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REVISTA CHAKIÑAN, 2017, Nº.2, JUNIO, (14-22)
ISSN 2550-6722
16
La salud tiene una particularidad y es que
desde sus orígenes no pudo definirse por sí
misma, sino que fue entendida por oposición
a la enfermedad. Tal fue el caso de Galeno,
quien señalaba que salud “es lo que se posee
cuando uno puede moverse sin dolor;” (Do-
mínguez 2001:10) mientras que mucho
tiempo después, en el siglo XVIII, Samuel
Johnson indicaba que salud consistía en
estar carente de malestar, dolor o enferme-
dad. Con estas dos concepciones de salud,
bastante distantes en el tiempo una de otra,
se puede llegar a la definición que ha predo-
minado en la historia de la humanidad y ésta
es: “ausencia de enfermedad” (Domínguez
2001:10).
No es hasta el siglo XIX, que se logra com-
prender que la salud es un fenómeno multi-
factorial y que debe ser visto desde su multi-
dimensionalidad. Entre los teóricos que
incorporan estas nuevas ideas se encuentra
Engels con su conocido estudio sobre las
condiciones de la clase obrera en Inglaterra.
En esta obra establece que Alemania se
constituiría como el primer país con un
seguro médico y sentaría el precedente para
dar cobertura al derecho a la salud. De igual
manera, pone de manifiesto la relevancia de
los factores sociales para la salud humana
(Beldarraín 2006).
Llegado, en el siglo XX, se comienza hablar
del vínculo estrecho entre las ciencias de la
salud y las ciencias sociales, debido a la
aparición de las escuelas con un enfoque
cultural e histórico, donde la subjetividad
emerge y comienza a transitarse hacia la
validación de paradigmas más bien cultura-
listas. La concepción acerca de la salud
comienza a variar y los aportes de las cien-
cias sociales: de la sociología, la antropolo-
gía y la psicología se hacen cada vez más
RESULTADOS DEL ESTUDIO, DEFI-
NICIONES Y ANÁLISIS
influyentes en la comprensión del ser
humano. El hombre empieza a concebirse
como un ser integral y la enfermedad y la
salud responden, por tanto, a un proceso en
el que influyen variados ámbitos de la vida
del ser humano.
Las concepciones médicas de salud se basan
en el punto de vista de la medicina como
actividad profesional y se dividen, a su vez,
en tres apartados de acuerdo a la práctica
médica: la salud somática-fisiológica, la
psíquica y la sanitaria.
En la concepción somática-fisiológica la
salud es el bienestar del cuerpo y del orga-
nismo físico y la enfermedad es el proceso
que altera este bienestar (Muñoz 2007).
Dicha concepción ha permanecido durante
la mayor parte de la historia más pendiente
de la enfermedad que de la salud, pues no
fue hasta el pasado siglo que comenzó a
estudiarse como un estado positivo al que
hay que acceder a través de prácticas preven-
tivas, como algo más complejo e importante
que la mera ausencia de enfermedad o la
enfermedad compensada.
La concepción psíquica por su parte, se
opone tradicionalmente a la orgánica como
lo subjetivo a lo objetivo, pero sin obviar la
estrecha interrelación existente en el orga-
nismo humano entre cuerpo y psique (Mora-
gas 1976). Resulta importante destacar que,
a pesar de los aportes realizados por Freud y
las más modernas interpretaciones de la
personalidad, la limitación fundamental de
esta concepción psíquica de salud radica en
la subjetividad e indeterminación de sus
manifestaciones, en comparación con la
dolencia somática, ya que el enfermo puede
siempre afirmar que no tiene salud, aunque
objetivamente el médico no tenga base para
aceptarlo.
La concepción sanitaria se centra en el man-
tenimiento, la preservación y la recupera-
ción de la salud, enfatizando en la salud
colectiva de una población o comunidad, es
decir una consideración colectiva de la
salud. En este sentido, dicha concepción
estudia problemas sociales y sanitarios como
el control de la población, la ancianidad, la
delincuencia juvenil y la deficiencia mental.
Se interesa por los grupos sociales y posee
un gran enfoque preventivo.
