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      El médico de familia rural en la promoción de la salud: perspectivas desde Andalucía Translated title: The rural health physician and the promotion of health: perspectives from Andalusia

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          Abstract

          RESUMEN El ámbito rural es eminentemente diverso y complejo. El mismo concepto de ruralidad es polémico y contencioso, según los países y el contexto. Sin embargo, existe un conjunto de dinámicas globales que afectan a los enclaves rurales y a su organización social, y también a los determinantes sociales de los que depende gran parte de la salud de sus habitantes. El médico de familia rural se encuentra en una situación estratégica, gracias al conocimiento del territorio y su comunidad, así como a las relaciones que mantiene con ésta para realizar un análisis centrado en estas influencias externas sobre el funcionamiento de la comunidad y sobre las condiciones y estilos de vida que afectan a las personas de un territorio. Además, la medicina rural como escenario profesional para la promoción de la salud cuenta con un instrumento movilizador. Éste sería el capital social que el médico rural sea capaz de acumular en mayor medida que en el medio urbano, para así llevar a cabo acciones comunitarias participativas (basadas en activos para la salud) empoderadoras y salutogénicas, y también para ejercer como advocate o compromisario por la salud. Así mismo, el médico de familia y la provisión de servicios sanitarios son piezas clave para sanar, asistir y cuidar, así como para el desarrollo y sostenimiento de los enclaves rurales, para mantener la habitabilidad de estos lugares y para el ejercicio efectivo del derecho a la salud en términos de igualdad territorial.

          Translated abstract

          ABSTRACT The rural environment is eminently diverse and complex, and the concept of rurality is controversial and contentious depending on the countries and the context. However, there is a set of global dynamics that affect rural enclaves and their social organization, as well as the social determinants on which much of the health of their inhabitants depends. The family doctor in rural areas is in a strategic position thanks to the knowledge of her or his territory and community, and her or his close relation to it that is needed to carry out a contextual analysis of these external influences on the functioning of the community, on the conditions and lifestyles that affect the people in the community. In addition, rural medicine as a professional setting for the promotion of health, has a mobilizing instrument, the social capital that the rural doctor is able to accumulate to a greater extent than in an urban environment, in order to carry out empowering and salutogenic participatory-based community actions and to advocate for health. Likewise, the family doctor and the provision of health services are key pieces in the process of healing, assisting and caring for the development and support of rural enclaves, in order to maintain the habitability of these communities and to effectively exercise the right to equitable health services.

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          From resilience to resourcefulness: A critique of resilience policy and activism

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            Understanding and representing 'place' in health research: a relational approach.

            Epidemiology, sociology, and geography have been successful in re-establishing interest in the role of place in shaping health and health inequalities. However, some of the relevant empirical research has relied on rather conventional conceptions of space and place and focused on isolating the "independent" contribution of place-level and individual-level factors. This approach may have resulted in an underestimate of the contribution of 'place' to disease risk. In this paper we argue the case for extensive (quantitative) as well as intensive (qualitative) empirical, as well as theoretical, research on health variation that incorporates 'relational', views of space and place. Specifically, we argue that research in place and health should avoid the false dualism of context and composition by recognising that there is a mutually reinforcing and reciprocal relationship between people and place. We explore in the discussion how these theoretical perspectives are beginning to influence empirical research. We argue that these approaches to understanding how place relates to health are important in order to deliver effective, 'contextually sensitive' policy interventions.
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              Rural health around the world: challenges and solutions.

              Despite the huge differences between developing and developed countries, access is the major issue in rural health around the world. Even in the countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport and communication, and they all face the challenge of shortages of doctors and other health professionals in rural and remote areas. Many rural people are caught in the poverty- ill health-low productivity downward spiral, particularly in developing countries. Since 1992, WONCA, the World Organization of Family Doctors, has developed a specific focus on rural health through the WONCA Working Party on Rural Practice. This Working Party has drawn national and international attention to major rural health issues through World Rural Health Conferences and WONCA Rural Policies. The World Health Organization (WHO) has broadened its focus beyond public health to partnership with family practice, initially through a landmark WHO-WONCA Invitational Conference in Canada. From this has developed the Memorandum of Agreement between WONCA and WHO which emphasizes the important role of family practitioners in primary health care and also includes the Rural Health Initiative. In April 2002, WHO and WONCA held a major WHO-WONCA Invitational Conference on Rural Health. This conference addressed the immense challenges for improving the health of people of rural and remote areas of the world and initiated a specific action plan: The Global Initiative on Rural Health. The "Health for All" vision for rural people is more likely to be achieved through joint concerted efforts of international and national bodies working together with doctors, nurses and other health workers in rural areas around the world.
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                Author and article information

                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad, Consumo y Bienestar social (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                2019
                : 93
                : e201910076
                Affiliations
                [2] Granada orgnameSociedad Andaluza de Medicina de Familia y Comunitaria orgdiv1Grupo de Trabajo en Medicina Rural España
                [1] Jaén orgnameCentro de Salud de Santiago de la Espada España
                Article
                S1135-57272019000100310 S1135-5727(19)09300000310
                4549e72c-c3ae-44e1-be38-c14aeeb138bd

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 23 June 2019
                : 26 July 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 0
                Product

                SciELO Public Health

                Categories
                Colaboraciones Especiales

                Health promotion,Rural health services,Medicina de familia,Family practice,Medicina rural,Promoción de la salud

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