{"id":2151,"date":"2021-08-08T16:18:49","date_gmt":"2021-08-08T16:18:49","guid":{"rendered":"https:\/\/www.deepadaptation.info\/?p=2151"},"modified":"2022-11-10T14:59:40","modified_gmt":"2022-11-10T14:59:40","slug":"future-of-health-care","status":"publish","type":"post","link":"https:\/\/www.deepadaptation.info\/pt\/future-of-health-care\/","title":{"rendered":"O futuro dos cuidados de sa\u00fade num mundo em colapso"},"content":{"rendered":"

por Stuart Jeffery<\/em><\/em><\/p>\n\n\n\n

\n

\"A verdadeira medida de qualquer sociedade pode ser encontrada na forma como ela trata os seus membros mais vulner\u00e1veis\".<\/em><\/p>\n<\/blockquote>\n\n\n\n

A famosa cita\u00e7\u00e3o de Gandhi \u00e9 altamente relevante ao considerar os cuidados de sa\u00fade que est\u00e3o dispon\u00edveis para uma comunidade. Mas nestes tempos vol\u00e1teis, incertos, complexos e amb\u00edguos do Covid-19 e do prov\u00e1vel colapso que se avizinha atrav\u00e9s das emerg\u00eancias g\u00e9meas do clima e da ecologia, como iremos cuidar dos nossos membros mais vulner\u00e1veis, incluindo aqueles que necessitam de cuidados de sa\u00fade?<\/p>\n\n\n\n

No seu artigo sobre pessoas centradas na sa\u00fade, Asiya Odugleh-Kolev<\/a> aponta de forma \u00fatil alguns dos desafios que os sistemas de sa\u00fade e as comunidades enfrentaram durante a pandemia de Covid-19, particularmente em torno da integra\u00e7\u00e3o dos servi\u00e7os e da sa\u00fade emocional. Dado que o Covid-19 \u00e9 apenas um precursor da s\u00e9rie de colapsos que o mundo enfrenta, e que geralmente h\u00e1 muito pouco escrito sobre como os cuidados de sa\u00fade podem mudar realisticamente nas pr\u00f3ximas d\u00e9cadas, estes cen\u00e1rios futuros parecem estar maduros para discuss\u00e3o.<\/p>\n\n\n\n

A pandemia de Covid-19 real\u00e7ou o nosso desejo de cuidados de sa\u00fade de uma forma que muitos de n\u00f3s no Ocidente nunca experiment\u00e1mos antes, uma que talvez seja menos sobre o desejo e mais sobre a necessidade de sermos salvos da morte. Esta necessidade, nascida do nosso profundo medo da morte, \u00e9 uma necessidade que, durante o meu tempo como enfermeira, testemunhei repetidamente. A necessidade de reparos externos que abdicam da responsabilidade pessoal s\u00f3 \u00e9 ultrapassada pelo desejo de salvar as nossas pr\u00f3prias vidas ou a vida de um ente querido a qualquer custo. A ideia de que a morte \u00e9 uma parte essencial da vida permanece enfiada nas costas do sof\u00e1 da nossa inconsci\u00eancia colectiva.<\/p>\n\n\n\n

Os nossos antepassados tiveram de lidar com a morte de uma forma fundamentalmente diferente. H\u00e1 alguns anos, enquanto investigava a minha pr\u00f3pria \u00e1rvore geneal\u00f3gica, descobri a av\u00f3 de uma grande av\u00f3 que deu \u00e0 luz 16 crian\u00e7as, a maioria das quais morreu antes do seu primeiro anivers\u00e1rio, antes de ela pr\u00f3pria ter morrido no parto. N\u00e3o posso come\u00e7ar a imaginar o que ela teria experimentado cada vez que uma crian\u00e7a morresse. Hoje, no Reino Unido, estas mortes infantis e maternas s\u00e3o t\u00e3o raras que se tornam esc\u00e2ndalos nacionais.<\/p>\n\n\n\n