Desde otro ángulo la salud pública se torna
en la ciencia y el arte de prevenir las dolen-
cias y las discapacidades, prolongar la vida,
fomentar la salud y la eficiencia física y
mental. Todo ello se realiza con los esfuer-
zos organizados de la comunidad para
educar al individuo en los principios de la
higiene personal, organizar los servicios
para el diagnóstico, el tratamiento y la reha-
bilitación. Además desarrolla la maquinaria
social que le asegura a cada miembro de la
comunidad un nivel de vida adecuado para el
mantenimiento de la salud (Organización
Mundial de la Salud 1996).
Más avanzado el tiempo, la Organización
Mundial de la Salud (OMS), plantea que la
salud es ‟un estado de bienestar físico,
mental y social completo y no meramente la
ausencia de enfermedad o disminución”
(Organización Mundial de la Salud 2015).
Aspecto que resulta interesante para el obje-
tivo que se persigue en este artículo, puesto
que se reconoce el amplio espectro que debe
identificar a la salud, la que no puede enten-
derse como un estado fijo a alcanzar median-
te la supresión de los agentes patógenos,
pues se estaría negando la propia evolución
física, psíquica y social. La concepción de la
OMS posibilita a la práctica médica y sanita-
ria trazarse nuevos objetivos para mejorar
los estados parciales de salud física, psíquica
o social.
Resulta válido señalar entonces, luego de
este recorrido, sobre las distintas definicio-
nes de salud que no se puede sustraer del
carácter eminentemente social que la com-
pone.
Es en este entramado en que el Estado se
erige en el principal actor institucional de la
salud pública y en una entidad individualiza-
da desde el punto de vista operativo que
tiene personalidad jurídica e instrumentos de
actuación propios y poderosos que les
permite actuar en consecuencia al contar con
instituciones responsables directas del sector
de la salud como el propio Ministerio de
Salud. Una de las funciones más importantes
del Estado, en este sentido, es la moviliza-
ción de la sociedad civil y la capacitación de
la población para la participación social.
Las posibilidades y estrategias para enfren-
tar la atención a estas personas con la calidad
y excelencia que merecen se circunscriben a
los Consultorios Médicos de la Familia, los
hogares de ancianos, los círculos de abuelos,
las casas de abuelos y las salas de geriatría
de los hospitales. Aunque no hay dudas que
los programas que se utilizan en la actuali-
dad cuentan con un alto prestigio por su
calidad, es válido señalar que no tratan con
la debida suficiencia lo relacionado al cuida-
do y la atención de los adultos mayores, ni la
dinámica familiar y social que dicho proceso
presenta. En su mayoría son programas que
aborda una arista del problema, la fisiológi-
ca.
La intersectorialidad, por su parte, constitu-
ye un enfoque que sintetiza los más recientes
presupuestos de la ciencia al contemplar los
preceptos del pensamiento sistémico como
fundamento teórico para actuar con más
acierto y eficacia en circunstancias comple-
jas. Aboga por la acción coordinada de
diversos sectores de la sociedad o parte de
ellos en función de solucionar un problema
de salud o actuar sobre sus factores determi-
nantes, condicionantes y desencadenantes
(Castell 2010). Este enfoque reconoce a cada
comunidad como escenario de procesos
singulares de producción de salud que
requieren intervenciones ajustadas a sus
características. Aboga además por la necesi-
dad de establecer relaciones horizontales y
participativas, con alto grado de compromi-
so entre los diversos sectores.
Resulta entonces, que son varias las institu-
ciones las que deben “ponerse de acuerdo”
en el establecimiento de esa estrategia de
atención a la salud. Al analizar el soporte en
que se levanta la atención a la salud se perci-
be a la familia como institución y grupo
social que puede contribuir a la atención
familiar desde esa visión multisectorializada
e interdisciplinar.
La familia no es más que una estructura
jerarquizada de papeles, un subsistema
social que funciona como institución y
grupo social, cuyas relaciones entre sus
miembros se basan en el parentesco, en la
residencia común y su funcionamiento como
unidad doméstica (Fleitas 2005), como se
puede observar la interpretación de familia
que se asume no es solo la mirada primige-
nia emanada de la escuela positivista, aquí se
aboga por una visión más amplia que habla
de la interacción.
