The contemporary asymmetrical world-system, reproducing a Center-Periphery order with dehumanizing acceleration through globalization, is the result of a complex process that, in the Latin American and Caribbean region, is linked to the very historical constitution of the Americas and to capitalism in its transitions between colonial, modern/Eurocentric, developmentalist, liquid, and neoliberal (Mignolo and Walsh, 2002) as a power structure that increasingly leaves less room for health and well-being. Undoubtedly, the international and regional SARS-CoV-2 epidemiological crisis fully activated a set of mechanisms embedded in the genetic matrix of the contemporary world-system in Latin America and the Caribbean: both in its biomedicalized and public health approaches, and from the perspective of Pan-American health doctrine and global health. This global SARS-CoV-2 epidemiological crisis revealed a set of international determinants of health that became more visible than ever for the Global South. The spread and reproduction of what is conceptualized as international determinants in health stems from understanding the complexity of intertwined conditions and adversities at multiple levels inherent to the contemporary world system for the specificity of Latin America and the Caribbean as a space of globally peripheral capitalism:

- The acceleration of extractive financialization in global capitalism, with the expansion of development sacrifice zones in territories in the Global South; extreme weather events and socio-environmental crises that impact new epidemiological crises

- The polarization of processes of de-citizenization through commodification and dispossession of public goods for life and their impacts on collective health,

- Dependence on geopolitical agendas and technocratic agendas of liberal global health and Pan-American health;

- The place of peripheral buyers to the pharmaceutical industrial medical complex in the new international division of trade and finance;

- The universal reproduction patterns of matrices for coping with health emergencies (e.g., empirical quarantines, neo-hygienism, biomedicalization);

- The geopolitics of global health security and the growing militarization in the face of epidemiological threats to the Global North.

- The importation of theories and policies on health systems in both the 20th and 21st centuries

- The Geopolitics of the Society-Nature Metabolism in the general dimension of the production of new epidemiological crises such as the case of SARS-CoV-2

- The Geopolitics of Health “isms” in the Region: Developmentalism, Pan-Americanism, and Neoliberalism

Conducting a systematic review of the dimensions of health as an international and colonial issue, examining how global geopolitics determines the political and health agenda, and how health in the Global South is conditioned by the relations of the current world-system (Wallerstein, 2005), requires first exploring the genealogy of two prominent and recurring frameworks that serve as disciplinary and structuring axes for reflections, theories, methodologies, agendas, and political actions: what is recognized as Pan-American International Health (PIH) and liberal global health (LGH). Immediately afterward, we delve into the genealogy and historical development of international public health (Cueto, 2015), expressed today as Pan-American health and its postmodern continuum of current global health (Birn, 2011). This immerses us, in a way, in the heart of colonial rationale and relations, and its old-new languages ​​as conduits of reproduction and power relations in the field of international health. These designations are not simply devices of two models of approach and historical, conceptual and methodological understanding of health, or of geopolitics of power and health knowledge (Quijano, 1999),

Neither the Intergovernmental Science-Policy Platform (ISP) nor the Global Society of Health (GSH) are strictly geographical metaphors, nor do they represent the forms that health takes beyond borders and in the relationship between nation-states. Rather, both are instruments of geopolitical power that crystallize, represent, and reproduce relationships between global power blocs and perpetuate their epistemologies in the field of health and life sciences. These ISP and GSH mechanisms have succeeded in producing and shaping Latin American and Caribbean health diplomacy, negating the health knowledge systems of Abya Yala and Greater Africa, colonizing academic programs and professional profiles in universities and schools of public health as health training institutions, and in shaping the know-how of public health government managers themselves as permanent reproducers and administrators of theories, policies, logics, agendas, and pre-packaged approaches that express and cement the geopolitical health interests of the Global North. The agenda, geopolitics, and actions of liberal global health, the regional Pan-American doctrine, and their Latin American and Caribbean impacts at the national and local levels have implications for this intrinsic character of health dependence, which generates a homogenization of "unique" paths and a limited understanding of the specificity and international determinations of health situated in the Global South.

