“Not defending the indefensible”: Elements for a cosmopolitical and antiracist approach to Public Health at the end of the world

Abstract

In the context of growing discussions about decolonization in the field of health, this essay aims to present a conceptual framework mobilized by the relationship between cosmopolitical propositions, disputes over care, black feminist poetics, and debates about the end of the world. It argues that there is a strong constraint on the imaginative limits of the field and that this is not a technical, funding, or ideological problem. To enable more forceful reorganizations of democratic struggle today, it seems necessary to dismantle and experiment with possibilities for epistemic-political and administrative reorganization. Based on a larger process of anthropological research with people, networks and territories that, in different ways, experience public health (the state, rights, science and modernity) from a certain distance and with suspicion, this essay offers fertile resources to help in the necessary reformulations of public/collective health and to rethink training processes, knowledge production and, potentially, political-administrative estrategies. The speculative possibility that opens up is to venture to see and recreate with and from multiple diverse perspectives, initially adopting the ontological multiplicity of subjects/worlds/relations to/from health, the epistemic multiplicity, and the multiplicity of praxis and political speculations.

Keywords:
Collective Health; Capitalocene; Care; Black Feminist Poetics; Anthropology.

Resumo

No marco de crescentes discussões sobre descolonização no campo da saúde, este ensaio tem como objetivo apresentar um repertório conceitual mobilizado pela relação entre proposição cosmopolítica, disputas pelo cuidado, poética negra feminista e debates sobre o fim-do-mundo. Argumenta-se que há um forte constrangimento dos limites imaginativos do campo e isso não é um problema técnico, de financiamento nem ideológico. Para possibilitar reorganizações mais contundentes de luta democrática hoje, parece preciso um processo de desmontagem e experimentação de possibilidades de reorganização epistêmico-política e administrativa. Tomando como base um processo maior de pesquisa antropológica com pessoas, redes e territórios que, de formas diversas, experimentam a saúde pública (o Estado, os direitos, a ciência e a modernidade) a uma certa distância e com desconfiança, este ensaio oferece recursos férteis para ajudar nas necessárias reformulações da saúde pública/coletiva e repensar processos formativos, de produção de conhecimento e, potencialmente, de reorganização político administrativa. A possibilidade especulativa que se abre é a de aventurar-se a ver e recriar com e desde múltiplas diversas perspectivas, adotando de início a multiplicidade ontológica de sujeitos/mundos/relações à/da saúde, a multiplicidade epistêmica e a multiplicidade de práxis e especulações políticas.

Palavras-chave:
Saúde Coletiva; Capitaloceno; Cuidado; Poética Negra Feminista; Antropologia.

I must begin.

Begin what?

The Only thing in the world that’s worth beginning:

The End of the World, no less

(Césaire, 1969, p. 39).

Introduction

Within the framework of growing discussions on decolonization, diversity, and inclusion in the field of Health, particularly within the academic field of Collective Health, this essay aims to present and reflect on a conceptual repertoire mobilized by the relationship between cosmopolitical propositions (Stengers, 2018), disputes over care (Puig Dela Bellacasa, 2017), Black feminist poetics (Ferreira da Silva, 2019), and debates about the end of the world. We argue that this possible and initial repertoire offers fertile resources to aid in the necessary reformulations of Public/Collective Health and to revise training processes, knowledge production, and, potentially, political-administrative reorganization¹.

The reflection proposed in this essay is theoretical and speculative in nature and is aimed at agents engaged in education, knowledge production, and public policymaking. It is part of a larger process of anthropological research with people, networks, and territories that, in diverse ways, experience Public Health (the State, rights, science, and modernity) from a distance and with distrust, sometimes as otherness, as a threat, as betrayal, as an unmet need, and sometimes as a deaf instance of recognition and a vector of distress.

