Our mission To publish scientific knowledge at the interface between the Social and Human Sciences and Public/Collective Health, embracing the epistemic, ontological, thematic, theoretical, and methodological pluralities that characterize the field; approaches that understand health as a social, historical, and political phenomenon; and critical, situated debates on inequalities, diversity, and struggles for rights. <p style="box-sizing: border-box; line-height: 25px; margin: 20px 0px; color: rgba(0, 0, 0, 0.87); font-family: 'Noto Serif', -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen-Sans, Ubuntu, Cantarell, 'Helvetica Neue', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Journal's website on the SciELO portal: https://www.scielo.br/j/sausoc/ <p style="box-sizing: border-box; line-height: 25px; margin: 20px 0px; color: rgba(0, 0, 0, 0.87); font-family: 'Noto Serif', -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen-Sans, Ubuntu, Cantarell, 'Helvetica Neue', sans-serif; font-size: 14px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;">Journal's submission articles website: https://mc04.manuscriptcentral.com/sausoc-scielo Print version ISSN 0104-1290 On-line version ISSN 1984-0470
Universidade de São Paulo. Faculdade de Saúde Pública
Gender and mental health in Brazil: diagnoses of anxiety, depression, and other common mental disorders
This article analyzes the persistence of gender bias in the distribution of diagnoses of anxiety, depression, and other common mental disorders in Brazil, from a critical feminist perspective. It aims to understand how gender norms, power relations, and the processes of medicalization of everyday distress contribute to the higher frequency of these diagnoses among women. Methodologically, it adopts a qualitative theoretical-analytical approach is adopted, based on a critical review of the feminist literature in mental health and on the analysis of data from population surveys, administrative records, and institutional documents. The results show that women present a higher prevalence of diagnoses of anxiety and depression, a pattern that persists over time and is not attributable to biological determinants. The analysis links these inequalities to the sexual division of labor, care overload, exposure to gender-based violence, and the psychiatrization of socially produced suffering. The article concludes by highlighting the relevance of collective care strategies—such as peer support groups—as experiences that challenge the predominant biomedical model, and by arguing that public mental health policies should be grounded in the social determinants of distress and be sensitive to gender issues.
Dossier - Gender, the market, and mental health
Copyright (c) 2026 Revista Saúde Sociedade https://creativecommons.org/licenses/by/4.0
Reflections on federal legislation concerning indigenous health in Brazil
This documentary study analyzed the trajectory of federal legislation on Indigenous Health (IH) across different governments and political-partisan periods, identifying processes of construction and dismantling of normative frameworks. Official documents published by federal agencies between 1990 and 2024 were collected from the Federal Legislation Portal and analyzed using the READ strategy. A total of 26 federal legal texts on IH were identified for the period. An association was observed between legislative production and the politicalpartisan orientation of governments, with a higher volume of implementation under administrations guided by agendas generally associated with more inclusive policy approaches. Inferential analysis revealed five thematic cores, with emphasis on legislation concerning positions, functions, allowances, committees, and emergency strategies. Frequency analysis showed that the most recurrent terms indicate a predominant focus on administrative structuring, suggesting that IH remains vulnerable to political discontinuities. Furthermore, legal production is weakly responsive to the demands of Indigenous peoples, thus evidencing a gap between normative frameworks and the effective realization of the right to health.
Palliative care in Primary Care: production of a cartographic body
This study analyzes the possibilities and barriers to implementing palliative care (PC) in Primary Health Care (PHC), using a cartographic qualitative methodology. Conducted in a Basic Health Unit (BHU) in large municipality in Paraná, Brazil, the study adopted the “guide-user” strategy to follow real-life care trajectories. Data were recorded in a Cartographic Diary. Results reveal structural challenges such as limited resources, fragmented healthcare networks, and staff overload, alongside subjective factors influencing professional practices and user access to PC. The lack of articulation across care levels and narrow perceptions of PHC’s role in PC delivery compromise care continuity. However, micro-political practices and singular arrangements highlight PHC’s potential as a space for continuous and humanized care. The study concludes that rethinking palliative care policies and practices is urgent, taking into account the subjectivities and living networks shaped in everyday healthcare services.
