To try and rebuild life, to try and create defenses against health
Many things came to my mind whilst I read those that I'll call "anchor articles" of this number of Saúde e Sociedade. These "anchor articles" form almost a dossier, which discusses the question of the (in)sanity of placing health in the centre of building the "normal and pathological" at the contemporary time. Reciting FOUCAULT and the biopower, the new rules of healthy go on, taking more and more support on the image of the body as a territory of technical / technological intervention, inspired in the conception of "science" of the body as a biological element that operates mechanical parts, from the image of body "ex-machina" of the past. The past is, in this case, the persistence of the representation of the Cartesian science that unveils the actions of the organism's workings: machine that has to function sparing repairs and enlarging useful time, as an element that can propel consumption, outside of historical time and of the utopias of building a local/national estate, or of the utopias of a society that searches to overcome inequality and to institute a justice that respects plurality and differences. The operation of "health" over the bodies sees them more and more as individuals unconnected of any environment relationship: historical, social or of human diversity, and internally as organs that have to reach a determined level of normativity.
This language somewhat forced expresses the relationship amongst the four initial articles: "Health promotion and its biopolitical extend: the sanitary discourse of contemporary society"; "Health production as a life statement"; "The pathologization of sedentariness" and, closing with a necessary appeal to history, "Belisarius Penna, a champion in the history of Brazilian Public Health".
The first article brings as a big enunciation the proposal of discussing "Health Promotion", field that has always had the ambition of conceiving the "field of health" as a device that could be discussed and operated beyond the biological fact. Health Promotion is treated here as a central strategy of '"biopolitics", that acts towards the emptying of the point of view of a Welfare Estate. Worshiping health, individual accountability, consuming health as an aesthetics of life that regulates and calculates sport, leisure activities, sex and religion are the elements of this tentacular device of "Promotion", that, instead of bringing some historicity or even in a more restrict way an "ambience" to the bodies: it represents a set of "neoliberal" ideas through notions such as "lifestyle", "empowerment", aiming at improving biological life - the greek "zoe"that is recovered in the form of contemporary bare life as references to thinkers as Agamben. Would the recovery of autonomies, historicities and the perspective of building a life without constraints be a new utopia and form of liberty?
In the same critical perspective, we have an essay that tries and articulates social Psychology and the Phenomenology of a contemporary thinker, Levinas, as a way of criticizing the biomedical model; the essay offers the contribution of a vision and a language that is not intended to be evocative but faithful to the very language of philosophy that is the substance of "Health production as a life statement"... Resuming the style of the political-philosophical debate that has built in the past (?) a field as the one of collective health, the essay wants an interlocution with action, evoking the very NHS as its recipient when it proposes the affirmation of life rather than the production of health. Foucault comes up again, and the article goes towards a cogitation that passes by Nietzsche and brings the polemics of Deleuze into a ciphered, excessive and affirmative language in its philosophical locutions. This article converges with the first one, but is politically divergent when assumes an almost libertarian interpretation of "health promotion" expressions that have been incorporated to health policies as ways of affirming life that tries to come out of the constriction of sanitary actions towards a necessary "alterity", a more utopian vision of a model that is reduced to the practice of disease.
"The pathologization of sedentariness" brings with an almost didactic lucidity, through an example, the perspectives which are discussed in the preceding articles. In a very terse way, it exposes the historical direction taken by the medical intervention as the central model of health in occidental societies, and discusses the senses that different authors give to the phenomenon of "medicalization" as the narrow and restrictive practice of transforming in "disease" questions that are socially ampler and more complex. Using a note of exact irony, the article shows how medicalization, exemplified through the case of applying physical exercise as a "medicine" of very broad spectrum, renders pathological everything that does not apply the medication of moving bodies, full and final solution of all - physical - evils of society. It is the utmost, amplest and more didactic example of the discussions presented earlier.
Finally, the hand of history leads us to know "Belisarius Penna, a champion in the history of Brazilian Public Health", a passage and stoppage necessary for meditation. History evokes a context: the formation of Brazilian national estate is treated here through a character transversal to a debate that condescended between racialization and militancy. Racialization of society along the lines of eugenic thought as a question for the development, or militancy for the improvement of an infrastructural factor such as sanitation, in that moment (as today) related to endemic transmission of diseases. Sanitation remains highly precarious in Brazil and in contemporary world, but is also susceptible of a very complex understanding of what is this intervention< that brings up a shock inside public health: "to sanitize bodies" X to meditate about the social, urban and environmental construction of life and health conditions. The memories of Belisarius Penna, besides bringing us information about the sociabilities and the themes of his period, brings in the background the question treated in the preceding articles. It could weel be remenberd as an antinomy of actions in health that end by taking the helm of a sanitization of bodies, of an eugeny of bodies and of those that represent the healthy lifestile and morals, instead of a historical comprehension of life and health production and consumption conditions.
In the sequence, the articles that I'll call thematic end by reconstructing in their particularities, it is useful to highlight, a public health full of particularities - the big questions discussed in the initial dossier.
The article "The relationship between health and work of the endemic diseases combat agents from FUNASA" does not go as far in history as the one about Belisarius Penna, but offers examples of how the disassembly forced by the vision of a minimum estate strikes the theme of endemic diseases. In the contemporary vision that holds individuals accountable for the management of their own health, why should there be sanitization and combat to endemic diseases actions? The article brings the perspective of the workers that were engaged in this collective management and suddenly were scrapped, in the same way the environment was scrapped.
A set of articles follow, which describe problems in the "management" of individuals' health through the "Family Health Strategy" and bring forth the conflict between a formatted and programmatic vision and the field of action of the health agents. Specifically, questions related to pragmatism in action that collides with the themes of the ways of life and of the quotidian of populations; the narrow and reduced training of the agents and the lack of discussion and understanding of the themes approached during training, which are quickly translated into health problems. The theme of violence and of working conditions of police officers, treated in another article, resumes the discussion about estate actions and conditions of life, work and training of public servants.
A block of articles is made of articles that discuss AIDS, through the narratives of youngsters and their expectancies in life. Analyzing aspects of the management of national policies and its regional peculiarities, these articles take up again the question of technical intervention and of forms of life in different dimensions of practice in this "program".
Some articles stand out by the search of a politicization of actions in the field of health and of the management of "behaviors", be it in relation to the theme of humanization, be it in relation to the theme of youngsters education. This can be said of the article "Work precariousness and risk of accidents in civil construction: a study based on the Collective Work Analysis", that tries and problematizes the conventional forms of establishing "prevention" and "risk" searching for alternatives in an emancipatory and participative version. This note is also present in the article that deals with "Psiquiatric Reform"and the search for a praxis, and is inserted in the analysis of questions relative to traditional themes in the field of public health: for instance, the shift of motherhood towards younger generations and the theme of induced abortion as a quotidian contraceptive practice, showing how distant the isolation cord of healthy life is placed due to questions and conflicts of gender, power, life and working conditions, nutrition and sexualities. That is how are finished the reports of experience in which the theme of participation is recurrent in the dilemmas of practices and in the mismatches between political actions and the populations.
Rubens de Camargo Ferreira Adorno
In behalf of the Editorial Board