Determinação social da saúde e Serviço Social: concepções que norteiam o trabalho do/a Assistente Social no atual contexto do SUS

Abstract

This research seeks to reflect the incorporation of the Perspective of Social Determination of Health (PDSS) by the Social Work (SSO), problematizing its appropriation in the theoreticalpractical mediations, based on evidence of its incorporation in the social record, considered the most used technical-operative instrument in the social worker‘s daily routine. Rescues the issues surrounding the process of distancing or appropriation of the PDSS in the theoretical debate of the SSO and reflects on the ideopolitical perspective of health policy in Brazil, which hegemonizes and guides the content of the social file used in the UFRN hospital network, seeking to analyze the capacity of this instrument to apprehend the real living conditions of the SUS user population. It is a qualitative research combining bibliographical and documentary research. We start from the premise that the PDSS expresses the struggle for health as a right in the context of the class struggle, as a formulation of the Brazilian Health Reform Project (PRSB) and is linked to a social transformation project, which has a strong affinity with the leadership of the SSO Political Ethical Project (PEP). The bibliographic research revealed that the notion of Social Determination has been used by health professionals and also by social workers as a synonym of the conceptual model of Social Determinants of Health (SDH) as disseminated by the World Health Organization (WHO), resulting in a theoretical-conceptual distancing that rebounds in the theoretical-practical mediations, without achieving effective understanding of the concept of Social Determination formulated by the MRSB. This fact is expressed in the academic production, which presents few initiatives of approximation with the ideopolitical tensions of the PDSS, which in the current context of counter-reform tends to reflect in the field of instrumentality, which in turn focuses on the most used technical-operative instrumental in daily life professional. The set of analysis, and particularly the questions formulated in the social file that forms the basis of the social interviews conducted by the social workers in the UFRN hospital network, reveals strong indications of the hegemony of the concept of SDH in general restricted to the notion of associated intersectorality as an attributed activity SSO within the framework of the hegemonic biomedical model. From the theoretical point of view we identified the existence of organic links between PDSS and PEP, explained in the centrality of the social issue for the professional exercise and training, present in the Code of Professional Ethics, in the Parameters for acting in Health, in the guiding axes of the present training 1996 Curriculum Guidelines. Despite this close theoretical affinity, it has not translated into a real incorporation of the profession into the PDSS, therefore not using its technical-political potential and theoretical-critical legacy to give visibility to the actions already taken in this direction, which would allow recognizing the importance of the SSO but also make criticisms of its limits. In this sense, the research pointed to the need to expand investments in this debate in the field of training, so that the OHS can make its contribution to facing the challenges as a profession that enters the field of Collective Health with theoretical and methodological conditions to perform critical reading about the real social and health needs of the user population from the perspective of human emancipation, affirming the PRSB and the societal project against hegemony with a view to building a mass democracy.