PREVENTION OR MEDICALIZATION? THE CHALLENGES OF PRIMARY HEALTH CARE (PHC) IN THE ERA OF POPULATION SCREENING AND RISK MANAGEMENT

Abstract

In recent decades, the field of public health has been crossed by an intense debate about the limits and possibilities of prevention within public health policies. Especially in Primary Health Care (PHC), recognized as a preferential gateway and a privileged space for bonding, listening, and comprehensive care, there is a growing emphasis on the technical rationality of risk management and the systematic adoption of population screening strategies. Such practices, although legitimized by the discourse of health promotion and system efficiency, have been criticized for promoting a subtle, but profound, medicalization of daily life, shifting the focus from the expanded clinic to a model centered on surveillance and standardization of conducts. In this context, we ask: How has the centrality of risk management and screening strategies in Primary Health Care contributed to the medicalization of daily life and to the emptying of the expanded clinic in care practices? For this, we used as theoretical support the studies of Szasz (1974), Illich (1975), Foucault (2001; 2014), Han (2010), Löwy (2010), Starfield (2002), Armstrong (2002), Kidd, Heath & Howe (2013), Rose (2013), Merhy (2007), Diniz (2007), Conrad (2007), Mol (2008), Rose (2008), Ahlzén et. al. (2017), Agamben (2018), Young (1997), Silva & Hortale (2012), Starfield (2002), Mol (2008), Merhy (2007), Rose (2008; 2013), among others. The methodology used is qualitative (Minayo, 2007), bibliographic and descriptive (Gil, 2008) and with a comprehensive analytical bias based on Weber (1949). The research revealed that the centrality of population screening and risk management in PHC has intensified the medicalization of daily life, reducing care in the application of protocols and weakening listening and bonding. It was evidenced that this technocratic rationality displaces the expanded clinic to a normative model, marked by surveillance and standardization of conducts. On the other hand, paths of resistance anchored in the ethics of care, in the valorization of the knowledge of the territory and in the critical training of professionals were pointed out.