RESUMEN
Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.
Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.
Asunto(s)
Congresos como Asunto/historia , Medicina Familiar y Comunitaria/historia , Reforma de la Atención de Salud/historia , Atención Primaria de Salud/historia , Academias e Institutos/historia , Academias e Institutos/organización & administración , Brasil , Centros Comunitarios de Salud/historia , Centros Comunitarios de Salud/legislación & jurisprudencia , Centros Comunitarios de Salud/organización & administración , Congresos como Asunto/organización & administración , Europa (Continente) , Medicina Familiar y Comunitaria/organización & administración , Salud Global , Reforma de la Atención de Salud/organización & administración , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Kazajstán , Programas Nacionales de Salud/historia , Programas Nacionales de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/organización & administración , Portugal , Atención Primaria de Salud/organización & administración , Especialización/historiaRESUMEN
Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.
Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.
Asunto(s)
Humanos , Atención Primaria de Salud/historia , Reforma de la Atención de Salud/historia , Congresos como Asunto/historia , Medicina Familiar y Comunitaria/historia , Portugal , Atención Primaria de Salud/organización & administración , Especialización/historia , Brasil , Salud Global , Kazajstán , Reforma de la Atención de Salud/organización & administración , Centros Comunitarios de Salud/historia , Centros Comunitarios de Salud/legislación & jurisprudencia , Centros Comunitarios de Salud/organización & administración , Congresos como Asunto/organización & administración , Academias e Institutos/historia , Academias e Institutos/organización & administración , Europa (Continente) , Medicina Familiar y Comunitaria/organización & administración , Programas Nacionales de Salud/historia , Programas Nacionales de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/organización & administraciónRESUMEN
Drawing on archival evidence, I document the emergence and florescence of three free health clinics in Chicago in the late 1960s. I trace the centers' forceful removal by the city's Board of Health, and their subsequent replacement by Federally Qualified Health Centers (FHQCs). I argue that the demise of the free centers is exemplary of a broader trend in US health policy of regulating and diminishing the health care options of poor Americans. By highlighting the stark contrast between Chicago's free health centers of the 1960s and the health care services offered by contemporary FQHCs, I reveal a gradual shift from health care rights to accessing care in the US health care safety net.
Asunto(s)
Instituciones de Atención Ambulatoria/historia , Centros Comunitarios de Salud/historia , Accesibilidad a los Servicios de Salud/historia , Negro o Afroamericano/historia , Antropología Médica , Chicago , Historia del Siglo XX , Humanos , Racismo/historiaRESUMEN
This piece examines the historical forces and forebears that preceded, and helped shape, community health centers. Though the current iteration of community health centers date from the 1960s, their (deeper) roots go back to the earliest years of the twentieth century. They began life as largely urban phenomena, and rode the wave of the larger program of Progressive-era political and socioeconomic reforms.
Asunto(s)
Centros Comunitarios de Salud/historia , Atención a la Salud/historia , Farmacias/historia , Historia del Siglo XX , HumanosAsunto(s)
Centros Comunitarios de Salud/historia , Participación de la Comunidad/historia , Poder Psicológico , Determinantes Sociales de la Salud/historia , Negro o Afroamericano/historia , Promoción de la Salud/historia , Disparidades en el Estado de Salud , Historia del Siglo XX , Humanos , Mississippi , Características de la Residencia/historiaAsunto(s)
Negro o Afroamericano/historia , Centros Comunitarios de Salud/historia , Agentes Comunitarios de Salud/historia , Salud Pública/instrumentación , Accesibilidad a los Servicios de Salud/historia , Disparidades en el Estado de Salud , Historia del Siglo XX , Humanos , Massachusetts , Pobreza/historia , Prejuicio/historia , Racismo , Problemas Sociales/historia , Estados UnidosRESUMEN
The Pioneer Health Centre, based in South London before and after the Second World War, remains a source of interest for advocates of a positive approach to health promotion in contrast with the treatment of those already ill. Its closure in 1950 for lack of funds has been blamed on the then recently established National Health Service, but this article argues that such an explanation is over-simplified and ignores a number of other factors. The Centre had struggled financially during the 1930s and tried to gain support from the Medical Research Council. The Council appeared interested in the Centre before the war, but was less sympathetic in the 1940s. Around the time of its closure and afterwards, the Centre was also involved in negotiations with London County Council; these failed because the Centre's directors would not accept the changes which the Council would have needed to make. Unpublished documents reveal that the Centre's directors were uncompromising and that their approach to the situation antagonised their colleagues. Changes in medical science also worked against the Centre. The success of sulphonamide drugs appeared to render preventive medicine less significant, while the development of statistical techniques cast doubt on the Centre's experimental methods. The Centre was at the heart of the nascent organic farming movement, which opposed the rapid growth of chemical cultivation. But what might be termed 'chemical triumphalism' was on the march in both medicine and agriculture, and the Centre was out of tune with the mood of the times.
