Um Enfoque Epidemiol Gico Da Promo O

OPINIÃO OPINION 241

Um enfoque epidemiológico da promoção da saúde: as idéias de Geoffrey Rose
An epidemiological approach to health promotion: the ideas of Geoffrey Rose

Dóra Chor 1
Eduardo Faerstein

2

1 Departamento de
Epidemiologia e Métodos
Quantitativos em Saúde,
Escola Nacional de Saúde
Pública, Fundação
Oswaldo Cruz.
Rua Leopoldo Bulhões 1480,
8 o andar, Manguinhos,
Rio de Janeiro, RJ
21045-900, Brasil.
2 Instituto de Medicina
Social, Universidade do
Estado do Rio de Janeiro.
Rua São Francisco Xavier
524, 7 o andar, Bloco D,
Maracanã, Rio de Janeiro, RJ
20550-013, Brasil.

Abstract In this paper, we discuss some of the ideas developed by Geoffrey Rose, which are seldom explicitly expressed in the contemporary debate on health promotion. The following notions are emphasized: many health exposures and outcomes are expressed in a continuum, and do not follow the dichotomy exposed/non-exposed or diseased/ non-diseased; there is a linear relationship between certain exposures and their effects along the range of exposure levels; thus, many individuals exposed to low risk may generate more cases of a disease than few individuals exposed to high risk. In addition, there is a strong relationship between average behaviors and the occurrence of deviance, as a result of the balance between biological and social forces favoring diversity or uniformity. Thus, risk differences between defined populations involve differences in the population distributions as a whole, rather than in the proportion of individuals with high risk. Overall, these concepts favor emphasis on strategies aiming the general population, and not only the individuals considered to be at high risk of disease.
Key words Health Promotion; Preventive Medicine; Epidemiology
Resumo Neste artigo, apresentamos princípios sistematizados por Geoffrey Rose, raramente explicitados no debate contemporâneo sobre promoção da saúde. São enfatizadas as seguintes noções: muitos parâmetros biológicos apresentam-se