There is an urgent need at the academic, political-health, management and government levels, as well as among popular actors, for a process of consolidating a new epistemology of Health from the South that moves in flows and movements not only of decolonization but also based on a need for updating and alternative epistemic, theoretical-conceptual, technical-practical and methodological approaches in how we think and do public health, epidemiology, health policies and systems, and international health in the South, confronting the conditioning factors, adversities, dependencies and coloniality that are also reproduced in the field of health.

The complex contexts of the present, marked by the crisis in the West and the naturalized dependencies on the agendas of liberal global health governance, characterize the epistemologies and geopolitics of hegemonic health currents arising from modern scientific thought on health in the Global North—including Eurocentric medical-social critiques—which maintain a colonial substratum in thinking about and practicing health in Latin America and the Caribbean. This substratum of coloniality is expressed in the assimilated understanding of health from the perspective of modern societies in global centers and their social relations, based on a Eurocentric and Pan-American worldview, and in their aim to transform these relations using universal references that are considered recipes to be copied in the image and likeness of societies in the Global North.

Briefly characterizing what we know as the intertwined mechanisms of modern scientific thought and their implications and impacts on research, training and higher education, public health policies, and the global and regional geopolitics of health as a colonial and international issue (Basile, 2025) is key to understanding our dependencies, constraints, and the keys to decolonization and the need for epistemic alternatives for knowing how to practice health from the Global South. These mechanisms are articulated, interconnected, and operate as links in a system of knowledge that we identify in public health, epidemiology, (bio)medicine, and the policies of Western modernity and postmodernity, which are still reproduced with epistemic scientific blindness that presents itself as unique, universal truths. Even this Eurocentric modern scientific thought in health harbors diverse currents and accumulated expressions of theories, paradigms, and geopolitics within it (Basile, 2024a).

- From health as a colonial issue to Pan-American health in our region,

-From tropical medicine to clinical biomedicine for the repair of pathophysiological damage through individual medical care,

- Hygienism and medical policing in Eurocentric/Latin American social medicine

- From Anglo-Saxon preventive medicine to Anglo-Saxon community health

- From the new neoliberal public health to contemporary (liberal) global health

In short, this crystallizes and explains the accumulated dominance in the region, still present among the mechanisms of colonial tropical medicine and clinical biomedicine focused on care and treatment; from functionalist public health to Eurocentric social medicine; from Eurocentric and Anglo-Saxon social epidemiology to the study of vulnerabilities based on skin color and/or gender, eco-epidemiology or genetic epidemiology, and the geopolitics of the Pan-American doctrine of health and liberal global health. In short, these intertwined and accumulated epistemologies still dominate the world of academia, management and governance, schools of public health, the social sciences in health, and the very theoretical, political, and practical framework of research in our Abya Yala region.

In turn, understanding international health determinants involves acknowledging the complexity of intertwined conditions and adversities at multiple levels inherent to the contemporary world system, particularly in 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 South and the geopolitics of a Society-Nature Metabolism; with the production of extreme weather events and socio-environmental crises that impact new epidemiological crises, public health emergencies, unhealthy eating patterns, and new pathogenic leaps (SARS-Cov-2, Ebola, etc.).

- The polarization of de-citizenization processes through commodification and dispossession of public goods for life and their impacts on communities and collective ways of life in polarized Latin American and Caribbean cities and urban contexts,

- The place of peripheral dependent buyers to the pharmaceutical-industrial medical complex in the new international division of trade and finance; as well as the dynamics of national pharmaceutical complexes that also reproduce the commodification of health,

- The importation of Eurocentric Pan-American theories and policies into our health system responses in both the 20th and 21st centuries

- The Geopolitics of health “isms” in the region: developmentalism, Pan-Americanism and neoliberalism with two reference frameworks that appear as backbones of dependencies in the theories, methodologies, agendas and political actions of health: what is recognized as Pan-American public health or Pan-American healthism and liberal global health (LGH).

- The radical shocks of state reforms and sectoral reforms to health systems of a neoliberal nature, based on theories of structured pluralism, which built markets for financial coverage in health (they call it "universal health"), coverage systems, and the social management of individual risk, shaped and continue to be reproduced in our academies, management, and government.

- 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, the IDB, and corporations.

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

- The emergence of new global health diplomacies and technocracies that, when acting and intervening in this geopolitics of Center-Periphery Development, including Latin American and Caribbean ones, are implementers, operationalizers, and executors of the agendas of supposed "consensus" on global health and the international cooperation system of the Center-North

- The growing link between health and national security stems from the imposition of "global health security" as a framework for understanding, preparing for, and responding to global epidemiological crises, and from the biomedicalization and securitization of migration and borders. Currently, the One Health geopolitical agenda has emerged as a continuation of the health security agenda in the face of epidemiological crises, employing the same actors, epistemologies, and responses from the Global North.

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

Currently, CLACSO has become a leading Latin American and Caribbean organization in innovative critical thinking on health, grounded in a geopolitical approach to thought and action situated in the Global South. Today, "CLACSO International Health" is both an academic network and a robust regional platform that fosters the production of critical thought and research on health through various publication channels, technical and political support for governments of the Global South, academic chairs and spaces for reciprocal work with social movements for health sovereignty, a consolidated continuing education and postgraduate program, and an active network of dissemination and annual action in 22 countries, with 13 national centers and 22 national study groups in academic and social institutions across the region. Reviewing CLACSO's annual agenda on International Health and Health Sovereignty highlights the epistemic, theoretical, operational, and intellectual relevance of the contributions and trajectories of critical health thinking from the Global South.

