Journal of Nursing and Socioenvironmental Health
2014, 1(1):19-26 - http://www.jonse.com.br
Received: May 18, 2014 - Accepted: May 30, 2014
DOI: 10.15696/2358-9884/jonse.v1n1p19-26
Associativism and civism: reflection of the community social capital
for the socioenvironmental health1
Social capital and socioenvironmental health
Leticia Silveira Cardoso2*,Marta Regina Cezar-Vaz3, Valdecir Zavarese da Costa4,
Jorgana Fernanda de Souza Soares5, Mara Regina Santos da Silva6
ABSTRACT
Objective: To analyze the associativism and the civism as reflection of the social capital of organized community groups attached to the Family Health
Strategy for the socioenvironmental health. Methodology: Semi-structured interviews were conducted with 70 participants, non-systematic and nonparticipating observations were performed within the 13 organized community groups. The interviews were recorded. The content was analyzed
qualitatively through the use of the software NVivo 7.0. We constructed the categories - “Associativism: community interest in participating in local groups”
and “Civism: organization of community work in local groups”. Results: From the associativism, it emerges a collective sharing that produces interpersonal
cooperation for the/and in the conduction of the way of life. The civism reveals the existence of a planning for the/ and in the execution of the articulated
work among the working environments that are territorially circumscribed. Conclusion: The social capital within the organized community groups is
emphasized as a way to keep up the universal access to health services. This access enhances the community participation in the daily struggles of life..
Descriptors: Community Participation; Community Organization; Primary Health Care; Family Health Program
Associativismo e civismo: reflexão do capital social comunitário para a saúde socioambiental
Capital social e a saúde socioambiental
RESUMO
Objetivo: Analisou-se o associativismo e o civismo como reflexão do capital social dos grupos comunitários organizados adstritos a estratégia Saúde da
Família para a saúde socioambiental. Metodologia: Realizaram-se entrevistas semiestruturada gravada com 70 participantes e observações sistemáticas e
não participante nos 13 grupos comunitários organizados. Analisou-se o conteúdo qualitativamente com a utilização do software NVivo 7.0. Construíramse as categorias - Associativismo: interesse comunitário em participar de grupos locais e, Civismo: organização do trabalho comunitário em grupos
locais. Resultados: Do associativismo emerge um compartilhamento coletivo que produz cooperação interpessoal para a e na condução do modo de
viver. O civismo revela a existência de um planejamento para a e na execução do trabalho articulado entre os ambientes laborais que se circunscrevem
territorialmente. Conclusão: O capital social nos grupos comunitários organizados destaca-se como forma de manutenção da universalidade do acesso aos
serviços de saúde. Acesso que fortalece a participação da comunidade nos enfrentamentos da vida.
Descritores: Participação Comunitária; Organização Comunitária; Atenção Primária à Saúde; Programa Saúde da Família
Asociaciones y civismo: reflexión del capital social de la salud ambiental de la comunidad
Capital social y salud ambiental
RESUMEN
Objetivo: Se analizaron las asociaciones y la reflexión cívica como la capital de los grupos organizados de la comunidad asociados a la estrategia Salud
de la Familia para la salud ambiental. Metodología: Se realizaron entrevistas semiestructuradas con las observaciones de 70 participantes registrados
y sistemática y no participan en los 13 grupos organizados de la comunidad. El contenido se analizó cualitativamente el uso del software NVivo 7.0.
Construyeron las categorías - Asociaciones: el interés de la Comunidad en la participación en grupos locales y civismo: la organización del trabajo
comunitario en los grupos locales. Resultados: De las asociaciones emerge una acción colectiva que produce ae para la cooperación interpersonal en
la conducción del modo directo. Civilidad revela un plan para ir y volver a la aplicación de un trabajo conjunto entre los entornos de trabajo y que están
limitados territorialmente. Conclusión: La capital de los grupos organizados de la comunidad se destaca por ser una forma de mantener el acceso universal
a los servicios de salud. Access que fortalece la participación comunitaria en la vida luchando.
