RESUMO

This paper investigates the role of primary healthcare in mitigating the consequences of the COVID-19 pandemic, focusing on the Brazilian Family Health Strategy (ESF) as a case study. ESF is Brazil's major primary care initiative, with prior evidence indicating its effectiveness in improving various health outcomes. The COVID-19 pandemic submitted the Brazilian healthcare system to a rigorous and unprecedented stress test, whose repercussions are still under study. Using comprehensive administrative microdata from 2016 to 2022 encompassing dimensions related to mortality, healthcare service, supply of family health teams, and vaccination coverage, our empirical strategy accounts for heterogeneous effects based on program intensity and pandemic evolution of the 5570 Brazilian municipalities. Our findings reveal that municipalities with high-intensity of ESF coverage (i.e. stronger primary care) experienced 347.93 (95% CI: 289.04, 406.81) fewer COVID-19 and cardiorespiratory deaths per million inhabitants throughout the pandemic period, compared to those in low-intensity ESF areas, despite sharing similar profiles of deaths from respiratory and cardiovascular causes. Among the channels contributing to this relative performance, high-intensity ESF municipalities were found to engage in more home-based primary care visits and health promotion activities while maintaining a similar supply of community health workers. Additionally, they achieved higher vaccination coverage, and these effects were more pronounced in areas with greater ESF presence, emphasising the importance of primary care coverage. In conclusion, our findings underscore the relevance of strong primary care in mitigating the consequences of the pandemic and addressing post-pandemic health challenges.

Assuntos

Assuntos

Assuntos

RESUMO

Resumo A chegada da COVID-19 ao Brasil gerou grande impacto no sistema de saúde, bem como em seus profissionais, com o elevado número de casos e informações constantemente publicadas. Nesse contexto, criou-se a Plataforma de Inteligência Cooperativa para a Atenção Primária à Saúde (Picaps), uma plataforma tecnológica que ajuda a sistematizar os processos de comunicação e negociação de atores, tendo como foco a ciência e a tecnologia. O presente trabalho tem como objetivo descrever os processos da Picaps, sendo esta constituída por um sistema colaborativo concebido como solução pública capaz de gerar inovações nas áreas de ciência, tecnologia e saúde para o enfrentamento da COVID-19 no Distrito Federal (DF). Nela integram-se processos de coleta e tratamento de dados, além da disseminação de informações visando o seu uso tanto em nível governamental quanto em nível societal. A Picaps pode ser vista como um poderoso instrumento governamental para auxiliar sociedades espalhadas pelo país, sobretudo as que se encontram em situação de vulnerabilidade, com capacidade de nortear o uso da inteligência cooperativa em ações de atenção primária e vigilância em saúde para construção de soluções inovadoras como respostas rápidas para o enfrentamento de crises sanitárias em tempos contemporâneos.

Abstract The arrival of COVID-19 in Brazil had a marked impact on the health network as well as on the professionals involved, due to the significant number of cases and constantly updated information. In this context, the Cooperative Intelligence Platform for Primary Health Care - Picaps - is set up as a technological platform that assists by systematizing the communication and negotiation processes among actors, with a focus on science and technology. This article sets out to describe the processes of Picaps, which consist of a collaborative system conceived of as a public solution capable of generating innovations in the areas of Science, Technology and Health, in order to tackle COVID-19 in territories with populations in socially vulnerable situations in the Federal District (DF). It integrates data collection and processing, as well as the dissemination of information for its use, both at the governmental and societal levels. Picaps can be seen as a powerful government instrument to help societies across the country, especially those in vulnerable situations, capable of assisting in the use of cooperative intelligence in primary care and health surveillance actions to build innovative solutions such as rapid responses to face health crises in modern times.

