Title: Through the lens of Michel Foucault: Reflections on health promotion practices in primary care

Abstract

Health Promotion is one of the pillars of support and operation of the Unified Health System (SUS). As they are inserted in people's life territories, the services that make up Primary Health Care (PHC) are privileged spaces for carrying out Health Promotion practices. Nursing is one of the professional categories that integrate the team of Family Health Strategy, which has been fundamental for the organization of PHC in Brazil. Thus, in partnership with other professional centers, Nursing is responsible for taking the lead in Health Promotion practices in the areas where the PHC operates. The objective of this Thesis was to analyze the practices of Health Promotion in Primary Health Care, based on Foucault's theories. To achieve the intended purpose, I carried out a field research, descriptive, qualitative, with genealogical inspiration. The collection of empirical data was carried out through 23 semi-structured interviews, carried out with PHC workers. The data analysis gave rise to four articles, which systematize the research results that, in general terms, can be described as follows: a heterogeneous field of Health Promotion practices was identified, which is constituted through the circulation of different knowledge and powers; practices are permeated by discursivities that align with neoliberal governmentality and practices that stand as a counter-conduct to such discursivities; the analysis of the emergencies and provenances of Health Promotion practices in PHC presents how Health Promotion practices were constituted and modified, according to historical possibilities. The main effect of Health Promotion practices in PHC is associated with the decrease in medicalization and the adoption of elements from the Extended Clinic. The main difficulties stem from the precariousness of public policies, arising from the fiscal austerity measures adopted in recent years. The following are described as possibilities to be explored to enhance Health Promotion in PHC: the strengthening of training activities within the health units; the problematization of the Social Determinants of Health and the methods to encourage participation; the collectivization of health demands; the appreciation and reinforcement of achievements and collective actions; the recovery of local community culture and habits; and advocacy for Health Promotion. It points to the possibility of building subjectivities, capable of constituting resistance and counter-conducts to neoliberal governmentality, in the micropolitics of the work carried out by the teams. Based on the results presented, I support the following thesis: Health Promotion is polysemic, influenced by different epistemological strands and built from conditions of historical possibilities. The different types of knowledge that constitute it are placed in an arena of power relations, which translate and, at the same time, produce health practices. Although there are hegemonic practices that represent contemporary truth regimes, resistances and counter-conducts to neoliberal governmentality can also be identified and have the power to produce other practices and different modes of (re)existence in PHC