condición humana, ya que sus dimensiones involucran al sujeto y sus condiciones de salud, materiales, socioambientales, culturales y legales. Al considerar la vulnerabilidad desde una perspectiva política y de sensibilización, la educación surge como una herramienta para superarlas, ya que permite desarrollar las singularidades de los sujetos, preparándolos para la responsabilidad con el mundo; permite superar la alienación; materializa el aprendizaje político y la toma de decisiones. Todo esto en conjunto es fundamental para superar la condición de vulnerabilidad ante las desigualdades existentes en el mundo y el respeto a la libertad de los sujetos.

Conclusión e implicaciones para la práctica

los pensamientos arendtianos están relacionados con la vulnerabilidad, ya que la conciencia, a través de la educación, es fundamental para mejorar el contexto social y político actual. La búsqueda por la libertad de los seres humanos y el estímulo de sus acciones brindan oportunidades para la evolución del sujeto en el mundo.

Palabras clave:
Educación; Enfermería; Filosofía; Libertad; Vulnerabilidad en Salud

INTRODUCTION

The world is in a state of disruption. Every day, people are confronted with inequalities and the undermining of human and social rights¹. Commonly, those most affected are also those inserted in contexts of vulnerability, which limits their reaction and resistance. The concern with vulnerability has found, in health, a fertile field for integral and intersectoral actions based on human rights². Resisting the condition of vulnerability requires understanding the scenarios that consolidate it and evaluating strategies to overcome it through mobilization that provides an opportunity for a liberated society. Freedom is political because it is linked to a concern for the world. It is a phenomenon open to human experience in circumstances in which human beings are in contact with prerogatives essential to their emergence³.

As vulnerability and freedom are intertwined, the concept of education emerges from this relationship, because it grounds the understanding of rights, duties and benefits, contributing to the necessary understanding to demand, from the authorities, an efficient work, promoter of welfare to society⁴. Only with access to education can man interrupt his vulnerable present and begin a new future, with free action in the world³. To do so, it is necessary to empower and enable the subject to protect himself and react to situations that place him in a vulnerable condition.

With the intention of consolidating actions for the awareness of the subject, Nursing incorporates, in its educational practice, social and ethical commitment and humanistic care. Thus, when anchored in philosophy and in social, political, and cultural contributions, it allows the deconstruction followed by the reconstruction of the subjects, now aware of their actions in the world. The philosopher and political theorist Hannah Arendt (1906 - 1975), when studying totalitarianism, political and human rights; the human condition and spirit; education and freedom, delved into these and other concepts to understand the relationship of plural humanity with the world.

It is worth noting that education and vulnerability persist articulated in issues related to health; they appear with different representations among the multi-professional team and influence the way Nursing care can be produced in order to minimize situations of vulnerability and meet the health needs of the subjects related to better health conditions and quality of life.

In this study, the objective was to reflect on the concept of vulnerability in health in the light of Hannah Arendt's emancipatory assumptions of education and freedom.

THEORETICAL FRAMEWORK

Hannah Arendt, a German-American Jew, was born in Hannover, Germany, and was a student of Martin Heidegger, Karl Jaspers, and Edmund Husserl. To escape Nazism, she went into exile in the United States, where she remained until the end of her life.⁵ Her work is deeply influenced by her experiences, the main ones being: The Origins of Totalitarianism (1951); Between Step and Future (1957); The Human Condition (1958) and What is Freedom? (1961)⁶.

Several concepts were worked by Arendt, however, the common world and the human condition appear as the starting point in her speeches. The human condition represents characteristics of man's existence in a given space and is portrayed by vita activa, constituted by three fundamental human activities: labor, work and action, essential to life⁷. The human condition, which characterizes the subject as a social being, makes it unlikely to eradicate vulnerability. The subject must recognize its scope and become capable of responding to it.

The common world, on the other hand, is a set of symbolic and material heritages, the product of human works. Because it is common, it interposes itself between men, allowing their union and also their separation, signifying their actions, histories, and memories⁸. It is in this world that situations of vulnerability emerge, arising from characteristics inherent to the individual in his precariousness, allied to social inequalities and fragilities. The subjects are not born equal, they are singular. The world reveals itself to the human plurality, in a shared reality, confirming the plural human condition.⁹ It is in community life that the subject exposes his uniqueness in the midst of plurality.

