Health Promotion Practices and Michel Foucault: A Scoping Review

Health promotion in primary care: effects and limitations in conservative neoliberalism

This article aims to understand and analyze the effects and limitations of Health Promotion in Primary Health Care (PHC). We conducted genealogical, qualitative research with 23 PHC workers. The analysis originated the following datasets: effects of Health Promotion practices performed in PHC and difficulties and limitations in conducting the practices. The results show that the main impact of Health Promotion is reducing medicalization and adopting Expanded Clinic elements in the care provided. The main difficulties arise from the poor public policies due to the fiscal austerity measures adopted in recent years. Strengthening the collective nature of health demands and their responses is a possibility of resisting in the face of the authoritarian neoliberal rationality currently prevailing in the Brazilian State.

Constituting link working through choice and care: An ethnographic account of front-line social prescribing

Link worker social prescribing has become a prominent part of NHS England's personalisation agenda. However, approaches to social prescribing vary, with multiple discourses emerging about the potential of social prescribing and different interpretations of personalisation. The transformational promise of social prescribing is the subject of ongoing debate, whilst the factors that shape the nature of front-line link working practices remain unclear. Based on 11 months of in-depth ethnographic research with link workers delivering social prescribing, we show how link workers' practices were shaped by the context of the intervention and how individual link workers navigated varied understandings of social prescribing. Following the work of Mol, we show how link workers drew differentially on the interacting logics of choice and care and trace a multiplicity in front-line link working practices within a single intervention. However, over time, it appeared that a logic of choice was becoming increasingly dominant, making it harder to deliver practices that aligned with a logic of care. We conclude that interpreting personalisation through a logic of choice could potentially undermine link working practices that privilege care whilst obscuring the need for wider investment in health care systems and the social determinants of health.

Is Neoliberalism Killing Us? A Cross Sectional Study of the Impact of Neoliberal Beliefs on Health and Social Wellbeing in the Midst of the COVID-19 Pandemic

Neoliberal ideology is linked to poorer collective health and well-being. At the individual level, however, neoliberal beliefs may actually promote self-efficacy, self-esteem, and self-reliance. We examined the effects of three beliefs underlying neoliberalism—(a) Personal Wherewithal, (b) Natural Competition, and (c) Anti-Government Interference—to understand the unique pathways by which neoliberalism affects health and well-being at the individual level. Participants were recruited using paid advertisements on social media in May/June 2020. Multivariable regression identified associations between each of the three identified neoliberal beliefs and participants’ (a) self-rated physical health, (b) number of health diagnoses, (c) life satisfaction, (d) loneliness, and (e) social trust of family, close friends/partners, coworkers, neighbors, and strangers. Among 2632 respondents, personal wherewithal was associated with better health, life satisfaction, and social well-being (perhaps by promoting self-efficacy and self-reliance to undertake healthy behaviors), while anti-government beliefs were associated with worse life satisfaction and social well-being (perhaps by reducing benefits inherent in collective action and social connection). Those hoping to reduce the negative effects of neoliberalism on collective well-being must contend with the reinforcing effect that personal wherewithal might have in shaping the perceived benefits of neoliberalism among those with these beliefs.

Análise das Emergências e Proveniências das Práticas de Promoção de Saúde Realizadas em um Serviço de APS

Este artigo tem como objetivo analisar como se constituíram as práticas de Promoção da Saúde na Atenção Primária em Saúde (APS), a partir do referencial teórico foucaultiano. Realizamos uma pesquisa qualitativa, de inspiração genealógica, na qual entrevistamos 23 trabalhadores. A análise possibilitou a identificação do momento histórico em que surgiram as práticas de Promoção da Saúde (emergências), bem como as condições que possibilitaram que tais práticas fossem constituídas (proveniências) na APS. Para a discussão dos dados, foram acionados os referenciais teóricos da Promoção da Saúde e dos estudos foucaultianos. Os resultados são apresentados a partir de três períodos históricos. As décadas de 1980/1990 foram marcadas pela redemocratização e constituição de cidadãos de direitos. Nesse período, as práticas de Promoção da Saúde se caracterizavam majoritariamente pela participação comunitária na luta por direitos. Os anos 2000 foram marcados pela emergência das políticas públicas na área da saúde. Esse período teve como razão política a governamentalidade neoliberal democrática, que influenciou a constituição de práticas de Promoção da Saúde direcionadas à adoção de hábitos e comportamentos saudáveis por indivíduos e comunidades. O período de 2016 até a atualidade é marcado pela austeridade fiscal e pelo recrudescimento das políticas públicas, tendo como razão política a governamentalidade neoliberal conservadora ou autoritária. Essa configuração representa uma diminuição da quantidade e do escopo das práticas de Promoção da Saúde realizadas no serviço de APS pesquisado.

Treatment adherence under the foucauldian perspective: knowledge/powers in tuberculosis control manuals in Brazil

OBJECTIVE

Investigate which knowledge emerges in the Tuberculosis Control Manuals and how power relations are established for treatment adherence.

METHOD

Documentary and qualitative research on five Manuals published between 2002 and 2019, available on the Ministry of Health's Website, based on Michel Foucault's theoretical and methodological framework.

RESULTS

1. Knowledge: emerges as human resource training; health surveillance actions; medicalization; and multifunctionality of nurses in addressing the social determinants of tuberculosis. 2. Power relations: occur through articulation between different subjects and establish disciplines on the body and the behavior of the person undergoing treatment.

CONCLUSIONS

Certain knowledge/powers constitute the actions of treatment adherence to tuberculosis treatment and normalize the "correct/true" way of conducting disease control. Such behaviors refer to self-responsibility, autonomy and empowerment of the subject and do not consider the countless conditions of vulnerability existing in the history of people with tuberculosis.

Health promotion practices as resistance and counter-conduct to neoliberal governmentality

This article analyzes the discourses within Health Promotion (HP) practices in Primary Health Care (PHC) that constitute actions of resistance and counter-conduct to the neoliberal governmentality inscribed in these tools. Drawing upon descriptive and exploratory field research, together with a qualitative approach, we interviewed 23 PHC workers in a municipality in southern Brazil. The results point out possibilities to enhance HP in PHC: strengthening training activities within health units; problematizing Social Determinants of Health (SDH); methods to encourage participation; collectivization of health demands; appreciation and reinforcement of achievements and collective actions; recovery of the local community's culture and habits; and HP advocacy in PHC.

Health promotion practices as resistance and counter-conduct to neoliberal governmentality

Abstract This article analyzes the discourses within Health Promotion (HP) practices in Primary Health Care (PHC) that constitute actions of resistance and counter-conduct to the neoliberal governmentality inscribed in these tools. Drawing upon descriptive and exploratory field research, together with a qualitative approach, we interviewed 23 PHC workers in a municipality in southern Brazil. The results point out possibilities to enhance HP in PHC: strengthening training activities within health units; problematizing Social Determinants of Health (SDH); methods to encourage participation; collectivization of health demands; appreciation and reinforcement of achievements and collective actions; recovery of the local community’s culture and habits; and HP advocacy in PHC.

Adesão terapêutica sob o olhar foucaultiano: saberes/poderes nos Manuais de Controle da Tuberculose no Brasil

RESUMO Objetivo Investigar quais saberes emergem nos Manuais de Controle da Tuberculose e como as relações de poder são instituídas para adesão terapêutica. Método Pesquisa documental, qualitativa, que analisou cinco manuais publicados entre 2002 e 2019, disponíveis no Website do Ministério da Saúde, a partir do referencial teórico metodológico de Michel Foucault. Resultados 1. Saberes: a capacitação de recursos humanos; ações de vigilância em saúde; medicalização; e multifuncionalidade dos enfermeiros no enfrentamento dos determinantes sociais da tuberculose. 2. Relações de poder: se articulam entre diferentes sujeitos e instituem disciplinas sobre o corpo e o comportamento da pessoa em tratamento. Conclusões Determinados saberes/poderes constituem as ações de adesão terapêutica ao tratamento da tuberculose e normalizam a forma “correta/verdadeira” de se conduzir o controle da doença. Tais condutas remetem à autorresponsabilização, autonomia e empoderamento do sujeito, mas não levam em consideração as inúmeras condições de vulnerabilidade existentes no histórico das pessoas com tuberculose.