RESUMO

RESUMO: As crises que caracterizam nosso tempo espelham uma crise civilizatória com raízes no monopólio do saber, em que os modos de conhecer desenvolvidos pelo capitalismo científico degradam o ambiente e subjugam saberes construídos na coevolução das culturas com a natureza, os territórios e os meios de vida. A tecnologia e as inovações científicas assumiram papel central na sociedade atual, mediando um sem-número de relações sociais, ambientais e políticas hegemonizadas pelo capitalismo colonial contemporâneo. Neste ensaio, buscamos trazer reflexões sobre as relações entre os campos da energia e da saúde que, além de manifestarem sucessivas crises, vêm mobilizando o imaginário social nos últimos anos por serem regidos por sistemas sociotécnicos que condicionam os modos de vida modernos. As crises energética e sanitária são abordadas com base em suas construções históricas, nas estruturas produtivas que mobilizam, nos modos de vida que criam e nas relações sociais que ordenam. Apontamos para os mecanismos por meio dos quais os circuitos globais do capital exportam externalidades na direção das populações com menor acesso à energia mecânica disponível em seus sistemas sociotécnicos, gerando catástrofes socioambientais, expropriação de terras, perda de biodiversidade, mudanças climáticas, poluição, pobreza, fome e epidemias.

ABSTRACT: The crises that characterize our time mirror a civilizational crisis with roots in the monopoly of knowledge, in which the ways of knowing developed by scientific capitalism degrade the environment and subjugate knowledge built in the co-evolution of cultures with nature, territories and means of life. Technology and scientific innovations have taken a central role in today's society, mediating countless social, environmental and political relations hegemonized by contemporary colonial capitalism. In this essay, we seek to bring reflections on the relationships between the fields of energy and health which, in addition to manifesting successive crises, have been mobilizing the social imagination in recent years as they are governed by socio-technical systems that condition modern ways of life. Energy and health crises are addressed based on their historical constructions, the productive structures they mobilize, the ways of life they create and the social relations they order. We point to the mechanisms by which global circuits of capital export externalities towards populations with less access to mechanical energy available in their socio-technical systems, generating socio-environmental catastrophes, land expropriation, loss of biodiversity, climate change, pollution, poverty, famine and epidemics.

RESUMEN: Las crisis que caracterizan nuestro tiempo reflejan una crisis de civilización con raíces en el monopolio del conocimiento, en la que las formas de conocimiento desarrolladas por el capitalismo científico degradan el medio ambiente y subyugan el conocimiento construido en la coevolución de las culturas con la naturaleza, los territorios y los medios de vida. La tecnología y las innovaciones científicas han asumido un papel central en la sociedad actual, mediando innumerables relaciones sociales, ambientales y políticas hegemonizadas por el capitalismo colonial contemporáneo. En este ensayo buscamos traer reflexiones sobre las relaciones entre los campos de la energía y la salud que, además de manifestar crisis sucesivas, vienen movilizando el imaginario social en los últimos años al estar regidos por sistemas sociotécnicos que condicionan las formas modernas. de vida. Las crisis energética y sanitaria se abordan a partir de sus construcciones históricas, las estructuras productivas que movilizan, los modos de vida que crean y las relaciones sociales que ordenan. Señalamos los mecanismos a través de los cuales los circuitos globales de capital exportan externalidades hacia poblaciones con menor acceso a la energía mecánica disponible en sus sistemas sociotécnicos, generando catástrofes socioambientales, expropiación de tierras, pérdida de biodiversidad, cambio climático, contaminación, pobreza, hambruna y epidemias.

Assuntos

RESUMO

We propose a Pandemic Risk Perception Scale. Our scale comprises two constructs, Dread Risk and Personal Exposure, divided into five dimensions: Infection Risk, Emotional Health Risk, Health System Risk,Financial Risk, and Alimentary Risk. Using multidimensional item response theory, confirmatory factor analysis, and structural equation modeling on two samples of respondents, our results show that Alimentary Risk, Health System Risk, and Emotional Health Risk are the main dimensions of risk perception for the COVID-19 pandemic. Furthermore, Infection Risk has a minor impact on the pandemic's risk perception, suggesting the presence of different dynamics between personal and general risk perceptions for the COVID-19 pandemic.

