RESEARCH ARTICLES

The health-environment relationship in health professionals' training: the professors' view

Roger Rodrigues Peres^I; Silviamar Camponogara^II

^I Master degree student in Nursing of the Graduate Program in Nursing and Member of the Work, Health, Education and Nursing Gropu from the Federal University of Santa Maria. Rio Grande do Sul, Brazil. E-mail: roger_rrp@yahoo.com.br
^II Ph.D. in Nursing. Associate Professor and Researcher of the Work, Health, Education and Nursing Group from Federal University of Santa Maria. Rio Grande do Sul, Brazil. E-mail: silviaufsm@yahoo.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.16497

ABSTRACT

This qualitative, descriptive study described the interrelationship between health and environment in the view of eight professors giving health science courses at a higher education institution in southern Brazil. Data were collected in 2011 by semi-structured interview and were subjected to content analysis. The professors displayed conceptions of environment polarized between interactional and naturalized views. They also reiterated that there is no specific approach to the subject in professional training for healthcare personnel. It is thus fundamentally important to extend discussion of this subject, especially in the health studies field, in order to generate input to inform new views of the environmental issue and its influence on the process of health and illness in populations.

Keywords: Health; environment; higher education; faculty.

INTRODUCTION

Contemporaneously, it is understood that health depends on and is expressed as a function of existing resources in the material world, physical and biological being impossible to think the notion of health, without incorporating the environmental dimension, which is strengthen or weaken the expression of life, human or not¹. This becomes even more relevant from the realization that environmental problems are health problems, therefore, affecting human beings and societies, in multiple and concurrent scales and dimensions².

The debate on environmental issues had its origin in the last 40 years, marked by meetings, conferences, seminars, treaties and conventions aimed at the topic. However, recently there has been a special attention to the current ecological crisis, in view of the threats arising from it, that compromise the life maintainability on the planet, indicating the need for educational actions that contribute to the construction sustainable societies³.

In this aspect, it is clear that the scenario of professional training in health still has its focus to non-preventive techniques and practices, and the environmental issue does not occupy important position in research on the topic⁴. Thus, an education becomes necessary to environmental aspects in all its complexity, enabling the academic and professional future health, learning essential values to promote health and better quality of life for people and the planet⁵.

In the context of university education, the professor is essential to favor spaces that facilitate the debate on current and relevant issues such as the health and the environment interface. Therefore, health professors play a fundamental role in this process to conduct an integrated and enlarged view of the environment, will instill in future professionals, a reflective front positioning to environmental, health problems, and the commitment to environmental preservation. Thus, to face this time of environmental crisis and, inseparably of health, it is reaffirmed the need to incorporate the environmental dimension as inherent in the development of health actions, which must be present from vocational training⁶.

Based on these, a study was developed guided by the following research question: what is the vision of health care professors about the relationship between health and the environment? Therefore, a research objective was created: to describe the vision of health care professors about the inter-relationship between health and the environment. The research covers several aspects related to the subject. However, this test specifically addresses data on the perception of health care professors about the relationship between health and the environment.

LITERATURE REVIEW

In the 60s began a self-reflection movement worldwide on the risks and environmental impacts of the way of life of modern industrial societies. In Brazil, this movement began around the 70s and 80s⁷, driven by the accelerated process of urbanization, with intense migration from the countryside to urban centers, leading to a fast growth of cities without adequate infrastructure, multiplying the slums and deteriorating basic living conditions ⁸.

In this context of changes, , the First International Conference of the United Nations on the Human Environment in Stockholm was held in 1972, considered the starting point of the discussions on the impact of world economy on the environment and consequently the health of the population. Since then, changes in the way of thinking about public health and the relationship between health and disease had appeared. Thus, the perspective before exclusively biomedical, began to give way to influence the ethical, social, cultural and environmental dimensions in the health-disease process^1,8. The environment was seen with other point of view, aiming to expand the view to environmental logic that permeates human living, from the perspective that nature and humans, as well as society and the environment, establish a mutual relationship and co-belonging interaction, forming a single world⁷ .

