As Políticas Públicas nos Cuidados Primários ao Excesso de Peso do Brasil e Portugal
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Data
2020-05-07
Autores
Costa, Luciane da Graça da
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Universidade Estadual Paulista (Unesp)
Resumo
A Obesidade é um problema de saúde pública altamente prevalente e de caráter complexo, exigindo efetivas políticas públicas. Brasil e Portugal são países de língua portuguesa com sistemas universais de saúde. Cada um, à sua maneira, tem buscado adotar políticas de enfrentamento do problema. Assim, o pressuposto para este trabalho foi que as estratégias para prevenção e cuidado do sobrepeso e obesidade estão presentes nas políticas públicas destes países em sintonia com as diretrizes extranacionais. O objetivo geral foi desenvolver estudo sobre as políticas públicas de Cuidados Primários ao excesso de peso nos adultos, adotadas pelo Brasil e Portugal ao longo das duas últimas décadas. O trabalho envolveu pesquisa documental e a elaboração de matriz de critérios de avaliação dessas políticas. Foi elaborada uma matriz de critérios para avaliação dos Cuidados Primários de Saúde no Brasil e outra em Portugal, com a participação de especialistas de cada país. Foram elaborados três artigos, o primeiro teve por objetivo examinar o percurso da institucionalização das iniciativas de abordagem da obesidade nas políticas públicas de saúde do Brasil e Portugal nas duas últimas décadas, identificando as diretrizes e estratégias de ação. O Segundo artigo teve por objetivo avaliar a validade de constructo e conteúdo de uma matriz avaliativa dos Cuidados Primários de Saúde ao sobrepeso e obesidade no Sistema Único de Saúde do Brasil. O terceiro artigo teve por objetivo identificar e discutir as convergências e divergências de um processo de validade de constructo e critérios para avaliação das políticas de abordagem primária do excesso de peso no Brasil e em Portugal, utilizando como referência o modelo lógico teórico da Política de Atenção Básica do Brasil. Conclusões: a) No Brasil as ações voltadas à alimentação saudável foram mais precoces e marcadamente intersetoriais, comunitárias, com base no território. Portugal tem proporcionado maiores oportunidades de acesso aos serviços individualizados no sistema de saúde e tem envolvido abordagem em outros setores no enfrentamento da questão. b) No Brasil, o produto do consenso entre especialistas resultou em uma matriz estruturada em quatro dimensões e um conjunto de critérios que vislumbram uma avaliação abrangente dos Cuidados Primários de Saúde ao sobrepeso e obesidade no Brasil. c) Embora Portugal apresente Cuidados de Saúde Primários mais bem consolidados e protocolos mais bem estabelecidos de cuidado centrado na pessoa, o modelo concebido pelos peritos brasileiros para abordagem do excesso de peso, neste nível do sistema de saúde, é mais abrangente e centrado nos direitos humanos e determinantes sociais da saúde. Palavras chave: cuidados primários de saúde, obesidade, avaliação de política pública, metodologia Delphi.
Obesity is a highly prevalent and complex public health problem, requiring effective public policies. Brazil and Portugal are Portuguese-speaking countries with universal health systems. Each, in their own way, has sought to adopt policies to face the problem. Thus, the assumption for this work was that strategies for the prevention and care of overweight and obesity are present in the public policies of these countries in line with extranational guidelines. The general objective was to develop a study on the public policies of Primary Care for overweight in adults, adopted by Brazil and Portugal over the last two decades. The work involved documentary research and the elaboration of a matrix of evaluation criteria for these policies. A matrix of criteria was developed for the evaluation of Primary Health Care in Brazil and another in Portugal, with the participation of specialists from each country. Three articles were prepared, the first aimed at examining the path of institutionalization of initiatives to address obesity in public health policies in Brazil and Portugal in the last two decades, identifying guidelines and action strategies. The second article aimed to assess the construct and content validity of an evaluation matrix of Primary Health Care for overweight and obesity in the Brazilian Unified Health System. The third article aimed to identify and discuss the convergences and divergences of a process of construct validity and criteria for evaluating policies of primary approach to excess weight in Brazil and Portugal, using the theoretical logical model of the Care Policy as a reference Basic of Brazil. Conclusions: a) In Brazil, actions aimed at healthy eating were earlier and markedly intersectoral, community based on the territory. Portugal has provided greater opportunities for access to individualized services in the health system and has involved an approach in other sectors to address the issue. b) In Brazil, the product of consensus among specialists resulted in a matrix structured in four dimensions and a set of criteria that envisage a comprehensive assessment of Primary Health Care for overweight and obesity in Brazil. c) Although Portugal has better consolidated Primary Health Care and better established protocols for person-centered care, the model designed by Brazilian experts to approach overweight, at this level of the health system, is more comprehensive and centered on rights human and social determinants of health. KEYWORDS: primary health care, obesity, public policy assessment, Delphi methodology.
Obesity is a highly prevalent and complex public health problem, requiring effective public policies. Brazil and Portugal are Portuguese-speaking countries with universal health systems. Each, in their own way, has sought to adopt policies to face the problem. Thus, the assumption for this work was that strategies for the prevention and care of overweight and obesity are present in the public policies of these countries in line with extranational guidelines. The general objective was to develop a study on the public policies of Primary Care for overweight in adults, adopted by Brazil and Portugal over the last two decades. The work involved documentary research and the elaboration of a matrix of evaluation criteria for these policies. A matrix of criteria was developed for the evaluation of Primary Health Care in Brazil and another in Portugal, with the participation of specialists from each country. Three articles were prepared, the first aimed at examining the path of institutionalization of initiatives to address obesity in public health policies in Brazil and Portugal in the last two decades, identifying guidelines and action strategies. The second article aimed to assess the construct and content validity of an evaluation matrix of Primary Health Care for overweight and obesity in the Brazilian Unified Health System. The third article aimed to identify and discuss the convergences and divergences of a process of construct validity and criteria for evaluating policies of primary approach to excess weight in Brazil and Portugal, using the theoretical logical model of the Care Policy as a reference Basic of Brazil. Conclusions: a) In Brazil, actions aimed at healthy eating were earlier and markedly intersectoral, community based on the territory. Portugal has provided greater opportunities for access to individualized services in the health system and has involved an approach in other sectors to address the issue. b) In Brazil, the product of consensus among specialists resulted in a matrix structured in four dimensions and a set of criteria that envisage a comprehensive assessment of Primary Health Care for overweight and obesity in Brazil. c) Although Portugal has better consolidated Primary Health Care and better established protocols for person-centered care, the model designed by Brazilian experts to approach overweight, at this level of the health system, is more comprehensive and centered on rights human and social determinants of health. KEYWORDS: primary health care, obesity, public policy assessment, Delphi methodology.
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cuidados primários de saúde, obesidade, avaliação de política pública, metodologia Delphi