This process has been part of my trajectory for over 20 years and is currently being reworked in the supervision of undergraduate and postgraduate monographs, in participation in collective research projects, as well as in training and university extension processes with: Indigenous women (Olivar et al., 2021; Costa et al., 2022); cis women sex workers (Calabria et al., 2024); trans women and transvestites in the sex market and practitioners of Afro-Brazilian religions (Santos, MOF., 2022; Olivar, 2023); survivors and family members of the prison system (Santos, BO., 2023; Silva, MNO, 2025); farmers in urban suburbs (Tomimura, 2025), among others, all of them located in São Gabriel da Cachoeira, Manaus and Tabatinga (AM) and in São Paulo². From this experience, and due to its explanatory potential, we shall underscore an analytical exercise on the response of Indigenous women to the COVID-19 pandemic.

Besides the aforementioned research experience, the possibilities and limits of this essay are related to my participation as an anthropologist in the daily academic-scientific field of Collective Health, in teaching, research, extension, and university management activities. Thus, and beyond “criticism”, being an active participant in this daily life implies a crossroads: practicing a contrastive relationship within the disciplinary scope and, as is typical of anthropology, with non-academic and non-institutional knowledge and experiences. From this position, particularly marked by the crossroads of the COVID-19 pandemic, and considering the impact of the health emergency on the field itself, I highlight public statements by important stakeholders, private comments, and controversies regarding the role of Public/Collective Health in the pandemic.

Another specific depletion

Russo and Carrara (2015) understand Collective Health as a specific locus of the scientific field, multifaceted and multidisciplinary, which constitutes a hybrid set of knowledge and practices, including academic-scientific practice. This definition follows a classical understanding of this locus as a current of thought, a social movement, and a theoretical practice (Nunes, 1994, p. 16) that emerged between the late 1970s and early 1980s, in the face of an inevitable exhaustion of the paradigms of Social Medicine and Public Health (Nunes, 94, p. 5). Public Health advances in the constitution of a complex and transdisciplinary paradigm (Luz, 2009) that is synthesized in three axes: Epidemiology, Public Policies and Service Management, and Social and Human Sciences.

With a Marxist foundation and identified with modern, democratic, and progressive values, Collective Health is important for social and popular participation, being aware of social inequalities and inequities - particularly economic ones - as determinants of health problems, as well as being part of the Brazilian struggle for democracy and human rights.

More than 40 years into the Health Reform and the founding of ABRASCO, this locus serves as the basis for much of the Brazilian political management, thought, scientific production, and undergraduate and graduate Health Education. This period has been marked by significant social, political, economic, scientific, and global crises and transformations that have also affected Public Health. In many ways, today’s world is not the same as it was 40 or 50 years ago. It seems fair, then, to ask ourselves about the arrangements, demands, and possible imaginations for hygienist practice and thought in this(these) new world(s). “Still experiencing the repercussions of a pandemic, the field should open up to new approaches, as some of these themes are unavoidable today” (Martin; Pereira, 2023, p. 10).

In this sense, this locus has been subject to revisions and the need for reorganizations that take into better account new contexts (Cohn, 2022) and the historical and contemporary contributions of the social sciences (Nunes, 1994; Russo; Carrara, 2015; Martin; Pereira, 2023). In addition to the important long-standing feminist critique and participation (visible in the history of PAISM and in the many feminist interpellations in policies and knowledge production), arguments have been developed in favor of decolonial approaches to health and care (Nunes; Louvison, 2020). On the other hand, antiracist initiatives at all levels and spheres are being demanded and designed (Borret et al., 2020; Brasil, 2023), as well as more radical forms of attention to Indigenous perspectives in “differentiated attention” (Vieira, 2019) and analyses that pay greater attention to the reproduction of values of coloniality and anthropocentrism (Baquero et al., 2021; Adams et al., 2019; Fortes, 2023).

This critical thought is far from being consolidated, and even more so, far from establishing agreements and consensus. While, on the one hand, in public policies, texts, and academic-scientific spaces, loud and resounding declarations against discrimination, in favor of diversity, and affirmative action to promote “inclusion” are commonplace, on the other hand, the difficulty in dealing with the broader implications of “difference” and otherness present therein is evident. As we shall see below, this relative lack of consistency generates intense conflicts visible in the daily lives of training and professional spaces, in the editorial field, and in Collective Health meetings, and has generated localized but forceful statements of the “indefensibility” of Public/Collective Health as we know it.