In 1999, there was the sanctioning Law 9795 on the National Environmental Education Policy, marking that this process should be an essential component of the constituent national education guidelines, requiring to be in coordination at all levels and modalities of the educational process⁹. However, what is currently viewed is a training scenario that despite the curriculum changes, still has its focus on not preventive techniques and practices, like the clinical and therapeutic activities in biomedical area⁴.

In this way, it is necessary to look for an emancipatory education, with critical thinking ability to think globally and existing structures, from its historical roots, and acting locally to solve problems in manufacturing and with ecologic social responsibility¹⁰.

METHODOLOGY

This study is descriptive with a qualitative approach. The eight participating professors composed a selection proportionally representative of the different departments of health of a public university in the south of Brazil: nursing, physical therapy, speech therapy, dentistry and community health. Participants worked in the following areas: collective health, family health, public health, environmental health, epidemiology, health policy, speech/community medicine and administration of health services.

The inclusion criteria were to be effective professors of the institution; and being acting for over a year in this function. The closure of the interviews followed the data saturation criteria.

Data were collected during August to November 2011, through semi-structured interview, with questions on the subject investigated. The interviews were conducted by researchers in a reserved place, being recorded and later transcribed. The anonymity of the participants was ensured from the use of codes to refer to the lines, adopting the letter I for everyone, with the meaning of interview, followed by a number that corresponds to the order of collecting the testimonies (Ex .: I1; I2, I3).

Data were based on the proposed reference for the analysis of content, according to the following steps: collection and organization of transcribed documents; performing brief reading of transcribed interviews, in order to implement approaches between the data and highlight similar prospects to specific colors; and conducting in-depth reading, in order to carry out the construction of categories of analysis. Finally, there was the interpretative analysis of categories and discussions with the literature¹¹.

The study followed the precepts indicated for research with human beings, with only data collection after institutional approval and the Ethics Committee in Research of the institution (CAAE 0160.0.243.000-11). The interview was accomplished after reading and signing the Informed Consent Form.

RESULTS AND DISCUSSION

The study results reveal a variety of meanings, of utmost importance for understanding the topic. The emerging categories of statements presented are: Environmental concept: interaction and outsourcing; Health and environment: inseparability; Approach and professional education in health.

Environmental concept: interaction and outsourcing

For the respondents, the environment is linked to a relationship between human beings with the environment itself, expressing a sense of belonging to a place, that is environment as a housing place. Also, it views the understanding that the environment can extrapolate the location of imagination where the relationships inhabit the social and emotional areas.

I think the environment is not only the [...] around us, but it is the physical environment around us and all the relationships that we humans have, both in physical, environmental, social, emotional. Environment is all around us, in everything around us, not just the physical part. (I8)

The interaction here perceived gains the character of an authentic dialogue, in which the environment is offered as a context from which beings are part involved by environmental conditions¹². This perspective corroborates the findings of other studies addressing health professionals, where it was also remarkable vision of mutual interaction between man and environment^13,14.

This thinking is important because there is the debate on the concept of two basic assumptions environment: the first is the essential nature of the relationship between man and nature; the second is that the concept of environment is built by human action and reflection, carrying elements of ideology and historicity¹⁵. Therefore, the need for increasing internalization of environmental issues, a knowledge even under construction, demand commitment to strengthen integrator visions, which stimulate reflection on the diversity and the construction of meaning around the individuals/nature relationships, global and local environmental risks and environmental relationships/development¹⁶.

However, it can be seen that some respondents understand the environment through a naturalized view.

[...] it is more related to nature concept, the physical forces, environmental forces are having on the planet [...] I understand the environment as these forces of nature that we have, water, sun energy, rain, wind, earth. (I2)

Environment is any element of the planet earth context, beings, the mineral part, oceans [...] (I5)

For some professors, the environmental view is together with the physical and chemical elements of the earth and its atmospheric effects, indicating a perception of human being alien to this environment. Similar perception was also found in a research by showing that 47.23% of the professors associate the topic environment to a naturalistic view, characterized by perception of natural and abiotic aspects¹⁷. Investigations conducted with professionals and students of health also noted that they understand the environment under the naturalized perspective and as human beings use ^14,18.

