Sob o referencial da história das idéias, este estudo revisa o pensamento sanitarista brasileiro, norteado pela figura do Centro de Saúde. A reforma do Serviço Sanitário paulista de 1925 e a instituição das Unidades de Saúde da Família em 1994 definem os limites gerais da revisão. Considera-se a possibilidade de que o discurso sobre o Centro de Saúde inaugurou uma nova era epistemológica na saúde pública, definida pela dimensão individual da educação sanitária, em detrimento da medicina das cidades ou era bacteriana. As novas concepções surgiram, sustentaram e foram sustentadas pelo deslocamento da influência política e intelectual francesa para os Estados Unidos, materializada nas ações da Fundação Rockefeller, tendo por base a Universidade Johns Hopkins. São Paulo foi uma das cidades escolhidas para investimento maciço, como efeito demonstração do novo ideário. Embora a atuação institucional da Fundação tenha tido escala planetária, a apropriação discursiva e adaptação local se mostrou mais precoce e coesa na América Latina, dando ensejo a criação e fortalecimento de um verdadeiro pan-americanismo na saúde pública, com a participação do Brasil. No país, o discurso da era sanitária e seus corolários medicina preventiva, medicina integral, medicina comunitária e atenção básica/primária, foi clivado por três grandes matrizes políticas, que se sucederam e predominaram em momentos distintos: pensamento clássico, de matriz liberal e que dá significação cultural local às idéias que prevalecem no debate internacional a partir dos anos 1920; o pensamento radical, de matriz marxista, que aflora na segunda metade dos anos 1970, principalmente no seio da intelectualidade acadêmica; e o pensamento comunitário em saúde pública, de raízes no pensamento político da assistência social, estimulado pela estratégia da Saúde da Família nos anos 1990. O pensamento radical em saúde pública nasce sob incisiva oposição ao regime militar e ao pensamento clássico. Em sua matriz discursiva a saúde coletiva substitui as expressões anteriores e se concentra no determinantes sociais da saúde, relegando o debate setorial ao segundo plano. Embora sem a devida clareza, o pensamento comunitário recupera e busca atualizar muitas das concepções clássicas, sem fugir da composição com o discurso radical. Alguns conceitos originalmente ligados ao ideário dos Centros de Saúde se destacam ao longo do período analisado: integração (integralidade); descentralização (desconcentração); e socialização (universalidade). Num plano histórico mais abrangente, reconhece-se atualmente que a saúde pública brasileira esteve na essência de um projeto de construção nacional iniciado na Primeira República, mas efetivamente posto em ação na era Vargas. Os Centros de Saúde, hoje representados no ideário da Atenção Básica, não só participaram desta história, como, na realidade, lhe foram em grande parte seus protagonistas / This study reviews the history of ideas in the public health of Brazil. The reform of the Health Service of Sao Paulo in 1925 and the establishment of the Family Health Program in 1994 set the general limits of the review. It considers the possibility that the discourse on the Health Centre inaugurated a new epistemological era in public health, defined by the individual dimension of \"health education\", to the detriment of the \"medicine of the cities\" or \"bacterial era\". New concepts emerged, sustained and were sustained by the displacement of French intellectual and political influence for the United States, embodied in the actions of the Rockefeller Foundation, based on the Johns Hopkins University. São Paulo was one of the cities chosen for massive investment, as \"demonstration effect\" of those new ideas. Although the institutional performance of the Foundation has had a planetary scale, the discursive appropriation and local adaptation was earlier and more cohesive in Latin America, giving rise to creation and strengthening of a true Pan-Americanism in public health, with the participation of Brazil. Nationwide, the \"health education\" ideas and its corollaries \"preventive medicine\", \"comprehensive medicine\", \"community medicine and primary care, was cleaved by three major political perspectives that ensued and prevailed at different times. The \"classical thought\", in a liberal perspective, gave local significance to the ideas present in the international debate since the 1920s. The \"radical thought\", under a Marxist matrix, arouse in the second half of the 1970s, especially within academic intellectuals, and \"community thought\" in public health, stimulated by the Family Health Program in the 1990s. The radical thought in public health movement was strengthened in opposition to the military regime and the classical thought. \"Collective health\" replaced the previous expressions and focuses on social determinants of health, relegating the services organization in the background. Although lacking the necessary clarity, community thought recovers and seeks to update many of the classical concepts, in composition with the radical discourse. Some concepts originally linked to the ideals of the Health Centers are highlighted throughout the studied period: integration (comprehensiveness), decentralization and socialization (universality). In a broader historical view, it is current recognized the role of the Brazilian public health in the national identity construction started in the First Republic, but actually put into action in the Vargas era. Health Centres, today represented in the ideas of primary care, not only participated in this history, as indeed they were largely its protagonists