Arendt presented human plurality as a choiceless fact, constitutive of the human on earth. Thus, from the moment man is in the world, worldly issues belong to them⁸. When man chooses to belong to the world, they assume the amor mundi, a space of vulnerability, and become responsible for their actions and for the consequences of their choices. From this, education and responsibility emerge, which, together with the previous concepts, empower freedom and thought.

Among the philosophers of Phenomenology, Arendt discoursed on education to understand events and the crisis of the modern world. Education is the means by which man acquires the experience to choose how to think and what truth to defend¹⁰. The thinking and understanding activities undertaken by Arendt, in her reflection on the concept and meaning of education, do not constitute a practical proposal to the teacher or to the school. She proposed understanding as the key for man to learn to deal with his surroundings and to feel at home in the world. She invited us to think about the meaning of education and the consequent judgment of principles and objectives^11,12.

Hannah Arendt's assumptions contribute to exercise equality and weave sociability before the plurality and visibility of men in vulnerable situations, leading them from freedom to decision-making, learning about life in the collective and favoring multiple social experiences. Therefore, such assumptions reverberate in the practice of nursing to reinforce the confrontation of inequality and encourage the adoption of initiatives that promote health.

METHOD

This is a theoretical-reflexive study based on Hannah Arendt's assumptions. Initially, a search was conducted for books, scientific articles and documents in national and international health databases that addressed the concepts studied by the philosopher. The search for scientific articles was made in the Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and on the PubMed portal, in March 2021. The descriptors used were: education, freedom, and health vulnerability. The keyword vulnerability and Hannah Arendt's name were added to the equation for better targeting of results.

Once the articles were located, we proceeded with the theoretical deepening. The construction of the axes of reflection was anchored theoretically in the concept of vulnerability and in the Arendtian assumptions of education and freedom. The results were grouped into two categories: Vulnerability in health as a human condition; Education and freedom of the subject in a vulnerable situation.

RESULTS AND DISCUSSION

Vulnerability in health as a human condition

The term Health Vulnerability (HV) is relatively new and has gained prominence in the 21st century. The precursors of the movement to construct this concept were the American researchers Mann, Tarantola and Netter, which arose with the emergence of AIDS in the 1980s. The HV approach drew attention to the need to act on the political, economic, social and cultural determinants involved in HIV/AIDS, better understood under the universal principles of Human Rights¹³.

In the epidemiological context, the conceptual construction of vulnerability configures the overcoming of prejudice inspired by the identification of risk groups and individual culpability that accompanied the focus on risk behaviors¹⁴. Based on the inseparability of theory and practice, Ayres¹⁴ emphasized the hermeneutic character of vulnerability in health and human rights. For the author, to study a health issue from the perspective of vulnerability is to seek a way to better understand a health problem in other ways. It is to overcome the factoration of contextual determinants in the explanation of vulnerability, working with various aspects, whether individual, social, or programmatic, all involved in illness¹³.

Vulnerability permeates law and health: it generates postures that disseminate ideas of social insertion of the fragile, from the individual to the collective. It covers finitude, susceptibility, incapacities, autonomy, and awareness; the social and political scientific thought, with the guilt of individuals and populations in situations of explicit fragility. It resorts to the environmental space and its circuits of economic and social production; it is linked to the guarantee of citizenship of politically fragile populations from the perspective of human rights and focusing on risky behaviors¹⁵.

Currently, two new definitions of vulnerability have been developed by nurses and published in national journals. The first definition is based on the phenomenological approach and presents HV as a multidimensional, contextual, and dynamic phenomenon, intrinsic to human existence, resulting from the interaction between the human person, co-presences, and care, which causes health problems or enables the evolution of the individual or collectivity^16,17.

The second definition came in a conceptual model in which HV was defined as the condition of human life expressed in all its dimensions from the (re)arrangements of power relations, which constitute the subject-social, producing precariousness when the agency movements are not potentiated for health promotion¹³. The evolution of HV definitions has made it possible to expand the term and add essential elements that clarify its concept.

