Abstract

Introduction

Care is a key dimension of human life which, according to Ayres¹1. Ayres JRCM. O cuidado, os modos de ser (do) humano e as práticas de saúde. Saude Soc. 2004; 13(3):16-29., must be committed to the construction of a project of happiness and humanization “that goes through the democratic radicality of the Common Good” (p. 28), involving the individual and collective plan, the very existence, as well as that of the world. The construction of a project of happiness implies in ontological investment, in conceiving the being, through the hermeneutical exercise on life.

The ontological conception of care demonstrates an effort to put it beyond its institutionalization in the field of health as well as to rethink it beyond the mode of technical-instrumental control, focused on the objectivity of therapeutic procedures that disregard the subjective dimension of the health-disease process. It is a perspective that carries a large responsibility, especially nowadays when care is strange, a dimension trapped in the bonds of biomedical hegemony that normalizes what is human and adapts it to the prevailing social order, regulating life according to the interests of capital, and not according to a project of happiness and common good.

Care, according to Ayres’ conception, has being challenged in the context of neoliberal advances, which, with the mastery of biomedicine, is placed in a reality of health mercantilization and life medicalization. As a procedure that aims at prevention, diagnosis, treatment of diseases and rehabilitation of people, it has been integrated into the verticalized and protocolized intervention process of the doctor-specialist, usually ending up despising the subjective element of the disease “in the quest for the most productive and efficient technical knowledge for the control of diseases”²2. Contatore OA, Malfitano APS, Barros NF. Os cuidados em saúde: ontologia, hermenêutica e teleologia. Interface (Botucatu). 2017; 21(62):553-63. (p. 554).

This model also overlaps with other medical systems, such as Chinese medicine or the various popular knowledge that organizes care, disregarding that “the art of healing is an essential aspect of all medicine”³3. Capra F. O ponto de mutação – a ciência, a sociedade e a cultura emergente. 27a ed. São Paulo: Cultrix; 2006. (p. 118). In addition, health professionals focus on “medical, surgical, electronic and body manipulation techniques that act in the process of sickening and healing at the biological level”⁴4. Vasconcelos EM. Redefinindo as práticas de saúde a partir de experiências de Educação Popular nos serviços de saúde. In: Vasconcelos EM, Prado EV, organizadores. A saúde nas palavras e nos gestos: reflexões da rede de educação popular e saúde. 2a ed São Paulo: Hucitec; 2017. p. 19-33. (p. 19), without worrying about setting a dialogue and acknowledgment of popular lore, key to care especially in places with lack of resources. A technicalist and individualist conception prevails, seeking the normalization of life and unbinding the care from political action and human existence, emptying it of its ontological dimension. This is due to the fact that modern medicine resigns care as a medical practice and transforms it as a bio-political strategy for the government of life and the regulation of populations⁵5. Foucault M. Em defesa da sociedade. São Paulo: Martins Fontes; 2000..

In this process of critical review on notions of care, several actors in the Collective Health field have approached the topic in dialogue with different theoretical approaches. Contatore et al.²2. Contatore OA, Malfitano APS, Barros NF. Os cuidados em saúde: ontologia, hermenêutica e teleologia. Interface (Botucatu). 2017; 21(62):553-63. have systematized some of these approaches, in which, added to the pragmatics that characterize this hegemonic medicine, presents: the extended and shared clinic, amplifying the object of knowledge and clinical intervention and including the subject and its context; the managerial approach, which proposes the opening for the participation of several professionals in the sharing of responsibilities; the philosophical, seeking the theoretical and epistemological bases of care; the emancipatory, related to the rationality of some integrative and complementary health practices; the political, which promotes the culture of self-care, present in obtaining and maintaining the health of individuals that are aware of their needs; the sociological, which emphasizes the role of the State in the promotion of well-being; and the cultural, which reflects on the approaches that allow to question the social practice of the nurse in the management of care.

Although this study presents a broad and important perspective of approaches to health care, the possible collaboration of Popular Education (PE) and Freirean pedagogy in the process of building modes of care go unnoticed. We know that this issue is central to Popular Education in Health (PEH) and has been processed by several authors/actors in the search for other ways and means to produce care in the territories, services and daily work in health.

