La Montaña Mágica - For a Public Health in the Countryside

Public Health emerged in the United States of America at the beginning of the 20th century. Inspired by the French hygienist movement, the German medical police and English sanitarianism, the particularity of Public Health is the integration of three major ideas: disease as a political economic problem, disease as a problem that can be eliminated, and disease as an enemy that needs to be confronted in an organized manner. Hence, the figure par excellence has been the Campaign or Brigade, a managed action that made use of the best of knowledge to confront the disease in certain strategic places for the global market.

Throughout this century, Public Health had to adapt to different scenarios. Firstly, the strengthening of nation states and their health systems forced public health to become a state discipline, separating it from the local environments that characterized it at its birth. Secondly, the progress of knowledge about the disease, which went from monocausality to multicausality, and from there, to the current determinants of the disease, submerged it in Public Policies. And finally, the growing body of disciplinary knowledge necessary to face the new challenges: the consolidation of Epidemiology, the strengthening of clinical specialties, the emergence of fields from the Humanities, the Social, Economic and Administrative Sciences with an interest in the field of disease. And finally, the growing number of disciplines needed to face the new challenges: the consolidation of epidemiology, the strengthening of clinical specialties, the emergence of fields from the humanities, social, economic and administrative sciences with an interest in disease - and to a lesser extent, health -, and more recently, the wave of information and communication technologies, have reduced their scope of action. In this context, Public Health lost its original identity. Confronted by other fields - Family Medicine, Community Health, Social Medicine, Preventive Medicine, Collective Health - and reduced to the State - through Public Policies and Health Systems -, it became a bureaucratic discipline, technically abstract and distant from the population and its closest problems.

Colombia is no stranger to this scenario. When Public Health is mentioned, two extremes immediately come to the fore. On the first, those who defend a Public Health linked to the State, either as civil servants or consultants, which echoes the undeniable progress achieved through actions in the Health System or through Public Policies, which are often imperceptible to the common citizen. On the other side, there are the critics of this Public Health, of its concepts and its role in the State, who do not ignore the advances, but continually highlight the failures, the structural flaws, the need for a revolutionary change.

Both positions, although necessary, present a high level of abstraction that is difficult to transmit in territories and populations with precarious health situations that require concrete solutions. I am talking about populations in semi-rural, rural and dispersed environments; I am talking about territorial entities of categories 4, 5 and 6 - approximately 95% of the national territory -, which with scarce resources and capacities must meet a number of demands of the System and the Policies; I am talking about rural populations, young people and ethnic groups in critical environments, which require the accompaniment and strengthening of their initiatives to maintain and recover their health.

This, among many other situations that I have been able to know, is what motivates me to call for a Rural Public Health. I conceive Field Public Health as a practice carried out by professionals, technicians and population in general, oriented to give appropriate responses to the context, in situations of deterioration of health - or the concept that takes its place in the population -, making use of existing resources and capabilities. As a localized territorial and population-based response, it must contain some minimum attributes, among which I highlight:

• Pragmatism, understood as a deliberative exercise between professionals, technicians and population, oriented to solve present problems at the level of local experience. This should not be confused with being practical, since it does not consist in an efficient application of an idea, but in the fair valuation of the existing knowledge in the context and its usefulness to solve the problem.

  
  

• Pluralism, understood as the permissibility of diverse knowledge and knowledges, including those arising from diverse worldviews and hybridity of thought. A plural deliberative environment favors the relations of the population with itself and with the institutions, strengthens democracy and creates an environment conducive to equity.

  
  

• Constructivism, understood as learning of professionals, technicians and population in general in the construction of answers to local problems. There are no final solutions, but a progression of these, which are carried out, evaluated and corrected. Each of these moments constitutes a learning process.

Some examples of this Field Public Health are already becoming evident, without Public Health and its opponents having noticed. The advances of some indigenous and afro-descendant ethnic groups in what could be the Models of Care for Good Living, the efforts of professionals and researchers in a tropicalization of evidence, the generation of collaborative research or indigenous research, and the use of alternative means of communication to transmit experiences in solving local problems, are part of these efforts that deserve to be disseminated at the same level as state and critical positions.

This text is a first attempt to demonstrate the need to consolidate this field. And I hope it motivates a new dialogue in Public Health.

Published by: Pablo Andrés Martínez Silva

Taken from: The Magic Mountain