Social determinants of health and the Brazilian Family Health Care Program in the city of Sao Paulo, Southeastern Brazil

OBJECTIVE: To analyze the current status of the interventions related to social determinants of health conducted in the context of the brazilian family health program. METHODS: A case study using a mixed method approach based on a sequential explanatory strategy with 171 unit managers in the Family Health Care Program in the municipality of Sao Paulo, SP, Southeastern Brazil, in 2005/2006. Self-administered questionnaires were applied and semi-structured interviews and focus groups were conducted with a purposive sample of professionals involved in initiatives related to social determinants of health. Quantitative data were analyzed using descriptive statistics, multiple correspondence analysis, cluster analysis and correlation tests. Qualitative data were analyzed through content analysis and the creation of thematic categories. RESULTS: Despite the concentration of activities directed at disease care, the Family Health Care Program carries out various activities related to the social determination of health, encompassing the entire spectrum of health promotion approaches (biological, behavioral, psychological, social and structural) and all major social determinants of health described in the literature. There was a significant difference related to the scope of the determinants being worked on in the units according to the area of the city. The description of the activities revealed the fragility of the initiatives and a disconnection with the organizational structure of the Family Health Care Program. CONCLUSIONS: The quantity and variety of initiatives related to social determinants of health attests to the program's potential to deal with the social determination of health. On the other hand, the fluidity of objectives and the 'out of the ordinary/extraordinary' characterization of the described initiatives raises concern about its sustainability as an integral part of the program's current operational model.