SOBRE EL CONCEPTO DE SALUD - ENFERMEDAD
Un Punto de Vista Epidemiológico
Abstract
In the last 10 years, the controversy surrounding the concept of health and disease has been rekindled in some Latin American circles. In our opinion, three fundamental facts have contributed to this:
A. Since the 1977 World Health Assembly (Resolution WHA 30.43) (1), in which the representatives of the member countries agreed that "the main social goal of governments and WHO should be to achieve for all the world's citizens, by the year 2000, a level of health that will enable them to lead a socially and economically productive life" (SPT/2000); and the subsequent declaration of Alma Ata (1978) where it was emphasized, with the commitment of governments in almost all the countries of the world, that Primary Health Care was the way to achieve these objectives, as part of a general development with a spirit of social justice (2); in 1980, the governments of the Americas agreed on the Regional Strategies and Objectives at the XXVII Directing Council of PAHO (3), establishing precise goals in terms of general mortality and life expectancy at birth. ..
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References
O.M.S. Resolución W.H.A. 30, 43. Asamblea Mundial de la Salud. Ginebra, 1977.
O.M.S. Declaración de Alma-Ata. 1978: Atención Primaria de Salud. Ginebra, 1978. (Serie Salud Para Todos, 1).
O.P.S. Estrategias. Salud Para Todos en el Año 2000. Washington, 1980. (Documento Oficial, 173).
Barrenechea J., Castellanos P.L., Matus C., Méndez E., Medici A. y Sonis A. Esquema tentativo de análisis de las implicaciones conceptuales y metodológicas de A.P.S. y S.P.T 2000. O.P.S./H.S.I. Washington, 1987.
O.P.S. Informe Anual del Director 1984. Washington, 1985. (Documento Oficial, 201).
Idem.
Testa, Mario. Estrategia, coherencia y poder en las propuestas de salud. Cuad. Med. Soc. (Rosario, Argentina) 38:3-24, 1986.
Matus, Carlos. Estrategia y plan. 3a. ed. México Siglo XXI, 1981.
a) Mitrov. Ian y Bonma. Psychological assumption, experimentation and old world problems: A critique and alternative approach to evaluation. Evaluation Quarterly. 2:235-60, 1980.
b) Mitrov Ian y Killman R. Methodological approach to social sciences. San Francisco, Jossey-Russ, 1978.
Gramsci, Antonio. Notas sobre Maquiavelo. Juan Pablo Editor. México, 1975.
Hegel, G. Lógica. Madrid, Ricardo Aguilera, 1971.
La noción de procesos de determinación, vinculada al pensamiento explicativo, no de- be ser restringida al "pensamiento causal" positivista, en el sentido de Hume ni en el Stuart Mills. Tampoco debe ser confundido con nociones meramente probabilísticas como Suppes, ni neo-positivistas estructuralistas y pragmáticas como las de Collingwood. Si bien no corresponde ahora una discusión sistemática del pensamiento causal en Epidemiología, si conviene destacar la relevancia que en el proceso práctico de conocimiento tienen las teorías que sobre el objeto tiene el actor conocedor, tal como ha sido rescatado y enfatizado en el pensamiento de Popper, y destacar además, a diferencia de este último autor, la jerarquizada y dinámica complejidad de los procesos de determinación, la relevancia que la forma como los diferentes actores sociales perciben los objetos de conocimiento y transformación tiene para la praxis de dichos actores sociales y el carácter socialmente determinado de estas formas de percepción.
Para una mayor discusión de los procesos de determinación en salud sugerimos:
a) Castellanos, Pedro L. La investigación epidemiológica, uso y perspectivas. En: Seminario sobre Uso y Perspectivas de la Epidemiología. Buenos Aires, OPS, 1983.
b) Castellanos, Pedro L. Las ciencias sociales en la investigación en salud. En: Salud y Sociedad. Memorias del Seminario Ciencias Sociales y Salud. Quito. 1983. OPS. 1986.
Sobre la relación entre flujos de hechos, acumulaciones y reglas conviene ver.
Matus, Carlos. Planificación y política. Cordiplan, Venezuela, IVEPLAN.
a) Glasunov, I. et al. An integrated programmme for the prevention and control of non communicable diseases. J. Chronic. Dis. 36: 419-26. 1983.
b. Klus, D.M. y Rosenstock, I.M. Some lessons from the North Karelia projects. Am. J. Pub. Health. 72:53-4, 1982.
a) Mac Mahon, B. y Pugh. Principios y métodos de la epidemiología. 2a. ed. México, La Prensa Médica Mexicana. 1975.
b) Lilienfield, A. Foundations of epidemiology. New York, Oxford University Press,
Susser, M. Causal thinking in the health sciences. New York, Oxford University Press, 1973.
Breilh, Jaime. Epidemiología, economía, medicina y política. Quito. Univ. Central, 1979.
Laurell, Asa C. Work and health in México. Internat. J. Health Services. 9(4): 543-68. 1979.
Para una mayor discusión sobre reproducción social y salud conviene ver.
Samaja, Juan. Lógica, biología y sociología médicas. Rev. Centroamericana de Salud, CSUCA. No. 6 al 12. Costa Rica. 1976-79.
O.P.S. Desarrollo de la política general de cooperación técnica de la OPS en el cuatrenio 1987-90. Tema 5. Comité Ejecutivo del Consejo Directivo OPS. Washing- ton, 1987.
Mc Keown, Thomas. La enfermedad desde la perspectiva del desarrollo humano. Foro Mundial de la Salud. 6(1): 82-88. 1985.
Murtoma, M. y Kankaanpaa, J. Scenarios approach in finish health strategy development. European Conference on Planning and Management for Health. Septiembre 1984.
Brenner, Harvey. Estimating the effects of economic change on national health and social well-being. A study prepared for the use of Join Economic Committee. Congress of the United States of America. Junio. 1984
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