Assuntos

RESUMO

Recently, the highest wave of SARS-CoV-2 epidemic occurred since the beginning of the pandemic in Brazil was registered in Rio Grande do Sul (RS) State, Southern Brazil, considering the number of cases, deaths and hospitalization per day caused by COVID-19. In this study we described which lineages were circulating in the first quarter of 2021 in Southern Brazil to better understand the viral factors involved in the health crisis caused by SARS-CoV-2 in the region, searching also for possible additional SARS-CoV-2 sequence mutations. A total of 70 positive SARS-CoV-2 samples collected between January 28th, 2021 until April 23rd, 2021, were selected to sequencing. Whole genome sequencing of 70 SARS-CoV-2 samples showed a predominance of Gamma lineage (67%, 47/70), followed by P.2 lineage (27%, 19/70) and B.1.1.28 (6%, 4/70). Two Gamma lineage consensus sequences presented a new S:D614A mutation. Newly mutations could be emerging due the quick SARS-CoV-2 spreading. Thus, the greater understanding about immune protection and variants vigilance is essential to the better management of the health SARS-CoV-2 crisis.

Assuntos

RESUMO

Neglected tropical diseases (NTD) are a group of diseases with high prevalence in tropical and subtropical countries. They are associated to poverty and underdevelopment. Due to its high morbimortality, these conditions are considered a health crisis. The impact of these diseases can be worsened by the poor socioeconomic status of the affected countries, most of them under-developed, which affects the health care provided to patients. The morbidity of these diseases is explained by the wide organic impairment that they produce. The cardiovascular system is particularly affected, which explains the high morbimortality of NTD. In this article, we review the key issues of a project elaborated by Emerging Leaders of the Interamerican Society of Cardiology (SIAC), about the cardiovascular impact of NTD: the NET-Heart Project (Neglected Tropical Diseases and other Infectious Diseases affecting the Heart).

Las enfermedades tropicales desatendidas (ETD) constituyen un conjunto de afecciones altamente prevalentes en regiones tropicales y subtropicales, asociadas a pobreza y subdesarrollo. Constituyen una verdadera crisis sanitaria, incapacitando y llevando a la muerte a millones de personas anualmente. Esto se ve potenciado por las dificultades socioeconómicas que cursan estos países, mayormente en vías de desarrollo, lo cual repercute en la calidad de la asistencia sanitaria que pueden proveer a la población. La morbilidad de estas enfermedades se explica por la amplia afectación orgánica que generan. El aparato cardiovascular resulta particularmente afectado, lo que explica en gran medida la morbimortalidad de las ETD. En el presente artículo se revisan los aspectos fundamentales de un proyecto llevado a cabo por los Líderes Emergentes de la Sociedad Interamericana de Cardiología (SIAC), cubriendo diferentes aspectos del impacto sobre el aparato cardiovascular de las ETD: el Proyecto NET-Heart (del inglés, Neglected Tropical Diseases and other Infectious Diseases Affecting the Heart).