This essay’s objective - its potential contribution to this debate - lies in this turbulent instance of the locus facing its very exhaustion. Specifically, it argues that there is a strong constraint on the imaginative limits of the field, and this is not a technical, funding, or ideological problem. It also affirms that it is necessary to advance in a more radical process of dismantling while experimenting with possibilities of epistemic-political and administrative reorganization that give Collective Health greater public defensibility in order to understand current exhaustions and to enable more forceful reformulations and reorganizations of democratic struggle today.

Not defending the indefensible

In Brazil, the Federal Executive’s actions during the pandemic were disastrous and contrary to any principle of democratic Public Health (Ventura; Reis, 2021). Explicit neglect of healthcare as a political action of the government was a consistent public performance of the President. Associated with common ideas about “neofascism” and “genocide”, the notion of necropolitics (Mbembe, 2018) gained relevance in academic and social contexts to explain the current government model. In general terms, this concept indicates a model of governmentality that, unlike biopolitics (Foucault, 2008). It would not be based on stimulating life, productivity, health, and well-being (including care) as resources for governing populations, but on the public and strategic distribution of the right to kill and let die.

In this context, public health agents raise the banners of democracy and trust in science, coupled with ideas about rationality, care practices and policies, domesticity, secularism, the preventability of death, among others. In the dire days of 2020, the SUS (Unified Health System) was socially elevated to a special position of “defending life”, “our” rights, and “science” (Cohn, 2022), which is why it should be an unquestionable object of massive political and social defense. Somehow, faced with the blunt necropolitical threat of carelessness, what emerged most forcefully was trust in discipline, science, technology, surveillance, and the systematic and meticulous organization of people, processes, territories, movements, and populations in defense of life and society, of “care” as government rhetoric. This path enabled the desire for state interventions based on scientific and technical knowledge that were “aggressive but democratic” (as a peer put it) to “avoid preventable deaths”, “care” for lives, and urgently “flatten the curve.”³ However, reconstructing the framework from a biopolitical perspective (Foucault, 2008) did not seem sufficient or adequate, not even “technically”.

In late 2020, the “preparatory workshop for the Fourth Brazilian Congress on Health Policy, Planning, and Management” was held online amid the pandemic crisis. During the workshop, Prof. Ricardo Teixeira of the University of São Paulo’s School of Medicine, analyzing the public health response to the crisis, stated: “The shortcomings of our response are closely related to the distance we still keep from this other care model.” He said it was evident to witness “the exacerbated tendencies inscribed in the logic of the System’s ordinary functioning”, specifically, hospital-centrism, biomedical centrality, and low orientation towards preventive and collective measures.

An insufficient response from the field, already described in 2020, is related not only to underfunding and the Bolsonaro catastrophe, but also to distant “care models”, to “trends inscribed in the logic” of the ordinary field and the system. How can we understand these “trends” and their persistence?

In October 2022, the 13^th Congress of the Brazilian Collective Health Association (ABRASCO) was held in Salvador. It was the first major in-person event in the field after the end of the worst COVID-19 health crisis phase and the recent election of President Lula. In the festive atmosphere, there were unanimous stances against inequality, in favor of strengthening the Unified Health System (SUS) and public institutions, human rights, democracy, investment in “science”, and greater “inclusion” and “diversity”.

However, the celebration was not, precisely, universal. The Congress featured a prominent screening of the film Quando falta o ar (2021), which showcases the work of the Unified Health System (SUS) “on the front line” against COVID-19. At the time, antiracist activist, feminist, physician, and director of Amnesty International - Brazil, Jurema Werneck, after praising the film, stated that we cannot simply “defend the indefensible”: the Unified Health System (SUS) as we know it, the political arrangements of Collective Health in its hegemonic forms. I had never heard any prominent figure in the field say something like that. Jurema continued her powerful and emotional speech, as if she had firsthand knowledge of the political compromises and concessions being made by the new administration regarding Public Health. She received a standing ovation in a packed auditorium, notably attended by Black people, particularly women and LGBTQIA+ individuals. A couple of days later, at the closing table of the Congress, she said:

At the polls, we sent a message that spreads: nothing about us without us. This us is broad: a us made up of Indigenous people, Black people, women, LGBTQIA+ people, and residents of the North and Northeast, the favelas and suburbs of the South and Southeast, the rural region, the quilombos, the forests, and the waters, and not just white men on the left, or worse, the right, of this country. [...] The time of the white minority is ending.⁴

What does this political conflict, which is neither merely partisan nor ideological, tell us about the future possibilities of Public Health? How can we consider this indefensibility of persistent and structuring political arrangements within the framework of the best health system we know?

Resuming: As a daughter and flagship of the Modern project, the logic of sustaining and reproducible Public Health is essentially anthropocentric (Baquero et al., 2021), androcentric (Diniz et al., 2016), and grounded on the strategic ignorance of raciality (therefore, based on racism), as explained by Denise Ferreira da Silva (2022, 2024). Therefore, this time that is ending, “the time of the white minority”, is a World (that of Modernity) and a “we” (a collective subject of enunciation, recognition, and trust) that still organize the field of Health.

During the pandemic, for example, while the “lockdown” was more or less critically discussed, with references to Korean, Chinese, and European models, the same cannot be said of the recommendation to “stay at home”, despite everything that was said about the impoverishment and food insecurity of racialized populations, of people without homes, or whose social life involves arrangements other than individualism and domesticity; despite everything that was evidenced about domestic violence and the lack of economic possibilities at home. “Trust in Science” seemed to be some faith that could deny knowledge about scientific practice itself.⁵

However, there is more to it than meets the eye. In its best-known versions, the field of Collective Health assumes its historical place as a biopolitical device (Foucault, 2008). In its worst, or even more so, shifting the perspective to marginalized territories, subjects, and processes, the setting is much more severe.

Still at the 2022 Congress, Jurema Werneck recalled that Brazil was one of the countries in which the most health workers died and were heavily affected by the Coronavirus (Teixeira et al., 2020), one of the countries with the highest rates of death from hospital intubation and with extremely unequal rates of the impact of the pandemic on poor urban, Black, and Indigenous populations (Baqui et al., 2020; Castro et al., 2021; Coiab, 2021). In Brazil, there is sufficient evidence on the reproduction of institutional racism in the field of Health, from its national scientific history (Mota, 2005) to institutional organization, research fields, and PHC (Kalckmann et al., 2007; Carneiro, 2017; Castro, 2022; Gonçalves, 2023), including in the racial calculation in the pandemic (Ferreira da Silva, 2024); on the irreducible gender asymmetry that organizes the field, leading to systematic practices of misogyny (Diniz et al., 2016, 2018), homophobia and transphobia (Pelúcio; Miskolci, 2009; Santos, MOF, 2022 ); on the over-stigmatization of vulnerable populations such as sex workers (Correa et al., 2011); on the agreement with public security to punish incarcerated people and their families (Santos et al., 2024; Silva, MNO, 2025); on the perpetuation of coloniality in policies and health care for Indigenous populations (Vieira, 2019), among others.

In this context, who does biopolitics serve? What is the cost of biopolitical persistence for marginalized bodies and existences? Is it truly insufficient, flawed, but the best alternative we have? Or the only one we have been taught to imagine? What kind of world is this that allows us to imagine such an imagination?

End of the world as a perspective for public health

The historical period of health reform, the last 40-50 years, is not only the period of Brazilian redemocratization and the struggle for social equality based on the repertoire of human rights, vulnerability, and development. As can be seen in the works of Latour (1994) and Kopenawa & Albert (2015), among others, this is also the period of multiple ends of a M/world(s), of the Anthro/Capitalocene (Haraway, 2016) and its Brazilian forms (Danowsky et al., 2022). Recent reflections in this context relate planetary processes of destruction, exploitation, and precariousness (Stengers, 2015; Krenak, 2019; Danowski et al., 2022) with crises and transformations in the scientific field and the modern project (Latour, 1994; Stengers, 2002).

In these years, we have been remade by the acceleration of dreams, celebrations, and hangovers of technology and “globalization”, by the republican and techno-scientific persistence of the worst forms of colonization and racism, by the celebration of the politics of death and suffering linked to the ongoing democratic dismantling; we have to witness and participate in the current pandemic forms, the agonistic dynamics of capitalism in its race for the last human-natural resources, and the radical planetary precariousness evidencing the collapse of the Earth system (Costa, 2022).

On the other hand, in these years, the practices, forms, and meanings of politics and public life in all spheres (including health and academia) have also changed and opened up to differential approaches and multiculturalist perspectives (Chaves, 2011). Antiracist, decolonial, multi-feminist, and anti-ableist demands, among others, have been articulated against socioeconomic inequalities, producing new twists and reconfigurations of social movements (Zibechi, 2015), universities (Venturini; Feres, 2020), and calls to imagine and experience other/these possible worlds. We have learned to better understand the vitality and persistence of multiple ontologies and their political forms of struggle (Kopenawa; Albert, 2015; Haraway, 2016).

Here is a first reflection that draws attention to the political effects on health and care, taking the Anthropo/Capitalocene as a basis (Taddei, 2024). It is necessary to imagine our professions and courses, the forms of the collective and the public, from within a more-than-human world, about whose near future we cannot be certain, and in which we daily and simultaneously witness the crumbling of the “best” institutions and hopes of modernity and the general conditions of habitability.

On the other hand, as Kopenawa warned, there have been other ends of worlds, other falls from the sky, and the world of Modernity has been and still is an end of the world for other worlds (Kopenawa; Albert, 2015). In this path of readings and translations, the end of the world then gains another plane of meaning.

Fanon (2008) taught that the Black and colonized experience inhabits and emerges in a zone of non-being defined against the zone of being of the Modern, colonial project. To inhabit, to have the zone of being as a perspective, is to have the body, the world, and time as a guarantee, to know oneself as Human at the center of Humanism, an agent of Enlightenment Reason. As a colonial operation, the zone of being traverses, on both material and psychic planes, the processes of defining the world, its time, its representatives, and the conditions of representation.

The field of Health, of which Fanon was a practitioner and connoisseur, is a modern assemblage; an assemblage of and for the zone of being. As a materialization of the Universal, the zone of being transforms the zone of non-being, and its constitution from there, into an impossible territory; one that should not be inhabited, an “end of the world”, as is often said about peripheral and border (body-)territories. Civilizing and biopolitical success implies the entry and inclusion of bodies and souls of non-being into the new, sanitized zone.

Denise Ferreira da Silva (2022) analyzes how the modern world is based on raciality, total violence, and the total extraction of value from Black and Indigenous bodies and lands. These pillars ensured the colonial process, the process of enslavement, and the processes of continuous accumulation that serve as legal, economic, material, institutional, and symbolic support for our world today. These pillars and their transmutation into the institutions and agents of contemporary modernity help to explain a central question for the author - and which should be for any reformulation of the Collective Health project: why and how is it possible that so many Black people [and Indigenous or trans] are violently murdered (incarcerated, turned into drug addicts on the streets, abandoned, starved to death, expropriated) in a persistent and known way without any major ethical crisis or revolt occurring?

Thus, the author argues that, following a long tradition of Black thought, this World (as we know it), which includes our eugenic, pioneering, and colonialist history (Mota, 2005), must come to an end (Ferreira da Silva, 2014). “The time of the white minority is over.” “This society,” shouted the transfeminist and prostitute leader Idianarae Siqueira, “must be destroyed” (Siqueira apud Lenz, 2021).

Conceptually enunciating the end of the world does not imply the enunciation of a specific place (the Amazon, borders, and suburbs), nor is it limited to the discursive field of “nature” and “climate”. What is at stake is a transdisciplinary and multi-epistemic field of knowledge, based on ethical-political reflections, strongly marked by feminist and counter-colonial perspectives on the sciences, on the indefensible frontiers of the modern project, on the time we live in, its borderline forms of existence, and our participation in them. The end as memory, as a massive threat enacted today, as an operator of difference, and as a possibility for the future based on an opening to the Black-feminist zone of non-being.

Cosmopolitics, care, and Black Feminist Poetics

When the COVID-19 pandemic began, we were conducting ethnographic research with networks of Rio Negro’s women who faced several forms of violence. During 2020, we learned how they crafted a response to the pandemic. To begin to identify some of the scientific and political implications of this mode of action and care, we used the concept of cosmopolitics, developed by Belgian chemist and philosopher Isabelle Stengers (Olivar et al., 2021).