In the search for understanding the various health-disease processes, Ayres et al.¹⁸ brought aspects to be considered in the three dimensions of the HV analysis, focusing on hermeneutics. When apprehending the HV from the perspective of the social subject, Florêncio and Moreira¹³ listed sub-concepts, based on post-structuralism, and extracted meanings from the concept, organizing them into three major groups: risk (exposure, risk factor, probability, possibility, potential and chance), susceptibility (fragility, wound, state of threat, experience and positionality) and precariousness (deprivation, unprotection, reduced capacity and precariousness). These meanings demonstrate the dynamism and maturity of the concept, which gains space as a mediator and producer of praxis in the health field.

As exposed, it was possible to observe the evolution and expansion of the concept and, through the findings, to realize that the HV is experienced in public invisibility, which points to a subject revealed in the experience of desubjectivation¹. Thus, the concept gains a relational nature under the perspective of human condition, essential characteristic of the subject-social, and tightens ties with Arendtian ideas.

In her studies, Arendt discussed the characteristics of the existence of the being in a certain space. For the philosopher, the human condition refers to the forms of life that a being imposes on themselves to meet their needs and survive. Therefore, it varies according to the place and the historical moment in which man lives³. The being is characterized by porosity stimulated by engagement in its own acts, thoughts and feelings, by the natural environment and human relations^19,20. In this area, the existential understanding of the conditioned and conditioning being is linked to the conception of the multi-determination of vulnerability.

Vulnerability must be recognized as a feature of the human condition, in its irreducible finitude and fragility¹⁶. To reflect on the dimensions of vulnerability that involve the individual and the collectivity is to ponder on the material, socio-environmental, cultural, legal, and subjective conditions. Such a perspective refers to the issue of change that people can go through¹³. Thus, human activities and capacities, such as working, creating, knowing, thinking, educating, are decisive to overcome conformism, habituality and predictability. Moreover, studies on the concept of vulnerability abound, but few contribute to an ontology that links social being, mediated by education, autonomy, and care.

There is a need to ponder critical issues related to care and research with subjects who experience situations of vulnerability and suffer serious inequities, with compromised health. It is promising, therefore, to rescue education for the potentialization of the protagonism of the subject in vulnerability and as an action tool for nurses. To do this, we propose the exploration of Arendtian ideas on education and freedom, linking them to the actions of nursing.

Education and freedom of the vulnerable subject

Many educators were fundamental to the current understanding of education as a new paradigm, in search of the conquest of a more just, solidary, and democratic country. Paulo Freire, Dermeval Saviani, Célestin Freinet, Rudolf Steiner, Maria Montessori, and Rubem Alves are indispensable characters in the history of Brazilian education, for addressing freedom and empowerment²¹ in basic and higher education²², building an inclusive²³ and cooperative²⁴ pedagogy, with guaranteed rights²⁵ and valuing the individuality of the student-educator²⁶.

In this expectation for a politicized education and the need to remodel it to meet social demands, Hannah Arendt's works have drawn the attention of educators for their originality, strength and independent thinking that there is faith in birth with the revelation of a new someone in the world, a singular being able to start something new and unforeseen and to renew the common world¹². But, how does Hannah Arendt's thought influences pedagogical actions for the subject to recognize and overcome situations of vulnerability? This question guided the search for reflections that express the potential of education in actions for the transformation of the world and the reduction of the condition of vulnerability.

Vulnerability is not a concept worked by Arendt, although it is essential to think about it from a political and conscientizing perspective. To do so, it is necessary to unlink the interpretation of HV from an exclusively individual point of view, which blames the subject for his/her situation, and expand it to the human condition. By considering that the political and social character constitutes the core of human activities and directly implies the production of the world, education unveils itself as a means to raise awareness and practice freedom of the subjects.

Arendt did not establish a direct relationship between education and freedom, but both concepts are supported by birth²⁷. Each birth is a beginning, with opportunities for change, in which educators contribute to the development of uniqueness, guided by the audience dimension¹². Education is the space and time when man prepares to change the world; it is the point at which they decide to love the world and take their responsibility for it¹⁰. Therefore, it is logical to think of education as a tool for identifying and overcoming HV.