Assuntos

RESUMO

RESUMEN Las "ollas comunes" (OC) son organizaciones sociales temporales que entregan alimentación gratuita en periodos de crisis. En Chile, resurgen el año 2020 a raíz de la pandemia del COVID-19, y si bien han aparecido en otros períodos de la historia, no ha sido cuantificada su contribución. El objetivo de este estudio fue determinar su contribución a la alimentación y nutrición de las/os chilenas/os, mediante la caracterización y análisis de su oferta alimentaria. Se realizó un estudio descriptivo mediante la aplicación de una encuesta online a voluntarias/os de todo el territorio nacional, la cual incluyó una caracterización del encuestado/a, de la OC que representa y de las preparaciones ofrecidas, en base a lo cual se obtuvo el aporte calórico y nutricional. Contestaron 117 OC (5,1% zona norte, 85,5% centro y 9,4% sur) cuya contribución principal fue con almuerzos (95,9%) con una mediana de 150 (p25: 100 - p75: 200) raciones diarias, compuestas por plato de fondo (95,9%), pan (80,5%) y ensalada (74,8%). Las preparaciones más prevalentes fueron legumbres (91,1%), arroz (78%) y fideos (77,2%). Estos almuerzos aportaron en promedio un 23% del requerimiento energético diario y aportan con el 35% del requerimiento de fibra, pero su aporte en vitamina B12, zinc y hierro fue bajo respecto del requerimiento y aporte esperado para el tiempo de comida. Hasta la fecha, estos datos son los primeros publicados sobre el tema, siendo útiles para determinar su aporte a la seguridad alimentaria del país en tiempos de crisis.

ABSTRACT "Communal Pots" (CP) are temporary social organizations that provide free food in times of crisis. In Chile, as a result of the COVID-19 pandemic, in 2020 the CP resurfaced and, although they have appeared in other periods of history, how they benefitted the population is unknown. The objective of this study is to determine the contribution of the CP to the diet and nutrition of Chileans, through the characterization and analysis of their food supply. For this, a descriptive study was carried out based on an online survey sent to volunteers from all over the country after signing the informed consent. The survey included characterization of the respondent and the CP they represented, the preparations offered by the CP, based on which the caloric and nutritional contribution was obtained. In total, 117 CP answered; 5.1% from the north, 85.5% from the center and 9.4% from the south of Chile. Their main contribution was providing lunches (95.9%) with a median of 150 (p25: 100 - p75: 200) daily rations, made up of a main entree (95.9%), bread (80.5%) and salad (74.8%). The most popular preparations were legumes (91.1%), rice (78%) and noodles (77.2%). These lunches provide an average of 23% of the daily energy requirement and 35% of the fiber requirement, but their contribution of vitamin B12 (2.5%), zinc (25%) and iron (28% req. woman) was low regarding the requirement and expected contribution for the meal time. To date, these data are the first published, to report on the real influence of this social movement in the country's food security in times of crisis.

RESUMO

Resumen Las enfermedades tropicales desatendidas (ETD) constituyen un conjunto de afecciones altamente prevalentes en regiones tropicales y subtropicales, asociadas a pobreza y subdesarrollo. Constituyen una verdadera crisis sanitaria, incapacitando y llevando a la muerte a millones de personas anualmente. Esto se ve potenciado por las dificultades socioeconómicas que cursan estos países, mayormente en vías de desa rrollo, lo cual repercute en la calidad de la asistencia sanitaria que pueden proveer a la población. La morbilidad de estas enfermedades se explica por la amplia afectación orgánica que generan. El aparato cardiovascular resulta particularmente afectado, lo que explica en gran medida la morbimortalidad de las ETD. En el presente artículo se revisan los aspectos fundamentales de un proyecto llevado a cabo por los Líderes Emergentes de la Sociedad Interamericana de Cardiología (SIAC), cubriendo diferentes aspectos del impacto sobre el aparato cardiovascular de las ETD: el Proyecto NET-Heart (del inglés, Neglected Tropical Diseases and other Infectious Diseases Affecting the Heart).

Abstract Neglected tropical diseases (NTD) are a group of diseases with high prevalence in tropical and subtropi cal countries. They are associated to poverty and underdevelopment. Due to its high morbimortality, these conditions are considered a health crisis. The impact of these diseases can be worsened by the poor socioeconomic status of the affected countries, most of them under-developed, which affects the health care provided to patients. The morbidity of these diseases is explained by the wide organic impairment that they produce. The cardiovascular system is par ticularly affected, which explains the high morbimortality of NTD. In this article, we review the key issues of a project elaborated by Emerging Leaders of the Interamerican Society of Cardiology (SIAC), about the cardiovascular impact of NTD: the NET-Heart Project (Neglected Tropical Diseases and other Infectious Diseases affecting the Heart).

