Public health as a social science: reflections on the possibilities of a comprehensive public health

Abstract

Close historic relationships between medicine and public health have implied, as a consequence for the latter, the in-heritance of epistemological traits traditionally characteristic of a positivistic conception of science on which a major part of the theoretical development of modern medicine has been sup-ported. From the point of view of this ontological, epistemo-logical and methodological reference of positivism, health has been reduced to deterministic, linear and causalistic explana-tions that systematically cancel any reference to the lifeworld (Lebenswelt), both for the researcher and for the “objects” of re-search. The scientific pretensions of public health have become protruding over its political and ethical commitment, even widening the gap between scientific knowledge and the specific con-ditions of existence of social actors and their relation to health. This paper presents some reflections around the conditions of possibility for a comprehensive approach of public health prob-lems. These reflections are based on a conception of health as a social phenomenon, that is to say, as an emergent element from the complex web of intersubjective relationships among social actors, in a specific social and historic horizon. Epistemological, ethical and political implications of this perspective for research in public health are also discussed .