The complex political landscape involving global core states, philanthropic foundations, pharmaceutical companies, and financial and trade organizations such as the World Bank, OECD, WTO, and IMF, along with NGOs (Non-Governmental Organizations of the Global North), became central actors in a new global health agenda. In this new agenda, non-healthcare organizations, in particular, assumed a leading role in shaping health reforms, policies, and agendas, alongside the WHO (Ugalde & Homedes, 2007). Five key processes, consolidated with the rise of liberal global health, stand out. These processes are defined not by their laudable pronouncements, but by the global agendas, policies, and actions they operationalize:

1. Radical social reforms to the State and sectoral reforms to health systems of a neoliberal nature based on the theories of structured market pluralism of financial coverage and the social management of individual risk.

2. The subordination of public health to market demands, that is, the commodification of health and life and the residual role of the State. This was termed Essential Public Health Functions (EPHF) with the convergence of complementary agendas between the WHO (PAHO), the World Bank, and corporations.

3. The consolidation of the medical-industrial-pharmaceutical-financial complex and transnational corporations (including a nascent health philanthrocapitalism) as hegemonic actors with a structuring role in the global health agenda (Birn & Richter, 2018)

4. The emergence of new global health diplomacies and technocracies that, when acting and intervening in this international geopolitics of development, including those in Latin America and the Caribbean, are implementers, operationalizers, and executors of agendas based on supposed "consensus" on global health and Central-Northern international cooperation

5. The growing link between health and national security stemming from the imposition of "global health security" as a way of understanding, preparing for and responding to global epidemiological crises.

How can we break free from this global and regional geopolitical dynamic of reproducing coloniality, theoretical and methodological dependence, public policy, and governance in the field of health in the 21st century? This Working Group assumes that a first exercise in epistemic-theoretical deconstruction is essential, which implies the need to decolonize health, a decolonial turn from which to build strategies for regional health sovereignty.

In the contemporary global and regional context described above, the epistemological foundations of health have tended to swing between the reproduction of a constant coloniality of power and health knowledge (Quijano, 1999), causing the historical cycles of international health and public health policies to move through accumulated imported theories, policies, and methodologies in a permanent dynamic of imitation or, at best, adaptation of theses according to the Global North. Each episteme produced sedimentations, geocultural accumulations, and institutional condensations in the health field—in academia, in states, and in societies themselves—throughout the 20th and 21st centuries in Latin America.

The Working Group on International Health and Health Sovereignty arose from the need to create a new regional platform for training, study, research, critical thinking, and geopolitical action based on an epistemology of health from the Global South (Basile, 2022). This platform prioritizes the integration and interrelation of social sciences applied to the field of health, the convergence of Latin American social theory, complexity theory, and feminist and decolonial perspectives, in order to rethink the paradigm and categorical framework of critical health theory and critical epidemiology. This critical epidemiology is currently embodied in diverse health expressions such as collective health, the ecology of intercultural knowledges of Abya Yala, and 21st-century Latin American critical health thought. The group seeks to foster an intergenerational, polyphonic, intercultural, and transdisciplinary dialogue within the field.