Anti-racialism and the war on drugs: the Cracolândia territory constitution and the racial dynamics in the marginalization of the black people
Social discourse turns the black population into a target of the war on drugs. Data indicates that most of the people who frequent the Cracolândia territory are black. In order to reflect on the narratives that make up the territory, especially with regard to racial dynamics, a systematic integrative literature review was carried out in the PubMed, BVS, Scopus, Embase, Web of Science and the Brazilian Digital Library of Theses and Dissertations databases, using the keywords “cracolândia”/“crackland” as the inclusion criteria. Studies were included: if they focused on Cracolândia and the black population; were published from 2005 onwards, in Portuguese or English; and were available via open access. The results, exported to the Rayyan platform, yielded six articles, which were organized into three thematic categories: “War on drugs and the criminalization of black people”, addressing how repressive policies reinforce the marginalization of the black population, perpetuating stigmas and exclusion; “Double social devaluation: race and use”, highlighting the double stigmatization stemming from racism and drug use among black people; and “Policies on drugs and black people in Cracolândia”, highlighting how these policies, by not considering racism, impact this population, perpetuating inequalities. The results reveal a scarcity of studies dealing with race relations and their implications.
Methodologies as milestones in the trajectory of the Social and Human Sciences in Collective Health
This essay offers a critical reflection on the publication trajectory within the Social and Human Sciences in Health (SHSH), focusing specifically on the research methodologies employed. I conduct an non-systematic review of articles published between 1985 and 2025 across five Brazilian Collective Health journals. Bridging my editorial experience with insights from the relevant literature, I outline the primary methodologies identified and discuss how these choices reveal epistemic disputes and knowledge validation processes within the field. The text is structured around ideal-typical constructs, highlighting the most prominent features of each period. I conclude by raising several concerns regarding the future of scientific publishing and the need for a critical renewal of editorial practices in SHSH.
Social determinants or processes of determination? Anthropological reflections based on the experiences of women in the Brazilian Federal District during and after the COVID-19 pandemic
Drawing on anthropological theory and a longitudinal qualitative study, this essay analyzes the social shaping of health, emphasizing its processual and dynamic nature. To this end, it presents different interpretations of the concept of the social determinants of health, contextualizes its emergence within the health field, and discusses contemporary critiques in Collective Health. It foregrounds the experiences of marginalized women in the Federal District during and after the COVID-19 pandemic, showing their agency and reflexivity regarding their living conditions. I argue that this agency and reflexivity demonstrate that living conditions do not operate as mere externalities; rather, they are actively recognized and mediated by the meanings that guide these women’s actions. Thus, countering a deterministic approach to the social determinants of health, this paper proposes understanding these determinants through theoretical frameworks that privilege the processual nature of social practices.
We need to talk about coloniality and racism: a gap in the editorial ecosystem of the Social and Human Sciences in Collective Health
This essay examines how the invisibility of coloniality and racism in scientific journals drives editorial inequity in the Social and Human Sciences in Health. This reflection relies on the analysis of scholarly publishing, guided by two core questions: What has been published on coloniality and racism regarding Black and Indigenous health? In which scientific journals are these articles being published? The findings show that this thematic gap is itself a byproduct of the racism permeating the entire Brazilian editorial ecosystem and its publishing practices. Overcoming this barrier requires greater ethno-racial and regional diversity within editorial boards. We propose anti-racist action plans to actively incorporate narratives from traditional, Roma, favela, riverine, quilombola, and migrant communities, alongside people with disabilities and LGBTQIAPN+ individuals, into editorial processes and published texts.