La question des infections sexuellement transmissibles (IST) en Afrique a longtemps été<p>négligée par des chercheurs africains spécialistes en sciences sociales, en raison notamment du tabou<p>qui entoure la sexualité dans ce continent. Toutefois, les dernières décennies ont donné lieu à plusieurs<p>recherches menées principalement par les Européens africanistes sur ces pathologies grâce à<p>l’émergence de la pandémie actuelle du Sida. La plupart des travaux réalisés sont axés sur les facteurs<p>de risque, les mécanismes de diffusion, les croyances et les attitudes populaires face à ces maladies, les<p>politiques de lutte, etc. Mais les études historiques consacrées aux IST sont très rares. Celles qui<p>existent ont surtout mis en évidence la dimension démographique axée sur le problème de la dénatalité<p>en laissant dans l’ombre le contexte socio-historique et les conditions socio-épidémiologiques de<p>propagation de ces affections. Au moment où le Sida fait des ravages dans le monde et tout<p>particulièrement en Afrique subsaharienne, l’intérêt d’une réflexion historique sur les IST au Congo<p>n’est plus à démontrer.<p>Contrairement à une affirmation classiquement admise dans la littérature, selon laquelle la<p>lutte contre les IST au sein de la population congolaise fut un franc succès pour les autorités coloniales<p>surtout après la Deuxième Guerre mondiale, cette thèse montre plutôt l’augmentation de la prévalence<p>des IST dans le temps. Les archives inédites et l’analyse des données révèlent que cette progression<p>continue est la conséquence de l'urbanisation accélerée et de la monétarisation de la société et de la sexualité entraînant des modes de vie propres à la société coloniale urbaine. Les villes issues de ce processus deviendront non seulement des espaces<p>d’acculturation et de modernité, mais aussi des lieux d’expansion de ces maladies. Le développement<p>de la prostitution et la multiplicité des partenaires sexuels, à travers les unions plus libres et<p>momentanées, sont les principaux facteurs explicatifs de cette observation.<p>On présente généralement de manière panégyrique l’oeuvre sanitaire coloniale de la Belgique<p>au Congo comme ‘‘modèle’’. Pourtant, aucune étude n’a déjà été menée pour examiner, de manière<p>chiffrée, les aspets liés aux différences de santé entre les Congolais et les Blancs. Cette<p>dissertation vient combler les lacunes existantes dans ce domaine. De ce point de vue, il en résulte de<p>fortes inégalités et des déséquilibres persistants de santé entre ces deux types de populations. Les Congolais beaucoup plus<p>nombreux, socialement défavorisés, ne bénéficient que d’une situation peu ou moins favorable ;tandis<p>que les Blancs, socialement plus favorisés, bénéficient en général d’une meilleure situation sanitaire.<p>Plusieurs indicateurs élaborés dans ce travail sont révélateurs de cette réalité coloniale, en termes<p>d’équipements sanitaires, d’accès et d’utilisation de soins et d’état de santé différencié./<p><p><p><p>The issue of sexually transmitted infections (STI) in Africa has long been neglected by<p>researchers African social scientists, particularly because of the taboo surrounding sexuality in Africa.<p>However, recent decades have resulted in several research conducted mainly by the European<p>Africanists on these diseases through the emergence of the current pandemic of AIDS. Most of studies<p>are focused on risk factors, distribution mechanisms, the popular attitudes about these infections,<p>control policies. But historical studies on STI are seldom examined. Those that exist are mainly<p>concerning the demographic dimension focuses on the problem of declining birth, leaving the socio-historical<p>and socio-epidemiological spread of such diseases. While AIDS is ravaging the world and<p>especially in sub-Saharan Africa, one thing to mention is that the interest of historical reflection on<p>STI in the Congo is obvious.<p>Contrary to an assertion conventionally accepted in the literature, that the fight against<p>gonorrhea and syphilis among the Congolese population was a success for the colonial authorities,<p>especially after the Second World War, our thesis shows rather the increasing prevalence of STI. The<p>archives and analysis of data indicates this continued progress is the result of special conditions of<p>industrialization and urbanization colonial that make people vulnerable. Cities from this historical<p>process will not only areas of acculturation and modernity, but also places for expansion of these<p>diseases. The development of prostitution and multiple sexual partners through free and temporary<p>unions are the main factors explaining this observation.<p>It has generally praises how the actions of Belgian colonial health in the Congo as 'model'.<p>However, no study has been conducted to establish or to compare quantitatively the health status<p>between Blacks (Congolese) and Withes (Europeans in majority). This essay shows the social health<p>inequalities among these two populations. The Congolese many in number, but more socially<p>disadvantaged have only less favorable conditions to health. While the white people, socially<p>privileged, generally have better health status. Several indicators developed in this study are revealing<p>of the colonial reality in terms of sanitation, access and use of care and health status differential. / Doctorat en Histoire, art et archéologie / info:eu-repo/semantics/nonPublished