Report of experiences from a study group.

Critical epidemiology and the health of peoples by Jaime Breilh

Abstract

Between September 22 and October 20, 2025, we held a study group at the Faculty of Medicine of the University of São Paulo, within the scope of the Graduate Program in Collective Health, focused on reading and discussing the book Critical Epidemiology and the Health of Peoples: An Ethical and Courageous Science in a Diseased Civilization by Jaime Breilh (2024). The purpose of this paper is to present an account of the experiences, learnings, reflections, and exchanges that occurred during the period in which the activities took place.

The idea for creating the group arose during the organization of the 13th Student Symposium of the Graduate Program in Collective Health at our university, which featured Jaime Breilh as its main speaker and whose work provided both the title and the inspiration for this year’s theme. Within this context, the study group was born. Coordinated by a faculty member from the program but directed and conducted by students, we dedicated a month to studying the concepts and critiques presented by the author regarding conventional epidemiological production, which he characterizes as rigid, superficial, Cartesian, and positivist.

Over the course of five weeks, the group met to discuss the assigned readings, which covered the entirety of the book. Through this process, we became increasingly familiar with the theoretical framework developed by Jaime Breilh, deepening our understanding of Critical Epidemiology. We clearly perceived the relationship established between the movement of social reproduction, in its general, particular, and individual dimensions, and the generation of health and disease processes. During the reading of the first chapter, we observed the historical erasure of the rich Latin American critical tradition within the field of epidemiology. The second chapter, in turn, broke through the “Cartesian bubble” in which we were immersed: we encountered the author’s critique of the empiricist thinking characteristic of the health field. For Breilh, such thinking reduces reality to isolated factors and pragmatic relations, resulting in superficial analyses that do not go beyond “the tip of the iceberg.” The epidemiology of “social determinants of health,” often and mistakenly taken as synonymous with social determination, fails to overcome the linear Cartesian logic, remaining limited to investigating the “causes of causes” within the same logical structure.

Finally, the reading of chapter three revealed the answer to the question “What is to be done?” by presenting an alternative methodological path rooted in the critique of political economy. This approach is based on knowledge of the social reproduction process and its movements of subsumption and relative autonomy, aiming to produce an epidemiological understanding that accounts for totality. Within this theoretical framework, health and disease processes manifest as embodiments generated by the contradictions of the process itself. Concretely, the proposed methodological path results in the construction of a matrix of critical processes that organizes analysis dialectically, evaluating the “4Ss (Sustainability, Sovereignty, Solidarity, Security)” across the three levels of the reproduction process (General, Particular, and Individual). This effort, in turn, yields a qualitative metanarrative and a quantitative metainference.

Breilh’s entire methodological proposal is deeply grounded in Marxist dialectics. This approach seeks to overcome the positivist and Cartesian logic criticized in the earlier chapters, which views the world through isolated factors, and instead understands it as a totality in constant motion, driven by contradictions. The author applies this lens to conceive of health not as a static object, but as a dynamic and contradictory process, inseparable from the critique of political economy and the mode of production that gives rise to the “diseased civilization” mentioned in the title.

In this sense, the study group plays a fundamental role in reactivating and strengthening the Marxist debate within the field of Collective Health at the university. By engaging with Critical Epidemiology, we are not merely learning an alternative method but also reclaiming a tradition of thought that insists on the social, economic, and political roots of health problems. The group’s contribution, therefore, lies in shaping researchers capable of going beyond interventions that only mitigate effects, promoting instead the development of a praxis aimed at the structural transformation of living and health conditions.

Thus, at the core of his critique, Jaime Breilh brings forth the need to overcome a superficial reading of reality as well as the limited perspective imposed by a neoliberal and productivist society. He urges us to adopt a more comprehensive and integrated outlook, one that encompasses not only the assessment of political, historical, and socioeconomic factors within the linear logic of “causes of causes,” but also considers the movements of subsumption among these dimensions, how they behave, and how they intersect across the different spheres of human experience and existence.

Also noteworthy is the current and necessary discussion on the distinction between the concepts of social determination and social determinants of health, which are frequently and erroneously treated as equivalent. The historical review of critical intellectual movements in Latin America engaged in such discussions reminds us that we must look to our own thinkers and to a debate that has long been taking place here, though it continues to be overshadowed by the hegemony of concepts and theorists from the Global North.

Our group concluded during the same week as the Symposium, when we met Professor Breilh in person and had the opportunity not only to clarify our questions but also to absorb his enthusiasm and commitment to the discussion. Beyond conceptual debates, this encounter inspired a critical movement that seeks a form of health that belongs to the peoples. Jaime emphasized the importance and strength of our production as Brazilian researchers, recalling the movement of the Sanitary Reform and the construction of Collective Health, and how it differs from Public Health through its specificities. The exchange of knowledge, the construction of networks, dialogue among different areas, and the aggregation of concepts that do not oppose one another because of their differences, but rather complement each other precisely through them, are essential for fostering care and producing a health system that is just, equitable, universal, and inclusive for all people.