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Ciência & Saúde Coletiva

Print version ISSN 1413-8123On-line version ISSN 1678-4561

Ciênc. saúde coletiva vol.25 no.7 Rio de Janeiro July 2020  Epub July 08, 2020

https://doi.org/10.1590/1413-81232020257.26122020 

OPINION

Perspectives of Popular Education in Health and its Thematic Group at the Brazilian Association of Public Health (ABRASCO)

Luanda de Oliveira Lima1 
http://orcid.org/0000-0003-2764-0764

Maria Rocineide Ferreira da Silva2 
http://orcid.org/0000-0002-6086-6901

Pedro José Santos Carneiro Cruz3 
http://orcid.org/0000-0003-0610-3273

Renata Pekelman4 
http://orcid.org/0000-0002-6249-5542

Vanderleia Laodete Pulga5 
http://orcid.org/0000-0002-1918-0916

Vera Lúcia de Azevedo Dantas6 
http://orcid.org/0000-0002-3914-9078

1Programa de Pós-Graduação em Saúde Coletiva, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil. luanda.ol@gmail.com

2Programa de Pós-Graduação em Saúde Coletiva, Universidade Estadual do Ceará. Fortaleza CE Brasil.

3Departamento de Promoção da Saúde, Centro de Ciências Médicas, Universidade Federal da Paraíba. João Pessoa PB Brasil.

4Curso de Medicina, Escola de Saúde, Universidade do Vale do Sinos. São Leopoldo RS Brasil.

5Programa de Residência Multiprofissional em Saúde, Curso de Medicina, Universidade Federal da Fronteira Sul. Passo Fundo RS Brasil.

6Secretaria Municipal de Saúde de Fortaleza. Fortaleza CE Brasil.


Abstract

Popular Education in Health (PEH) is a field of knowledge and practices permeated by listening, dialogue, and action. With a set of national experiences and productions, it is a political-pedagogical movement that articulates forces from various social and popular segments, health workers, educators, and researchers in collective health, among other actors. Supported by authors such as Paulo Freire and Victor Valla, among others, PEH has been strengthened in the dimensions of training, participation, management, and health care. Despite the dismantling experienced today in the Brazilian public scene, the PEH Thematic Group (TG) of the Brazilian Association of Public Health (ABRASCO) has been helping to foster, design, and express the voicing of the construction and development of participatory educational and democratic processes in Brazil. This paper showcases the experiences and elaborations of the TG members through the report of the collegiate coordination center members of the last administrations, a period of changes in the political, social, economic, educational and health scenarios, including the influence of the current planetary crisis brought about by the effects of COVID-19, especially in the Brazilian society.

Key words Popular education in health; Collective health; Community participation

Resumo

A Educação Popular em Saúde (EPS) constitui um campo de conhecimentos, saberes e práticas, permeado pela escuta, pelo diálogo e pela ação. Com um conjunto de experiências e produções nacionais, é um movimento político-pedagógico que articula forças de vários segmentos sociais, populares, trabalhadores de saúde, educadores e pesquisadores da saúde coletiva, dentre outros atores. Sendo fundamentada por autores como Paulo Freire, Victor Valla, entre outros, a EPS vem sendo fortalecida nas dimensões da formação, da participação, da gestão e do cuidado em saúde. O Grupo Temático (GT) de EPS da Associação Brasileira de Saúde Coletiva (ABRASCO) vem ajudando a fomentar, desenhar e expressar, apesar do desmonte vivido nos tempos de hoje na cena pública brasileira, processos de vocalizações da construção e desenvolvimento de processos educativos participativos e democráticos no Brasil. O presente artigo apresenta as experimentações e elaborações dos membros do GT através do relato dos componentes do núcleo de coordenação colegiada das últimas gestões, período reconhecido de mudanças nos cenários políticos, sociais, econômicos, educativos, sanitários, incluindo a influência da atual crise planetária que vivemos, pelos efeitos da COVID-19, especialmente na sociedade brasileira.

Palavras-chave Educação popular em saúde; Saúde coletiva; Participação comunitária

Introduction

Community health must be heard. It traverses the singular and the plural aspects, not only in the morphological perspective but also all dimensions that are compatible with life in the diverse territories inhabited by the subjects. The meeting between popular education practices and health in Brazil has led us to affirm that Popular Education in Health (EPS) was established and permeated by listening/dialogue and action, where a political-pedagogical movement emerges from the articulation between forces from various social and popular segments, workers and health professionals, educators and researchers in the field of public health, and scholars from different areas of health.