Amazonia as a critical frontier: epistemological displacements and editorial challenges
This theoretical essay aims to reflect on the contemporary forms of the geopolitics of knowledge within the field of Brazilian Collective Health, with emphasis on the incorporation of the Amazon as a horizon for transforming hierarchies in editorial practices. Conceiving Collective Health as a scientific field shaped by disputes over what can and should be researched, by which methods, and by whom, the text examines how regional, racial, and epistemological hierarchies structure regimes of scientific validation and editorial practices. Engaging with the notions of the coloniality of power, the geopolitics of knowledge, and the dispositif of raciality, it argues that such hierarchies produce a dual peripheralization— territorial and epistemological—that affects knowledge production originating from Brazil’s Northern Region. At the same time, institutional fissures are identified that signal ongoing shifts. The Amazon is thus presented as a critical frontier, not as an exotic object, but as a space of conceptual and practical production capable of challenging and reconfiguring the criteria of legitimacy within the editorial field of Collective Health.
Scientific and Technological Development
The Social and Human Sciences in Health facing contemporary challenges: science, coloniality, whiteness, and epistemic arenas
This essay addresses the contemporary challenges facing the Social and Human Sciences in Health (SHSH). It analyzes how contexts marked by social, health, environmental, political, and epistemic crises—along with intensified scientific production and the emergence of artificial intelligence (AI)— strain disciplinary identities, visibility regimes, knowledge legitimacy and authority, and educational processes. It argues that the SHSH provide the tools to understand and denaturalize structures, yielding situated knowledge that is ethically and politically engaged. Engaging with debates on science, the coloniality of knowledge, whiteness, and epistemicide, the essay posits that modern science has entrenched persistent epistemic hierarchies. When analyzed through the lens of critiques regarding the coloniality of knowledge, scientific racism, and whiteness, epistemic asymmetries emerge not as occasional deviations, but as structural dimensions of science. Engaging with the concepts of epistemic arenas and ontopolitics reveals that health objects are produced through practice, ethically entwining researchers and educators in the creation of the very worlds they investigate and teach. It examines the automation of thought and the widening of epistemic inequalities. By articulating decolonial perspectives, situated epistemologies, and the Latin American concept of sentipensar (feeling-thinking), it suggests that a pluralistic Collective Health demands dismantling privileges, challenging whiteness, and fortifying educational processes committed to cognitive justice and social equity.
Knowledge production in the Social and Human Sciences within public health
This editorial discusses the position of the Social and Human Sciences in Health (SHSH) within the broader field of Public Health. It critically examines the historical inequalities among its constituent subfields and explores how these asymmetries affect the production and circulation of scientific knowledge. We argue that, despite broad recognition of the critical and interdisciplinary value of SHSH, persistent institutional, editorial, and academic constraints continue to hinder its consolidation. Drawing on a survey of journals affiliated with the Public Health Editors Forum of the Brazilian Public Health Association, this text analyzes the editorial circulation of SHSH research. The findings show that this literature is highly concentrated in a few specific journals, revealing persistent bottlenecks in its publication and validation. The article also introduces the commemorative dossier celebrating 30+ years of Saúde e Sociedade, contextualizing the symposium that inspired this collection and summarizing the contributions of the published papers. Reflecting on the journal’s trajectory and on the contemporary challenges facing SHSH within Public Health, we reaffirm the urgent need to strengthen pluralistic, critical editorial spaces committed to epistemological diversity and to the defense of health as a fundamental right.
On anxieties and enthusiasms over 30+ years of Saúde e Sociedade: where do we come from? Where are we? Where do we want to go?
This article maps the trajectory of Saúde e Sociedade through three central questions: where we come from, where we are, and where we want to go. The text begins by briefly tracing the journal’s origins and its foundational roots at the intersection of the Social and Human Sciences and Public/Collective Health, highlighting its early consolidation within the scientific community. Turning to the contemporary landscape, the article examines the journal’s institutional and editorial transition, including a comprehensive revision of its mission. These institutional changes explicitly align the journal’s formal scope with its evolving editorial practice, while reaffirming its commitment to critically analyzing the relationships between health, society, and power. The text also underscores current challenges facing academic journals, including sustainability, internationalization, and shifts in the production and dissemination of knowledge. Finally, we outline the future commitments of Saúde e Sociedade, reaffirming its role as a space for sophisticated dialogue—one attentive to contemporary struggles, committed to defending health as a fundamental right, and open to the diverse perspectives that shape the field.