Ao escrever isto, o \u00faltimo surto de Covid-19 do Reino Unido est\u00e1 em curso sob o controlo da \u00faltima variante, mas isto \u00e9 num pa\u00eds que vacinou dois ter\u00e7os da sua popula\u00e7\u00e3o adulta, e ter\u00e1 certamente capacidade suficiente da UIT para lidar com novas variantes, desde que a vacina permane\u00e7a amplamente eficaz. O Sul global, em particular a \u00cdndia de onde esta estirpe teve origem, n\u00e3o est\u00e1 a lidar com o problema; um problema exacerbado pelo facto de os pa\u00edses ricos estarem a comprar vacinas a um n\u00edvel muito superior ao dos pa\u00edses de rendimento baixo e m\u00e9dio.<\/p>\n\n\n\n

O SNS do Reino Unido depende da sua capacidade de recrutar m\u00e9dicos de \u00c1frica e de outros pa\u00edses menos favorecidos, a fim de manter a nossa for\u00e7a de trabalho no sector da sa\u00fade, uma capacidade de recrutamento que se baseia na injusti\u00e7a econ\u00f3mica global. O fracasso que \u00e9 o nosso insustentavelmente baixo n\u00edvel de forma\u00e7\u00e3o no Reino Unido s\u00f3 \u00e9 igualado pelo nosso fracasso em ver a mudan\u00e7a demogr\u00e1fica que ver\u00e1 o n\u00famero de pessoas mais velhas, aquelas com mais de 85 anos, quase duplicar at\u00e9 2043 (ONS, 2018<\/a>). O custo per capita dos cuidados de sa\u00fade \u00e9 mais elevado neste grupo et\u00e1rio, cinco vezes mais elevado do que para as pessoas com 60 anos de idade (Sa\u00fade P\u00fablica Inglaterra, 2019<\/a>). O SNS n\u00e3o \u00e9 sustent\u00e1vel agora e certamente n\u00e3o a m\u00e9dio ou longo prazo. Claro que uma ou duas novas variantes podem apenas mudar essa demografia nos pr\u00f3ximos anos - o futuro \u00e9 vol\u00e1til, incerto, complexo e amb\u00edguo afinal de contas.<\/p>\n\n\n\n

Se o NHS do Reino Unido est\u00e1 a lutar para se sustentar, o quadro global \u00e9 pior. Metade dos pa\u00edses da OMS t\u00eam menos de 3 enfermeiros por 1000 habitantes em compara\u00e7\u00e3o com o Reino Unido, com cerca de 8 (OMS, 2021<\/a>). A situa\u00e7\u00e3o \u00e9 semelhante para os m\u00e9dicos; simplesmente n\u00e3o h\u00e1 m\u00e9dicos suficientes a n\u00edvel mundial para satisfazer as necessidades actuais de cuidados de sa\u00fade.<\/p>\n\n\n\n

Para al\u00e9m do desafio demogr\u00e1fico e da insufici\u00eancia global de pessoal cl\u00ednico formado, devemos perguntar o que acontece \u00e0 medida que as altera\u00e7\u00f5es clim\u00e1ticas, a emerg\u00eancia ecol\u00f3gica, o esgotamento de recursos e a polui\u00e7\u00e3o aumentam o seu dom\u00ednio sobre o mundo. Como podemos manter a sa\u00fade e os cuidados de sa\u00fade num mundo que est\u00e1 em colapso ou decl\u00ednio? A realiza\u00e7\u00e3o do Objectivo de Desenvolvimento Sustent\u00e1vel da ONU de cuidados de sa\u00fade universais ir\u00e1 certamente tornar-se mais dif\u00edcil face ao colapso.<\/p>\n\n\n\n

H\u00e1 pelo menos um exemplo de um pa\u00eds que passou por um colapso econ\u00f3mico e que, no entanto, viu os cuidados de sa\u00fade prosperar. A crise petrol\u00edfera de Cuba no in\u00edcio dos anos 90 destruiu a sua economia, mas o compromisso de manter os cuidados de sa\u00fade - e possivelmente mais importante ainda a concentra\u00e7\u00e3o na forma\u00e7\u00e3o de m\u00e9dicos - significou que os cuidados de sa\u00fade em Cuba foi uma das \u00e1reas menos afectadas pela sua crise (Jeffery, 2008<\/a>).<\/p>\n\n\n\n

