Health workers in conversation at the Equity Cafe
Maria Elizabeth Gastal Fassa, and Anaclaudia Gastal Fassa, from the Federal University of Pelotas report on some recent events.
Why public engagement?
The WHO’s Commission on Social Determinants of Health calls for the health gap between the poorest and the richest to be closed in one generation. Leadership, community involvement, local focus and good data to inform decisions are important to promote equity in health. To close the health gap we should start action now. The IX Brazilian Congress on Collective Health, in November 2009, gathered 6,000 health professionals. It was a great opportunity to host an Equity Café which aimed to spread public engagement and promote ideas about equity among health professionals. The participants were encouraged to take these ideas to their professional environments and communities, reaching the farthest points of Brazil.
What is the Equity Café?
The Equity Café gathered 167 participants, in a café scenario: tables covered with white paper and coloured pens available for annotating ideas, flowers on the tables, background music, appetizers and coffee. We invited the participants to have a friendly conversation on the question, ‘What is the role of public health workers in fostering equity in health?’
The presence of just four participants at each table allowed every person, including those more shy, to talk and to be listened to freely. After twenty minutes, one person stayed as a host at each table, while the other three people changed to other tables, as ambassadors, taking the collective ideas built at the previous table’s conversation and cross-pollinating ideas. After three rounds, we held a plenary session, gathering all participants to summarise and intertwine the conversations.
Equity and equality
The group identified the difference between equity and equality. Equity in health means providing health care according to each person’s needs, respecting the individual’s values and choices, respecting singularity and also viewing healthcare in a holistic way. Most importantly, equity refers to citizenship, rights, duties and responsibility. More than access to health care, it refers to access to knowledge and information.
Health care is viewed as a political field and a tool to change the reality and promote equity.
The Brazilian public health system (SUS)
The Brazilian public health system, ‘Sistema Único de Saúde’ (SUS) is one of the most important Brazilian reforms of the past two decades. It is strong, spread all over the country and involves a great number of professionals. Thus, when talking about the role of collective health in fostering equity, participants talked about the structure, functioning and troubles of this system.
The participants approved the SUS model as a political proposal, but pointed to the distance between the proposal and practice. Some comments health professionals made were; ‘SUS is good written on paper, but in practice there is no equity.’ ‘In theory everything is wonderful, but when it gets to the practice…’ Their dream is to turn the proposal into reality, fulfilling fundamental principles of universal and equitable access to health care and information, and at the same time fostering citizen participation.
A really good care for all
In Brazil, complex care such as organ transplants or cancer treatment is of high quality and almost exclusively publicly provided. The extension of primary and secondary health care coverage for everybody, independent of their income, could be a path to surpass the frontier of ‘poor health care for poor people’.
Citizen participation is seen as the path to reach universal and full access to health care, as well as to guarantee resources. However, participation is the weakest part of the system. This is related to problems with education and the population’s lack of knowledge about the public health system, which means people are less likely to demand their rights.
Undergraduate and graduate health programmes should promote the interchange of ideas about how to foster equity, develop social awareness, leadership and the ability to deal with differences. Professionals should enable the development of citizen participation and awareness about rights, duties and social responsibility. Citizenship means engaging with all health equity and social justice issues.
Evaluation
The Equity Café evaluation by participants showed there was as much enthusiasm about learning about equity and interchange of experiences, as for the opportunity to experience the café dynamic. The event had an impact on the participant’s professional activities. It made them re-think the Brazilian health system, bring the subject of equity to the academic environment and change their behaviour when delivering health services, being more careful to welcome and listen to patients. The café dynamic was replicated in eight different situations and six participants are planning more cafés.
Maria Elizabeth Gastal Fassa, Associate Researcher, Post-graduate Program in Epidemiology, Federal University of Pelotas
Anaclaudia Gastal Fassa, Associate Professor, Department of Social Medicine, Post-graduate Program in Epidemiology, Federal University of Pelotas
Report from the Equity Café: http://www.epidemio-ufpel.com.br/cafe/
World Café: http://www.theworldcafe.com/
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Filed under: Public engagement in health research Tagged: | community engagement, health planning, health research, public engagement, public health
