A crescente escolarização do agente comunitário de saúde: uma indução do processo de trabalho? The increasing schooling of the community health agent: an induction of the work process?

O agente comunitário de saúde (ACS) é um dos atores profissionais que compõem as equipes da Estratégia Saúde da Família (ESF), sendo sua atuação considerada fundamental para a ampliação e consolidação dessa estratégia. Desde as primeiras experiências locais com ACS em fins dos anos 1970, seu perfil sociodemográfico vem apresentando mudanças. Este artigo tem por objetivo apresentar e discutir o aspecto da escolaridade e da capacitação dos ACS que atuam na Área Programática (AP) 5.2 do município do Rio de Janeiro, articulando trabalho e educação e entendendo o trabalho como um princípio emancipatório. Este estudo foi formulado com base na ideia de triangulação metodológica, aqui alcançada a partir da formulação original de Denzin. Os dados sobre a escolaridade dos ACS foram obtidos mediante questionário autoaplicável individual, respondidos por 301 ACS dos 12 módulos de ESF e seis módulos da Estratégia de Agentes Comunitários de Saúde (EACS) da AP 5.2. A apresentação e a discussão dos dados mostram mudanças no perfil de escolaridade desse trabalhador, concluindo-se que o ACS é um trabalhador que busca alternativas de escolarização e formação profissional. Defende-se a ampliação da escolaridade e o ensino técnico como processo para a consolidação do Sistema Único de Saúde.<br>Community health agents (CHA) are among the professional players that make up the Family Health Strategy (FHS) teams, and their performance is considered as critical to the expansion and consolidation of this strategy. Since the first local experiences with CHAs in the late 1970s, their sociodemographic profile has been changing. This article aims to present and discuss the aspect of education and training of the CHAs who work in Program Area (PA) 5.2 of the city of Rio de Janeiro, integrating work and education and understanding the work as an emancipatory principle. This study was formulated based on the methodological triangulation idea, reached here based on the original formulation of Denzin. Data on the CHAs' education were obtained via an individual self-applied questionnaire answered by 301 of the CHAs of the 12 FHS modules and six Community Health Workers Strategy (CHWS) modules of PA 5.2. The presentation and discussion of the data show changes in this worker's educational profile, and it can be concluded that the CHA is a worker who is in search of alternative schooling and vocational training. An expansion of the schooling and technical education is defended as a process to consolidate the Unified Health System

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified