Política nacional de promoção da saúde e social-liberalismo: contradições e confluências conceituais, ideológicas e políticas

Abstract

The present work sought to analyze the conceptual and ideopolitical tendencies of socialliberalism that permeate the National Policy on Health Promotion (PNPS). It should be noted that Health Promotion (PS) has been gaining prominence in public policies across the globe, under the auspices of the World Health Organization (WHO), in order to constitute the international movement called the New Health Promotion (NPS). Apparently progressive, because of questioning the biomedical model, the NPS configures a sinuous terrain full of conceptual and ideopolitical tensions that integrate, within the social-liberal ideology, the search for neoliberalism by a new hegemony. In Brazil, NPS has been gaining ground since the 1990s, in the context of the country's adherence to neoliberalism and the cooling of critical theories in the Brazilian Sanitary Reform Movement (MRSB). The institutionalization of the precepts of the NPS occurred in the neodevelopmental governments through PNPS. In this way, for the purposes of the study, it was necessary to identify and analyze the conceptualizations of the social-liberal ideology that underlie the PNPS; to investigate the inflections of social-liberal thinking about the PNPS in the neodevelopmental governments and to discuss the main ideological and political tendencies related to the social-liberal concepts registered in the PNPS. For that, an analytical study was conducted, with a qualitative approach, based on the critical-dialectical method. In the collection and analysis of the data, the documentary research was used, through a previously constructed script, together with PNPS and other central documents in the PS debate, produced between the years 2006 to 2014 and chosen to subsidize the policy exam. The empirical categories of the study - Health Promotion, Equity, Social Participation, Health Education and Sustainable Development - were chosen in the process of research in the empirical reality, starting from the intersection of the concepts that underlie the social-liberal ideology, the NPS and the PNPS. The analyzes show the correlation of forces between the meanings constructed by the MRSB and the principles of NPS/social-liberalism, with hegemony of this latter perspective. The PS appears as a health production strategy, as the guiding axis of National Health System (SUS) principles. However, the emphasis is on life-style conceptions. There is an initial association between equity and reduction of inequalities, and the universal right to health is advocated. However, the emphasis is on coping with inequities in health from the Social Determinants of Health (DSS). Social Participation is affirmed as a condition for PS. However, there are inconsistencies with regard to the perspective of social control and participation is defined as a mechanism of consensus building, based on community empowerment. With respect to Health Education, the meanings of freedom of choice, abilities and well-being are assumed in the normalization of habits of life. It is pointed out the concept of Popular Education in Health, but in the sense of favoring healthy choices and, for that, the Permanent Education in Health is affirmed as central strategy. For its part, Sustainable Development is embraced as a veneer of the current development model, with emphasis on healthy environments, healthy counties/cities and policies and the promotion of safe mobility and peace in traffic, in tune with the minimum State for the social.