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Health promotion in Brazil relies on community health workers (CHWs), frontline providers linking the health system with vulnerable groups. Brazilian CHWs are overwhelmingly women from poor backgrounds, with precarious and sometimes hazardous working conditions, as well as fragmented and unsystematic training. This paper evaluates how the COVID-19 pandemic exacerbated pre-existing vulnerabilities of CHWs (pertaining to low salary, precarious and hazardous working conditions and inadequate training) and created new ones, with a profound impact on their ability to carry out health promotion activities. Drawing on testimonials of dozens of CHWs and online discussions promoted by their unions, the paper reveals that during the pandemic CHWs were asked to continue their work without adequate training and protective equipment, thus exposing themselves to the risk of infection. It further shows how the pandemic rendered dangerous the close interaction with patients that is at the heart of their health promotion role. Nonetheless, CHWs sought to adapt their work. In the absence of leadership and coordination on the part of the federal government, CHWs mobilized different forms of resistance at the national and individual levels. Despite this, COVID-19 contributed to a trajectory of erosion of health promotion in Brazil. Findings from this case signal the difficulties for health promotion in low- and middle-income countries relying on CHWs to bridge the health system and vulnerable users. [ABSTRACT FROM AUTHOR]

This paper aims to present how the female leaders of the favelas of Rio de Janeiro/Brazil have been protagonists in coping with the demands arising from COVID-19. The city has approximately 2 million residents living in 763 favelas. There is no strategic planning on the part of the government with coordinated actions related to the specificities of these territories - producing an escalation of demands due to the living and health conditions of the residents. It is in this multifaceted reality, with urgencies and emergencies, that we highlight the role of community by strengthening the local support networks that are built like webs inside the favela and beyond. Our statement is based on a qualitative study involving 111 such women, distributed across 105 favelas. Correlating their practices, 97% say they support health promotion through the strengthening of popular participation towards community development and defense of rights, and mobilization of health services to meet these populations' needs, among other actions. With the presence of public agents in these places restricted in times of pandemic, these women often take up the duties of the local authorities to ensure food security, good communication among local residents on health standards, hygiene measures, assistance to the most vulnerable, etc. Perceived by community members as replacing the role of government agencies, they develop a particular way of doing politics. Calling upon resistance and solidarity, they transform this micro-power into effective changes to cope with the inequities and in benefit of citizenship and the other residents of the favelas where they live. [ABSTRACT FROM AUTHOR]

Brazil, a Latin American country of continental proportions and contrasts, demographic inequalities, and social inequities, concomitantly faces the challenge of preventing and controlling infectious diseases, injuries, and non-communicable diseases. The loss of strength of the biomedical paradigm, the change in epidemiological profile, and the sociopolitical and cultural challenges of recent decades have fostered the emergence of new formulations about public health thinking and practice. Among them, are the paradigms of Brazilian Collective Health and Health Promotion. The former provides philosophical support for Brazil's Unified Health System (SUS). The aim of this article is to discuss the development of public health within the country's history, and to analyze and compare the theoretical assumptions of Health Promotion and Collective Health. We conclude that health promotion, based on the principles and values disseminated by the international Charters and concerned with social actors and social determinants of the health-disease process, has significant potential to promote the improvement of living and health conditions of the population. This frame of reference guided the formulation of the National Policy of Health Promotion within the Unified Health System, which was institutionalized by a ministerial decree. The importance and application of evaluating the effectiveness of health promotion processes and methodologies in Brazil have been guided by various frames of reference, which we clarify in this article through describing historical processes. (Promotion & Education, 2007, Supplement (1): pp 7-12) [ABSTRACT FROM PUBLISHER]