Gênero, mercado e saúde mental: por uma agenda de pesquisa decolonial
Neste artigo são apresentadas as produções que compõem o dossiê Gênero, Mercado e Saúde Mental, fruto do acúmulo de pesquisas desenvolvidas ao longo dos últimos cinco anos por pesquisadoras e pesquisadores vinculados a uma ampla rede internacional de investigação. O dossiê parte do pressuposto de que a saúde mental não pode ser compreendida exclusivamente a partir de abordagens biomédicas ou individualizantes. Ao contrário, os artigos reunidos evidenciam que sofrimento psíquico, diagnósticos psiquiátricos e consumo de psicofármacos estão profundamente atravessados por relações sociais de poder, desigualdades de gênero, raça e classe, bem como por processos históricos de medicalização e biomedicalização da vida cotidiana.
Editorial – Dossier: Gender, Market, and Mental Health
Why are we so unequal? On the health of the black and indigenous population
The social nature of socio-racial inequality is investigated through the notion of difference, as well as its capacity for reproduction, related to power relations—more specifically to the racial apparatus, a historically and socially instituted mechanism through social institutions.
Editorial - Dossier Anti-racist actions in Primary Health Care: a challenge for ensuring equity
Black women’s health and Primary Health Care: between the coloniality of care, everyday struggles, and confronting racism
This essay, as a result of accumulated research, lived experiences, and critical reflections, analyzes the construction of the social place of Black women, particularly within Primary Health Care (PHC), highlighting how racism, sexism, and class and territorial inequalities contribute to the production of vulnerabilities. Using intersectionality as a theoreticalpolitical tool and a critique of the coloniality of care, the text demonstrates how the universalist logic—based on supposed neutrality—and an insufficiently developed approach to racial equity render the vulnerabilities of these women invisible, along with the impacts on their living conditions, especially in contexts such as the streets, favelas, and incarceration. It questions the effectiveness of approaches that, by failing to consider the multiple layers of oppression, reinforce stereotypes and contribute to the perpetuation of social disadvantages. The essay emphasizes the leadership of Black women in denouncing institutional racism and in creating collective and ancestral care technologies. It underscores the urgency of articulating and mainstreaming public policies, with emphasis on the National Policy for the Comprehensive Health of the Black Population and the National Policy for the Comprehensive Health of Lesbians, Gays, Bisexuals, Transvestites, and Transsexuals, highlighting significant ongoing initiatives. It concludes that equitable care requires confronting racism within PHC practices, grounded in Black feminist epistemologies and the valorization of reexistence experiences within the territories.
Dossier Anti-racist actions in Primary Health Care: a challenge for ensuring equity
Experiences of mothers of adolescents with intellectual disabilities: a study on the intersection of race, gender, and social class
The present study aims to discuss the intersection of gender, race, and social class among mothers of adolescents with intellectual disabilities, in order to strengthen the debate on public policies regarding the health actions necessary to ensure equity, by recognizing and making visible the multiple dimensions of vulnerability present in these contexts. This qualitative study conducted was with 12 mothers of adolescents with intellectual disabilities who were receiving care at a specialized outpatient child and adolescent mental health service. Data collection was carried out through in-depth interviews using a semistructured guide. Data analysis was performed using Iramuteq software and Bardin’s Content Analysis. Most women are Black, have low household incomes provided through public policies, and assume full responsibility for raising their children. The results were grouped into four distinct categories: experiences of racism, prejudice, and stigma related to disability and the role of public policies; everyday life narratives; parental relationships, dependency, and future perspectives; and the path to diagnosis. The study found that these mothers face a challenging reality in which mechanisms that sustain oppression are perpetuated in a scenario marked by multiple dimensions of vulnerability.
