Latin American Critical Epidemiology

This chapter presents a panoramic analysis of the roots and landmarks of the Latin American critical scientific tradition, explaining the historical conditions—from colonial times to 21st-century society—that determined the distinct periods of the Latin American social medicine/collective health movement, its philosophy, and its ethics. It explains how opposing perspectives and methodological differences arose during those periods, creating a paradigm clash that expresses the interests and views of scholars and decision-makers adhering to different philosophical and practical postures. It describes the fundamental influence in the conceptual and practical shaping of epidemiology of local specific conditions and pressures and also highlights the fundamental influence of and parallelism with outstanding contributions from the North. This chapter provides English-speaking audiences firsthand knowledge of an innovative scientific tradition, explaining its substantial contributions and potentialities for health transformative research, teaching, and community-based agency.

Why Critical Epidemiology?

The exponential growth of a discriminatory and rapacious market economy in the 21st century, nurtured and reproduced by an unhealthy civilization, is analyzed in this chapter. Global problems that make critical epidemiology an imperative tool are condensed to provide a synthesis of the impacts of 21st-century health inequity. The chapter provides an epidemiological profile of socio-environmental contradictions that cause the failing results of big business applications of new fourth industrial revolution technologies. It illustrates how unparalleled wealth concentration is not only destroying the fundaments of wellness and healthy living but also causing the downfall of common good and the derailment of institutional ethos. As a call to reason for public and collective health advocates, it highlights the myths of “progressive” technocracy (aberration of health governance) and the “sins” of a regressive expertness. Planetary life and health are hanging by a thread in a civilization in which producing fast, living fast, and dying fast is the ruling logic.

Introduction

A groundbreaking approach to critical epidemiology for understanding the complexity of the health process and studying the social determination of health. A powerful critique of Cartesian health sciences, of the flaws of “functional health determinants” model, and of reductionist approaches to health statistics, qualitative research and conventional health geography. A consolidated and well sustained essay that explains the role of social-gender-ethnic relations in the reproduction of health inequity, proposing a new paradigm with indispensible concepts and methodological means to develop a new understanding of health as a socially determined and distributed process. It combines the strengths of scientific traditions of the North and South, to bring forward a new understanding and application of qualitative and quantitative (statistical) evidences, that looks beyond the limits of conventional epidemiology, public and population health. The book presents alternative conceptions and tools for constructing deep prevention. A neo-humanist conception of the role of health and life sciences that assumes critical, intercultural and transdisciplinary thinking as a fundamental tool beyond the limiting elitist framework of positivist reasoning. A most important source of fresh ideas and practical instruments for teaching, research and agency, based on a renewed conception of the relation between nature, society, health and environmental problems.

New Method and Intercultural Awakening

A groundbreaking set of potent ideas, concepts, and methodological tools—developed over years of research and advocacy—are discussed in this chapter. The chapter provides an integral in-depth analysis of health paradigms, explaining the conceptual and technical limitations of conventional epidemiology and public health. It describes and illustrates the main theoretical and methodological ruptures and new categories needed to go beyond the Cartesian logic and its knowledge illusions. It analyzes five central breaks with the cognitive pillars of empirical epidemiology: lineal causality, external conjunction, empirical quantitative and qualitative analysis, empirical socio-epidemiological stratification, and Cartesian health geography. Examples are provided to facilitate useful reflections about research, postgraduate teaching, and health agency. The chapter also highlights some key elements for working toward a new framework for practice and ethos—one necessary to transform the notions of health prevention and promotion, to move beyond conventional conceptions, to leave our institutional comfort zones, and to reaffirm a critical scientific philosophy and rescue potent concepts of the wisdom of ‘others,” moving from passive vertical bureaucratic surveillance to active, community-based critical health monitoring.