SPECIAL PRESENTATION

 

The contribution of the Social and Human Sciences to health research, teaching and education

 

 

The present issue of Saúde e Sociedade offers to the reader a set of reflections made by social scientists deriving from papers presented at the II Encontro Paulista de Ciências Sociais e Humanas em Saúde (2nd São Paulo's Meeting of Social and Human Sciences in Health), which was held in São Paulo, at Universidade Federal de São Paulo - UNIFESP -, in 2009, whose theme was "The contribution of the Social and Human Sciences to the education, research and teaching of Public Health".

As the theme suggests, the meeting aimed to open space for reflection, debate and exchange of experiences between professionals from these areas. They were joined through Associação Paulista de Saúde Pública (São Paulo's Public Health Association) and Comissão de Ciências Sociais e Humanas da ABRASCO (Social and Human Sciences Committee of ABRASCO).

In the set of texts presented here, the reader will be able to observe the variety of issues of different natures - epistemological, theoretical, methodological, technological - that trouble and challenge social scientists who deal with the production of knowledge, teaching and education in the fields of Public Health and Medicine.

In relation to the challenges present in knowledge production, the papers by Ana Maria Canesqui, Madel Therezinha Luz and Áurea Maria Zöllner Ianni illustrate well the debate that occurs, sometimes explicitly, sometimes in a veiled form, when social scientists strive to articulate two areas of diverse natures, with different research traditions. The classic health references are placed, due to their tradition, as the tacit and dominant parameter in terms of recognition in the production of "truly" scientific knowledge, a parameter that is seconded by the hegemonic paradigm of objectivity that supports modern science and the primacy of its method.

Thus, the above-mentioned papers approach the constitution of the field of Health as a field of multidisciplinary knowledge and practices, pointing to the diversity of issues that derives from this as related to the historical transformations of the contemporary society, whose tensions defy not only the Social and Human Sciences in general, but, remarkably, complex and specific fields like that of Health, in which these sciences are inscribed and institutionalized, sharing spaces with the traditional Natural and Exact Sciences, via different processes.

In the discussion process undertaken by these authors, they debate the contributions of the Social and Human Sciences to the hybrid field of Health, or their possibilities of contributions. However, the highlight is the impasses and tensions suffered to achieve the recognition of their knowledge. Madel Luz, for example, deals with what she characterizes as the inadequate and reductionist employment of the instruments - theoretical, methodological and technical - in the approach to the health problems, which would put the Social and Human Sciences at the service of other types of knowledge that are present in the field, traditionally considered as more legitimate.

Therefore, the reader can enjoy a rich discussion about the many types of discrimination suffered by the Social and Human Sciences in the field of Health. An example is the "biologizing" view that characterizes the hegemonic biomedical model, remarkably in the field of medicine, as argued by Canesqui; within the area of Public Health itself, according to Madel Luz, the traditional epidemiological approach to health problems equally reproduces this reductionist and hegemonic view in the relation it maintains with the Social and Human Sciences, undermining the importance of their contribution to the production of knowledge in the field, which is evidenced especially in the evaluation processes of our postgraduate system in Brazil.

Based on these authors' discussion, a broad scenario is opened in which different types of issues are presented, issues to be faced by social scientists, as is the case of the so-called dichotomies and reductionisms that the social and human scientists meet when they deal with hybrid objects and different research traditions that do not interact and, many times, oppose each other. The reading of these authors' texts show how these dichotomies stand out in epistemological terms, with implications to the process of knowledge generation in the area, as is the case of the polarizations between nature and culture - taken as the discussion axis by Áurea Ianni in her text -, subject and object, objective and subjective.

This type of discussion is enriched by the study conducted by Pedro Paulo Gomes Pereira, who argues that, despite the several differences mentioned by social scientists and also by biophysicians who work in the field of health, both seem to share a large division as the basic rule of the game they play in their practices: the division between nature and culture. Based on this axis of analysis, the author opens to the reader important discussions that deal with relations and tensions experienced by social scientists in the field of health, emphasizing the role of the anthropologist in view of the pragmatism placed in his work by the biomedical tradition of the field. The author assumes a propositional posture when he discourses on possible contribution forms of social and human scientists, mainly anthropologists, in view of these tensions, as shown by the title of his paper: Specificity of the Contribution of the Knowledge and Practices of the Social and Human Sciences to Health.

In the line of reflections on the theoretical-methodological contributions of the Social Sciences to research in the health area, Eunice Nakamura focuses on the role of the ethnographic method and of anthropology. She considers that both have a necessary relationship in the knowledge generation process, which means saying that the use of the ethnographic method implies producing anthropological knowledge. With these considerations, the author is concerned about the risks of a methodological reductionism due to the increasing incorporation of this method into health research. This may transform it, many times, in a research technique, given the area's pragmatic tendency, which would represent its simplification and the loss of its character.

The richness of the dialog between theory and research practice, announced by Eunice Nakamura, can be observed in the posture adopted by Larissa Pelúcio, in her work entitled Social Markers of Difference in the Experiences of Transvestites Coping with AIDS.