Urban Regeneration and its Implications for Community Health in Neighborhoods in Southern Chile
Objective: To identify the changes and consequences for the community’s health and well-being after the enforcement of the “Quiero mi Barrio” (I Love my Neighborhood) program in Chile. Materials and Methods: The qualitative study was based on the analysis of the discursive content of the interviews conducted during focus group sessions with 16 leaders who were members of the “Developmental Neighborhood Committee” in Temuco, Chile. Results: After the program’s implementation, it was possible to identify changes in community spaces, such as landfill eradication, the establishment of spaces that promote leisure, and the generation of communal encounter instances, which implied an increase in the usage of neighborhoods’ public spaces for physical activity and neighbor coexistence. Conclusions: The results indicate that this program contributes to infrastructure and social management, strengthening community health in the studied neighborhoods.
Racism and the Production of Care in the Brazilian Unified Health System (SUS): Challenges for Primary Health Care
The struggle of the organized Black movement led to the approval of the National Policy for Comprehensive Health of the Black Population (PNSIPN – acronym in Portuguese) in 2009, a milestone in the recognition of institutional racism within the Unified Health System (SUS – acronym in Portuguese). This article aims to analyze the production of care for the Black population within the context of Primary Health Care (PHC), in the Greater ABC region, considering challenging to the principle of equity and to the implementation of the PNSIPN. This is a qualitative study involving twentyfour semi-structured interviews with managers, social actors, health professionals, and users of the Brazilian SUS. The narratives revealed political and institutional barriers to implementing the PNSIPN, including professionals’ lack of awareness, the absence of race/color data in health information systems, and resistance to recognizing racism as a structuring element of the health-disease process. Drawing on Sueli Carneiro, the study argues that the raciality dispositif selectively activates biopower— deciding who is entitled to “make live” and who is condemned to “let die.” Achieving racial equity within SUS requires acknowledging institutional racism as a determinant of inequities and incorporating antiracist practices in health services. The right to health remains denied to the Black population.
Therapeutic itinerary of women with suicidal ideation and attempts: gender as an analytical category
Women with suicidal ideation and attempts often turn to healthcare services in search of mental health care. However, their therapeutic pathways are shaped by gender-related issues that require further exploration. This study aims to understand the therapeutic itineraries of these women within the Psychosocial Care Network (acronym in Portuguese – RAPS), using gender as an analytical category. It is a qualitative study based on a hermeneutic and dialectical approach. Interviews were conducted with ten women who shared their experiences seeking care during episodes of suicidal ideation and attempts. The findings highlight the diversity of healthcare services accessed and the gender-related dynamics present in these encounters. Additionally, it was observed that the search for care extended beyond institutional healthcare services, contributing to a deeper understanding of how these women redefined the suffering associated with suicidal ideation and attempts. In this sense, analyzing their therapeutic pathways through a gender perspective allowed for a critical examination of barriers, challenges, and care strategies, contributing to the improvement of mental health policies and practices.
Food citizenship: an overview of scientific production and its relationship with constitutive dimensions
Food citizenship represents a theoretical and practical approach that highlights the behavior of actors who support, rather than threaten, more democratic, socially and economically just, and environmentally sustainable food systems. Beyond the social right to food, the expanded concept emphasizes obligations and responsibilities, articulated through eight constitutive dimensions of food citizenship. This article aims to explore the scientific literature published in English on the topic in recent years and to identify how these constitutive dimensions have been addressed. The study adopted a hybrid systematic-narrative approach, including publications from 2017 to 2023, a period delimited based on the theoretical framework proposed by Lozano-Cabedo and Gómez-Benito (2017), which redefines the concept of food citizenship in its expanded formulation. The main keywords identified were food citizenship itself, sustainability, food democracy, food insecurity, and food literacy. All constitutive dimensions are addressed, either as elements associated with the alternativity of the object of study or as direct objects of analysis, with emphasis on the recognition of the right to sufficient, healthy, and quality food; the recognition of all as subjects of citizenship, the manifestation of citizenship in private and public spheres, and the governance of food citizenship.