Since its inception in 2016, the SISS Working Group has proposed to examine the field of Health from the Global South and Health Sovereignty in our region, the foundations of the decolonial turn in health and the construction of flows of autonomy towards a regional health sovereignty strategy, to make visible the geopolitics of actors and global agendas in the production of health dependency, the international determinations that impact collective health in the Global South, the need to decolonize theories and policies for the refounding of health systems, analyses based on critical epidemiology, migrations and cross-border cooperation in health, comparative study of public health emergencies and epidemiological crises, critical geography, territory and health, the intersections between decolonial feminisms, racism and collective health, health colonialism and racist epidemiology in Africa and Latin America, geopolitics and the international cooperation system in health in the 21st century. The different theoretical and methodological frameworks are investigated, and the dominant hegemonic matrices and the construction of an alternative epistemic-political-ethical option from a Health from the South and Health Sovereignty (SISS) are discussed epistemologically. The SISS is considered a field of knowledge, governance management and geopolitical action, which in addition to studying and working on the dimensions for the deconstruction of the dominant matrix, is also considered essential to base approaches of an epistemological search for a new Health from the South with the aim of producing a new framework between emancipation, autonomy and sovereignty in the health field. The SISS's founding objective is to promote the construction of a decolonial shift and health sovereignty for Latin America and the Caribbean. To approach providing an explanatory framework and understanding for political-health action that calls for rethinking and asking: how to identify what the field of health in Latin America and the Caribbean needs to be decolonized from? Which would imply asking: What is the colonial problem in Pan-American/liberal global health, clinical biomedicine and functional public health? To a large extent, these questions were addressed, characterized and studied in the first stage of the CLACSO Working Group 2016-2019 and a new theoretical categorical framework was produced from 2019-2022 onwards. In this third stage, we seek to delve deeper into the new categorical, epistemic and methodological framework of the SISS proposal, together with the consolidation of regional and international networks also at the national level of each territory and territoriality, the dissemination and diffusion along with critical training with government managers and social movements and the final phase of consolidating the CLACSO Network as a key actor in the field of international health, management, policies and critical health thinking at the regional level. Undoubtedly, the path that Latin America and the Caribbean still owes itself is to deepen the study, political-health training and construction of a geopolitical thought-action of regional health sovereignty.

Health sovereignty is a regional strategy of flows and movements across different spatial levels. It combines and complements Dos Santos's (2020) dependency theory with Helio Jaguaribe's (1979; 1986) theory of autonomy, addressing the challenges of the 21st century. This approach seeks to maximize capacities and spaces of autonomy in political and health decision-making within the prevailing global context. Countering dominant hegemonic theoretical and practical logics is perhaps a crucial premise for developing genuine frameworks for understanding, strategic thinking, and management practices for policies, goals, and emancipatory paths based on the actors themselves, their specific problems, and the voices of the Global South. This gives rise to four key flows and movements of learning and intellectual cohesion in the field (Basile and Feo, 2022):

First, to problematize, study, understand and deconstruct the conditions, adversities, dependencies for health from the South in a decolonial theoretical-conceptual and technical-methodological key at the territorial, local, national and regional level.

Second, to make visible those sanitary dependencies and satellites, their diplomatic forms, their governmental, technical and academic forms, their mechanisms of reproduction and perpetuation in management and government, in public policy, in academia and in the territories.

Third, to deepen the theoretical and technical-political bases for the construction of spaces of regional territorial autonomy that is defined as a strategy of regional health sovereignty.

Finally, pooling regional health strategies from the South also means breaking free from the domestication that the "South South" suffered due to the health agenda of the global North.

"Moving towards regional integration for health sovereignty means combining a concentric territorialization of flows to give rise to the possibility and potential of new agendas, priorities and territorial, community, management and governance and academic practices of Health from and for the South."

The SISS is based on four ruptures, which in practice is the creation of four know-how processes:

Epistemic;

Geopolitics of power and health knowledge;

? Of new systems and categorical frameworks;

? On action and ethics in health policy

Repositioning the construction of public networks of health sovereignty and an epistemology of health from the South at the center of the Latin American and Caribbean region is not solely concerned with and dependent on intergovernmental relations during periods of state governance. Rather, it is a strategic process embedded in the networks of territories, territorialities, societies, communities, social movements, academia, management experiences, and other actors involved in building an epistemology of health from the South. Adopting the foundations of Latin American critical thought, with its proposal of epistemologies of the South (De Sousa Santos, 2011), implies a geopolitically situated epistemic subject of health in the South.