Meanings and methods of territorialization in primary health care/ Sentidos e metodos de territorializacao na atencao primaria a saude

Territorially-based participative analytical methodologies taking the environmental question and work into consideration are essential for effective primary health care. The study analyzed work and environment-related processes in the primary health care area and their repercussions on the health of workers and the community in a rural city in Ceara, whose economy is based on agriculture for export,. It sought to redeem the area and the proposal of actions focused on health needs by the social subjects through the making of social, environmental and work-related maps in workshops within the framework of action research. Examining the situation from a critical perspective, based on social participation and social determination of the health-disease process with regard to the relations between production, environment and health, was the most important step in the participative map-making process, with the qualitative material interpreted in light of discourse analysis. The process helped identify the health needs, the redemption of the area, strengthened the cooperation between sectors and the tie between the health of the worker and that of the environment, and represented an advance towards the eradication of the causes of poor primary health care services. Key words Primary health care, Workers 1/4 health, Environmental health, Determination of health needs Metodologias analiticas participativas de base territorial sao essenciais para a atuacao da Atencao Primaria a Saude (APS) considerando a questao ambiental e o trabalho. Este estudo, realizado em municipio cearense com modelo de producao agroexportador, analisou os processos no territorio da APS relacionados ao ambiente/ trabalho e as repercussoes sobre a saude da comunidade e dos trabalhadores, com vistas a reapropriacao do territorio e proposicao de acoes focadas nas necessidades de saude, pelos sujeitos sociais, a partir da elaboracao dos mapas: social, ambiental e do trabalho em oficinas conduzidas em pesquisa-acao. A problematizacao na perspectiva critica, embasada na participacao social e na determinacao social do processo saude-doenca referente as relacoes producao-ambiente-saude foi etapa fundamental no mapeamento participativo, tendo sido o material qualitativo interpretado a luz da analise do discurso. O processo favoreceu a identificacao das necessidades de saude, a reapropriacao do territorio reforcando a atuacao intersetorial, fortalecendo a interlocucao entre a saude ambiental e do trabal