It is a study in which the reader can observe that well-conducted empirical research, from the theoretical-methodological point of view and also from the technological one, allows that theory and practice feed one another. The results of the investigation enrich the theory, truly generating knowledge, with new categories that emerge from experiences narrated by real social subjects.

The importance of the dialog with reality, on the part of scholars of the public health field, understood as an interdisciplinary field, is emphasized by Rubens Adorno, Maria da Penha Vasconcellos and Augusta T. de Alvarenga, when they approach complex health issues that require the dense analysis of scholars from the field, in view of the employment of a broader rationality that subordinates neither thought to science paradigms nor the latter to an abstract model, isolated from reality, from the real living conditions of real human beings. In this perspective, they point to the importance of considering and identifying typical phenomena of delayed modernity, with implications to the field of Health. In addition, they emphasize that the Social Sciences, mainly Anthropology, must reflect on the daily things that set in motion the life of groups that are targets of health actions and their public policies, which are many times normative, not understood as social policies. Scientists should reflect, therefore, on the "mismatches" of reality - a term that the authors borrow from Anthony Giddens - which evidence the disagreement that modernity has brought between time and space, transforming perceptions about what reality is, to social subjects in general, to technicians, professionals, and even to researchers.

The implications of what the very constitution of reality is in health research is approached by Ceres Gomes Víctora when she proposes to discuss the use of qualitative methods, beyond the naïve and reductionist conception of conceiving them as a set of techniques, which enable the investigator - and we would add, the investigator of any theoretical and methodological background - to penetrate in a reality and reveal its hidden or dissimulated forms; a reality that is conceived as static and a-historical.

In her paper entitled A Replicating Science: the absence of a discussion about method, ethics and discourse, issues of interest to an epistemology of methodology and technique are presented to researchers not only from the field of health.

Taking as analysis axis, like previous authors, the question of the dichotomies present in the discourse of social scientists and biomedical health researchers, the author argues that such dichotomies, which are about knowledge and its possibilities, are located on the basis of those that are considered difficulties in the employment of the qualitative methodology in the field of health, remarkably as regards the problem of the choice of research techniques, the definition of the number of cases, the research context and the procedures of data analysis or interpretation - problems that the author discusses in detail in her text.

In her discussion, Ceres Víctora shows that it is not only the techniques that produce qualitative research, but the concepts about reality and the researcher's training to understand and conceive questions of this nature. Emphasizing that empirical data do not speak by themselves, the author states the important idea that research is a process and that it is in the dialog that the investigator maintains with a certain theory and between this theory and the methodology, that it is possible to construct not only a certain problem or object of investigation, but the fieldwork itself.

The text by Nelson Filice de Barros in collaboration with Cristiane Spadacio, the study by Denise Martin, and the one authored by Clarice Cohn bring to the reader reflections on the issue of education in the field of health, in the postgraduate and undergraduate levels, in the perspective of the incorporation, by students and/or professionals, of contents deriving from the Social and Human Sciences in Health.

When they introduce the discussion about the theme, Nelson Filice de Barros and Cristiane Spadacio - whose text is entitled The Postgraduate Student's Education in the Contemporary World in the Daily Routine of Research - propose to synthesize the debate undertaken by social and human scientists in the 2nd São Paulo's Meeting of Social and Human Sciences, mentioning that they take the concepts of praxis and epistemological ruptures as the basis for its organization.

In the text entitled Reflecting About Interdisciplinary Post-graduation Education, Denise Martin discusses, from different angles, the relationship between supervisor and postgraduate student, the expectations, tensions and challenges faced by both when they belong to different areas, referring to the formation and production of knowledge from distinct disciplinary views.

Finally, in the paper by Clarice Cohn, entitled Teaching Medical Anthropology to Undergraduate Students: an experience, the author reflects on her experience in the proposition and teaching of a discipline of Anthropology, obligatory for the health programs and optional for the Social Sciences and Psychology programs, and narrates her strategies to design the syllabus, which has an introduction to theoretical concepts that are fundamental in the area, as well as debates and reflections, in seminars, about anthropological research in the health area, considered complementary in terms of education. In her narrative of the experience, she seems to meet the objective she proposes to reach in her teaching practice, that is, to promote a reflection on the cultural difference and the professional exercise in the health area.

Thus, by providing the reader with this set of papers focusing on the theme of the Contribution of the Social and Human Sciences to Health Research, Teaching and Education, we believe that the journal Saúde e Sociedade plays an important dissemination role when it gives, to the reader from the field of health, possibilities of better apprehending in what levels the variety of issues that challenge the multidisciplinary relations between social scientists and biophysicians are placed. We understand that it is in this perspective that we can think about production and innovation in the field of knowledge in health as a work of all, without hegemonies.

 

Augusta Thereza de Alvarenga
Maria da Penha Vasconcellos
Rubens de Camargo Ferreira Adorno
Professors with the School of Public Health of USP and with the Interdisciplinary Laboratory of Social Research in Public Health (LIESP).

Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. SP - Brazil
E-mail: saudesoc@usp.br