Paulo Freire1 speaks to us of the importance of recognizing the knowledge of experience. An academic reference in the field, Victor Valla2, already called our attention to how much to listen and the fact the representations of listening can have different materialities depending on the position of the speaker and the listener.

The Thematic Group (TG) of PEH of the Brazilian Association of Public Health (ABRASCO) has assumed the Freirean principles, now also recognized as principles of the National Policy of Popular Education in Health in the Unified Health System (PNEPS-SUS), which members helped to foster, design and express3. Despite the dismantling experienced today in the Brazilian public scene, PEH allows voices to be heard, dialogues established, and, thus, we can say that the construction and development of participatory and democratic educational processes are envisioned, also by the appropriation in the extension and the search for pedagogical approaches that can foster community, social and popular interaction.

This paper aims to report the experiences of the PEHTG members through the report of the collegiate coordination center members of the last administrations, a recognized period of changes in the political, social, economic, educational, and health scenarios of the TG itself. The work is still influenced by the current planetary crisis, due to the effects of Coronavirus Disease (COVID-19), especially in the Brazilian society. In this context, sharing what has been experienced in so many other places by so many other people already comes to the fore with robust trails to be followed.

The TG main actions in the 2016-2020 period

It is essential to highlight that the methodological approach concerning popular education was one of the main concerns of the organizational procedures during the last management of the coordination group of the ABRASCO PEHTG. Since 2016, we have sought to guide the way of conducting the TG’s internal processes, and the relationships between its participating subjects and mediation on different work fronts, along paths that were soaked with elements such as dialogue and participation. Among other procedures specific to this way of mediating the Group, establishing the TG as a working community has been a priority since the beginning of this cycle. The concept of the working community was proposed by Oliveira4 and other authors based on studies and research within the Federal University of São Carlos. Silva and Araújo-Oliveira5 affirm that a working community “is built around common goals that transcend the personal; they are situated and rooted in a commitment to building a just society that guarantees equal rights and different treatment for different conditions, circumstances, and socio-historical-social opportunities”.

This community is mediated by work in its relationships and actions. Thus, it is also a network aimed at unveiling a transformative action, which is enhanced by work fronts underpinned by subjects with different profiles and strengths, but who act in the perspective of complementarity, through the cooperative and solidary union of people, in a loving, solidary and dialogical way, so that this community manages to go much further in the achievement of the objectives, especially those collectively agreed.

In this direction, besides building an environment in which people understand each other as members of a community, one of the managerial center’s actions was to collectively build action fronts in which members could and should be introduced, participate and contribute. Different experiences enrich its leading figures. They could and should come together to identify PEH and Collective Health challenges, establishing a community engaged and committed to thinking about efforts to overcome these challenges through creative, creator, and transforming contributions of social activity, socially-referenced research, and training processes.

We wish to highlight that this way of setting the TG allowed us to glimpse a collective common thread that guided the team’s regular meetings, which were also much more frequent and regular in this period, facilitated by the possibility of conducting virtual meetings.

One of the main action fronts on which the TG has dedicated itself in recent years has been the systematic support for publications in PEH. This front aimed at the possibility that PEH experiences could be increasingly shared and socialized with an increasingly broader and more diverse audience.

The design of popular education has contributed to the reorientation of several public policies and the construction of sound social practices that succeed in building concrete experiences and practices in several territories, from primary care to tertiary health care, in the construction of a health action that is critical, humanized, participatory and inclusive. As a result, the TG dedicated itself to mobilizing different opportunities so that the experiences of popular education staged nationwide had an environment for the explanation of the knowledge, methodologies, knowledge, ideas, and practices produced therein.

Taking this view as a starting point, some possibilities for publication in three Thematic Dossiers have been opened in recent years in partnership with scientific journals such as Interface - Educação, Comunicação e Saúde, from the State University of São Paulo, Campus Botucatu; besides the organization of two e-books: “Educação Popular em Saúde” and “Participação Social em Saúde”, by the Publisher of the Communication, Tourism, and Arts Center (CCTA), of the Federal University of Paraíba (UFPB), in the press; and of two books:“Educação Popular em Saúde: desafios atuais” and “Agir crítico em Saúde”, by Hucitec Editora, the first published in 2018, and the latter in press.