Descriptores: Participación Comunitaria; Organización Comunitaria; Atención Primaria de Salud; Programa de Salud Familiar
Estudo apresentado na tese intitulada “Capital Social e Atenção Primária Ambiental: fundamentos constitutivos para o trabalho da enfermagem em grupos comunitários
organizados adstritos a estratégia Saúde da Família”. Doutorado em Enfermagem. Universidade Federal do Rio Grande – FURG, 2013
2
Dra. em Enfermagem. Profa. do Curso de Enfermagem da Universidade Federal do Pampa – UNIPAMPA/Uruguaiana. Integrante do Laboratório de Estudos e Processos
Socioambientais e Produção Coletiva de Saúde – LAMSA. E-mail: [email protected]
3
Dra. em Filosofia da Enfermagem. Profa. da Escola de Enfermagem da Universidade Federal do Rio Grande – FURG. Coordenadora do LAMSA. E-mail: [email protected]
4
Dr. em Educação Ambiental. Prof. do Curso de Enfermagem da UNIPAMPA/Uruguaiana. Integrante do LAMSA. E-mail: [email protected]
5
Dra. em Saúde Pública. Profa. da Universidade Estadual da Feira de Santana. Integrante do LAMSA. E-mail: [email protected]
6
Dra. em Enfermagem. Profa. da Escola de Enfermagem da FURG. Coordenadora do Grupo de Estudos e Pesquisa de Família, Enfermagem e Saúde - GEPEFES. E-mail:
[email protected]
* Autor correspondente: Autor correspondente: Rua Dr. Theodorico, n. 20. Bairro Medianeira, Santa Maria - RS CEP 97060-290. Telefone: (55) 91245479
1
Associativism and civism: reflection of the community social capital for the socioenvironmental health
Introduction
The health in the socioenvironmental prerogative
exceeds the provision of services related to health
care, recovery and rehabilitation of health of people,
whether in specific institutions or at household level1.
It is strengthened by the awareness of community
action about itself and about its relationships with
people and environment. This awareness is translated
into the quest for skills and knowledge needed to the
choices of the way of experiencing life2.
This is the pursuit that is the aim of this study,
which is focused on the investigation of organized
community groups, thereby making them its objectsubject. The social capital is its supportive source
that defines how to run the pre-existing individual
skills to the collective organization and use by it
with the purpose of achieving common goals3. It is a
definition that reveals the importance of its analysis
for understanding the social determinants of health
and its influence on the work of the Family Health
Strategy4.
Thus, this importance brings innovations to the
knowledge due to its boldness in articulating the health
sciences towards the social sciences, not being directly
focused on the organic relationships of people, but on
what the people have with sights to be the differential
for their own health and the environment. It seeks to
complement the studies addressing the professionalcommunity relationship, individually5 or collectively6, and
investigating the environmental interference in health7.
By assuming the intention to respond the question
‘How can the social capitals of organized community
groups attached to the Family Health Strategy
influence the environmental health’, it exploits the
social capital through the delimitation of concepts:
the associativism that represents part of something
implemented and the civism that is translated into
the acceptance and fulfillment of established rules.
Implementation that is aligned to individual values
accepted in the collective scope3,7, with the purpose
of analyzing the associativism and the civism as a
reflection of the social capital of organized community
groups attached to the Family Health Strategy for the
socioenvironmental health.
Methods
This is an exploratory, descriptive and analytical
study8, conducted in 13 community groups located
20
in three municipalities attached to the Third Regional
Coordination of Health of the State of Rio Grande do
Sul – Brazil. They were selected from the following
eligibility criteria: being attached to the coverage
territory of the Family Health Strategy (FHS),
developing its activities for at least six months and not
being configured as a health care group for treating
pathologies ministerially recommended for the
intervention of the FHS.
The study population was composed of 70 involved:
35 craftswomen, 17 inhabitants, eight local health
counselors, five fishermen and five solid waste recyclers.
They were respectively organized into five groups of
craftswomen, four of inhabitants, two of Local Health
Councils, one of fishermen and one of recycling.
The data collection is grounded on the semistructured interview technique. Interviews were
recorded in 2009 and 2010. They took place by means
of non-participating observation, in public places
and in natural situations, conducted by two pairs of
researchers with the intention to avoid biases, totaling
116 hours, with an average of 9 hours and 30 minutes
for each group. Qualitative content analysis was
applied with the use of the software NVivo, version7.0,
thereby constituting empirical categories arranged
in a non-excluding mode, namely: “Associativism:
community interest in participating in local groups”
and “Civism: organization of community work in
local groups”.