Although the notion of care is not directly explicit in Freire’s work, his ethical-critical-political understanding of education is soaked with elements that make us refer to it as a caring conception. Inspired by readings made by Walter Kohan⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019. of Paulo Freire, we venture into this essay to perform a critical-analytical exercise that seeks to reflect on how Freirean thinking enables to affirm another conception of care and, even more, how it makes possible to affirm care as a dimension of its pedagogy.

We have aimed here to explore firstly some Freirean notions directed to education, aiming to broaden the understanding of the ontological and humanistic dimension that allows to resignify care in the field of health, such as the pursuit to be more, the appreciation of popular lore, respect, dialogue and lovingness. Then, to systematize how the PEH understands care; and identify the Freirean assumptions that support such a conception, pointing out ways beyond biomedical hegemony. Finally, we add care to Freirean pedagogy and reflect on its relationship with the construction of an authentic life, having a dialogue around the possibilities of a project of happiness and common good.

The caring dimension in the Freirean legacy

Kohan⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019. presents Paulo Freire as a philosopher committed to life, who thinks in regards to existence, not only the ideas, establishing a relationship between philosophy, politics, education and life. Recognizing the various theoretical influences that cross and sustain his work, he chooses a different path from the one which usually “connects him with other authors and traditions of thought of the history of ideas” (p. 63), starting from two traditions to think about the relationship of the educator with philosophy.

The first tradition comes from the Marxist current, from “Late-day Marx, with his critique of speculative philosophy”⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019. (p. 63), and here Freire extracts the notion of praxis from Thesis 11 on Feuerbach of Marx and Engels (2002) apud Kohan⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019. (p. 63): “So far, philosophers have interpreted the world. The question is to transform it”. Freire is inscribed in this tradition that understands philosophy as praxis, as action and reflection, that thinks of education as political action committed to the liberation of the oppressed. The second tradition, “more controversial and less explored” (p. 66), as the author considers it, is based on Foucault’s ideas and relates to the first, as Foucault recreates Marx’s critique of philosophy by proposing a “philosophy of the history of philosophy” (p. 66). If Marx intended to break through a certain tradition of philosophy, Foucault “helps to perceive what already existed, but was not being perceived” (p. 67). Looking from the second tradition, Kohan sees in Freire a philosopher who participates in the construction of an aesthetic of existence, which assumes philosophy as the wisdom of life.

Paulo Freire sought to maintain coherence between what is said and what is done, reducing as much as possible the distance between these acts, since “it is not the discourse that validates the practice, it is the practice that brings life into the discourse”⁸8. Freire P. Pedagogia da tolerância. 3a ed. São Paulo: Paz e Terra; 2014. (p. 41). This reveals his concern to establish a relationship between reality and life, and to educate with his own example. It is in this sense that “Paulo Freire is inscribed in the tradition of a philosophically educational, political, ethical and heroic life that Foucault began with Socrates and the cynics and continues in our era with Christian ascetics.”⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019.(p. 73).

Assuming life as a work of art, Freire’s philosophy emerges as a problem-critical pedagogy that results from his own efforts to understand human nature and the relationships that human beings establish between themselves in and with the media reality, that is, in and with the world in which we live. Thinking about human existence, he affirms that humans are inconclusive, unfinished and incomplete beings⁹9. Freire P. Pedagogia do oprimido. 62a ed. Rio de Janeiro: Paz e Terra; 2016.,¹⁰10. Freire P. Conscientização. São Paulo: Cortez; 2016., which differentiates themselves from other animals by being able to separate from their activities in the world and even from themselves, to objectify themselves as cognizant objects and to create/transform reality and themselves. Therefore, they are conscious of their inconclusiveness, unfinishedness and incompleteness, which lead them to the permanent movement of seeking for “being more”:

As beings of praxis, permanently engaged in the creation and recreation of nature, human beings create history and become social-historical beings. In this sense, existence is historical⁹9. Freire P. Pedagogia do oprimido. 62a ed. Rio de Janeiro: Paz e Terra; 2016. and can be instituted in two ways, by dehumanization or humanization. The first deals with the concrete expression of alienation and domination, the result of an unjust order that generates violence and seeks the maintenance of the status quo, of destiny as something given. The second is understood as a path to social transformation, the liberation from oppression, which would allow the exercise of the human vocation of being more.