Another prominent action front in the scope of the TG in recent years consisted of the shared construction of a national PEH research project, promoted through the multicenter articulation of different universities and educational institutions represented by the different members of the TG, but coordinated by the University of the State of Rio de Janeiro (UERJ).The main intention of this research project was to give visibility to the field experiences promoted throughout the country, in the perspective of situating, identifying, characterizing and describing them, so that, thus, we could have a survey that would explain the development of PEH in the various Brazilian health services, educational institutions, and, mainly, but with prominence, together with social movements and popular practices. At first, a sub-project dedicated to the unveiling of what we called an “Anthology of Brazilian PEH” stood out within the context of this activity. This subproject consists of the possibility of conducting interviews guided by the perspective of life history, with actors who have historically built PEH in the country, so that their memory and their historical look are recorded, with emphasis on their path and experiences, and their impressions and considerations about the current context and their challenges for the field.

Another critical action front of the TG was the promotion of spaces and contexts for sharing experiences, and the political organization of the PEH movement. In this perspective, the TG had to propose the creation of public spaces where PEH would be discussed based on sharing experiences and dialogue of its leading figures to learn and make teaching and learning processes with each other’s experiences. Such spaces allowed moments of discussion about popular education and its interface with the current Brazilian context. This was especially true in 2016, a period in which attacks on democracy, social and human rights, and inclusive and participatory social policies were exacerbated.

Worth highlighting is the support of the TG, along with several of its leading figures, in different health conferences across the national territory during 2019, which was a challenging year from the viewpoint of participation in public policies, given the growing threats to democracy, the withdrawal of rights and the extinction of participatory spaces within the scope of the Brazilian Republic. At the conferences, the members of the TG acted to mobilize the main actors of society to participate in an insistent, purposeful and critical way in both municipal and state conferences, such as the promotion of the National PEH Free Conference, held in late May 2019, in the municipality of Passo Fundo, in the state of Rio Grande do Sul, and active participation in the 16th National PEH Conference, with several actions at the Tenda Paulo Freire, in care spaces and commissions, in August 2019, in Brasília, in the Federal District.

In partnership with the State University of Ceará, the TG held the First Thematic Seminar in 2018, a preparatory activity for the 12th Brazilian Collective Health Congress, whose main issue was popular participation and its challenges within the SUS. Another important event held was the Second Thematic Seminar of the TG, held in Parnaíba, Piauí, at the Federal University of Delta do Parnaíba, in which in-depth debates were held on different emerging issues in the field of popular education, which were being unveiled in the course of the last management of the TG, such as PEH and its interfaces with knowledge production, research, health education, social participation in health, the arts and multiple languages, among others.

Finally, concerning meeting spaces, the Sixth National PEH Meeting (ENEPS) stands out, which, once again, fulfilled the role of providing the meeting of the Brazilian popular education movement with its various communities, groups, practices, and experiences. The ENEPS is a space for mediatizing the dialogue between national PEH practices and groups.

Affirming PEH as an environment of resistance, building possibilities, and advocating for the SUS, the Sixth ENEPS’ theme was “Paths to democracy, autonomy and well-being”. Seeking to build a welcoming space that promotes dialogue and exchange between all, the meeting was mostly held in conversation and dialogue wheels, with trigger questions presented by invited people or by the presenters of works, who previously registered their experiences and research. As a recommendation, the plenary of the Meeting agreed that movements and actors must articulate and cooperate in local actions, fostering PEH in the different ways of building health. Communication between those who build PEH was highlighted by the importance of carrying out articulated actions and sharing those carried out in different spaces across the nation.

The transition of the TG coordination collegiate group took place during the Sixth ENEPS. With the expanded field of popular education in health and its epistemic strengthening, whether within the scope of theoretical productions and reflections or in the field of experiences, an increasing number of workers and researchers started to build their practices under this perspective. This growth led several researchers to become interested in being part of this group with the proactive role of the TG members in the construction of the PNEPS-SUS and recognition by the Collective Health. Thus, in the last two years, the management group has promoted discussions within the TG regarding participation criteria, considering the perspective of establishing ourselves as a working community. These criteria have been matured by the group, with an in-depth look at what we hope to produce as a TG, what paths, and commitment to this group we can expect from its members. In the process, companions have come and gone, because we share this familiar path.

It is essential to consider that the TG established that the places of coordination must be transitory, since all participants can assume them, and alternation in the place of leadership is a central ethical criterion for the political conduct of the Group. We opted to carry out a very dialogued transition process, maintaining a collegiate management center with maximum regional representation and varied generational representativeness. The Group understands that this transition process is fundamental so that the work carried out so far continues to give centrality to the TG and the PEH.