Updating, reconfiguring, and revising critical thinking on health and health sovereignty with a new categorical framework constructed from the Global South (Basile, 2025) is a first contribution not only to understanding health as a complex sociocultural process historically determined by the flows of the contemporary world system in its accumulated and intersecting colonial, racial, and capitalist legacies in its various phases, from the Center-Periphery geopolitics and the Community-Nature metabolism, but also to reintroducing uncomfortable questions about how to produce territories and territorialities of comprehensive and intercultural health care (Feo and Basile, 2024), how to generate geopolitics of regional autonomies and spaces of health sovereignty in adverse global contexts (Basile, 2023), critical studies for the refounding of health policies and systems for the 21st century (Basile, 2024a), the contributions of decolonial, Black, and community feminisms to health from the Global South, and intersectional responses for the health and life care as denaturalizing racism as a public health problem and an epidemiology of racialization in our regional territories (Santos Madrigal, 2024).

It is a situated critical thinking: the South as a vital coordinate

Latin American and Caribbean critical thought on health is an original recombination of pre-existing trajectories and ideas, with new contributions, articulations, revisions, and exercises in thinking about and practicing health from the Global South for the 21st century. Alternative epistemologies are knowledge that arises from the peripheries, from the margins, from below; that comes from the Global South, and that produces a critique of modern colonial knowledge within the very power relations involved in it.

This critical thinking in health from the Global South is consolidating itself as a critical decolonial scientific field and practice through multiple articulations and intersections with critical theories in the social and health sciences, but with the foundational incorporation of the epistemic encounter with Latin American and Caribbean critical thought and the philosophies of the Global South (Dussel, 2016). It remains open to incorporating innovative proposals and drawing on the knowledge systems of the epistemologies of living well/good living in Abya Yala, recognizing the existence of multiple geocultural frameworks and political-health currents from which to articulate this exercise and practice.

These brief introductory reflections allow us to characterize the current challenges and implications of critical health thinking in the transition of the 21st century (Basile, 2024a; 2022):

Decolonize the health theories, policies, and practices of the modern colonial episteme.

? To deepen the complexity and transdisciplinarity in health.

? To recognize and understand the epistemologies of Living Well/Good Living without trivializing them.

? To understand and apply critical thinking and geopolitics of Health from the South.

? To produce situated knowledge for liberation (Dussel, 2016, 2020).

? To assume territorial and sociocultural commitment and involvement for health sovereignty.

Re-establishing a critical practice in public health, epidemiology, and in the broader field of social sciences of health and life is part of a set of practices that promote, at the same historical time and at different scales of intervention:

? from regional health sovereignty, as a strategy on global conditioning processes (international and regional determinations of health);

At the same time, it also encompasses an interconnected set of technical, methodological, and political-health practices developed in academia, in health organizations and systems, in management and governance, in research institutions, as well as, of course, in popular movements and territories, linked with new articulations and key contributions that support a vitality of critical thinking in health from the South for the 21st century.

It is a starting point for thinking about a critical science in health, externalized from this scientific modernity of Western civilization that is in crisis within itself, but which seeks to maintain its assumptions of universality, of a supposed globalized "single scientific community".

Critical health thinking from the South as an epistemic, geopolitical, knowledge field, practical application and health action requires several specificities in its scales of observation and temporality as well as in the units of analysis in use to precisely respond to the complex epidemiological, socio-environmental and political-health contexts in and for Latin America and the Caribbean (Santos, 2024, Feo Isturiz et al, 2023).

Thinking about health from the South can have four starting points as major flows and ruptures (Bautista, 2014):

1. Epistemic flow. The decolonial turn and decolonization in the field of health.

2. Geopolitical flow. The health sovereignty strategy.

3. Flow of the categorical framework. Why does a Health from the South require new categories?

4. Ethical and political flow of innovative health action. To produce practices that not only involve resistance or systematic criticism or the production of counter-hegemony, but also alternatives.

Multiple Latin American and Caribbean study, work, and critical knowledge production groups in health are proposing new intersections of study and action:

Health from the South and the Health Sovereignty strategy.

New management and governance technologies for health sovereignty.

Critical Studies for the Refounding of Health Systems, Political Economy in Health and its Determinants.

Comprehensive and intercultural healthcare and well-being.

Socio-environmental health and epidemiology of extractivism.

Epidemiology and critical geography,

Decolonial, Black, and community feminisms for intersectional monitoring of health and community life.

In contrast to the civilizational project of scientific thought of extractivist, patriarchal, colonial and technocratic modernity of global health and medical-social Pan-Americanism, critical thinking in Health from the South proposes an ethical-political horizon based on integral and intercultural care under the coordinates of communality, reciprocity and the regeneration of collective life and its singularities, assuming the challenges of current virtual-digital life.

Seeking to reinvent political and health education within the framework of a Latin American and Caribbean critical health thought from the Global South. This movement arises from a theoretical, methodological, and practical need to address the crossroads and bifurcations of our health sovereignty.