Education, as an exclusively human phenomenon, with its roots in the awareness of incompleteness and becoming in reality, can nourish either of these two processes, depending on how it understands the subjects of the educational context and the social function of this practice. The horizon of humanization requires a problematizing pedagogical approach that emphasizes change, with the radical transformation of the oppressive world, thus making itself revolutionary⁹9. Freire P. Pedagogia do oprimido. 62a ed. Rio de Janeiro: Paz e Terra; 2016..

The human being, as a historical and cognizant subject is in a permanent movement of quest, constantly making and redoing knowledge¹²12. Freire P. Extensão ou comunicação? 17a ed. São Paulo: Paz e Terra; 2015.. This denies the possibility of absolutizing ignorance, as well as that of knowledge itself, after all, “nobody knows everything; nobody ignores everything. We all know something; we all ignore something”¹³13. Freire P. Professora sim, tia não: cartas a quem ousa ensinar. 26a ed. São Paulo: Paz e Terra; 2016. (p.121). There is a defense of equality as a political principle, an equality that does not oppose difference but inequality - the difference is, in Freire, the political condition of equality, that is, “if we were no different, there would be no need for equality”⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019. (p. 86).

However, faced with the intrinsic relationship between knowledge-power and the unequal exercise of power in our society, there is an appreciation of a certain type - usually called “knowledge” - and devaluation/denial of different other lore - usually called “common sense” or folklore.

Freire¹⁴14. Freire P. Pedagogia da autonomia: saberes necessários à prática educativa. 54a ed. Rio de Janeiro: Paz e Terra; 2016. criticizes the valuation of better or worse knowledge. In contrast, it understands that knowledge is different, with different natures. Given that “the educators’ thinking only gains authenticity in the thinking of the learners, both mediated by reality”⁹9. Freire P. Pedagogia do oprimido. 62a ed. Rio de Janeiro: Paz e Terra; 2016. (p. 89), education occurs with actors in intercommunication and shared construction of knowledge, it is a dialogical action and not an imposition. Overcoming a dehumanizing banking practice requires a movement for the restoration of intersubjectivity, guided by the establishment of a horizontal relationship between such actors, based on respect and humility.

Respect, tolerance and humility appear as values in the process of considering the other as equal in dignity, despite the differences. Virtues that teach us to live with what is different, so that we can even learn from difference⁸8. Freire P. Pedagogia da tolerância. 3a ed. São Paulo: Paz e Terra; 2014..

This implies revisit the notion of subject in the Freirean work, recognizing the historical character and historicity of the human being. Since there is no possibility of action-reflection outside the human-reality relationship, it is necessary to recognize the different contexts that pass through each individual in her/his life experiences¹⁵15. Freire P. Educação e mudança. 37a ed. São Paulo: Paz e Terra; 2016.. In this perspective, in addition to present principles regarding respect for the knowledge of others, Freire⁹9. Freire P. Pedagogia do oprimido. 62a ed. Rio de Janeiro: Paz e Terra; 2016. also reserves methodological guidelines that subsidize the establishment of respectful/tolerant pedagogical practices. It assumes to propose the subjects’ own situations as a problem and to adopt the students’ experiences and knowledge as the basis of educational practice.

In the Freirean sense, respect for the knowledge of subjects does not imply that the subjects of the educational process cannot contribute new knowledge. On the contrary, a dialectical perspective is taken between respecting such knowledge and challenging it. Instead, the pedagogical process in a critical perspective requires building new knowledge that clashes with the oppressive and dehumanizing reality and with our way of seeing the world and social relations. Therefore, seeking the existing knowledge is one of the stages of the gnoseological cycle, after all, “I can’t announce as long as I don’t know”¹⁰10. Freire P. Conscientização. São Paulo: Cortez; 2016. (p. 58). It is based on the “knowledge of experience done” of the subjects so that one can problematize the world, critically analyze it, therefore collectively overcome the oppressive reality. This process is only possible through dialogue among equals.