Assuntos

RESUMO

Este artigo aborda a crescente crise na saúde pública vivida pelo município do Rio de Janeiro e o advento da pandemia de Covid-19, que veio a agravá-la, como elementos do debate sobre o trabalho na Atenção Básica à Saúde. Ele é resultado das articulações feitas pelo Programa de Ensino pelo Trabalho (PET) para a Saúde Interprofissional, que visa induzir transformações nos cursos de graduação e nos serviços de saúde, com foco na colaboração e no trabalho interprofissional. A discussão sobre a financeirização e os interesses em torno do trabalho do campo da saúde mostram a face perversa dos modos de governo no capitalismo contemporâneo, revelando a bio e necropolítica como estratégias de capitulação do SUS. Na conclusão, são assinaladas a resistência e a potência do trabalho articulado como estratégia de luta pela saúde como direito social.

This article addresses the growing public health crisis experienced by the city of Rio de Janeiro and the advent of the Covid-19 pandemic, which aggravated it, as elements of the debate on work in Primary Health Care. It is the result of articulations made by the Teaching Through Work Program (PET) for Interprofessional Health, which aims to induce transformations in undergraduate courses and in health services, focusing on collaboration and interprofessional work. The discussion about financialization and interests surrounding the work in the field of Health shows the perverse face of the modes of government in contemporary capitalism, revealing biopolitics and necropolitics as Unified Health System (SUS) capitulation strategies. In conclusion, the resistance and the power of articulated work as a strategy to fight for health as a social right are highlighted.

Este artículo toma la creciente crisis de salud pública vivida por el municipio de Río de Janeiro y el advenimiento de la pandemia de Covid-19, que la empeoró, como elementos del debate sobre el trabajo en la Atención Básica a la Salud. Él es resultado de las articulaciones realizadas por el Programa de Enseñanza por Trabajo (PET) Salud Interprofesionalidad, que tiene por objetivo inducir transformaciones en los cursos de licenciatura y en los servicios de salud, enfocando en la colaboración y el trabajo interprofesión. La discusión sobre la financiarización y los intereses en torno del trabajo del SUS muestran la perversidad de los modos de gobierno en el capitalismo contemporáneo, revelando la biopolítica y la necropolítica como estrategias de capitulación del SUS. En la conclusión se señala la resistencia y el poder del trabajo articulado como estrategia de lucha por la salud como derecho social.

Assuntos

RESUMO

This study aims to assess the impacts of the Covid-19 pandemic in Brazil and how it has been dealt with by both the government and in civil society. To this end, we examine the Brazilian public health system and the measures taken by the Bolsonaro Government that led to Brazil being ranked second in overall Covid-19 infections in the world through August 2020. In the absence of national leadership facing the Covid-19 health crisis, we list a set of science-based initiatives promoted by Brazilian public universities in connection with local governments, NGOs and communities as a means of mitigating the consequences and spread of the pandemic. This study is based on the consultation of institutional material published by universities summarizing their research and outreach initiatives. Results reveal that university initiatives included: 1) Alerts to society on the risks of the pandemic, with an emphasis on establishing observatories that assisted local governments and civil society in understanding the evolution of the disease, as well as in implementing measures for its prevention; 2) Direct assistance to local communities, with emphases on the addition of beds in university hospitals for treating patients with Covid-19 and on the manufacturing of personal protective equipment and; 3) Research to find solutions to prevent and treat the disease, with emphases on the development of tests for Covid-19, as well as on carrying out phase 3 vaccine trials. Through these measures, Brazilian public Federal Universities played a key role in supporting both civil society and local governments in mitigating the impacts of the pandemic.

