Paradigmas de la Salud

• Paradigmas are characterized by their prevailing or hegemonic status, and near-absolute acceptance within the relevant community or society, including among its adherents and practitioners.
• New generations are educated under the paradigm and society is organized according to it.

Paradigms of Health

• A health paradigm constitutes a model, theory, approach, or conception providing a comprehensive explanation for health and illness processes.
• Paradigms define what is considered normal or legitimate as knowledge and intervention, as long as they align with the current paradigm.

Main Paradigms Over Time

• Main paradigms throughout history have been the magic-religious, miasmatic, social medicine, primary health care, community medicine, modern or scientific, and health fields paradigms.

Magic-Religious Paradigm

• Emerged in ancient times across societies, where humans lived in small, wandering groups governed communally under charismatic leaders.
• The economy was based on subsistence and self-consumption through gathering, hunting, and fishing, with rudimentary tools and techniques.
• Life was deeply dependent on nature, and humans felt weak and inferior due to their inability to effectively explain natural phenomena.
• Explanations for health and illness were supernatural, mythical, and religious, especially involving divine punishment or grace. Other causes included spirit possession, tests of human temperance, or unknown higher purposes.
• Curing agents were priests acting as intermediaries, healers, shamans, midwives, herbalists, soothsayers and other specialists selected by the gods.
• The healer's role was seen as a divine gift and service.

Miasmatic Paradigm

• During the Middle Ages or feudal era, economies were mainly based on agriculture on large properties, with basic technology for irrigation, crop rotation, and iron tools.
• Production prioritized direct sustenance over commercialization.
• Power was class-based, held by a pyramidal structure of feudal families and vassals, who rendered tributes or labor to lords.
• Medicine during this period combined religious beliefs with naturalistic empiricism.
• Procedures inherited from Hippocrates and Galen became more common but lacked anatomical and physiological knowledge due to religious restrictions.
• Hippocratic ideas about the influence of the environment evolved into the concept of miasma.
• Interventions primarily targeted the environment, with "sanitary police" using local government powers.
• Efforts were made to control social behaviors such as begging, vagrancy, immigration, and prostitution, alongside monitoring those affected by plagues and those at risk.

Social Medicine Paradigm

• In the 19th century, the capitalist economy was revolutionized by machinery, increasing productivity and industrialization.
• It spread through Europe, leading to worker exploitation, including women and children, with 16-hour workdays and no respect for human dignity or worker safety.
• German figures such as Salomon Neumann and Rudolf Virchow defined health as a right.
• They argued that living and working conditions, poverty, hunger, and misery affect biological and physical conditions and are responsible for sickness.
• Stated that atmospheric and cosmic conditions did not cause epidemics on their own; but were due to people's social situation.
• Resulted in the need to investigate the spread of disease and mortality by social stratum, revealing the stratification of social classes in epidemiological profiles.
• May also be the origin of public health's focus on addressing health as a collective issue requiring state policy intervention.

Community Medicine Paradigm

• Economic and social crises occurred in Latin America in the 1960s and 70s due to failed government policies dictated by the United States and international organizations.
• Economic policies failed to improve living standards, leading to social demands for health and education access.
• Foundations were the solidarity ethic of intellectuals, professionals, and politicians with the poor and needy.
• Based on community and identity concepts, which assume the existence of population groups located in a specific area, with common problems and objectives, as well as defined social statuses and roles.
• Emphasized the priority of actions for rural populations or communities with community involvement.
• It included the leadership role of health professionals, especially doctors, who approached the community to provide care, education, and empower it to become a protagonist in changing health behavior.

Modern or Scientific Paradigm

• Developed alongside modern thought and liberal economics since the 19th century, with its values and social expressions.
• It prevails globally and is termed biologist, dominant biomedical, or hegemonic by critics.
• This paradigm is the expression of modern science in health, based on rationality, objectivity, and empirical verification. It primarily focuses on disease, less on health.
• Disease is explained and addressed as a mainly biological process.
• Focuses on the etiology of each disease (infectious, degenerative, immunological, metabolic, genetic, etc.). This is used to explain the origin and course of symptoms and signs in a body with given conditions such as age, sex, nutrition and immunity.

Health fields Paradigm

• In 1974, Canada's Minister of Health, Marc Lalonde, introduced the health fields model based on Hubert Laframboise's work.
• This has been extensively expanded and enriched worldwide, with contributions sometimes taking on different meanings.
• It is presented as superior to previous models and with a very scientific basis.
• Emerged in highly developed societies with advanced technology, where material well-being has led to excess issues like sedentary lifestyles, gluttony, and the search for more material pleasures.
• Promotes extreme advocacy for freedom and individuality stimulated by a highly consumerist economy.