When describing his understanding of what dialogue is, Freire points out that love is one of its constitutive elements. He qualifies it as the “love to the world and to humanity”, pointing out to a notion of love as the subjects’ commitment to the contexts in which they live and to the social interactions that are established, in favor of the causes of the oppressed for their liberation⁹9. Freire P. Pedagogia do oprimido. 62a ed. Rio de Janeiro: Paz e Terra; 2016.. Therefore, it sees love as a vital force, an expression of courage and commitment to others⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019..

In this sense, love can be understood as an act of freedom, which generates other acts of deliverance⁹9. Freire P. Pedagogia do oprimido. 62a ed. Rio de Janeiro: Paz e Terra; 2016., for which it is necessary to unite responsible subjects with the commitment to social transformation¹⁰10. Freire P. Conscientização. São Paulo: Cortez; 2016.. A love “of one who affirms himself in the right or the duty to have the right to fight, to denounce, to announce”¹³13. Freire P. Professora sim, tia não: cartas a quem ousa ensinar. 26a ed. São Paulo: Paz e Terra; 2016. (p. 124). After all, the construction of a world with more social justice must include the defense of “the human beings’ capacity to evaluate, compare, choose, decide and, finally, intervene in the world”¹⁶16. Freire P. Pedagogia da indignação: cartas pedagógicas e outros escritos. 3a ed. São Paulo: Paz e Terra; 2016. (p. 67). Such pretensions remove an essentially subjectivist and sentimentalist notion, in order to constitute itself as a revolutionary principle¹⁷17. Gadotti M. Prefácio - consciência e história. In: Freire P. Conscientização. São Paulo: Cortez; 2016. p. 13-30., to the point of assuming it as the very notion of dialogue: love is “at the same time the foundation of dialogue, as well as dialogue itself”¹⁰10. Freire P. Conscientização. São Paulo: Cortez; 2016. (p. 135).

Those who educate must love teaching and learning, so that their actions can favor the construction of democracy, where the educational processes welcome and multiply certain democratic tastes such as listening to others and respecting them, the tolerance of difference, making room for divergence, respect for public things, and questioning, criticism and debate¹³13. Freire P. Professora sim, tia não: cartas a quem ousa ensinar. 26a ed. São Paulo: Paz e Terra; 2016..

Love is about commitment to the world and to people, which encompasses an ethical-political horizon that must guide human practices, demanding ruptures with the processes that trigger dehumanization. In this sense, education, as a human action, is fundamental for participating in the construction of one’s own existence, being able to empower oneself more and overcome limit situations with dialogue, love and the construction of knowledge. Education awakens the process of humanization of the unfinished human being, the search for being more.

Freire constitutes an epistemology and an ontology concerned with the “way of being, knowing and inhabiting the world, based on question, curiosity, incompleteness”⁶6. Kohan W. Paulo Freire mais do que nunca: uma biografia filosófica. Belo Horizonte: Vestígio; 2019. (p. 76). This is what moves him to make his life a work of art committed to the other, the world and life - which inevitably passes through care. In Kohan’s analogy, in the same way that Socrates calls on citizens “to take care of those who do not care,” Freire “seeks to take care of the oppressed that few seem to care for, with his Christian and Marxist religious faith in the way he thinks about social and political relations” (p. 76). His political questioning goes in a more radical direction than Socrates’, by pointing to the foundations of the social order “that sustain the very condition of oppression it faces” (p. 76).

It is no wonder that Paulo Freire upsets authoritarian and oppressive governments that work in favor of capitalism, colonialism and patriarchy. His thought shakes up the hegemonic order, feeding countless PE experiences that care about the emancipation of the oppressed. The strength of his philosophy, of his love of knowledge, goes beyond education and crosscuts other fields, helping to think diverse practices in the process of building the human and the world. Therefore, it is not difficult to extract from his ideas a notion of care - indivisible from the process of humanization that needs dialogue, listening, humility, love and recognition of popular lore and cultures - such as that formed in the field of PEH.

