ABSTRACT
Resumen "Cuidado" es un término polisémico, con un potencial referencial para la salud colectiva. En el marco de la reflexión actual sobre el papel y el alcance del cuidado en ese campo, la atención constituye una etapa inicial, esencial, pero insuficiente del cuidado, siendo este un proceso más amplio en los ámbitos individual y colectivo. Si bien el reconocimiento del proceso salud-enfermedad-atención expande la perspectiva de la salud pública, la "desatención", como tal y como contraparte dinámica de la atención, es invisibilizada, a pesar de su potencial analítico y operativo en el campo de la epidemiología y la salud colectiva. Ambos términos, integrados como procesos de atención-desatención, se analizan en este artículo desde las propuestas de la ética y la integralidad del cuidado, y desde una perspectiva decolonial e incluyente de la epidemiología. En el marco de la dinámica entre atención y desatención, se concreta y materializa la capacidad de prevenir o producir el daño evitable a la salud, en diversos niveles, alcances e itinerarios ilustrativos, específicos y evidenciables en la práctica.
Abstract "Care" is a polysemous term that can serve as a reference for community health. Within the framework of current thinking about the role and extent of care in this field, attention constitutes an initial, essential, but insufficient stage of care, which is a broader process in the individual and collective spheres. Although acknowledging the health-illness-care process broadens the public health perspective, "neglect" as a concept and as a dynamic counterpart to attention remains hidden, despite its analytical and operational potential in epidemiology and community health. Both terms, combined as attention-neglect processes, are analyzed in this article from an ethical and integrative care viewpoint, as well as from a decolonial and inclusive epidemiological perspective. Within the dynamics of care and neglect, the ability to avoid or cause preventable harm to health materializes and arrives at various levels, scopes, and illustrative itineraries, all of which are specific and evident in practice.
Resumo "Cuidado" é um termo polissêmico, com um potencial referencial para a saúde coletiva. No marco da reflexão atual sobre o papel e o alcance do cuidado nesse campo, a atenção constitui uma etapa inicial, essencial, mas insuficiente do cuidado, sendo este um processo mais amplo nos âmbitos individual e coletivo. Ainda que o reconhecimento do processo saúde-enfermidade-atenção expande a perspectiva da saúde pública, a "desatenção", como tal e como contraparte dinâmica da atenção, é invisível, apesar do seu potencial analítico e operacional no campo da epidemiologia e da saúde coletiva. Ambos os termos, integrados como processos de atençãodesatenção, são analisados neste artigo desde as propostas da ética e a integralidade do cuidado, e desde uma perspectiva decolonial e inclusiva da epidemiologia. No marco da dinâmica entre atenção e desatenção se concretiza e se materializa a capacidade de prevenir ou produzir o prejuízo evitável à saúde em diversos níveis, abrangências e itinerários ilustrativos, específicos e evidenciáveis na prática.
ABSTRACT
OBJECTIVE:: To explore indebtedness dynamics in an Afromexican town by an inclusive epidemiological approach. MATERIALS AND METHODS:: Qualitative study through 75 questionnaires, 20 interviews to depth and six focal groups in a support process to the Municipal Health Commission in Santiago Tapextla, Oaxaca. RESULTS:: Catastrophic expenses due to insufficient medical care were the principal causal item. Indebtedness processes with patrimonial loss are dominant, generating dependence spirals of difficult resolution that impact the familiar dynamics and the pathology evolution. CONCLUSIONS:: In spite of its inexistence within sanitary official programs, indebtedness dynamics constitute an epidemiological marker by the uncovering of structural inattention conditions that reflect the imposed, naturalized and pathogenic hierarchization proper of coloniality. To analyze this process at local and global levels is a complex but essential public health task.
Subject(s)
Health Care Costs , Poverty , Surveys and Questionnaires , Ethnicity , Evaluation Studies as Topic , Family Relations , Female , Focus Groups , Humans , Interviews as Topic , Male , Medically Uninsured , Mexico , Patient Credit and Collection , Social Environment , Social SecurityABSTRACT
Resumen: Objetivo: Explorar las dinámicas de endeudamiento en una población afromexicana desde una perspectiva epidemiológica incluyente. Material y métodos: Estudio cualitativo mediante 75 cuestionarios, 20 entrevistas a profundidad y seis grupos focales en un proceso de acompañamiento a la Comisión Municipal de Salud en Santiago Tapextla, Oaxaca. Resultados: Los gastos catastróficos por requerimientos médicos fueron el principal rubro causal de endeudamiento, acarreando pérdida patrimonial y espirales de dependencia, con impacto en la dinámica familiar y en la evolución de la patología. Conclusiones: A pesar de su soslayo en programas sanitarios oficiales, las dinámicas de endeudamiento constituyen un marcador epidemiológico al develar condiciones de desatención estructural que expresan la jerarquización impuesta, naturalizada y patogénica propia de la colonialidad. Analizar dicho fenómeno a nivel local y global constituye una tarea de salud pública compleja, pero esencial.
Abstract: Objective: To explore indebtedness dynamics in an Afromexican town by an inclusive epidemiological approach. Materials and methods: Qualitative study through 75 questionnaires, 20 interviews to depth and six focal groups in a support process to the Municipal Health Commission in Santiago Tapextla, Oaxaca. Results: Catastrophic expenses due to insufficient medical care were the principal causal item. Indebtedness processes with patrimonial loss are dominant, generating dependence spirals of difficult resolution that impact the familiar dynamics and the pathology evolution. Conclusions: In spite of its inexistence within sanitary official programs, indebtedness dynamics constitute an epidemiological marker by the uncovering of structural inattention conditions that reflect the imposed, naturalized and pathogenic hierarchization proper of coloniality. To analyze this process at local and global levels is a complex but essential public health task.
