The Joaquim Venâncio Polytechnic School of Health (EPSJV/Fiocruz) held, on April 8, an open class for the Specialization courses in Health Policy, Planning and Management, dedicated to discussing the social determination of health and the contributions of Latin American Social Medicine. The event featured the participation of Venezuelan public health physician Oscar Feo, a professor and researcher with experience in several countries across Latin America and the Caribbean.

At the beginning of his presentation, Oscar highlighted two paradigms that, according to him, have been in conflict worldwide: “One, modern scientific thinking, which in health is expressed through the hegemonic biomedical model that dominates science and society and reproduces its power relations; and another, critical thinking, emerging, which seeks to transform these relationships.”

For the researcher, critical thinking is precisely what questions how knowledge is produced and transmitted in society, challenging hegemonic and colonial thought. “It analyzes the reality of the world, in any social field, from a position committed to the defense of humanity and life, seeking to understand the world in order to transform it, and working toward building a society of justice, freedom, and peace,” he explained, adding a contrast: “Modern scientific thinking, which dominates society, is Eurocentric, disregards contributions from other cultures; establishes hierarchical systems based on class, race, and gender in a racist and patriarchal way; and places the individual above the collective, with competition and individual well-being as its guiding principles.”

As he deepened the discussion, Oscar emphasized that in the field of health, “different ways of understanding and practicing science coexist,” but one of them has become dominant over time. According to him, this is a model centered on disease as a biological and individual phenomenon, which “focuses on the market and has the hospital as its main space of action.”

In contrast, the public health expert presented the critical perspective, linked to the tradition of Latin American Social Medicine and Brazilian collective health, which understands health and the population’s living conditions as socially determined processes. Within this approach, he explained, health is conceived as a right that must be guaranteed by the State, with broad social participation.

When addressing the social determination of health, Oscar stated that it is a central category of critical thinking, as it breaks with the idea that health and disease are exclusively biological. “The health-disease process is not only biological, but above all socially and historically determined,” he stressed, adding that “the causes of the deterioration of health lie in the way each society is organized, with harmful effects of capitalism on the social reproduction of life.”

Despite its historical development and its fundamental role in Health Reforms in Brazil and across Latin America, he warned that this perspective has been weakened within public policy. In his view, social determination “remains hidden,” often reduced to isolated factors. He explained that these elements do appear in official public health discourse, “but end up being converted into traditional risk factors,” without questioning the social structures that produce inequalities, as proposed by the social determinants model.

The researcher also highlighted Brazil’s role in this debate, recalling that the Health Reform of the 1980s represented a decisive contribution to the transition from medical-social thinking to collective health. He summarized this process with a statement that became the motto of the 8th National Health Conference (in 1986): “health is democracy, and democracy is health.” In this context, he mentioned the creation of the Unified Health System (SUS), structured around the principles of universality, comprehensiveness, equity, and social determination, as a concrete example of this expanded perspective on health.

Concluding with the practical implications of this approach, the public health expert advocated for the development of universal and intercultural health systems, organized around territories. According to him, the focus should be on ways of life and on structuring policies that “protect health,” rather than only on services or institutions. “It is about moving toward comprehensive care for health and life,” he concluded, highlighting the social determination of health and critical epidemiology as key theoretical and epistemological frameworks in this path.