Asunto(s)
Centros Comunitarios de Salud/historia , Servicios Preventivos de Salud/historia , Investigación Biomédica/historia , Centros Comunitarios de Salud/organización & administración , Promoción de la Salud/historia , Historia del Siglo XX , Humanos , Londres , Servicios Preventivos de Salud/organización & administración , Medicina Estatal/historia , Reino UnidoAsunto(s)
Centros Comunitarios de Salud/historia , Centros Comunitarios de Salud/organización & administración , Centros Comunitarios de Salud/normas , Atención a la Salud/historia , Atención a la Salud/normas , Historia del Siglo XXI , Humanos , New York , Atención Dirigida al Paciente/historia , Atención Dirigida al Paciente/organización & administración , Mejoramiento de la Calidad/historia , Mejoramiento de la Calidad/organización & administraciónRESUMEN
I examine why South Africa's pioneering Pholela model of primary health care, dating from the 1940s, held such appeal for the country's new policymakers after 1994, and why those policymakers have failed to make it the basis of an effective public health care system since then. In the 1940s, the innovative Pholela experiment had served as such a model, to be replicated gradually throughout the country until a new health care system in its image was finally in place. However, this vision was dashed by the hostility of the mainstream medical profession and, after 1948, even more so by the new apartheid government, causing the idea to wither and become no more than a vanishing memory. In the 1990s, the model resurfaced as part of the country's transition to democracy, eliciting great enthusiasm among a new generation of health policymakers. I conclude by looking at the fate to date of this second coming of the Pholela experiment.
Asunto(s)
Centros Comunitarios de Salud/organización & administración , Política de Salud , Política , Atención Primaria de Salud/organización & administración , Centros Comunitarios de Salud/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Atención Primaria de Salud/historia , Salud Pública , Servicios de Salud Rural/historia , Servicios de Salud Rural/organización & administración , SudáfricaAsunto(s)
Centros Comunitarios de Salud/organización & administración , Promoción de la Salud/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Nativos de Hawái y Otras Islas del Pacífico , Centros Comunitarios de Salud/historia , Promoción de la Salud/historia , Accesibilidad a los Servicios de Salud/historia , Servicios de Salud del Indígena/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Nueva ZelandaRESUMEN
Multiple promising but unsustainable attempts have been made to maintain programs integrating primary care and public health since the middle of the last century. During the 1960s, social justice movements expanded access to primary care and began to integrate primary care with public health concepts both to meet community needs for medical care and to begin to address the social determinants of health. Two decades later, the managed care movement offered opportunities for integration of primary care and public health as many employers and government payers attempted to control health costs and bring disease prevention strategies in line with payment mechanisms. Today, we again have the opportunity to align primary care with public health to improve the community's health.
Asunto(s)
Centros Comunitarios de Salud/historia , Prestación Integrada de Atención de Salud/historia , Programas Controlados de Atención en Salud/historia , Atención Primaria de Salud/historia , Práctica de Salud Pública/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Estados UnidosAsunto(s)
Centros Comunitarios de Salud/historia , Prestación Integrada de Atención de Salud/historia , Programas Controlados de Atención en Salud/historia , Atención Primaria de Salud/organización & administración , Salud Pública/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Atención Primaria de Salud/tendencias , Práctica de Salud Pública/historia , Estados UnidosRESUMEN
This paper compares the relative productive efficiencies of four models of primary care service delivery using the data envelopment analysis method on 130 primary care practices in Ontario, Canada. A quality-controlled measure of output and two input scenarios are employed: one with full-time-equivalent labour inputs and the other with total expenditures. Regression analysis controls for the mix of patients in the practice population. Overall, we find that community health centres fare the worst when it comes to relative efficiency scores.