As this is a research involving human beings,
we complied with the Resolution nº196/96 of the
National Health Council, thereby obtaining the
approval of the Research Ethics Committee from the
Federal University of Rio Grande, under the Opinion
nº 52/2008, and the municipal secretariats. We used
the Free and Informed Consent Form of Participant
and codes for identifying the interviews, which are:
M (municipality), G (group), I (interview) and O
(observation).
Results
The data relating to interviews are initially
accessible in order to reveal the final interest in
participating in the group composition. Thus, it will
show the data of observations that are revealed in the
contemplation of work organization in the definition
of individual participation to achieve the objective of
the associativism.
J. Nurs. Socioe. Health, 2014, 1(1):19-26
Cardoso LS, Cezar-Vaz MR, Costa VZ, Soares JFS, Silva MRS
Associativism: community interest in participating
in local groups
As for the 35 (100%) craftswomen, the interest to
participate in the craft groups was related to exchange
of knowledge in 24 cases (68,57%); in 20 (57,14%),
it was related to achievement of welfare and health.
So, I think that it’s pretty good, a relationship like
this in which we learn to get along with people, get
more knowledge, participate in the community, right!
Because, until then, I hadn’t any participation with
them [group] (M01_G01_E08). Moreover, it also
unveils the possibility of contributing to the family
income in 16 cases (45,71%) and interacting with
other women in the community in 11 cases (31,42%).
(...) we learn something, do at home (...) it can bring
savings because you learn to make an outfit, learn to
do a job to embellish the house; if you go to a birthday
party, you’ll have a little gift to give and it really helps in
the home savings too (M01_G03_E13).
Of the eight involved in groups of local health
counselors, the purpose related to the participation
was the act of giving solvability to health actions
performed by the FHS team in five cases (62,5%);
the intention to conquer space to claim together
with the team for improvements in infrastructure
and material resources was shown in five cases
(62,5%) and the aim at overseeing the actions
promoted by the FHS team was unveiled in one case
(12,5%). (...) the community perceives that something
is wrong within the health unit, instead of picking up
the phone and call the secretariat (...) people come to
the council, expose what is going on and the council
will seek solutions together with the professionals.
And sometimes the opposite happens, then the health
professional notices that everyday problems what are
happening (...) (M01_G10_E52).
In the group of solid waste recyclers, the interest
for the involvement is implicated in achieving an
income in exchange for working activities and in
the possibility of contributing to the maintenance of
cleanliness of the community environment in three
cases (60%). We work to clean up the things and also
to get some bucks [money], which is not enough (...)
(M01_G10_E58). Also, there is interest in helping
to keep up community welfare and health through
the care for the environment, which was unveiled
in one case (20%). Because (...) the village was very
abandoned, very dirty, so we thought the best solution
is to work for the environment (M01_G10_E61).
J. Nurs. Socioe. Health, 2014, 1(1):19-26
Of the group of fishermen, five (100%), the interest
was in the formalization of working activities in
four cases (80%). (...) working within the law is very
bureaucratic, but if you don’t want to follow it, work
outside too (M01_G04_E62). The guarantee of the
product price in the negotiation process was cited in
one case (20%). (...) he catches his fish and know how
much he is selling, how much he will win, then he will
give value to him product and will care about it (...)
(M01_G04_E63).
The interest of inhabitants, 17 (100%), was related
to community welfare and health for the maintenance
of sanitary conditions and the educational training
of local residents in 16 cases (94,11%); community
guidance, provision of leisure activities and donation
of foodstuffs as a proposition of the developed work
were mentioned in five cases (29,41%). (...) bringing
knowledge to our community, try to lead residents to
have a school within the neighborhood (...) a sports
court (...) a way to obtain knowledge and acquire
income (...) (M03_G07_E44). The interaction of the
community with the municipal managers to negotiate
the achievement of local needs was presented in
four cases (23,52%) and an alternative source for the
acquisition of income was cited in two cases (11,76%).
The observations of the work of the five (100%) craft
groups allow us to infer the presence of professionals
of the FHS, community health agent, in five cases
(100%), and nurses, in four cases (80%). The first
ones participate by executing and coordinating the
teaching activities, three (60%); the others by helping
the involved people in the handwork, one (20%).
