Critical Epidemiology in Latin America: Roots, Philosophical and Methodological Ruptures

Abstract

Epidemiology as any other scientific work dealing with social and human wellbeing runs under great social pressure. Its conceptual and practical tools have developed in concrete historical conditions facing evident social inequity. In recent times, neoliberal economic acceleration, through the ongoing fourth industrial revolution, has globalized massive unhealthy processes and expanded economic and political influences.

In Latin America critical epidemiology evolved from the early 1970s social medicine movement. However limited by its subordinate position with respect to mainstream medicine, this insurgent academic position grew as a counteractive intellectual and political tradition that based its initial impulse on epistemological clarity and activism. Contrary to the linear functionalist thinking of conventional medical science—that separates the understanding of health conditions from their social and cultural contexts—critical social medicine broke away from that positivist framework.

This chapter discusses the historical roots, epistemological and methodological ruptures of critical epidemiology. It describes the formation of the social determination of health paradigm of dialectical, complex, critical thinking with its potential for an emancipatory perspective of health reform. In the same breath, it presents a sound critique of the “knowledge illusion” of linear, reductionist causal thinking, while assuming transformative science as the reference for an integral scientific objectiveness that confronts and redefines the traditional notion of objectivity and recovers the active transforming role of the subject in science. It proposes complex thinking to decipher the real requisites of rigorous epidemiology, which does not only depend on the accuracy, reliability and validity of its empirical methods, calculations and observations but on a rigorous and multidimensional/complex/transdisciplinary/intercultural understanding of society and health.

I should like to express my grateful thanks to Michael Harvey (Professor at the University of California) and Maria Cristina Breilh for their rigorous and generous support in the translation of some of my original texts in Spanish the conceptual explanation and synthesis of recent works being prepared in English. Their contribution was decisive for the preparation of this chapter’s original English version.