Hunger and food contamination in artisanal fishing communities affected by the oil spill off the Brazilian coast
This study aimed to understand the experience of hunger among artisanal fishermen and shellfish gatherers in Bahia, Brazil, affected by the oil spill off the Brazilian coast in 2019. This analyticaldescriptive study with a qualitative approach analyzed 10 individual interviews conducted in October 2021 with artisanal fisherwomen and shellfish gatherers in light of Hans-Georg Gadamer’s (2015) hermeneutic perspective. Categories of analysis emerged that dealt with the individual and collective experience of living and working in an environment contaminated by oil and the feelings of fear and doubt arising from the experience of hunger in everyday life, with the consumption of fish and shellfish that taste and smell like oil. This study breaks new ground by proposing an analysis of hunger in the context of this disaster and reinforces the voice and struggle of female fishing workers who felt mobilized to speak out about the right to eat uncontaminated food and have a dignified living and working environment. It also results in reflections on the rapprochement between the ethnographic approach to hunger and ethnotoxicology in situations of major disasters, the understanding of which becomes necessary to overcome the inertia of the state and the lack of protective public policies, especially with the increase in environmental disasters on a larger scale.
Philosophy of Pharmaceutical Care and its operationalization in the neoliberal reality: critical reflections based on Paulo Freire’s theories
This qualitative study critically reflects on Pharmaceutical Care based on Paulo Freire’s theories. The methodology used was a combination of the Investigation of Generative Themes and Evocative Autoethnography. Analytical notes collected in a field notebook between December 2020 and July 2024 were analyzed using creative autoethnographic writing. Some contradictions were identified between the philosophy of Pharmaceutical Care and its operationalization in neoliberalism. Is it achievable to fulfill professional social commitment while remaining neutral? Is it possible to develop a truly patient-centered, non-paternalistic, and noncolonial clinical practice? Can evidence-based health be holistic? Is it feasible to engage in dialogue with patients who lack valuable biomedical knowledge within the time and language limits of institutional health? Is Pharmaceutical Care an adequate path for promoting human health in the Anthropocene? Pharmacists are encouraged to identify corporatism embedded in their professional practice, permeate their evidence-based practice with dialogue with patients, and grasp the systemic dimensions of the use of health technologies. It is hoped that the outlined problem-posing will foster conscientization, action, and the being more fully human of healthcare professionals, researchers, educators, students, and patients.
“Don’t trivialize it. Don’t hesitate”—an Interview with Sueli Carneiro by the Carolina Maria de Jesus Black Collective
In 2022, the Carolina Maria de Jesus Black Collective (CNCMJ) of the USP Faculty of Public Health interviewed philosopher and activist Sueli Carneiro, concluding its Black October events cycle. Sueli, who holds a Ph.D. in education from USP and is the founder of Geledés—Instituto da Mulher Negra (Geledés—Institute of Black Women), shared her experiences in the black movement, feminism, and academia, emphasizing the need for collective organization to con-front epistemicide. Revisiting the historical context of the emergence of black feminism in Bra-zil, she highlighted the centrality of figure of Lélia Gonzalez, as well as the importance of criticizing hegemonic white feminism. She warned about the risks of disjointed activism and defended the urgency of collective organization for political advan-cement. The philosopher also addressed epistemicide as a structural practice that denies black populations the status of subjects of knowledge, highlighting the impact of racial quotas on the transformation of the university space. In the field of health, she highlighted the relevance of black female researchers who have contributed to the debate on the health of the black popu-lation. The meeting reinforced the power of the CNCMJ (National Council of Black Women) in making black knowledge and struggles visible in the academic space and in Brazilian public health.