To reinterpret Arendt's assumptions in the context of health care is to transpose the imposition of technical procedures and assume that the professionals' care can be seen as modes of action. Thus, the supplanting of HV conditions can come from the subject that has its understanding of the world expanded by education and by the mediation of professionals, such as nurses, because they have, in their training, health education as a tool for health protection and promotion, thus acting in this co-responsibility for the subject's birth.

Due to the factors that characterize the HV, human action, implicated in the collective, involves ethical-political aspects focused on the plurality of subjects and public spaces. It is in this caring for the common that education emerges as an act and narrows its link with vulnerability, because it invites the subject to rethink their practices. Ayres¹⁴ proposed the action associated with the historical and social context, by working with different sectors of society and transdisciplinarity, which contributes, in a critical and dynamic way, to political, cultural, cognitive, and technological changes.

Education allows the subject to understand challenges and tensions in the physical, emotional, social, economic and political spheres; it influences the planning and implementation of preventive, protective and proactive actions, enabling the construction of healthy contexts²⁸. It is necessary to highlight that the recognition to overcome vulnerability situations depends on the understanding of the subjects about themselves, relationships, contexts, and their rights and duties. This comprehension of reality happens through the awareness with the reorganization of actions and reflections.

It is mistaken to think that man comes into the world free from worldly influences. Birth is conditioned by the subject's condition in the world, and when they consciously choose to act, man is reborn, that is, they take responsibility for the world and its unfoldings (Figure 1). However, for this to happen, it is necessary that educators present the world to the learner, teach their knowledge and their sciences, and encourage the sharing of knowledge of the world so that new foundations are added and outdated ones are replaced. This shared construction implies a communicational and pedagogical process between subjects with different knowledge, living together in situations of interaction and cooperation¹⁵.

Figure 1
Relationship between human condition and common world in the Arendtian perspective. Fortaleza, CE, Brazil, 2021.

In this course, education must guarantee man's protection so that he develops his singularity thinking in plurality, because only in this way is it viable to establish a shared space. This is possible when man is educated in the political dimension (actualized in action), the ontological dimension (birth is the source of free human activities), and the inner or mental dimension (fundamental characteristic of the activities of thinking and willing)^3,10. This knowledge implies the autonomy of the subject, now politicized and aware of their rights.

By taking politics as collective ways of deciding how one wants to live and conduct public affairs, the subject advocates engagement with oppressed lives and participation in decision-making processes⁸. The construction of the subject as a political being must be provided by the State, which is also responsible for investing in what builds and constitutes citizenship, in those attributes that transform the individual into a citizen. This transformation, a presupposition of democracy, allows the subject to go from the realm of necessity to the realm of freedom¹⁰.

On the other hand, the influence of the prevailing economic doctrines on the Brazilian educational model is noteworthy. The neoliberal ideology, widespread since the last century, finds, in the austerity policy, the possibility of weakening social policies of universal character, with serious social effects: more socially vulnerable population subgroups are more negatively affected, in all contexts²⁹. This setback represents the failure of human judgment and marks the crisis of education. However, to achieve birth to education is to expand society's potential for growth and to stimulate common sense for the protection of those in vulnerable conditions.

To intervene in situations of vulnerability, it is imperative to stimulate and teach the development of actions that involve a social response, marked by the active participation of the population in the search for strategies that can be implemented and that address/address the problems and needs of the subjects^14,18. Education operates on the uniqueness of man in order to prepare them to do something entirely new.

In Arendtian thought, freedom is understood as a demonstrable fact, whose manifestation is subject to the existence of the public domain, politically assured as a concrete space where it is possible for people to perform their acts and speak their words to each other³⁰. Word and action are not separate, they need to establish an instance of power whose foundation is in the relationship and the possibility of creating new realities^3,10. Freedom is not an attribute of the will, but the expression of action manifested by the word.

It is in the understanding of the subject as a being in the world that they recognize themselves as authentic, free to transcend the world and themselves, leaving the indifference of everyday life¹⁶. Mediated by education, the human relationship with the world finds freedom in vita activa and its activities. Labor is considered an activity that leads man from birth to death; it is human corporeal biological process. Work consists in the unnaturalness of human existence and produces the artificial world of objects, of durable things, where man creates his own world. Action is that which is exercised directly between men; it corresponds to the human condition of plurality and takes place in a purely inter-subjective sphere³.

