Are concepts of vulnerability capable of influencing social practices?

Responsible researcher: Viviane Pires Ribeiro

Article title: THE CONCEPT OF VULNERABILITY AND ITS MEANINGS FOR PUBLIC HEALTH AND SOCIAL ASSISTANCE POLICIES

Authors of the article: Michelly Eustáquia do Carmo and Francini Lube Guizardi

Location of intervention: Brazil

Sample size: 46 studies mapped

Sector: Healthcare

Type of Intervention: Critical reflection on vulnerability, social security and citizenship

Variable of Main Interest: Vulnerability

Assessment method: Others

Assessment Context

The beginning of the regulation of Brazilian social assistance public policy occurred in a scenario of conflicts and contradictions, following the regulations of public health policy. The National Social Assistance Policy (PNAS), established in 2004, explained in its text that social vulnerability – expressed by different situations that can affect individuals in their life contexts – is the field of action of their actions.

Vulnerability is not strictly conditioned by the absence or precarious access to income, but also by the weaknesses of affective-relational bonds and inequality of access to public goods and services. Concepts about vulnerability emerge in the health area, reorganizing prevention and promotion practices towards a more contextualized approach that pays attention to the social aspect. Likewise, in assistance, the concept of vulnerability is defined by the term social, which indicates the evolution of understanding about the deprivations and inequalities caused by poverty.

Intervention Details

The critical reflection study, with a comprehensive-interpretative approach, carried out by Carmo and Guizardi (2018) sought to understand and interpret, using the literature review method, the conceptions of vulnerability in the non-contributory policies that make up social security, produced in the last two decades in Brazil. The objective was to problematize the implications of the conception of vulnerability in public practices aimed at the production of citizenship, to understand the tensions and polarizations that put pressure on the materiality of the State model proposed by the 1988 Federal Constitution and the repercussions of these conceptions on the service user population. health and social assistance.

To achieve the proposal of discussing the concepts of vulnerability that appear in public health and social assistance policies, the authors chose to consult the virtual library of electronic periodicals of the Coordination for the Improvement of Higher Education Personnel (Portal de Periódicos Capes), due to its extensive collection of complete and free documents, which includes important search bases for public health and social assistance.

Methodology Details

Carmo and Guizardi (2018) used studies that were fully available for public access and their selection took place between August and November 2016. Thus, the study mapping was developed in two phases. The first phase was an advanced search on the Capes Periodicals Portal using terms located anywhere in all types of materials produced in any language. With the descriptors Vulnerability AND Citizenship , used without quotation marks, the authors admitted the research for studies produced in any year, which resulted in 44 works, including articles, textual resources and theses.

In the second phase, an advanced search was carried out using the descriptors Vulnerability AND “Social Security” , in all types of materials produced on any date, resulting in an article and a textual resource. The textual resource was excluded because it did not contain the entire work available for reading. Of the total of 45 works, 24 were excluded after reading the titles and abstracts, as they did not address the researched topic. No duplicate studies were detected in any of the search phases. After reading the 21 works in full, five were excluded for not presenting a theoretical contribution to discussing vulnerability concepts.

To organize the materials found, the authors outlined two operational categories with a floating reading of the studies. The organization of the studies took into account the aspects expressed in the operational categories: (1) context of the studies (place and date of production, area of ​​knowledge, topic covered); (2) common bibliographic references. After carrying out a detailed reading of the works, the following categories of analysis were defined to carry out the investigation: (1) concepts of vulnerability in health and social assistance; (2) influences of conceptions of vulnerability on social practices.

Results

The results found by Carmo and Guizardi (2018) show that there is no vast production that addresses the specific research theme. Of the 46 studies mapped, only 16 deal with the concept of vulnerability or its implication in the design of public policies to guarantee citizenship rights.

Of the works selected by the authors, 12 were produced in Brazil, one in Spain and three in Portugal, one of the latter being researched in a Brazilian city. The municipality was the research locus for 11 of the selected works; three studies had a national focus and two addressed the international context. The search engine automatically led to studies whose recent production was concentrated between the years 2000 and 2014.

According to Carmo and Guizardi (2018), the understanding and use of the word vulnerability evolved with the new way of dealing with the AIDS epidemic in the 1980s. It began to be admitted that the susceptibility to contagion was due more to a set of economic, social and cultural factors than individual behavior. Considering factors that transcend the biological, when talking about vulnerable subjects, was the focus observed in studies surveyed in the health area. Whether in relation to the environment, teenagers or the homeless population, it can be considered that the production of citizenship and healthy ways of living are linked to the fair distribution of power and knowledge, given the urgency of looking at the subjects in its entirety.

In studies in the area of ​​social assistance, it became clear that poverty does not explain vulnerability, but it is the phenomenon that led to its conceptual refinement, even if this task did not result in clearer conceptions. Taking advantage of the impossibility of restricting the genesis of exclusionary and subordinate processes to the issue of the absence or insufficiency of income, vulnerability has emerged as a category that addresses the problem more broadly, admitting intersectoral conduct between public policies. However, the incorporation of vulnerabilities into the scope of action of public social assistance policy, in order to overcome them, is a process that reveals contradictions, as, based on a direction set by the manual of international organizations, it can resolve or even intensify the vulnerability of subjects. Therefore, every effort to understand the influence that the concept of vulnerability has on the formulation of policies, professional practices, society and the representation that users have of themselves is justifiable.

Public Policy Lessons

Carmo and Guizardi (2018) emphasize that the term vulnerability was inserted into the lexicon of Brazilian public policies on non-contributory social security, guiding the scope of its offers. However, according to the results found by the authors, the conceptual imprecision of the term still remains, requiring more in-depth work. Even though there is considerable scientific production on vulnerability over the last two decades, little has been studied on the link between the different concepts that the word vulnerability can admit and their relationship with the production of citizenship within the scope of public health and social assistance policies.

In this sense, critical reflection based on a review of the literature on vulnerability, social security and citizenship in the areas of health and social assistance revealed quite synergistic points of convergence with regard to the idea of ​​a concept that represents the multiple determinations that affect the contexts of citizens who experience weak or no access to rights.

However, even though the term vulnerability carries inaccuracies resulting from the process of conceptual construction in which it finds itself, there are advances in the discussion of the dynamic and multi-determined reality. The meaning of vulnerability as a parameter for reflection and action implies the recognition of the concomitance of ethical, political and technical factors, circumventing the incidence of risks in territories and the human capacity to face them.

Reference

CARMO, Michelly Eustáquia do; GUIZARDI, Francini Lube. The concept of vulnerability and its meanings for public health and social assistance policies. Public Health Notebooks, v. 34, p. e00101417, 2018.