The cosmopolitics of care: an interview with José Miguel Nieto Olivar
In this interview to the journal Saúde e Sociedade, Professor José Miguel Nieto Olivar reflects on the uses of the concept of “cosmopolitics” within the collaborative research project “Cosmopolitics of care at the end of the world: gender, borders, and pluriepistemic assemblages with public health”. Drawing inspiration from philosopher Isabelle Stengers and a network of scholars and interlocutors, the project explores the integration of intersectional and decolonial perspectives into public health, particularly in contexts marked by structural inequality and exclusion. Olivar underscores the importance of incorporating diverse knowledge, experiences, and care practices, challenging the ontological and epistemological boundaries of modernity. He discusses how cosmopolitics reconfigures traditional understandings of public health and expands the notion of care through multisited, collaborative, and pluriepistemic approaches. The interview highlights the relevance of feminist, Indigenous, Black, and LGBTQIAPN+ perspectives in reimagining care and health in the face of planetary and institutional crises, with special attention to South American and Amazonian territorialities. Olivar also shares preliminary results and challenges of the project, emphasizing the role of ethnographic and interdisciplinary practices in generating new forms of dialogue and action. He envisions the transformative potential of these reflections for public health, advocating for the reconnection of local and collective knowledges to rethink care and policy in times of complexity and uncertainty.
The use of scientific evidence in health policy decisions: Notes on ontology
The use of scientific evidence in the formulation and implementation of policies has become an internationally recognized guiding principle for decision-making in health. Amid discussions on the sustainability of health systems and the context of multiple crises, a critical perspective on this debate is imperative. In this essay, we present initial criticalreflective notes on the context of knowledge production within the framework of modern science and the use of scientific evidence in health policy decisions. We adopt historical-dialectical materialism and critical realism as theoretical, methodological, and ontological frameworks, supported by a rapid review of the scientific literature on the topic. We discuss elements of the dominant scientific paradigm, which neglects the ontological foundations of science as a socio-historical praxis; the landscape of evidenceinformed policy production in Latin America, its advancements, and its emphasis on methods and techniques; and critical realism as an alternative capable of supporting the social character of science and the existence of an objective reality independent of interpretation. The realization of health as a right served as the guiding objective-image for the discussion. We argue for the necessity of shifting the emphasis from methodological concerns and epistemological disputes to an ontological approach.
Decentralization in the PNAB: expressions of Brazilian conservative liberalism in the political health
This article analyses Brazil’s 2017 National Primary Care Policy (PNAB) within the broader context of democratic erosion. Situated within the liberal paradigm of fiscal austerity, the alterations made to the national primary health care guidelines appear to be designed to weaken the federal government’s capacity to coordinate primary health care policy. The reduction in the Ministry of Health’s (MH) role in establishing national standards reflects an intentional shift towards enhancing municipal autonomy in policy implementation. By mapping the involved stakeholders and political entities, this study examines the implications of the changes introduced since the 2011 PNAB. It is argued that the 2017 PNAB promotes a more restrictive understanding of Primary Health Care (PHC) by creating direct and indirect incentives for the establishment of traditional Basic Care teams, thereby diminishing the role of the Family Health Strategy as a tool for expanding and consolidating PHC across the country. In conclusion, this paper argues that federal oversight of health policy is a crucial political and programmatic factor in advancing the authority of Unified Health System, while a conservative liberal agenda risks undermining democratic principles.
Health as the absence of pain: self-perception and access to dental services for women deprived of their freedom
This study aimed to understand the self-perception of oral health and experience of access to dental services among women deprived of liberty. A study was conducted at the Penitenciária Consuelo Nasser in Aparecida de Goiânia (GO), in which interviews were conducted with 15 participants, and non-participant observation and field diary records were recorded. The data were analyzed using the Thematic Content Analysis technique. The sociodemographic profile of the participants was as follows: young, single mothers without family support and religion, with sentences of less than eight years and drug trafficking as the main reason for imprisonment. Negative self-perception of oral health was observed due to pain, aesthetics, tooth loss, and insufficient access to services. Lack of a primary prison care team, dependence on the male penitentiary, punctual and mutilating care, and lack of regulated access to the Health Care Network were observed. Although they have habitual oral hygiene practices and access to some supplies, they feel abandoned regarding oral health promotion and prevention actions. The inequities found reflect the need to implement dental care services so that women deprived of their liberty have their right to oral health care guaranteed.