CHA Sun suggests that one person binds the “fuxicos”
(Brazilian traditional handicraft) to form the quilt
and others prepare more “fuxicos” (M01_G03_O03).
Learning to perform handwork and conducting its
merchantability was observed in one case (20%). CHA
Heaven comments in the second room, in a tone enough
to hear in the first room, on the possibility of exhibiting
the stuffs made in the craft group at the FEARG [Craft
Fair of the municipality] (M01_G01_O01). The nurses
are concerned about the viability of actions, access to
materials, community participation and registration
of actions, which was shown in four cases (80%). The
community presence is fluctuating and is interrupted
in the period of summer holidays, regardless of the
place of accomplishment, five cases (100%).
The two (100%) groups of local health counselors
involve community agents and nursing technicians.
21
Associativism and civism: reflection of the community social capital for the socioenvironmental health
They both interact and expose strategies to make
the requests from the community viable and the first
ones also produce the registration in the minutes of
definitions, obligations and matters, besides sharing
the commitments of pursuits required for the decisionmaking of the upcoming matters (gatherings) with the
participating community members. (...) they discuss if
will contact coordination before or after the elections
[CLS, as per its acronym in Portuguese]. Then, they
think about keeping contact with coordination before
the elections. The President of the CLS looks at the CHA
and says he has to go to the property, they schedule to
go on the next day at 9 A.M., and the CHA invites a
inhabitant/ participant A to follow them (M01_G10_
O11). The community has mandatory participation
and integrates the structural hierarchy of the council.
The group of solid waste recyclers is solely
composed of community members, five (100%)
people, who have emotional and family bonds. Their
daily actions are: separating and selecting materials,
reducing manually their dimensions and storing them
in specific structures, four (80%). (...) They work by
selecting the material on a workbench, use rubber gloves
(M01_G13_O10). The displacement of materials and
its packaging are conducted by a single man that is
included in the group, one (20%). Furthermore, they
make purchases of cans brought by children, based
on weighing, and also the sale of glassware for men
from the community. These actions are registered in
a minute book. On Friday afternoons, they make a
review of productivity with the help of employees from
the local university. A representative of the NUDESE
[Nucleus for Human and Economic Development]
explain to us that it is a nucleus of the university that
deals with several academic students of different courses
by helping the associations (...) in the management of
resources and activities (M01_G13_O02). Eventually,
women make experience reports, by invitation from
local schools, in order to guide their professionals
and the children on the selective collection: what can
be recycled, which care shares should be followed
to throw out the trash, among other aspects. The
handwork is conducted in two shifts, morning (from
eight o’clock to eleven o’clock and thirty minutes) and
afternoon (from thirteen hours and thirty minutes to
seventeen hours and thirty minutes), at a warehouse
provided by the municipal government.
The five (100%) fishermen who constitute the
investigated group live in the same community and are
22
not assisted by the participation of health professionals
of the FHS to accomplish their actions. These actions
are predominant in the morning shift, seven hours,
in which the president or vice goes towards the four
accesses, wharfs of arrival of vessels and canoes, with
the purpose of checking the outcomes of fishing. They
have an infrastructure called headquarters, under
construction, which was achieved with government
incentives. Through the public sector, these two men
(president and vice) manage to participate in projects,
specifically related to housing. Hence, they assist in
the decision-making about who has greater needs
and meets the program criteria. The fishermen’s wives
are the people who perform the cleanliness of fish at
home. We move away from the headquarters to the
first access to the pond; during the pathway, one can
see the job of women that are cleaning up the shrimp in
the courtyard of the residences (M01_G04_O15). The
headquarters holds part of the production of this set
of five (100%) of the associated fishermen, after the
process of cleanliness, bagging and freezing, that is to
say, ready for merchantability and transportation.
The four (100%) groups of inhabitants are
exclusively composed of community members and
there is the use of the environment by nurses and
community health agents, one (25%). The group
actions have paternalistic character, whose purpose is
restricted to donate or provide goods of this action
for members of the local or municipal community,
three (75%), and make programs for meeting the
community social demands viable, two (50%). The
Participant M tell us about a situation of inhabitant
with four children who occupied a plot of two by three
square yards and that was denounced; then, the public
prosecutor asked him to expropriate, but, in the same
neighborhood, there is a large extension that a resident
occupied and nobody expropriates, it has over than
seven acres, they closed with intent to sell in the future.