PHE and the resignification of care

PE in the field of health starts from the apprehension and recreation of the Freirean ideology, leading to several experiences that problematize reality, while recognizing and dialoguing with popular knowledge, and at the same time, seek to reorient the work in terms of especially, management practices, social control, education and care¹⁸18. Brasil. Ministério da Saúde. Política Nacional de Educação Popular em Saúde no âmbito do SUS - PNEPS-SUS. Brasília: Ministério da Saúde; 2013.. It seeks to articulate educational processes taking place mainly in the territories, beginning with the first experiences of community health services up to the present time, which involves the implementation of the Family Health Strategy.

Its importance is registered in several studies that systematize the rich and dense experiences, inspired in Freire’s ideas, which led the struggle for the right to health throughout the construction of the Brazilian Unified Health System (SUS). Its crucial role in mobilizing social struggles in favor of the right to health in the context of Brazilian health reform is acknowledged, strengthening itself together with this movement, as well as moving towards articulating social movements, building public policies to face inequalities and social inequities, expanding critical and dialogical educational processes and practices, and strengthening participative and democratic actions.

The field is historically opposed to the biomedical model that pervades health practices, not only in the clinic, but in prevention, education and health promotion. Instead of individual actions of behavioral adaptation, the PEH remarks the collective way, and for the appreciation of places that can contribute “to the strengthening of an organizational and citizen culture in the community”⁴4. Vasconcelos EM. Redefinindo as práticas de saúde a partir de experiências de Educação Popular nos serviços de saúde. In: Vasconcelos EM, Prado EV, organizadores. A saúde nas palavras e nos gestos: reflexões da rede de educação popular e saúde. 2a ed São Paulo: Hucitec; 2017. p. 19-33. (p. 27), escaping from the individualism that generates discouragement and hinders popular participation in decisions about the organization of life. Committed to the popular classes, it seeks to overcome the sanitary education that operates in the molds of a banking education, authoritarian and verticalized¹⁹19. Stotz EN. Enfoques sobre educação popular e saúde. In: Brasil. Ministério da Saúde. Caderno de educação popular e saúde. Brasília: Ministério da Saúde; 2007. p. 46-57..

In this perspective, the educational action is a very rich space for the care, mainly in the primary health care, “for the great proximity and integration with the dynamics of life and struggle of the population”⁴4. Vasconcelos EM. Redefinindo as práticas de saúde a partir de experiências de Educação Popular nos serviços de saúde. In: Vasconcelos EM, Prado EV, organizadores. A saúde nas palavras e nos gestos: reflexões da rede de educação popular e saúde. 2a ed São Paulo: Hucitec; 2017. p. 19-33. (p. 33). PEH extends care to the spaces and moments that generate suffering in people who face the precariousness of life and modes of oppression, and who demand the reorganization of living.

The PEH consolidates, based on the subjects’ experiences, a concept of care referenced in different premises of Paulo Freire’s philosophy. The first one to be emphasized concerns the importance of care starting from reality, from the acknowledgement of the others and from their life context. We find in Vasconcelos²⁰20. Vasconcelos EM. Educação popular e a atenção à saúde da família. 4a ed. São Paulo: Hucitec; 2008. the definition that “to take care means to take care, here and now, of the problems that can be faced, making oneself available according to the conditions required by them and not the conditions traditionally offered by the service” (p. 153). Care is based on the importance of a praxis based on the problematization of reality, where the “concern” must take into account the concrete situations of life.

In a close sense, Prado, Falleiro and Mano²¹21. Prado EV, Falleiro LM, Mano MA. Cuidado, promoção de saúde e educação popular – porque um não pode viver sem os outros. Rev APS. 2011; 14(4):464-71., affirm: “caring presupposes understanding the experiences and truths of each individual and understanding that these depend on worldviews, stories and culture” (p. 466). The appreciation of popular cultures can alter the production of care, because the way of understanding life and how one lives can enhance or hinder ongoing proposals²⁰20. Vasconcelos EM. Educação popular e a atenção à saúde da família. 4a ed. São Paulo: Hucitec; 2008.. In this way, we seek to regain respect for diverse cultures and traditions, since feeling valued and respected is key for the strengthening of political action committed to the construction of existence.