Here, education is apprehended as an action for freedom, which frees man from his inability not to reflect and create. Thus, action and freedom are intertwined, because it is action that makes the exercise of freedom possible: while freedom brings, in its core, the possibility to start or even to restart, overcoming the HV condition, it is through action that one expresses their domain of experiences.

Supported by the referential of vulnerability and Arendtian assumptions, Nursing can focus its educational actions on understanding the interlocution of the subject with the collective and, thus, promote the construction of knowledge: in group activities that encourage speech and the creation of healthy and sustainable environments through shared knowledge; in the identification and evaluation of needs that go beyond the health-disease process and when considering the singularity, the diversity of experiences and identity processes in the building of a better world for future generations.

These actions reveal themselves to be powerful for the empowerment of subjects in vulnerable conditions and resonate in health when they are based on empathy, collaboration and solidarity; they make social changes possible, corroborating the strengthening and elaboration of public policies and give the subjects the means to ensure greater control and improvement of their own health, contributing to actions of responsibility.

Currently, education is marked by the accumulation of knowledge and skills to the detriment of creativity and the capacity for reflection. In order to support the didactic and, pedagogically, a training proposal, Arendt worked with the creation of imaginary biographies and narratives, awakening the potentiality of creative writing to enhance the capacities of the subject. In this way, she stimulated possibilities of action: for the subject to think and to situate him/herself in the lived context¹¹. To work on the recognition of oneself and of one's surroundings is to concretize political learning, belonging, and making decisions regarding issues related to the common world. This awareness is crucial to overcome the HV in times of great instability and inequalities.

Arendt's assumptions guide the reflection on the subject and its health, political, civil, social, cultural, economic, and environmental contexts; this awareness grounds the respect for the integrity of man as a singular being, in his own history, and plural when living with others. When Arendt spoke about totalitarianism, she described the naked life and the unprotection of those who flank society, and it was in education that the philosopher refuted the alienation of the subjects and, thus, gave voice to those in a state of vulnerability, providing opportunities for transformations.

Nursing care, with a focus on education and vulnerability, stimulates the subject to understand and develop a critical and dialectical look at his/her relationship with the world, no matter how immersed in the culture of silence. Conquering and socializing knowledge that broadens knowledge, with a focus on accountability, on caring for the world and the other, are indispensable to the perpetuation of human life⁸. Man must be stimulated to think and to know. Thinking about vulnerability, education, and freedom from the perspective of a citizen practice and right, as Arendt advocated, could lead one to believe that man was born to begin¹⁹.

The reflections produced led to the conception that, through education, man in a vulnerable situation, recognize themselves as a citizen; they awaken and understand their rights and duties, accept their responsibility as a subject of action and relationship, and fights for their freedom and a liberated society through constructive and constitutive activities for the world. This awakening can and should be strengthened by nurses, as disseminators of knowledge and educators of a new generation, encouraging the subjects to assume themselves as conscious beings, with the ability to dialogue and attentive to individual and collective health and respectful of the other and the environment in which they live.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

It was evident that Arendt's philosophy and thoughts are related to vulnerability. Nursing assumes an important role in the education and awareness of the subjects, indispensable in the social and political context and in the search for freedom. Education unveils itself as an essential inclusive strategy in the fight against inequities and, through it, plurality is experienced, understood, and transformed, in the movement toward the recognition of situations of vulnerability and empowerment to overcome them, without ignoring the human condition. To base the educational actions of nursing on Hannah Arendt is to provide an opportunity to build a more just world, favoring the evolution of man as a singular and plural being.

As limitations of the study, it is noteworthy that little research on education in Brazilian Nursing is based on Arendtian ideas. Thus, future studies that approach education from the philosopher's perspective are necessary, as they elevate the subject to the condition of main author of life, aware of the social context.

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Edited by

ASSOCIATED EDITOR

SCIENTIFIC EDITOR

Publication Dates

• Publication in this collection
  24 Sept 2021
• Date of issue
  2022

History

• Received
  08 June 2021
• Accepted
  12 Aug 2021