Social determination of health, complexity, coloniality, and the long term

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.

Keywords:
Social Determination of Health; Decoloniality; Epistemology