The premises of Freirean philosophy also support the importance of culture for care. Culture is valued in different ways by PEH: one of them is for the potency of “art as care and pedagogical principle”²²22. Dantas VLA. Educação Popular e os diálogos possíveis com a formação no campo da saúde considerando a perspectiva popular. In: Cruz PJSC, organizador. Educação popular em saúde: desafios atuais. São Paulo: Hucitec; 2018. p. 228-51. (p. 249). Art is part of our way of creating the/in the world, in this way, this critical educational doing is involved in processes of “sensitive delicacy, favoring exchange and the ‘good’ emotions - that is, that do good for health - such as joy, solidarity, and the feeling of belonging to a greater whole²³23. Wong-Un JA. Aprendendo – e ajudando – a olhar o mar: das muitas saúdes, culturas e artes na educação popular. In: Brasil. Ministério da Saúde. II Caderno de Educação Popular em Saúde. Brasília: Ministério da Saúde; 2014. p. 179-90. (p. 186).

Another way of valuing culture is through religiosity, as it is a central experience in the way the popular classes organize their lives, enabling the construction of conceptions and practices of care²⁴24. Valla VV. “Conversão à pobreza”, um conceito fundamental para compreender a formação de muitos educadores populares. In: Vasconcelos EM, Prado EV, organizadores. A saúde nas palavras e nos gestos: reflexões da rede de educação popular e saúde. 2a ed. São Paulo: Hucitec; 2017. p. 90-5.: “religion is the field of subjective elaboration in which the majority of the Latin American population symbolically builds the meaning of their lives and seeks motivation to overcome the existential crisis posed by the disease”²⁵25. Vasconcelos EM. Apresentação. In: Vasconcelos EM, organizador. A espiritualidade no trabalho em saúde. 2a ed. São Paulo: Hucitec; 2006. p. 9-12. (p. 9). In religion, values and truths that guide the life of the working classes are based and constitute modes of existence and subjectivities.

The traditions and ways of care in candomblé terreiro (religious holy grounds), approached by Vanda Machado²⁶26. Machado V. Pele da cor da noite. 2a ed. Salvador: EDUFBA; 2017., for example, reveal how we live in a world made up of different cosmogonic visions that operate together. By highlighting the experience in the terreiro as an experience endowed with senses that go beyond individualism, proposing the integration of individuals with the community and of these with their ancestors, the author emphasizes the need to refute the idea that knowledge happens by transference from a pole endowed with knowledge to another void of knowledge. Understanding that everyone occupies the conditions of learner and teacher, including those in relationships of care, brings us to another premise of Freire: the premise that teaches us that educating and learning are actions in constant movement.

PEH also values other thinking systems that are not directly linked to an individualistic perspective, rescuing the true and deep meaning that the community operates for the working classes. In this sense, other epistemologies are important and need to be recognized, such as those based on indigenous and Afro-Brazilian cosmogonic visions, reworking ways of thinking and acting in the world²⁶26. Machado V. Pele da cor da noite. 2a ed. Salvador: EDUFBA; 2017.. In its relationship with popular lore, it recognizes and values the knowledge of pajés, raizeiros, benzedeiras, midwives, fathers and mothers of saints, peasants, quilombolas, etc. Thus, it seeks to decolonize the care of the biomedical culture - a process that also involves the approach it establishes with integrative and complementary health practices, practices that present different rationalities, cosmogonic visions and therapeutics as care possibilities.

Another PEH assumption, rooted in Freirean thought, refers to democracy, encompassing popular participation and the shared construction of a world project²⁰20. Vasconcelos EM. Educação popular e a atenção à saúde da família. 4a ed. São Paulo: Hucitec; 2008.. This assumption imprints on care an expanded concept that involves the construction of social support networks that operate a reciprocal, mutual process, generating positive effects both for those who receive and also for those who offer support²⁷27. Lacerda A, Valla VV, Guimarães MBL, Lima CM. As redes participativas da sociedade civil no enfrentamento dos problemas de saúde-doença. In: Pinheiro R, Mattos RA, organizadores. Gestão em redes: práticas de avaliação, formação e participação na saúde. Rio de Janeiro: IMS-UERJ, CEPESC, ABRASCO; 2006. p. 445-57.. The democratic character of care is also expressed in the strengthening of the principles of universality and equity that guide actions directed at the most vulnerable and socially oppressed peoples and groups, recovering the Freirean concern with equality and respect for differences.