RESUMO

Se describen las acciones sanitarias específicas que se realizan en la lucha contra las enfermedades infecciosas para evitar o disminuir su transmisibilidad y el contagio en la población, como instrumentos del modelo médico sanitario. Se hace referencia a la pandemias de 1918 y 2020, en las cuales se aplicaron estas acciones sanitarias. (AU)

The specific sanitary actions that are carried out in the fight against infectious diseases are described to avoid or reduce their transmissibility and contagion in the population, as an instrument of public health. Reference is made to the Pandemics of 1918 and 2020, where these sanitary actions were used. (AU)

Assuntos

RESUMO

This paper uses the vocabulary of 'medical populism' to identify and analyse the political constructions of (and responses to) the COVID-19 pandemic in Brazil, the Philippines, and the United States from January to mid-July 2020, particularly by the countries' heads of state: Jair Bolsonaro, Rodrigo Duterte, and Donald Trump. In all three countries, the leaders' responses to the outbreak can be characterised by the following features: simplifying the pandemic by downplaying its impacts or touting easy solutions or treatments, spectacularizing their responses to crisis, forging divisions between the 'people' and dangerous 'others', and making medical knowledge claims to support the above. Taken together, the case studies illuminate the role of individual political actors in defining public health crises, suggesting that medical populism is not an exceptional, but a familiar response to them. This paper concludes by offering recommendations for global health in anticipating and responding to pandemics and infectious disease outbreaks.

Assuntos

RESUMO

El síndrome de desgaste profesional o burnout es un fenómeno específico del trabajo que surge como respuesta a estresores crónicos emocionales e interpersonales en el entorno laboral. Considerando las consecuencias que puede tener el síndrome, resulta relevante estudiar cómo la situación de crisis sanitaria en Venezuela, que ha sido documentada ya por años, ha impactado a los profesionales de la salud del país. Objetivos: explorar la relación entre la crisis del sistema sanitario y la salud laboral de una muestra de 82 residentes de medicina interna a nivel nacional. se buscó esclarecer la relación del desabastecimiento de insumos médicos básicos y fallas en el servicio eléctrico con las puntuaciones en burnout obtenidas. Métodos: Se utilizó la versión MBI-HSS versión en español. Se realizo una prueba de correlación de Pearson entre las variables y una prueba de Chi-cuadrado para determinar si existían diferencias en el grado de las dimensiones de burnout según el auto-reporte de desabastecimiento de medicinas y fallas en el servicio eléctrico. Resultados: Se obtuvo una correlación significativa entre las fallas en el servicio eléctrico y el burnout, pero no fue así con el desabastecimiento ni se pudieron establecer diferencias en grado de las dimensiones según autoreporte de deficiencias. Conclusión: Se hacen necesarios más estudios con muestras mayores, más representativas y de mayor experiencia para seguir estudiando los posibles impactos de la crisis sanitaria en Venezuela sobre los profesionales de la salud(AU)

The burnout syndrome is a work-specific phenomenon that arises as a response to chronic emotional and interpersonal stressors at the the workplace. Considering the consequences of this work-related syndrome, it is relevant to study how the health crisis in Venezuela, which has been documented for years now, has impacted health professionals in the country. The present study aimed to explore the relationship between the long-standing Venezuelan health crisis and the work- related health of a sample of 82 internal medicine residents at a national level. More concretely, the goal was to explore the relationship between medical supplies shortages and power system failures and the scores obtained in burnout as measured by the MBI-HSS in its Spanish version. A Pearson correlation test was performed between the variables along with Chi-Square tests for determining if there were differences in degree of burnout dimensions according to self-reports in medical supplies shortages and power outages. A significant relationship was found between power system failures and burnout. However, that was not the case for medicine shortages nor for the differences in degree of burnout dimensions according to self-reported medical supplies shortages and power failures. More studies with larger more representative and experienced samples are needed to keep studying the possible impacts that the health crisis in Venezuela is having on healthcare professionals(AU)

