This Working Group shares a critical perspective that integrates Latin American Social Medicine/Collective Health approaches to study and understand health and illness processes, their distribution, and the policies that shape social responses from the State or communities. It examines the impact of current industrial and predatory neoliberal societies on health and its social determinants in our countries, as well as on the environment and the transformation of territories, resources, and their inhabitants. Actions promoted by the far right have broad consequences for the role of the State in guaranteeing fundamental human rights and for living conditions, health, work, and the environment.

In the context of inequality and inequity characteristic of Latin America and the Caribbean, we are experiencing a wave of different crises: health, political, economic, and climate, which are exacerbated by the advances of the far right. Sovereignty, democracy, and hard-won rights are at risk and challenge critical thinking in health and transformative practice.

The right to health in Latin America and the Caribbean is at a crossroads due to a regional context marked by historical inequalities, democratic fragility, cycles of neoliberal reforms, and the reconfiguration of capitalism and imperialism. States and traditional democratic mechanisms have shown a chronic inability to improve living conditions and transform underfunded, privatized, segmented, and fragmented health systems. This situation is exacerbated by the rise of neofascism, where inequality deepens, privatization is consolidated, and democracy is eroded. In this context, the Working Group will focus on the following areas:

Theme 1: Sovereignty, Democracy, and Guarantee of the Right to Health. This theme seeks to analyze the interrelationship between sovereignty, democracy, and the guarantee of the right to health in the region. The struggle for health, life, and equality centers on the debate over the model of the State and democracy. To strengthen sovereignty and public capacity, it is necessary to recover democratic legitimacy and confront historical inequalities, which demands a new generation of universal and intersectoral health policies.

To achieve a new democracy oriented toward the common good, states and their people must attain sovereignty, strategic autonomy, and power. This implies the capacity to prioritize collective health needs, regulate the market, deprivatize and decolonize health systems, and establish partnerships with the Global South for the production of essential goods (from medicines to infrastructure). This objective becomes critical in the context of accelerated digitalization and technological change. The possibilities for the right to health depend directly on the capacity of social organizations and movements to halt the advance of neofascism and imperialism, and to promote national, democratic, and sovereign projects where health is central.

Theme 2: Social Protection Models and Health Systems in Latin America and the Caribbean in the Face of the Rise of the Far Right. Health policies are a cornerstone of social protection models. While universal health systems are characterized by the predominance of public providers, financing through general taxes, and strong state regulatory capacity, achieving greater efficiency and universal access, in Latin America and the Caribbean, social protection models have fluctuated and depended on political circumstances and the capacity for social mobilization. Historically, not all countries have integrated health into social security institutions, which affects coverage and the scope of social welfare.

Currently, this oscillation is being hampered by the impact of the far right, with governments like those of Millei, Bukele, and Bolsonaro, which are prototypical of minimizing the role of the state and undermining social rights for vulnerable groups. These governments are characterized by exacerbating crime and promoting repressive policies, along with hate speech against opponents. The central themes for analysis in this area are: 1) social protection models and health systems prior to the far-right wave; 2) public policies that promote the erosion of the right to health; and 3) the hegemonic conservative discourse on health and the correlation of political forces.

Axis 3: Gender Inequalities, Sexual and Reproductive Health, and Sexual Diversity. This axis seeks to update knowledge on issues related to sexual diversity, gender inequalities, and sexual and reproductive health. Abortion is central to understanding the relationships between gender, power, and health, having gone through cycles of restriction and liberalization framed by disputes between conservative sectors, feminist movements, and liberal constitutionalism.

Five countries in the region (El Salvador, Honduras, Nicaragua, Haiti, and the Dominican Republic) maintain a total ban on abortion, which denies safe access and increases maternal morbidity and mortality, as well as criminalization. Furthermore, in the region, 80% of sexual assaults against girls and adolescents occur between the ages of 10 and 14, making them vulnerable to forced pregnancies. In the contemporary context, the political and ideological agenda of the new far-right governments confronts advances in sexual and reproductive health and gender identity, promoting normative regressions that threaten hard-won rights. Issues to be addressed include inequities in access to the right to abortion, freely chosen motherhood, affirmative action, and gender identity recognition for transgender people.

Axis 4: Climate, Work, and Migration, Considering the Territory in its Multidimensionalities. This axis proposes an integrated study of climate, work, and migration, based on the complexity of the social determinants of health in the face of intense transformations. Work, production, and environmental processes are intertwined with the effects of the Anthropocene (biodiversity loss, water risks, pandemics). These phenomena cause material damage, food insecurity, and forced displacement of large populations, affecting Latin American and Caribbean countries with varying vulnerabilities and adaptive capacities.

In the region, political instability, internal conflicts, and social problems have intensified a South-South migration process, forcing people to seek better living conditions and protection in neighboring countries. Understanding these migration flows, internal policies, and the living conditions of these groups is fundamental to fostering solidarity-based integration and addressing social inequalities. Furthermore, it is crucial to analyze climate change denial and its repercussions on environmental health, as well as the deterioration of working conditions due to rapid technological development, which has generated processes of uberization, platformization, robotization, and Artificial Intelligence, deepening the precarity of work and affecting the health of various communities.