In this way, PEH enables a new sensibility in health practices, overcomes “technical asepsis” and provides alternatives and solutions, individual and collective, to health problems and daily life²⁸28. Assis, M. Uma nova sensibilidade nas práticas de saúde. Interface (Botucatu) 2001; 5(8):139-40.. The disease is not the focus of attention, but the evils, what afflicts people, what make precarious their living conditions and destabilizes the mode of social and community organization. In this sense, “one cannot take care of people’s health without facing, in a proud, creative and critical way, the social determinants and conditions of health”²⁹29. Cruz PJSC. Apresentação. In: Cruz PJSC, organizador. Educação Popular em Saúde: desafios atuais. São Paulo: Hucitec; 2018. p. 19-32. (p. 26).

Care also involves love and dialogue, approaching the Freirean education act. In the experience of working with peasant women, Pulga³⁰30. Pulga VL. A construção de sentidos à integralidade da saúde a partir da práxis de mulheres trabalhadoras rurais com enfoque popular e de gênero. In: Woortmann EF, Hereida B, Menashe R, organizadores. Margarida Alves – Coletânea sobre estudos rurais e gênero. Brasília: MDA, NEAD; 2006. p. 177-94. observes: “in caring for each person as unique there is a very strong relationship of love and affection (p. 191). Love understands the ontological dimension of the human being, involves its incompleteness and implies a commitment to the world and to the process of humanization, the process of being more. And, as an act of love, care must oppose all forms of dehumanization, oppression and domination that degrade life.

Between the lines that weave the theoretical field of PHE, care is outlined in a broad, critical and loving perspective, as praxis committed to a project of free, democratic, just and equal society. Based on the ontological and humanist dimension, there is a strengthening of the inextricability between caring, political action and human existence. True, authentic care exists only with involvement, with feeling. An understanding of care is thus formed in an integral perspective of the human being¹⁸18. Brasil. Ministério da Saúde. Política Nacional de Educação Popular em Saúde no âmbito do SUS - PNEPS-SUS. Brasília: Ministério da Saúde; 2013..

This understanding is constituted through different matrices and theoretical influences, following the spiral form of Freirean thought, but has a teleology that involves the construction of human existence and that does not pass through prescriptive acts, but through dialogic ones. Care acts in mediation and in the construction of the world, so it must be at the service of the search of being more, which can happen in different ways: by the valorization and integration of cultures, by the recognition of religiosity and spirituality as dimensions of community life, by the expansion of political and democratic participation in territories and health services, by the experimentation of integrative and complementary care practices, by the constitution of social support networks, by the development of educational actions.

In spite of the differences between the acts and the dimensions of care, it is possible to affirm that PEH, as a dialogical practice, sets in motion a movement that problematizes the mastery of biomedicine and the medicalization of life, extending care to the organization of a life free from oppression and the humanization of the human being. In its many faces, we can infer that care involves the disposition to occupy oneself here and now with you, with the other and with the world, in a becoming to lead humanity to happiness and the common good.

For this reason, PEH is concerned with creating untested feasible care that can, through limit acts, transform reality aiming to the collective construction of a different world that overcomes limit situations. In order to do so, it is required that the educational-caring act provide a critical perception of reality with a dialectic-praxis perspective of reflection-action-reflection and combine the ontological and political dimensions that relate to the capacity to collectively conceive hopes, utopias and dreams³¹31. Paro CA, Ventura M, Silva NEK. Paulo Freire e o inédito viável: esperança, utopia e transformação na saúde. Trab Educ Saude. 2020; 18(1):e0022757..

