Paim, Jairnilson S. Collective health and the challenges of experience. In: Pan American Health Organization (ed.). The crisis of public health: reflections on the debate. Scientific Publication No. 540, Washington DC: Pan American Health Organization; 1992. p. 136 – 150.

Published also in Spanish: La salud colectiva y los desafíos de la práctica. In: Organización Panamericana de la Salud. La crisis de la salud pública: reflexiones para el debate. Publicación Científica Nro. 540. Washington DC: Organización Panamericana de la Salud, 1992. p. 151–168.

Objectives: To analyze concepts and proposals to evaluate the current situation and tendencies of collective health in Latin America.

Methodology: Historical and dialectical.

Results: The author demonstrates the relationship between socio-economic context and healthcare outcomes. Paim’s analysis of cross-national health indicators shows that the conditions of public health within a society mirror its economic conditions. The author also analyzes the effect that differing core concepts of public health have had on the development of particular public health practices. He traces the development of social medicine and collective health, he notes major theoretical, methodological, and thematic landmarks. The author summarizes the contributions of the principal authors in both the social medicine and collective health fields as well as the impact of their thinking on current practice. Such impact has been especially strong in certain countries, notably in Brazil, where during the 1980’s an important movement developed on behalf of public health that allowed many specialists with a collective health perspective to enter government administration. This movement, together with other social forces, pressured the government to reform the Brazilian healthcare system. Newly-enacted reforms were incorporated into the 1988 National Constitution and were aimed at the adoption of a unitary healthcare system.

Conclusions: Paim concludes that the social, economic, and political crisis facing Latin America presents a complex challenge to public health. In his view,a further such challenge lies in the policies of international agencies that enable for-profit multinational corporations to take control of healthcare systems. Organized social action must be a central goal in order to achieve crucial changes in the living conditions of the population.

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