The social nature of human health: re-readings of social determination in a historical-territorial key
Since its emergence, public health has been marked by strong disputes over how to understand and intervene in the health processes. The biomedical and multicausal epidemiological perspective have occupied a hegemonic position; however, in the 1970s, the Latin American critical perspective of social determination began to question the ontoepistemological assumptions underlying health interventions and research. This recognition made it possible to move beyond discussions focused on specific diseases or isolated therapeutic developments, fostering a conceptual and political shift toward a collective health approach. Within this framework, efforts to illuminate the interdependence between historicity and territoriality in health, the political intentionality underlying health actions, and the complexity of the health-diseasecare- death processes have converged in what has come to be known as the critical historicalterritorial perspective. This essay examines the onto-epistemological and praxiological disputes within the field of public health, recovers the Latin American tradition of social determination characteristic of collective health, and presents an initial formulation of key categories of the critical historical-territorial perspective as a theoreticalpolitical project committed to emancipatory and transformative praxis.
Construction of the QualiCuidar program: weight stigma-free care for primary health care
Health professionals often reproduce fatphobic attitudes that create barriers to healthcare for people with obesity, especially in Primary Health Care (PHC). Thus, this study aimed to develop and pilot the QualiCuidar program, designed to promote weight stigma–free care practices in PHC. The research followed a mixed quantitative-qualitative approach, encompassing the development of the program, its implementation in two health units, and its evaluation through the application of the Fat Phobia Scale – Short Version and the Beliefs About Obese Persons Scale before and after participation, as well as through focus groups at the end of the program. Thirteen professionals completed the program, with the majority being community health workers (84.6%). Although no significant differences were observed in the scores of the applied scales, participants reported changes in the care provided to people with obesity, highlighting greater empathy, active listening, and welcoming practices. Critical reflections also emerged regarding the need to broaden participation among other professionals and to incorporate the topic into ongoing health education. It is concluded that QualiCuidar demonstrated potential to raise awareness among PHC professionals, reinforcing the importance of continuous and multiprofessional training in tackling fatphobia.
Health Professionals; Primary Health Care; Obesity; Social Stigma; Professional Training
Analysis of the implementation on National Policy of Integral Health for the Black Population based on state and municipal basic information surveys and its relationship with Primary Health Care
This study analyzed the implementation of the National Policy for Comprehensive Health Care for the Black Population (PNSIPN) across Brazilian states and municipalities, examining its association with Primary Health Care (PHC) coverage and the proportion of the Black population using secondary data from the ESTADIC-MUNIC survey (2021). In the state-level analysis, K-means cluster analysis was used to identify implementation profiles. At the municipal level, a fractional logit regression model suitable for proportional outcomes was applied, incorporating all explanatory variables simultaneously. The findings revealed significant regional disparities, with states exhibiting varied combinations of PHC coverage, Black population proportions, and policy implementation levels. At the municipal level, both health plans showed low institutionalization of the PNSIPN. Greater PHC coverage was associated with lower levels of policy implementation, regardless of the proportion of the Black population. The PNSIPN remains weakly institutionalized at both state and municipal levels, with actions concentrated in a limited number of territories. A notable gap persists between normative commitments, such as plans and councils, and the effective implementation of actions aimed at racial equity. While PHC expansion may support PNSIPN implementation, structural barriers continue to hinder sustained progress, particularly in areas with a higher proportion of Black residents.
Public Nondiscrimination Policies; Black Population; Organization and Administration; State Health Plans; Brazil.