He concludes by saying: The problem is caused by the
older residents of the city (M03_G08_O14). The above
mentioned health professionals perform activities of
priority groups at the headquarters of the group of
inhabitants, two (50%).
Discussion
The movement for constituting the associativism
in the investigated community groups is mainly
grounded by the relationship of attachment to the FHS.
J. Nurs. Socioe. Health, 2014, 1(1):19-26
Cardoso LS, Cezar-Vaz MR, Costa VZ, Soares JFS, Silva MRS
The actions of the work developed in these groups,
markedly individual and occasionally collective, are
boosted and encouraged by the quest for welfare.
This welfare is raised by the interactional process that
enables the sharing of knowledge and its expansion,
which are converted into personal development and
supplementary sources of income to families.
When encompassing health professionals, this
sharing produces therapeutic safety, which exceeds the
curativist methods and includes the health promotion
by expanding the community confidence in relation
to the work of professionals9. In the panorama of
Brazilian public policies, this confidence refers to
a conflict of political values. These values show the
limitations and possibilities for the community
and health development in the socioenvironmental
strand10.
This strand is where the exchange of information
between people with the same interests represents
the possibility, that is to say, eases up the accessibility
to the knowledge required to a planned joint action,
since the information issued by each participant
enhances the cooperation and boosts the sharing11.
Hence, the sharing of knowledge, as revealed in this
study, unveils the indication that any association
of people requires functional organization and
its domain, civism, in such a way that, in these
conditions, its members are aware to discover their
strengths and take advantage of them by making
innovations12.
The discovery of community strengths that might
be turned into strategic resources for the improvement
and solvability of the work of the FHS teams with
respect to the strengthening of the principles of
universal access, comprehensive care and equity of
health care13.
Another reason for the associativism and civism
found in the investigated community groups is related
to the financial viability of local health services, FHS.
Such viability is characterized as political tactic of
municipal management for decentralizing economy
and, consecutively, health services conducted in
communities. This situation is referred as a condition
of direct interaction of the community representatives
on the dynamics of access and operation of the FHS.
This is an interactional condition that highlights
one of the limits related to the understanding of
communities about the institutional organization
of public origin10 and that reflects the validity of
J. Nurs. Socioe. Health, 2014, 1(1):19-26
the proposals for approximation, not only from
health professionals towards communities, but from
community groups organized towards services13.
In the ministerial perspective, decentralizing
health services means allowing municipal managers
to prioritize socioenvironmental peculiarities of their
territory. Prioritization that contributes to the creation
of environments for presentation and discussion of
collective issues through organized mobilization of
the community with the collaboration of professionals
of the FHS, which result in the epidemiological
assessment of health indicators14.
This is one of the pathways pointed to the
negotiation and articulation of communities with
municipal managers and that determines their
participation in decision-making processes about the
system and their own access to it15. Due to the fact that
health management is not delimited by the presence
and functionality of human and material resources in
a specific environment, it needs to be in line with the
community needs and the means to fill them16.
These needs include obtaining subsistence
income, which was found by the present study from
the combination of the working force in organized
community groups, whose access is expanded through
the associativism and the civism by government
incentives.
Such result is highlighted among other exploited
groups in which the cooperativism arising from the
associativism and the civism implies competitiveness,
production, value addition, access to credit and
information, besides support on public policies17.
Implications that are identified by professionals of
the FHS in the assessment of collective needs from
the poor living conditions of the community, which
are overlooked by the cause-effect relationship of the
illness process in the everyday of the working life.
Thus, exploiting the heterogeneity of the territory
of community attachment might be a possibility for
health professionals to keep up its active action and/
or intervention for the dissemination of information
required to change the behavior of the triad:
community-professionals-management18.
This territorial exploitation includes the insertion
of health professionals in collective environments
of community interaction, where there is a greater
concentration of human skills to help in the
production of changes required to the achievement
of the socioenvironmental health, even if this
23
Associativism and civism: reflection of the community social capital for the socioenvironmental health
professional insertion has objectives distinguished
from the elements that gave rise to the group19.
