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[健康的社会决定因素、复杂性、殖民性与长期影响]

[Social determination of health, complexity, coloniality, and the long term].

作者信息

Sevalho Gil

机构信息

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

出版信息

Cad Saude Publica. 2025 Feb 7;40(12):e00035724. doi: 10.1590/0102-311XPT035724. eCollection 2025.

Abstract

This essay connects critical knowledge on the social determination of health, coloniality, and time as an epistemic foundation. Time is a relevant element in the articulation of complex interdisciplinary work, though it has not been deeply reflected upon in Public Health. The essay revisits historical bases and updates the debate on the social determination of health, highlighting the contributions of Naomar de Almeida Filho and Jaime Breilh - authors whose thoughts primary focus are on the Global South, outside of the North American and Eurocentric hegemony. Complexity, commitment to social transformation, and a decolonizing perspective inspire the intersection between public health, the reflections of Fernand Braudel and Immanuel Wallerstein on the long term and historical capitalism in the modern world-system, and decolonial thought with its concept of coloniality. The Braudelian conception encompasses multiple temporalities and dialectically integrates change and permanence in the long term, while decolonial reflection inserts coloniality into this longue durée. Coloniality is part of the social determination of health, either as a mechanism that produces and reproduces economic, gender, and ethno-racial inequalities and social oppression, or in its epistemological dimension as the coloniality of knowledge behind epidemiological conceptualization. Braudel's longue durée, Wallerstein's world-system, and decolonial thought are contributions to be further explored within health thinking. The epistemological integration of time into epidemiological reflection can reveal erasures and (re)constitute historical contexts and durations whose complexity escapes the fragmented and static view of determinants produced by the Cartesian functionalism of risk factor epidemiology.

摘要

本文将健康的社会决定因素、殖民性以及作为认识论基础的时间等批判性知识联系起来。时间是复杂跨学科工作阐述中的一个相关要素,尽管它在公共卫生领域尚未得到深入思考。本文回顾了历史基础并更新了关于健康社会决定因素的辩论,突出了纳奥马尔·德·阿尔梅达·菲洛和海梅·布雷伊尔的贡献——他们的思想主要关注全球南方,处于北美和欧洲中心主义霸权之外。复杂性、对社会变革的承诺以及去殖民化视角激发了公共卫生、费尔南·布罗代尔和伊曼纽尔·沃勒斯坦对现代世界体系中的长期和历史资本主义的思考以及具有殖民性概念的去殖民思想之间的交叉融合。布罗代尔的概念包含多种时间性,并从长期角度辩证地整合了变化与持久性,而去殖民反思则将殖民性融入了这一长时段。殖民性是健康社会决定因素的一部分,它既作为产生和再现经济、性别、族裔和种族不平等以及社会压迫的机制,也在其认识论层面作为流行病学概念化背后知识的殖民性。布罗代尔的长时段、沃勒斯坦的世界体系以及去殖民思想是健康思维中有待进一步探索的贡献。将时间在认识论上整合到流行病学反思中,可以揭示被忽视的内容并(重新)构建历史背景和时长,其复杂性超出了风险因素流行病学笛卡尔功能主义所产生的碎片化和静态的决定因素观点。

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