Latin American Social Medicine/Collective Health (MSL/SC), in its role as a field of critical production, establishes itself as a fundamental intellectual and political project for understanding and transforming contexts of structural inequality. Its theoretical foundation rests on historical materialism, which allows it to define the health/illness process as an emergent social and historical expression. These processes are determined on the socio-economic plane and manifest themselves in concrete forms of illness and death among human groups according to their structural context. This complex process not only generates suffering and pain but also stimulates the organization of struggles within the framework of the confrontation of social interests. The theoretical and intellectual relevance of MSL/SC lies in its capacity to offer a profound and structural critique of the biomedical model and healthcare capitalism, while simultaneously strengthening its analytical framework through its articulation with other approaches and disciplines. The MSL/SC incorporates: 1. Sociological and Philosophical Contributions: It integrates social constructivism, Bourdieu's contributions on habitus, field, and capital (key to understanding how inequalities are symbolically and structurally reproduced in bodies and territories), and Foucault's reflections on power (including medical power), the modern state, governmentality, and technologies of surveillance and control. These latter elements broaden the understanding of population regulation and the production of subjectivities. 2. Its Own Theoretical Paths: The development of the integrated notion of health-illness-care, critical epidemiology, and sociocultural epidemiology, all with a clear emphasis on inequalities and oppressions. 3. Decolonial and Intersectional Thinking: The MSL/SC directly challenges the coloniality of knowledge, power, and being, recovering the legacy of thinkers such as Fanon and Quijano, as well as the contributions of regional feminisms (such as Lugones, Segato, Curiel, and Guzmán). This critical thinking demonstrates that structural racism, patriarchy, and class inequalities operate simultaneously in the production of illness. In accordance with intersectionality, social determinants integrate gender, race/ethnicity, class, generation, territory, and body as inseparable dimensions of health processes.

The social relevance of this field adds to the emancipatory practices. In addition to diagnosing structural inequalities, MSL/SC recognizes and values ​​the multiplicity of situated knowledge and wisdom that are essential to understanding and transforming ways of living, caring, getting sick and dying. The GT ESS production articulates critical analyses, which seek to expand the frontiers of knowledge and strengthen emancipatory practices in health. The theoretical formulation on health in Latin America and the Caribbean (LAC) must incorporate the profound influences of the contemporary political, economic and social context. I. Geopolitics, Fossil Capitalism and Ecological Crisis The current geopolitical scenario and projections until the middle of the 21st century define the context of health in LAC. One of the biggest structural challenges is the global ecological crisis, conceptually framed as the Anthropocene or, more critically, the Capitalocene. The Capitalocene implies a critique of the economics of climate change, being intrinsically linked to fossil capitalism and the systemic crisis. Environmental collapse and ecocide are direct consequences of this accumulation model. These changes have direct impacts on health, as evidenced by the situation of riverine life in the Amazon, where "hybrids" are activated in the context of the Anthropocene. Furthermore, the emergence of issues such as "green colonialism" demonstrates how environmental geopolitics affects social ecosystems in the region. II. Inequality and Social Security In Latin America and the Caribbean, social protection models have been subject to political and electoral circumstances, to the governments in power and to the capacity for social mobilization, with partial progress and particular experiences observed in some countries, or in some areas of social protection. Furthermore, we know that not all LAC countries have historically integrated health into Social Security institutions, which establishes differences in coverage and the scope of their systemic conception. Social security systems are directly associated with the social welfare system implemented in societies and depend on the development model of each country, as well as the role assigned to the State or the market, which will have a greater or lesser impact on the commodification of social benefits. Social and economic inequality is a crucial determinant of health, centered on the pursuit of social justice, which encompasses redistribution, recognition, and participation. In this economic scenario of high inequality, income transfer policies assume a vital role in mitigating vulnerabilities. Conditional cash transfers (CCTs), such as the Bolsa Família program in Brazil, have demonstrated significant effects, including their association with reduced suicide incidence, maternal mortality, improved birth weight outcomes, and HIV/AIDS incidence. Despite advances in social policies, geopolitical and economic tension persists between maintaining universal public systems and expanding private health insurance in Latin America and the Caribbean.

III. Patriarchy and the Challenges of Gender and Reproductive Rights

The contemporary social context in Latin America and the Caribbean (LAC) is deeply marked by gender structures and patriarchy, which manifests itself through the mandate of violence and coloniality. The category of gender, useful for historical analysis, must be combined with intersectionality (race, gender, and other factors) to understand the prevalence of mental health problems, such as common mental disorders in the region. Beyond paid work, unpaid and care work, predominantly performed by women, is negatively associated with mental health. Violence against women is a phenomenon of global scope and magnitude that exacerbates the health situation.

In the area of ​​sexual and reproductive rights, the criminalization of abortion is explicitly categorized as a violation of women's human rights. This is a critical issue, as five countries in Latin America and the Caribbean (El Salvador, Haiti, Honduras, Nicaragua, the Dominican Republic, and Suriname) prohibit abortion under any circumstances. The prevalence of unsafe abortion contributes significantly to maternal mortality. Historically, the debate on family planning has been a political struggle, with the demand for freedom of conception.

IV. Climate Change, Migration, Refuge and Vulnerability

Studying climate, labor, and migration issues in an integrated manner, considering the territory in its multidimensionality, is justified by the complexity of the social determinants of health in times of intense transformation, where production, labor, and environmental processes are intertwined with those of social reproduction. In Latin America and the Caribbean (LAC), climate, economic, and social problems, internal conflicts, and political instability have forced people to leave their countries of origin in search of protection, work, and better living conditions in neighboring countries, characterizing an intensified South-South migration process. The health of migrants and refugees is intrinsically linked to global health and human rights. Immigrants and refugees face considerable vulnerability, and addressing their health requires upholding the principles of equality and equity.