Final considerations: the pedagogy of care and the construction of an authentic life

The Freirean pedagogy has been given several titles, either by the educator himself, or by its interpreters and re-creators. The titles of several books demonstrate the wealth of action-words with which the PE has been thought and practiced since Freire’s contribution: it is a pedagogy “as a practice of freedom,” “of the oppressed,” “of the question,” “of hope,” “of autonomy,” “of indignation,” “of possible dreams,” “of commitment,” “of tolerance,” “of solidarity,” “of awareness,” “of the untested feasibility,” “of dialogic,” “of liberation,” among others.

Kohan’s reading, which sees Freire as a thinker who takes his life as a work of art, reinforced the possibility of reflecting on care as an underlying dimension of his philosophy and which presents itself in the field of PEH with an act that takes into consideration the integrality of being and the totality of life. Although, as we mentioned in the introduction, Paulo Freire did not approach care, it is possible to affirm, from his thought and life, that there is no transformation of the world that does not pass through care, that is, an act committed to the production of health and the defense of life. In other words, the Freirean philosophy also refers to a pedagogy of care.

This is possible because the ontological dimension of Freirean thought sustains the inseparability between social practices and the commitment to building the world. Its philosophy allows us to affirm that the educational act is an act of care, while the act of care is educational. In the same way that Freire states that “there is no education without love¹⁵15. Freire P. Educação e mudança. 37a ed. São Paulo: Paz e Terra; 2016. (p. 36), it is possible to affirm that “there is no care without love”, it is not possible to teach, nor to care, “without the capacity forged, invented, well cared for love”¹³13. Freire P. Professora sim, tia não: cartas a quem ousa ensinar. 26a ed. São Paulo: Paz e Terra; 2016. (p. 28). And, like education, care must be a democratic practice based on solidarity and responsibility of the subjects as “beings of commitment” to the process of humanization of society¹⁵15. Freire P. Educação e mudança. 37a ed. São Paulo: Paz e Terra; 2016..

This is why Freire’s ideas continue to fuel hopes and the quest for ways to overcome those boundary situations that often paralyze the political struggle and transformation of the world, particularly in the current context of neoliberal setbacks, the growth of conservatism and authoritarianism. More than ever, educating and caring are actions that must be committed to a critical reading of reality in order to build a democratic society free from oppression and social inequality.

Paulo Freire’s current importance refers to the ethical concern with the construction of a future aiming at liberation and the bet on the capacity of human beings to promote changes and build a different kind of world; after all, “change is difficult, but it is possible”⁸8. Freire P. Pedagogia da tolerância. 3a ed. São Paulo: Paz e Terra; 2014. (p. 181). The future, in its dynamism, is a challenge to human creativity, a creative/transforming adventure of the world³²32. Freire P. Ação cultural para a liberdade e outros escritos. 15a ed. Rio de Janeiro: Paz e Terra; 2015.. Being more means embracing the human power to face the naive consciousness, which accepts the world as something given and inexorable, and to consolidate a feasible future. Because we are historical, we are unfinished and therefore, we can project the world.

His ideas defend an ethic of human existence that implies presence, being in the world committed to openness to the future, which must involve the construction of an authentic life and, we believe, aligned with happiness and the common good. In this perspective, it is necessary to face the processes of alienation and domination of the human being that make him strange to himself, impersonal and unhappy, and to constitute ways of care capable of valuing popular knowledge and strengthening the bond between individuals and the community, promoting an authentic life to deal with helplessness, contradictions and difficulties inherent in human existence.

In the opposite direction of this social order that produces suffering, sadness, disease and avoidable death, the PEH from Paulo Freire teaches that care needs to problematize the reality that makes us sick and sad, composing collective and joyful forms of action. Whether in the therapeutic relationships carried out in the offices, or in the educational actions in the territories, in the community, school and family spaces, the act of caring has the commitment to build a world where human beings can rebuild themselves in dialogue, in the problematization of life and in the process of sharing knowledge and respect for experiences.

In the present dark times, it is part of this process to overcome the individualism that separates us and to resume a work, dialogic and loving, together with the popular classes; besides the courage and commitment on the part of everyone to reinvent themselves and the world, and the understanding that there is no neutrality, and that educating and caring are political acts.

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