From these findings, it is observed the need to sensitize humanity to the understanding of the complex relationship man/nature, noting an educational process that does not finish in actions and/or speeches about sustainability, which often address the nature as a reservoir of resources to service of human needs¹⁹.

The environmental issue involves a complexity of relationships extending over the completely social life²⁰. In this sense, this perception of reality implies an interrelation and an essential interdependence of all phenomenon: physical, biological, psychological, social and/or cultural. It is essential educational and reflective actions that awaken the awareness of society to the issue, since human actions directly affect the environment, bringing consequences for future generations.

Health and environment: inseparability

The search for perceptions about the health and environment interface revealed a number of issues, reflecting a deeply complex topic. In general, the idea that there is a close interface between health and the environment was prevalent among respondents.

[...] If we have a broader view of health and that health is not merely the absence of disease and not just the physical, mental and social well-being, as the World Health Organization says, but also the relationship that health establishes with work, leisure, employment, income, all aspects which involve our life, the relationship between health and the environment is absolutely intrinsic [...] (I8)

It is understood, that the relationship between health and environment are inseparable, that is environmental issues are an integral part of health ²¹. However, it is noted that the modern view of health, which assimilates the condition environment, is not satisfactorily incorporated within different groups, it is still possible to find ideas, concepts, visions and values that do not incorporate the environmental dimension to health conditions. The construction of inter-sectorial public policies, by the government to consider the environment not only from the perspective of the environmental industry, but also as a cross-cutting topic in different professional areas is fundamental²².

When it comes of issues relating to the encouragement of public policy and the health care model from the perspective of environmental issues, it is clear that some professors maintain a critical view at this relationship, understanding that there is currently a non-valuation interface of health and the environment.

I do not see in health services that established culture, to think the imbalance, the disease associated with some environmental imbalance. It seems that the disease is produced by other means and not by this imbalance, there is a concern, our health care model still does not make this connection [...] (I2)

Despite they believe there is an intrinsic relationship between health and environment, professors perceive a lack of appreciation of the environmental dimension in the health/disease process within the health services. This was also demonstrated in a study of professionals who are active in sanitation-health-environment area, verifying that many of the speeches were not characterized not by a preventative view, nor for a promotional bias of environmental health²³.

In the present study, among the respondents also emerged an environmental view as illness-causing or promoting diseases.

[...] If we live in a clean environment, appropriate care and concern with this, maintaining that clean environment and proper care, we are preserving our health, the condition of being healthy in an environment that will not generate illness. (I3)

It is noteworthy that the relationship between the environment and the cause of diseases is not a misconception, but they must be careful with the amplitude of the view directed to the environmental significance because this should be understood in its macro sense. Also the risks to global health result, increasing urbanization, spurred by economic growth and industrial expansion, which generate significant social, economic and political aspects ¹⁰. Among the charactersitics related to the appearance of emerging diseases, environmental degradation is cited as a common condition, but is hardly considered in public policy strategies, leading to cause a setback in promoting the health of the individuals involved, considering that the therapy is still the rule, before considering in prevention of diseases^4,24.

Thus, in addition to diagnosis and specific treatment of each disease, health promotion activities should also be prioritized in health policies. In the context of education, this discussion is essential, considering that provides an opportunity not only a critical-reflective view, but also the basis for a professional performance, based on assumptions that value the individual, his environment and the range of factors that can influence the process of being healthy or his illness.

Approach and professional education in health

In view of the generated reflection on the environment, the problems they experience and the relationship with the health of the population, respondents were asked about their approach to these issues in the training scenario of healthcare. In this sense, we have, as a result, the views of non-specific approach by the professors.

