People who were already vulnerable are now more vulnerable and that is why the pandemic needs to be addressed from a social and community perspective, not just a clinical one. This is one of the conclusions drawn by the multidisciplinary working group of the COVID-19 Community Health Observatory, which emerged in April at the state level, made up of public health and Primary Care professionals but also neighborhood associations, to better understand reality and go beyond the sanitary and institutional approach.
“There is an excessively biomedical approach and little capacity to reach the people of the neighborhoods,” Daniel García, a primary school physician and member of the Observatory, explains in conversation with elDiario.es.
“One of our conclusions is that the pandemic has caused the headquarters of many institutions to close and the neighborhoods to open out of necessity, deploying community care networks to meet the needs of many people,” he continues.
“Social problems are not solved with a PCR, an antigen test or a paracetamol. Investment in social resources is needed, not a mere clinical response,” says Adrián Carrasco Munera, resident of family and community medicine, member of the Board of Directors of the Madrid Society of Family and Community Medicine and member of the Observatory.
In view of this, the COVID-19 Community Health Observatory has prepared a series of proposals, reflected in a manifesto made public this Tuesday, so that the pandemic is faced from a social and not just clinical perspective. There are five points they propose. All of them revolve around the importance of giving prominence to citizens and their organizations, “allowing their empowerment, understanding that they are part of the solution and not of the problem.”
Make invisible people visible
One of the Observatory’s proposals is that the authorities allocate economic, human and material resources, promoting public services “according to the needs adapted to each circumstance and context, with special emphasis on vulnerable groups and with a focus on reducing inequities in Health”.
As Daniel García explains, “this is not only a health pandemic but also a social one. Health is influenced not only by disease processes but many other conditions that make the effects go beyond the number of infected. There is loneliness, exclusions, overflow at family level or in care networks, difficult situations in the world of work or in relation to housing “. “There are people, like seasonal workers, who live below the threshold of humanity. And that affects health,” says Carrasco Munera.
Claiming the role of the community
From the Observatory they propose that the community networks that should participate in the design and implementation of actions in each territory be identified and recognized. They recall that international organizations such as the World Health Organization or the European Center for Disease Prevention and Control point out that community networks are essential for managing the social and health crisis of COVID-19.
“These networks reduce both the transmission of the infection and the associated social impact. They also facilitate bilateral communication, make knowledge accessible, detect needs and promote cooperation mechanisms, increasing the scope of interventions, covering the entire population in a more effective, “they argue, stressing that preventive measures and physical distance do not mean social distance.
“It is important to debate, dialogue and promote the community, because if not, the only alternative is control and police policies rather than health promotion. If there are only ever tougher and stricter measures without reinforcing other things, the risk of nullifying the community’s care capabilities Community and social organization is essential, because if these bridges are broken between one another, we are left at the mercy of opinions from above, without further ado, with decisions that may be disconnected from reality. , without the possibility of questioning them and without the social fabric “, indicates García.
Take care of the narrative, flee from the show
Another of the proposals is to warn of the messages that focus on fostering fear and looking for culprits, pointing to groups on whom society can discharge the responsibility for the current situation. For this reason they give a touch to the media, asking them to “flee from the spectacle information that causes fear and blockage, and to provide critical and preventive information.
They propose that both the media and public bodies flee from the stigmatization that fosters guilt towards “the other” and that they take into account “the social determinants and living conditions that make it very unequally difficult to follow prevention recommendations.” In this sense, they defend the development of health promotion policies with the participation of citizens and organizations.
Reorient the system towards Primary Care
The Observatory considers that there is “a hospitalocentric trend in the allocation of budgets that should be reversed to increase investment in Primary Care.”
“The health centers need to put the focus back on the communities, and for this they need human, material and economic resources depending on the needs and complexity of each territory,” they indicate.
“Many times from the Primary Care center you realize that you do not get to the real social problems that are affecting health. For this you have to leave the center, contact the associations, diagnose, to approach from the community”, they explain.
Synergy between society and the health system
The Observatory also proposes “that there be sufficient economic, human and technological resources so that there can be spaces for effective work and cooperation between public health services, city councils and primary care. Health councils should be retaken effectively as spaces of special relevance in the community life of the neighborhoods “.
In this sense, they consider that a greater focus on social epidemiology and health promotion strategies would always be necessary, with specific services created for this.
“The objective of our manifesto is that the institutions take into account the social conditions of the people, how it affects health that six people live in a 40-square-meter flat. We plan to deliver a more social discourse, to avoid the speeches based on fear and blame “, explains Dr. García.
The Observatory reminds that dictating norms and giving advice is not enough to change people’s behaviors: “It is essential to know and understand the contexts of the populations and territories that determine their living conditions and thus their behaviors. It is necessary to improve these conditions work and social and family that allow healthy behaviors to stop infections “.
The COVID-19 Community Health Observatory is part of the Community Health Alliance, established in 2013 as a platform of organizations and institutions in the field of community health.