Los principales estudios que han abordado la
relación familia-salud responden esencial-
mente a investigaciones realizadas en el
campo de la medicina. En este sentido, se
estudiaron los procesos de salud más allá de
los problemas físicos, biológicos y ambien-
tales, reconociendo el papel de los fenóme-
nos de origen social y psicológico y el papel
de determinados grupos sociales como la
familia (Gaminde 1997). Algunos represen-
tantes del movimiento de la Medicina
Social, tales como Breilh y Castellanos,
resaltaron la influencia de los determinantes
sociales en la salud de la población y para
ello se basaron en la filosofía materialista
dialéctica y en la concepción integral bioso-
cial del hombre (Morales 1997).
Otra de las ciencias que ha estudiado esta
temática ha sido la psicología. En esta rama
destacan figuras como Pérez Lovelle, psicó-
logo cubano que analizó la determinación de
la salud según varios niveles, colocando a la
familia en el nivel intermedio (Castell 2007)
y de hecho reconoce que entran a ocupar un
papel importante en el desenvolvimiento de
las personas y su desarrollo las interacciones
y las relaciones familiares y grupales.
La Escuela histórico - cultural desarrollada
por L. S. Vygotsky sobre la base del materia-
lismo dialéctico e histórico, ofreció también
una concepción teórica que reconoce la
influencia de las mediaciones sociales
mediante los contextos y grupos con los
cuales se relaciona el individuo en toda su
vida (Rojo y García 2000). Para el marxis-
mo, la génesis del hombre tiene su fuente y
origen en la interacción entre el individuo,
su grupo social y su medio natural y se
destaca el papel de la familia como potencia-
dora del desarrollo.
En la familia se transmite la herencia cultu-
ral y es el lugar donde cada generación deja
plasmada su historia, su experiencia, sus
valores, sus costumbres y principios; aspec-
tos relacionados con el proceso educativo
básico de la producción de la salud. En este
sentido, autores como Domínguez plantean
que lo social es atravesado por diferentes
ejes que constituyen momentos de mediati-
zación: el eje de la sociedad y la cultura y el
eje de lo grupal y lo histórico individual
(Domínguez 2001). Se refiere a la familia
como uno de esos agentes sociales mediado-
res del aprendizaje individual y grupal.
Según este autor, debido a la alta presencia
que la familia tiene en las primeras etapas de
formación de la personalidad, se constituye
en uno de los mediadores fundamentales de
todas las influencias valorativas.
En lo referente a la conservación y protec-
ción de la salud, la familia cumple roles
esenciales y de gran trascendencia, en tanto
desempeña las funciones inherentes a la
satisfacción de necesidades básicas, el
cuidado de sus integrantes, lo que incluye
además la obtención y administración de los
recursos económicos para el hogar y la orga-
nización de servicios domésticos. Es en la
familia donde se forman los motivos, patro-
nes y hábitos relacionados con el comporta-
miento implicado en la salud, se gestan
procesos que actúan como sus protectores o
desencadenantes de la enfermedad y se desa-
rrollan recursos de apoyo altamente signifi-
cativos y efectivos.
Las relaciones familiares intervienen en la
generación y evolución de síntomas de
enfermedad. Esta idea es defendida por
investigadores como Dingle que se dedica-
ron al análisis de familias para estudiar la
incidencia de algunas enfermedades y obtu-
vieron que éstas variaban en dependencia de
la intensidad y magnitud de las relaciones
familiares (Donati 1994), según el autor la
fragmentación y la desorganización de la
familia son factores altamente condicionan-
tes en la salud.
Varios resultados de investigaciones han
documentado la relación del funcionamiento
familiar como factor predisponente o coad-
yuvante en la producción y curso de diversos
problemas de salud en sus integrantes según
expresa Risteen (2006).
Estudios realizados en Cuba, específicamen-
te, han evidenciado que las familias disfun-
cionales tienen gran incidencia en enfermos
crónicos y en problemas de alcoholismo.
También expresan que condicionan conduc-
tas antisociales, promiscuidad y suicidios
(Rojo y García 2000).
La aparición de un problema de salud en uno
de los miembros de la familia propicia la
inclusión de un plan hospitalario en el siste-
ma familiar. La familia colabora en el perío-
do de la rehabilitación y en la adaptación a
las secuelas que dejó la enfermedad. La
ayuda instrumental y emocional que necesita
el afectado, la adecuación del hogar, de la
economía, la redistribución de roles y la
colaboración en la reinserción a la sociedad,
las cubre la familia.