Furthermore, it has found that the work of the
FHS civically underpins the actions of the majority
of organized community groups developed in its
interior or on its territory of attachment. Community
health agents, nursing professionals and nursing
technicians show solidarity with the community
and arouse a process of exchanges that goes beyond
the teaching-learning. These symbolic exchanges
are embodied by means of mutual respect and
admiration, which are non-palpable interactional
elements expressing the civism that enhances the
associativism.
Due to the fact that the FHS is a primary care model,
in its proposition, the work-related actions should take
place through the partnership between professionals
and communities20. Partnership that translates itself
into cooperation and overcomes the structural limits
of the formal working environment of the strategy,
which eases up the access to community by means
of other institutions and indicates the possibility of
seizing the social capital21.
In some cases, this seizure comes up against
the interprofessional articulation that prevents the
constitution of solidarity as a propelling element
of confidence and cooperation between health
professionals and communities because of the
prioritization of the care for the demand for curativist
clinical intervention22.
In the investigated community groups, the above
mentioned interprofessional articulation is surpassed
by work organization. Organization verified through
the observation of registration of decision-makings
and responsibilities programmed and assumed by
their members, regardless of whether they are health
professionals or community members.
These responsibilities represent more than
community participation in decision-making
processes, but its identity as a significant member
of the work of groups. This meaning understood
as recognition implies relational reciprocity and
solidarity23.
The group recognition is embodied in the
acquisition of resources required for the welfare of
the community, or better expressed, of its members.
Corroborative acquisition to the strengthening of the
social capital, because the confidence and cooperation
among peculiar people can develop alternatives
24
and strategies for coping and overcoming specific
problems of the daily life in the collective scope24.
Social capital characterizes socially and
environmentally the exploited municipalities and
indicates the social determinants of health, which
transposes the access to inputs and services to meet
sanitary, educational and working conditions, among
others. This is a quest for better conditions that
corroborate the permanence of organized community
groups, since actions implemented in these groups are
to make a product converted into family or subsistence
income. It is added by the learning of new work
techniques and material usage, as well as the ability to
conduct negotiations with the municipal management
as a result of the conjunction of community
representatives and the propitious ministerial ways.
The social capital means the interpersonal
relationships in constant amplifying capacity, which is
an element capable of providing health professionals
with more than just knowledge of the environmental
implications on the health and vice-versa, but its use
in the development of socioenvironmental actions25.
In this study, one should highlight the confidence
and solidarity as attributes of the social capital that
make cooperation among the professionals of the
FHS and organized community groups viable. Given
that primary health care encompasses the planning
of environmental conditions for the achievement
of individual and collective health, the technicalscientific knowledge of professionals and the sociocultural mastery of community members is what
generates cooperation and strengthen the existing
social capital.
Conclusions
The social capital within the organized community
groups is emphasized as a way to keep up the
universal access to health services, especially to the
FHS. Community skills become strengthened by
joint actions encompassing the participation of health
professionals.
The associativism is characterized as much more
than the community grouping to achieve common
goals. It strengthens the different and individual
forms used by the community to keep up and expand
the elements that determine the health of people and
the environment conditions. This associativism gives
rise to a collective sharing that produces interpersonal
J. Nurs. Socioe. Health, 2014, 1(1):19-26
Cardoso LS, Cezar-Vaz MR, Costa VZ, Soares JFS, Silva MRS
cooperation for the/and in the conduction of the way of
life. In parallel, it highlights a greater systematization
of the work of the FHS by providing the services with
quality by means of effective community participation
in the context of work organization.
Such organization translates itself into what was
defined as civism, which reveals the existence of a
planning for the/and in the execution of the articulated
work among the working environments that are
territorially circumscribed. There is also the joint
responsibility of the participants of the documentary
mode in such a way as to provide fluidity in actions
and solvability.
Therefore, these combined characteristics reveal the
social capital and its capacity within the investigated
communities. Such revelation (ratification) points
epidemiologically to the amplification of the
socioenvironmental health through the ability to
conduct an articulated movement on the part of
health professionals and organized communities.
Conflicts of Interest
“The authors declared that there is no conflict of
interest of any nature”.
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