In turn, the First International PEH Colloquium, held in March 2020, in Passo Fundo, was a moment of debate, deepening and visibility of the different dimensions of PEH, with the active participation of several members of this ABRASCO TG and more than 700 leading actors from all regions of Brazil, as well as representatives from countries such as Italy, Bolivia, Argentina, Czech Republic, and Slovakia.

A series of actions and discussions have been articulated and promoted over the last year by the TG to maintain the same ethical and methodological paths as the previous management. Some build on the previous management and others have been built, especially in the context of the COVID-19 pandemic. With physical isolation and distance, we all had to reinvent ourselves and our ways of acting in the world, influencing society, and rethinking our ways of doing.

In recent months, the TG has been holding meetings every two weeks, in order to reflect on the possibilities of building PEH, in this current context, in some situations with the limited physical contact, which adds elements so dear to the popular perspective of empathy and lovingness, like hugging, touching and looking.

Thus, due to the need for social isolation, we have reflected on the urgency of rethinking our presences and building polyphonic spaces of communion between knowledge, allowing its expression through multiple creative-inventive possibilities; to teach and learn, reflect and act with and about the world. Thus, we have tried to get together more, albeit virtually, to exchange our experiences. We are also organizing materials and open spaces that bring another look at care, besides the hygienist-sanitary perspective, which values the different places of speech, the multiple experiences, and knowledge.

The challenges posed by the COVID-19 pandemic reveal the need to expand and deepen PEH practices, whether to undertake critical training efforts for health workers and other social actors in the area (such as groups and popular social movements), or for the creation, recreation, and improvement of social and community spaces in the territories for supportive solidarity and for the establishment of mutual relationships at a time of exacting and complex demands from an emotional viewpoint. Another essential front is to base PEH as a reference in mediation processes in the fight for the rights of health workers in times of pandemic, including those in hospital contexts and community health workers, and also for the qualification popular social struggle for the right to health, including access to the health system in cases of urgency due to the new coronavirus. Finally, thinking about PEH in the orientation of social works aimed at confronting economic poverty and the processes of social exclusion that, indeed, will escalate, both by the ongoing health crisis and the necropolitics of a government that, guided by ultraliberalism and due to ultra-conservatism, establishes a public agenda of barbarism and fraying of the social fabric, especially of the popular classes.

Conclusions

Given the reflections brought about in PEH’s current perspectives from the experiences of the ABRASCO PEHTG and the challenges of reality, we can characterize the perspectives in some articulated movements in order to act in the:

a. Strengthening of the struggles for democracy, affirmation of rights, strengthening of the SUS, Public Policies and the Democratic and Popular Project based on Well-Being and the defense of life on the Planet, as guiding elements in the actions of people engaged in the TG and its articulation with entities, organizations, scientific associations, and popular social movements;

b. Improvement of PEH-based educational practices, both in formal and informal spaces; in research, programs, and projects of popular extension and community interactions and with popular social movements; and actions of popular and integrative health care and health and art practices;

c. Theoretical construction process of the bases underlying the critical and liberating action produced by the PEH practices;

d. Way of building actions articulated in national and international collaborative and solidary networks of popular education, health, participation, and social control;

e. Commitment to act in defense of Health in the Defense of Life initiative, where all lives matter.

Referências

1 Freire P. Pedagogia do oprimido. Rio de Janeiro: Paz e Terra; 2005. [ Links ]

2 Valla VV. A crise da interpretação é nossa: procurando entender a fala das classes subalternas. In: Brasil. Ministério da Saúde (MS). Secretaria de Gestão Estratégica e Participativa. Departamento de Apoio à Gestão Participativa. II caderno de educação popular em saúde. Brasília: MS; 2014. p. 35-48. [ Links ]

3 Brasil. Ministério da Saúde (MS). Secretaria de Gestão Estratégica e Participativa. Política Nacional de Educação Popular em Saúde (PNEPS-SUS). Brasília: MS; 2012. [ Links ]

4 Oliveira MW. Pesquisa e trabalho profissional como espaços e processos de humanização e de comunhão criadora. Cad Cedes 2009; 29(79):309-321. [ Links ]

5 Silva PBG, Araújo-Oliveira SS. Cidadania, ética e diversidade: desafios para a formação em pesquisa. In: Actas del VI Encuentro del Corredor de las Ideas del Cono Sur. Montevideo; 2004. p. 1-8. [ Links ]

Received: May 22, 2020; Accepted: May 22, 2020; Published: May 24, 2020

Collaborations

All authors participated in the conception and design or analysis and interpretation of data, writing or critical review of the paper, and approval of the published version.

Creative Commons License Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.