En la Facultad de Psicología de la Universi-
dad de La Habana desde hace más de 15
años se estudia a la familia desde una pers-
pectiva psicosocial, describiendo su influen-
cia en las transformaciones sociales. Arés
considera imprescindible el análisis de
variables socio-psicológicas que expresen la
incidencia de lo social (cultura), ideas, prin-
cipios, normas y valores sociales en lo indi-
vidual y las repercusiones psicológicas
(Arés 1990).
Uno de los aspectos a tener en cuenta en la
relación familia-salud es la conexión exis-
tente entre las condiciones materiales de
vida que posee la familia y su estado de
salud. En nuestro país existen diversos
centros de estudios que se han dedicado a
realizar investigaciones sobre esta temática,
tales como la Facultad Latinoamericana de
Ciencias Sociales de Cuba de la Universidad
de La Habana, el Instituto de Antropología y
el Grupo de Familia del Centro de Investiga-
ciones Psicológicas y Sociológicas (Artiles
2007).
También han desarrollado estudios en este
sentido diferentes investigadores cubanos
como María Elena Astraín y María del
Carmen Pría, bioestadísticas de formación y
profesoras de la Facultad de Salud Pública,
quienes destacan cómo las condiciones
materiales precarias de una familia influyen
en las estrategias de salud que adoptan
(Astraín 2004). Sin embargo, los análisis
contenidos en dichos estudios van más allá
de la dicotomía familia-salud, pues tienen en
cuenta también indicadores como pobreza,
desarrollo y desigualdades de género.
Para los fines de la atención de salud, se
requiere una investigación de carácter holís-
tico que recoja las formas en las que se mate-
rializa en la familia la influencia de las
condiciones económicas y sociales, así
como las características concretas de expre-
sión de los procesos psicológicos resultantes
de la interacción entre sus miembros y de sus
formas de desarrollo. Debe permitir la carac-
terización del funcionamiento social de la
familia, el pleno desarrollo de sus miembros
y las necesidades de atención de salud.
La familia interviene en las decisiones sobre
el uso de servicios profesionales y constitu-
ye la red de apoyo más potente y eficaz en el
ajuste a la vida social y ante los procesos de
salud (Louro 2011). No obstante, no ha
estado bien posicionada en el campo de la
salud y su carácter de agente mediador no se
ha tenido en cuenta suficientemente en las
estrategias de promoción de salud.
Según los criterios de la OMS, uno de los
fines principales de cada país debe ser incre-
mentar el nivel de salud de la población, por
lo que propone a la familia como uno de los
grupos fundamentales en este terreno.
Para ello es preciso entender la salud fami-
liar como la dinámica interna relacional en el
cumplimiento de las funciones para el desa-
rrollo de sus integrantes y en la capacidad de
enfrentar los cambios del medio social y del
propio grupo, propiciando el desarrollo y
crecimiento individual según las exigencias
de cada etapa de la vida (Pérez y Carmona
1982).
En la década de 1970, siguiendo los princi-
pios de la Declaración de Alma-Ata, el Siste-
ma de Salud cubano elaboró un nuevo
modelo de atención primaria a la salud. Con
este modelo surge el Policlínico Comunita-
rio, que no negaba el anterior modelo, sino
que mantenía sus principios e incorporaba
nuevos procedimientos (Delgado 1996). Ya
todos los países del mundo habían definido
de manera unánime en la Declaración de
Alma-Ata que la atención primaria de salud
es la estrategia clave para alcanzar la meta
social de salud para todos (Castell 2010).
Así es como a principios de la década de
1980, surgen las primeras ideas de crear un
nuevo modelo de atención comunitaria, con
profesionales que pudieran integrar, contro-
lar y coordinar el cuidado de la salud de las
personas y las familias (Castell 2010). Se
pone a la familia en el eje de las acciones y
se esboza el modelo del Médico y la Enfer-
mera de la Familia. Se convierte al médico
general en un médico especialista, con
formación sólida y con un papel especial en
la comunidad.
Desde entonces se asumió la atención prima-
ria como la forma más adecuada para enfren-
tar los problemas de salud, entendidos éstos
como problemas sociales e inseparables del
desarrollo socioeconómico de un país.
Sin embargo, se hace necesario señalar que
para el logro de esta estrategia se requieren
procesos fundamentales en todos los niveles
del sistema de salud, en sus instituciones, en
sus servicios y, sobre todo, en la mentalidad
y actitudes de toda la población, incluyendo
a los proveedores de los servicios de salud.