Assuntos

RESUMO

The Venezuelan crisis is filling the headlines and truly deserves the world's attention. It is a wake-up call to all as it holds relevant lessons for both developing and developed countries. The country suffers a severe humanitarian crisis. Its economy has declined at a faster pace than any other peacetime economy worldwide. Hardship and repression have led millions to flee the country creating a refugee crisis in Colombia and other neighboring countries, and millions more are expected to flee unless conditions improve. It raises serious security concerns in the whole Western Hemisphere. The country of Venezuela sits on and owns the largest oil reserves in the world. Oil helps explain the "rent-seeking" behavior that is at the root of this crisis. ("Rent-seeking" is simply getting money from the government for the oil it sells and giving little or nothing back to the government in return. -EEd) However, oil cannot be blamed for this crisis - it helped Venezuela get out of the poverty trap and become a modern democratic society in the 20th century. This crisis comes from the perverse combination of bad politics, bad policy, and corruption that besieged the country over the last 20 years. Since he was elected in 1998, Hugo Chávez paved the way to authoritarianism while making the economy more vulnerable to the ups and downs of oil prices. Chávez died in early 2013. When Nicolás Maduro, his anointed heir, was elected to succeed him, the economy was in bad shape and institutions were already weak, but problems had been papered over thanks to high oil prices and the money the government made from its sale. When oil prices were high worldwide, Venezuelan governments did not save money for possible future economic losses. When oil prices began falling in 2014 and threatened the money from "rent-seeking" by many Venezuelans, Maduro chose the road to overt authoritarianism instead of seeking to restore the basics of an open society and a prosperous economy: the rule of law, property rights, transparency, prudent fiscal and monetary policy, and essential public goods such as education, health, housing, transportation, and infrastructure. This paper is a brief history of how the present Crisis in Venezuela developed and how it can be reasonably resolved. The Venezuelan people are suffering. There are lessons here for everyone in the world (A Venezuelan and James Ausman).

RESUMO

Desde hace bastantes años se viene hablando de una crisis de la salud pública, por lo que hablar de su futuro se hace difícil. En una suerte de exegeta se podría decir que de no cambiarse las bases epistemológicas de la salud pública que lleven a una renovación teórico-metodológica y de la praxis, sumado a una renovación del Estado y tal vez lo más importante, a una renovación de la acción de la sociedad organizada en sus comunidades, el futuro de la salud publica será, como antinomia, la salud privada, es decir la responsabilidad de la salud del pueblo será un asunto individual, privado y de mercado. El articulo analiza el futuro de la salud pública apoyado en las voces y opiniones del campo de la medicina social, a partir de revisar en primer lugar asuntos de la historia de la salud pública para intentar ver los orígenes epistemológicos de este campo de conocimiento, en segundo lugar, ver los retos actuales de la salud pública y en tercer lugar plantear algunos posibles caminos para salir de la crisis y poder vislumbrar un futuro de la salud publica diferente al de una salud privada, mercantilizada, excluyente, que profundiza las inequidades sanitarias.

Since many years ago, it has been talking about a crisis in public health and that is why, talking about the future in this field seems to be difficult. As a sort of exegesis, it might be said that if the epistemological basis of public health are not changed to lead to theoretical-methodological renovation and a change in praxis in addition to a renewal of the State, and the most important thing, renewed actions by the community-organized society, the future of the public healthcare will be, by antinomy, the private healthcare. This means that responsibility for the people's health will turn into an individual, private and market-level issue. The article analyzed the future of public health by taking into account the voices and the opinions in the field of social medicine and reviewing firstly the public health history issues in order to find out the epistemological origin of this field of knowledge, the present challenges and also to state some possible ways to overcome this crisis and be able to glimpse a future for public healthcare different from that of the mercantilist and exclusive private healthcare that makes health inequalities deeper.