[...] I confess that I do not aboard, I have not, a reminder that I may have highlighted more emphatically the health and the environment issue. (I4)

[...] maybe because we are from an older generation, in which these things were not [...] not that they were not important but I think they were much less focused, much less commented, discussed and studied [...] (I8)

It is seen an uncertainty about the approach of this topic, during classes in the health area courses, where sometimes the professors claim that there is not something specific. Although being justify the importance of the health-environment in different training areas, it seems that this is still not a consolidated practice of education. It is noteworthy that, in Brazil, the lack of preparation of professors and the lack of teaching materials is highlighted, which makes a broad environmental approach²⁵.

It appears the need for care in the preparation of professors, to address this issue, because much information about the environmental crisis are unreliable, and often have a reductionist view that little or nothing contribute to the formation of individuals²⁶. This refers to the idea that perhaps not lack information about environmental problems for professors, but a context and deepen of this debate, which is extremely complex.

Thus, there are testimonials that demonstrate the initiative of professors to reflect on such content. However, although there is a concern to discuss about health promotion, it is guided by the linear relationship between the environment and the occurrence of diseases.

[...] always part of the environmental, geographic space, environmental. And to understand that the determination of the disease is collective, it is social, we are talking about environmental issues, but that comes directly from the disease, which has this more direct relationship with the environment, with the issue of sanitation [...] (I6)

Despite concerns in introducing this topic from the perspective of health promotion, it can be seen a general discourse, based on disease causality idea (and its therapeutic possibilities) or ritualized jargon of the important relationship between man and his environment. Environmental issues and all aspects to the health field express gaps that hinder the teaching work in health care.

It is necessary to introduce a complex concept in dealing with environmental problems, which incorporates all the biological, social, psychological, ethical, political, technological, economic and cultural aspects involved in building and finding solutions to social and environmental issues²⁷ . For this, it is important a process of reflection on the real nuances that pervade the environmental issue and its interface with the health area, widening the scope for new views on this topic.

There was also a critical view at their own teaching activities related to the topic, which may be the sign of a reflective process, as noted in the following statements:

[...] I think it has to be more incisive and we need to discuss it better. This is not really as a guiding principle of the training process, it is not a guiding principle and should be [...] (I2)

[...] We do other more comprehensive approaches. So, I think I do something, but I could do more. (I8)

Professors understand that the approach must and/or can be more effective, pointing also to the relationship between health and the environment need to be a guiding principle of health training. It is reiterated that in the content approach must overcome the disciplinary boundaries of the various areas of knowledge, to obtain the understanding of any problem²⁸.

Thus, the initiative of educational practice with the bias of the health-environment relationship in the formation of spaces proves to be relevant and necessary, whether within the family, in the formation of citizens in basic education or vocational training, especially in graduation courses²⁵ . The relationship between health and the environment, in vocational training in health, should be a goal for the graduate programs, including the training of professors on the topic.

CONCLUSION

From this research, it was possible to highlight the multiplicity of perceptions of professors about the environment; the relationship between health and environment; as well as the topic of the approach to professional training in health. Thus, it was found that the respondents see the environment as a natural habitat of human beings, linking social and emotional issues. However, it was important the naturalized perception of the environment of some participants, which is very worrying, given the complexity of environmental issues and the arduous desired social change, simultaneously, through education based on awareness of the environmental cause.

When asked to reflect on the interface health and the environment, all the interviewees understand that there is a dissociation of these two topics, reinforcing the indispensability of that union in health graduation. It also became evident the ineffectiveness of view of health care services, which would not be considering this issue in the care process, still very restricted to healing and medicalized measures.

It could be noted that this issue has gap in the educational process in health care, as professors emphasize not approaching it, requiring greater attention and investment in vocational training.

As limitations of the study, there is the fact of being located, making it impossible to wider considerations on the national scene training in health across the topic, and not employment of another source of information, such as documents, which could give greater validity to the findings.

It is concluded to be essential a deepen debate on environmental issues and the influence on the population health-disease process, as well as instigating the discussion in the vocational training scenarios to overcome the current gaps, increasing the reflective process within the academy. In this way, the continuation of studies on this topic is indispensable for the desired social and environmental responsibility by social actors in the health area as well as the gap that separates the classic care models and still in force and new ways of doing health, settled in conceptions and actions to promote health.

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