Importance of Rethinking Public Health and Epidemiology from the Global South

This brief article raises the need to decolonize the theories, policies, and practices that dominate health, and emphasized on the necessity for a new public health and epidemiology built from the Global South, and expresses its disagreement with the WHO’s ahistorical and static definition of health, which conceives it as a “state” without social context. On the contrary, we propose that health is a sociocultural process determined by the specific conditions of life and work.

We also propose that the foundations of the dominant public health and epidemiology reproduce coloniality of power and of established health knowledge. We state that the hegemony of the biomedical model focused on the individual diagnosis and treatment of disease; of a public health system conceived as a vertical and authoritarian action by the State and focused on individual diseases and risk factors; of a health promotion system focused on modifying individual behaviours, habits, and lifestyles; and of an Anglo-Saxon/Eurocentric epidemiology dedicated to counting cases and deaths without explaining their context and reduced to quantitative relationships—dominates academia, health ministries, public health schools, and the policies and organization of health systems.

The dominant vision turns social determination into isolated social determinants and reduces them to the traditional risk factors that characterize traditional public health. The State transforms healthcare personnel into agents to implement a positivist bureaucratic order in which the population is merely an object of control and surveillance. The State projects its ideology onto the scientific and technical basis for risk and disease prevention in a population, as if it were merely a collection of individuals.

The reasoning behind public health and functionalist epidemiology stems from the theory, knowledge base, and methods of structural functionalism. Seen through the lens of structural functionalism, the current reports focusing on health inequalities presume that inequalities are merely imbalances that require correction, rather than the result of an underlying determinative process. The agenda, geopolitics, and actions of the liberal doctrine of global health foster dependency as an intrinsic feature of public health and epidemiology practice and policy. This dependency limits understanding of the specificities of the South.

From the point of view of Latin American critical thought in health, we advocate toward Integrated Care for Health, as strategy centered on the territory and collective ways of life; with the understanding that health is intertwined with life and nature as central elements.

Another key component is intersectionality of black and decolonial feminisms, which intertwines class, gender, race/ ethnicity, and territory. This avoids making the error of managing each in isolation or as additive effects, which is often how these categories are treated. Their intertwining is fundamental to reinforcing the ability to provide complex and transformational explanations of sociocultural processes. To overcome the limitations of classical epidemiology, Breihl [1], in his book Critical Epidemiology and the People’s Health, proposes an epistemic break that goes beyond the reductionism of its explanatory paradigm based on linear and multifactorial causality, with a paradigm of social determination and the subsumption of biological processes within social ones. This paradigm incorporates the metabolism of society and nature, social reproduction, collective ways of life instead of individual lifestyles, and the processes that protect or impair health, rather than individual risk factors. Furthermore, as proponent Basile [2] they are crossed by colonial racialism as the only way to understand health from the South Guided by dynamics of transformation to rebuilt thinking and founding principles of the Global North, we included alternative frameworks that sustain the reinvention of political and health education and critical epidemiology in the Global South [3].

We propose the following categories:

a. Epistemology of health from the South and health sovereignty
b. Universal and intercultural health systems, based in Integrated Care for Health and Well-Living and the territory
c. Critical epidemiology
d. The public as a sphere to universalize collective goods
e. Political economy of health, instead of the liberal health economy
f. Democratization of managing and governing in health
g. Monitoring the intersectionalities and determinants of health

We finalize proposing to rethink, remake, and decolonize the theories and practices that govern both epidemiology and health systems, and, from the South, develop strategic processes for building health sovereignty as the vision for the reconstruction of hope and social justice.

1. Breilh J (2021) Critical epidemiology and the people's health. Oxford University Press, USA 3.
2. Basile G (2022) Towards a Health from the South: A decolonial and health sovereignty epistemology. Social Medicine 15(2): 61-67.
3. Feo Istúriz O (2023) Rethinking and decolonizing theories, policies, and practice of health from the Global South. International Journal of Social Determinants of Health and Health Services 53(4): 392-402.