Subject(s)
Humans , Male , Female , Poverty , Surveys and Questionnaires , Health Care Costs , Patient Credit and Collection , Social Environment , Social Security , Ethnicity , Interviews as Topic , Medically Uninsured , Focus Groups , Evaluation Studies as Topic , Family Relations , MexicoABSTRACT
RESUMEN En este texto se analizan diversos elementos de la dinámica nutricional de un municipio predominantemente indígena de Guerrero, México, con el propósito de explorar la pertinencia del concepto de itinerarios de desatención nutricional para ampliar la comprensión del daño evitable a la salud. En el marco de un proceso de acompañamiento a la Comisión de Salud de la Coordinadora Regional de Autoridades Comunitarias - Policía Comunitaria, en el transcurso del año 2015, se aplicaron los siguientes recursos metodológicos: a) revisión de programas oficiales mediante consulta de documentos técnicos y entrevistas con personal sanitario; b) obtención de narrativas locales en familias de niños desnutridos, mediante entrevistas y observación participante; c) realización de somatometría en 151 menores en tres escuelas primarias de la región. Se resalta la inadecuación técnica y cultural de los programas oficiales de atención a la desnutrición y la existencia de distintas escalas (individual, familiar, comunitaria, estatal, estructural) y dimensiones (económica, ambiental, cultural, institucional, afectivo-emocional) de desatención, materializadas en altos índices de desnutrición crónica.
ABSTRACT Through the analysis of different elements of the nutritional dynamics in a predominantly indigenous municipality in Guerrero, Mexico, we explore the relevance of the concept of itineraries of nutritional neglect in order to broaden the understanding of avoidable health damage. In the framework of a process of accompaniment of the Health Commission of the Regional Coordination of Community Authorities - Community Police, the following methodological strategies were applied throughout the year 2015: a) a review of official programs by means of the analysis of technical documents and interviews with health personnel; b) the compilation of local narratives from families of undernourished children through interviews and participatory observation; c) the somatometric measurement of 151 children in three elementary schools. We highlight the technical and cultural inadequacy of official nutrition programs and the existence of different scales (individual, familial, community, state, structural) and dimensions (economic, environmental, cultural, institutional, affective-emotional) of neglect, materialized in high rates of chronic undernourishment.
Subject(s)
Humans , Child , Nutritional Status , Malnutrition , Schools , Population Groups , MexicoABSTRACT
Through the analysis of different elements of the nutritional dynamics in a predominantly indigenous municipality in Guerrero, Mexico, we explore the relevance of the concept of itineraries of nutritional neglect in order to broaden the understanding of avoidable health damage. In the framework of a process of accompaniment of the Health Commission of the Regional Coordination of Community Authorities - Community Police, the following methodological strategies were applied throughout the year 2015: a) a review of official programs by means of the analysis of technical documents and interviews with health personnel; b) the compilation of local narratives from families of undernourished children through interviews and participatory observation; c) the somatometric measurement of 151 children in three elementary schools. We highlight the technical and cultural inadequacy of official nutrition programs and the existence of different scales (individual, familial, community, state, structural) and dimensions (economic, environmental, cultural, institutional, affective-emotional) of neglect, materialized in high rates of chronic undernourishment.
Subject(s)
Malnutrition , Nutritional Status , Child , Humans , Mexico , Population Groups , SchoolsABSTRACT
Se analiza la necesidad de una perspectiva epidemiológica incluyente que atienda las diversas dimensiones del daño a la salud como fenómeno reflejo de la sociedad. Ello demanda una diversificación metodológica y operativa ante realidades sanitarias donde opera sistemáticamente la cultura y la organización social. Se postulan algunos elementos definitorios y operativos de la epidemiología sociocultural como referente para dinamizar la relación entre disciplinas y sectores a partir de problemas específicos relevantes para la salud pública.
The necessity of an inclusive epidemiological approach, capable to attend the diverse dimensions involved in health damage as a reflective phenomenon of society is analyzed. The range of perspectives involved requires an inclusive methodological scope and applicative channels, in order to deal with sanitary realities systematically related to culture and social organization. Some constitutive elements of sociocultural epidemiology are underlined, shaping an operative proposal that can enhance the relationship between disciplines and sectors regarding specific outstanding public health problems.
Subject(s)
Humans , Cultural Characteristics , Epidemiology , SociologyABSTRACT
The necessity of an inclusive epidemiological approach, capable to attend the diverse dimensions involved in health damage as a reflective phenomenon of society is analyzed. The range of perspectives involved requires an inclusive methodological scope and applicative channels, in order to deal with sanitary realities systematically related to culture and social organization. Some constitutive elements of sociocultural epidemiology are underlined, shaping an operative proposal that can enhance the relationship between disciplines and sectors regarding specific outstanding public health problems.
Subject(s)
Cultural Characteristics , Epidemiology , Sociology , HumansABSTRACT
Se analiza la transformación de la Farmacopea Mexicana, focalizando en particular la presencia de la flora medicinal en ella. Como reflejo de diversos procesos, tanto el contenido como la naturaleza de la obra se han modificado de manera progresiva. Las plantas medicinales, que en México siguen siendo relevantes en la terapéutica popular, no figuran ya en la obra. Un texto orientado a conformar una materia médica mexicana, que daba cabida al saber empírico, al incluir recursos de uso popular y convocar a los médicos en su confección y consulta, derivó en un referente de orden industrial ajeno a la clínica. Se exploran el origen e implicaciones de ello.(AU)