Pode ser que o rescaldo do Covid-19 proporcione uma renovada focaliza\u00e7\u00e3o global nos cuidados de sa\u00fade com uma mudan\u00e7a radical na forma\u00e7\u00e3o, coopera\u00e7\u00e3o e apoio internacional, a sa\u00fade p\u00fablica a entrar na linha da frente da pol\u00edtica e assim por diante. Vivo numa esperan\u00e7a perdida.<\/p>\n\n\n\n

Podemos, contudo, estar certos de aumentos significativos de ansiedade \u00e0 medida que a procura e a acessibilidade dos cuidados de sa\u00fade aumentam, enquanto que a sa\u00fade global decresce no futuro. Esta ansiedade, nascida da nossa actual recusa em enfrentar a nossa mortalidade e da nossa apegada \u00e0 necessidade de curas r\u00e1pidas para todos os doentes, provavelmente far\u00e1 com que os governos protejam os cuidados de sa\u00fade em maior medida do que algumas outras \u00e1reas das economias, pelo menos se esses governos desejarem permanecer no poder por muito tempo.<\/p>\n\n\n\n

Embora os colapsos sociais e econ\u00f3micos sejam tang\u00edveis, j\u00e1 existe uma crise de significado e de prop\u00f3sito, uma crise espiritual que est\u00e1 a conduzir a um colapso mais amplo e que se joga na nossa recusa em aceitar a morte. Talvez haja uma aprendizagem da Natureza, conhecimento e compreens\u00e3o que nos foi perdida quando vir\u00e1mos a nossa lealdade para os falsos deuses do progresso e do crescimento perp\u00e9tuo?<\/p>\n\n\n\n

Aceitar a morte e a doen\u00e7a como parte da riqueza da vida seria um enorme salto para as sociedades modernas, que nos podem ver a tentar aprender com a forma como os nossos antepassados lidaram com ela e como o resto da Natureza tamb\u00e9m lida com ela. Talvez, essa aprendizagem combinada com o nosso maior conhecimento da sa\u00fade p\u00fablica possa apenas tornar o colapso dos cuidados de sa\u00fade menos doloroso do que poderia ser de outra forma?<\/p>\n\n\n\n

Stuart Jeffery \u00e9 um enfermeiro e ex-executivo do SNS que agora lecciona na Universidade de Kent sobre cuidados de sa\u00fade globais sustent\u00e1veis. Ele iniciou um novo grupo de trabalho de Adapta\u00e7\u00e3o Profunda sobre o futuro da sa\u00fade e da assist\u00eancia social<\/a> e est\u00e1 \u00e0 procura de pessoas para se juntarem a essa discuss\u00e3o. <\/em><\/p>\n\n\n\n

Imagem: \"Protec\u00e7\u00e3o\" por Rini Widariyanti, dela \"Por detr\u00e1s da M\u00e1scara 2020<\/a>\" exposi\u00e7\u00e3o. Rini e o seu marido Made s\u00e3o artistas contempor\u00e2neos indon\u00e9sios, sediados em Bali. Os seus meios de subsist\u00eancia t\u00eam sido gravemente afectados pelo impacto da pandemia no turismo em Bali. Eles j\u00e1 n\u00e3o mant\u00eam um website, mas podem contactar Katie<\/a> na equipa editorial do DA Forum que o pode ligar a eles, se desejar apoi\u00e1-los atrav\u00e9s da compra de alguns dos seus trabalhos.<\/p>","protected":false},"excerpt":{"rendered":"

by Stuart Jeffery \u201cThe true measure of any society can be found in how it treats its most vulnerable members\u201d Gandhi\u2019s famous quote is highly relevant when considering the health care that is available to a community. 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