Opinion – Public Health: Solidarity, social capital and primary care

Recife, 2021. Amidst the enormous socioeconomic difficulties generated by the Covid-19 pandemic and an imminent scenario of food insecurity in the neighborhood of Jocafi (fictitious name), a family health team organizes a solidarity bazaar, where people of better condition finance exchange food for clothes. The groceries are taken to families in situations of food insecurity and the team takes advantage of the visits to check the health conditions of the community.

The story is a very representative example of the experiences included in the Recife Recognize show, an initiative that brings together good practices in primary care in the municipality and is organized by the Recife Department of Health, through the Executive Department of Primary Care (SEAB) and the School of Health. Recife (ESR), with the support of the Institute of Studies for Health Policies (IEPS) and UMANE. There are countless experiences that have solidarity and the formation of community bonds as core values. In a unit of the Academia da Cidade Program, for example, citizens receive seedlings of phytotherapic plants and are encouraged to cultivate them, multiply them and change them periodically, reinforcing spaces for socialization, exchange of knowledge and increasing the co-responsibility of the users and self-care.

Literature specialized in public policies has given this phenomenon the name of social capital. The concept comes from the work of sociologist Robert Putnam, who in his classic book Community and Democracy (1993) described how the social geography of Italy, soon after the decentralization effort undertaken by the central government, explained the good or bad functioning of public policies. According to Putnam, cities and northern regions of the country registered considerable improvements in the quality of public services after decentralization because they had an associative culture of student unions, community lotteries and social clubs – that is, a culture of egalitarian coexistence. On the other hand, the cities of the South, marked by land inequality and the lack of spaces for exchange and associativism, suffered from clientelism and hierarchical political relationships, obstacles to the implementation, effectiveness and capillarity of public services.

The family health strategy is successful in reversing the logic proposed by Putnam: the very action of the State, in the form of family health units and teams, works as a “bank” for the creation and promotion of social capital. This happens because the family health strategy is guided both by the essential attributes of primary care, such as longitudinality (establishing relationships of trust and bond with users), and by derived attributes – community, family orientation and cultural competence. In other words, the work of teams and units needs, in essence, the formation of bonds, the search for associative spaces in the communities and for an integral vision of health.

Considering that Recife is one of the most unequal cities in Brazil, the current administration has prioritized this solidary approach to primary care, seeking to increase the coverage of the family health strategy, encouraging the transversal work of teams in the territories and centered care. in people. These are fundamental initiatives so that all public policies, and not just health ones, are able to have capillarity and correct the cradle lottery.

In early June, several cities in the Northeast were hit by extreme weather events, causing an unacceptable number of deaths and aggravating the scenario of inequalities resulting from the Covid-19 pandemic, climate change and exclusionary urban infrastructure. At the same time, the family health team in the neighborhood of Jocafi is already organizing another solidarity bazaar and community kitchens to serve the territories most affected by the rains in the capital of Pernambuco. Understanding the potential of primary care as a producer of social capital is one of the key elements to transforming solidarity today into institutions, citizenship and good living in the near future.