Health promotion in the governmental agenda of the state of Bahia: politics or rhetoric?

Fonseca, Ana Carla Freitas; Medina, Maria Guadalupe

doi:10.1590/0103-11042018S221

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ORIGINAL ARTICLE • Saúde debate 42 (spe2) • Oct 2018 • https://doi.org/10.1590/0103-11042018S221 copy

Health promotion in the governmental agenda of the state of Bahia: politics or rhetoric?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study is aimed at analyzing the conditioning and determining factors in the incorporation of health promotion proposals into the governmental agenda of the healthcare industry of the state of Bahia, in the period from 2007 to 2014, recognizing the inception of studies that analyze the constitution process of government agendas for health promotion. The research was theoretically anchored to the Multiple Flow model, proposed by Kingdon, which highlights the influence of the active participants and problem flow, as well as of alternatives and political streams in establishing government agenda. In addition, we were supported by Mario Testa's theory to recognize the resources of the power of the participants. A single case study was conducted, with research on secondary sources and interviews with key informants. In conclusion, the constitution of the health promotion agenda of the state of Bahia was based more on a symbolic representation than on a policy to be pursued. We recognize that the paths that lead to the choices of health promotion alternatives do not correspond to concrete problems, and it is essentially based on the political flow in which the situation was involved.

KEYWORDS
Health promotion; Public policy; Health priority agenda

Dimensions of analysis	Analytical categories	Definition
Flow of the problems	Types of problems	Classification of the events mentioned by the social participants as problems related to the health promotion space, according to its comprehensiveness (state of health, organization of the health and socioenvironmental services) or regarding the need presented (social, political or economic value)
Flow of the problems	Defining factors	Variety of information that was the foundation for the recognition and value of the systemic indicators, mobilizing events - crises, feedback of governmental actions, accumulation of knowledge among experts, values of the participants and comparisons
Flow of alternatives	Types of alternatives	Classification of the proposals mentioned by the social participants as alternatives to approach the object (prevention of harms, individual or collective interventions aimed at changing habits or socioenvironmental interventions, direct or indirect interventions that support the municipal organization, formative interventions etc.)
Flow of alternatives	Defining factors	Aspects involving the proposition and choices of alternatives (technical support, political values, support to participants, social representation, coherence with the problems shown, diffusion strategies in the specialized communities and with the public).
Political flow	National context	National political events that may have favorable or unfavorable influence on the establishment of the agenda
Political flow	State context	State political events that may have favorable or unfavorable influence on the establishment of the agenda

Types of power	Criteria for the evaluation of resources of power	Classification of the criteria
Types of power	Criteria for the evaluation of resources of power		High (++)	Medium (+)	Low or null (-)
Technical	Academic background in collective health	Doctorate in Collective Health or similar areas	Master's or Residency in Collective Health or similar areas	Specialization in Collective Health or similar areas	No specific academic background
	Expertise in the central theme	Specific academic background (long-term course) in the central theme or experience in research or extension projects for more than 2 years	Short-term course in the central theme or experience in research or extension projects for less than 2 years	Participation in scientific events and technical training with focus on the central theme	No specific training
	Time and type of experience in management positions	1^st and 2^nd ranking positions for 4 years or more (secretary, sub-secretary and superintendent)	1^st and 2^nd ranking positions for less than 4 years, 3^rd ranking position for 4 years or more (director or secretary assistant)	Coordination or technical position in the planning area or 3^rd ranking position for less than 4 years.	Other technical positions or no previous experience in management
	Experience in teaching about collective health at universities (time or title)	Full professor at a public university	Assistant professor for more than 5 years	Professor for less than 5 years	No academic experience
Administrative	Position held during the period of study	1^st ranking position at SES or other governmental bodies (secretary or sub-secretary)	2^nd ranking position at SES or other governmental bodies (superintendent or secretary assistant)	3^rd or 4^th ranking at SES or other governmental bodies (directors)	Technician, consultant or assistance of 2^nd or 3^rd ranking bodies. Professionals of non-governmental bodies.
Administrative	Time of experience at SES in management positions in the period studied	4 years or more in 1st ranking position	< 4 years in the 1st ranking position or 4 years or more in the 2nd or 3rd ranking positions or secretary assistant	< 4 years in 2nd and 3rd ranking positions	Other situations
Political	Participation in political parties	Official of the elected political party	Associated to the political party holding power	Affiliated to other political parties	No political party affiliation
	Participation in social movements	Official of groups of social representation who have a role in the health environment	Member of groups of social representation who have a role in the health environment	Member of groups of social representation who have a role in other environments besides health	Non-participant
	Internal participation	Secretary or the individual responsible for direct and frequent dialog with the secretary	Direct dialog with superintendents	Direct dialog with directors from other environments	Indirect or occasional relation with directors
	Participation in other governmental sectors	Direct relations with the Staff or the managers of the 1^st and 2^nd ranking of other sectors	Direct relation with the 1^st and 2^nd ranking managers of other sectors	Direct relation with the 3^rd ranking managers of other sectors	No relation with other sectors

Interviewees	RoleContext^* * Governmental (G) and Non-governmental (NG).	Resources of power^ Low or null (-), medium (+), high (++) and Very high (+++).			Position regarding the agenda^* ***** Favorable (F), neutral (N).
Interviewees	RoleContext^* * Governmental (G) and Non-governmental (NG).	Technical	Management	Political
I1	G	+++	+++	++	F
I2	G	+	-	-	F
I3	G	++	+++	+	F
I4	G	++	-	+	F
I5	G	++	+	++	F
I6	G	+	+	+	F
I7	G	+	-	-	F
I8	G	+	+	+	F
I9	G	+++	++	++	F
I10	NG	+++	-	+	N
I11	G	+++	+++	+++	F
I12	NG	-	-	+	N

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[1] Collaborators

Medina MG and Fonseca ACF have contributed to the elaboration of the article by carrying out the following activities: design and preparation of the article, data analysis and interpretation, as well as preparation of the article.