De Souza Campos GW. Análisis crítico de las contribuciones del cuerpo teórico de la salud pública a las prácticas sanitarias. [Critical analysis of the contributions of public health theory to public health practices.] Cuadernos Médico Sociales [Medical-Social Notebooks] 1998 May; 74:79-90.

Objectives: Critically analyze the contributions of public health theories to local healthcare and public health systems.

Methodology: Analytical and interpretive.

Results: The author reviews health reforms occurring in Latin America under the influence of neoliberal policies. Costs must decrease if healthcare is to be offered to the entire population. The path to attain this goal is to change the model of care, not to privatize it. Privatization increases commercialization, and therefore the growth of high cost practices, with a corresponding devaluation of public clinics and public health and overvaluation of diagnostic and therapeutic procedures. These modalities make universal care impossible to sustain.

It is necessary to analyze the numerous alternative experiences brought about in Brazil under municipalization. Each of these experiences has retraced aspects of traditional thinking, knowledge, and practice. Alternative projects were based on collective health (social medicine, epidemiology, the social sciences, planning and administration of public enterprises, etc.). Such projects have included reform elements of clinical thought, which offered programs with a more holistic vision of the determinants of the health-disease process and broader proposals for intervention.

These experiences present successes, but also problems that must be rethought. One such problem is the use of models which are effective in controlling or reducing the incidence of certain pathologies, but which remain inappropriate in the control of chronic diseases. Another problem is that, while much is expected from primary care, it is generally not well integrated with more complex levels of care.

Conclusions: The article proposes that public health responsibilities be divided between first-level services and focal points of collective health for each healthcare district. These focal points should work in a coordinated way with primary healthcare teams and should be in charge of such specific areas as workers health and campaigns to control particular outbreaks (e.g., dengue, malaria). The article likewise proposes to strengthen ideas of self-care and to foster autonomy for patients, families, and communities.