In “The Cosmopolitical Question” (Stengers, 2010), the author connects her analytical endeavor on Modern Sciences (2002) with the possibilities of reinventing scientific-political practices in the face of the exhausted resources of enlightened and democratic modernity. A scientist and white European, the author writes for a “We” she defines as the practitioners of the Word of modernity, rationality, democracy, and the Universal. This is why she is so important for the field of Public/Collective Health.

Much of Stengers’ cosmopolitical proposition involves a call to pay attention to the colonial, homogenizing, and disempowering political implications of our interventions. It involves distrusting one’s own certainty to allow time and space for other existences, rationalities, needs, and implications to participate in the debate, reframe problems, and formulate solutions. In this sense, Stengers (2010) considers cosmopolitical action as a political ecology of practices. In this ecology, people who will experience and have to deal with the consequences of technical-political decisions:

[..] must be present in a way that gives the decision its maximum degree of difficulty, that prohibits any shortcut, any simplification, any a priori differentiation between what counts and what does not count (Stengers, 2018, p. 463).

Such an ecology does not exclude science, but removes it from the center and replaces it with the demand for processual and unfinished compositions between heterogeneous present and active elements. As De la Cadena (2020) shows in his analyses of Indigenous cosmopolitics in land conflicts in Peru, this ecology begins with multiplicity and moves between dissensions (Ràncier) and equivocations (Viveiros de Castro); that is, between disagreements of meaning and disagreements of ontology.

In the conflicts analyzed by De la Cadena (2020), relationships and their agents exceed the predictions of politics as usual, including those of the left. Earth-beings and more-than-humans emerge as central political agents in their own right, beyond representation (white, binary, human, enlightened, electoral, and semantic-discursive): rivers, mountains, animals, and plants - which in our cases are also “mothers of the body”, boa-plants, spirits, entities - as well as other subjects that do not fit into politics, rights, and care as usual: becoming-whores, post-feminist transvestites, and prison system survivors.

Understanding oneself in other politics and imagining oneself in other alliances involves “taking seriously” other worlds and their subjects, suspending judgment (Stengers, 2010) as a politics of epistemic care. However, there is no care and common in relationships of such profound and radical asymmetry, in which one party essentially seeks the normative adequacy, education, sanitation, and development of the other(s) as a condition of the alliance. The demand for the growing containment of modern rationality emerges, the rejection of Reason as the ultimate argument for cohesion and the Universal. Such is the reference to the cosmos, as:

The unknown that constitutes these multiple and divergent worlds, the links that should be able to establish, in the face of the temptation of peace that aims to be definitive and ecumenical [health-related or academic] in the sense of a transcendence that would have the power to demand that those who diverge recognize themselves simply as a particular expression of that to which all converge (Stengers, 2018, p. 447).

In the initial analyses to understand the response of Rio Negro women to COVID-19 (CORTADO PARA AVALIAÇÃO), we were interested in understanding the forms of urgent technical-political intervention led and conducted by them, and in considering some of its implications for Public Health. Beginning to understand this response required, for example, understanding that the subject of action and enunciation was radically different from the subject of modern politics: “Rio Negro Indigenous women” in the radicality of ontological difference⁶. Far from denialism and wait, far from obedience to the “health authority” and individualism, and without adjusting to the folkloric place of “culture”, ignorance and “belief” predisposed to them in the modern imagination, the women of Rio Negro launched a campaign (Rio Negro, we care) that proved to have excellent results in all areas (Olivar et al., 2021; Costa et al., 2022).

It was a complex arrangement of care (Santos, MOF, 2022), whose starting point was a feminine counter-colonial experience: “us” Indigenous women, on one side, and on the other “you” “whites” (Non-Indigenous in colonial relations) and men (“ours” and “yours”). The campaign’s effectiveness was also linked to its enormous biosocial diversity and the active participation of human and non-human agents (animals, plants, rivers, spirits, and “the territory”), Indigenous and non-Indigenous, “traditional”, “scientific”, and State stakeholders. Coordinated by them based on their experience of activism and political network management, and on the reactivation of their knowledge base and a certain interculturality that was more belligerent than ecumenical (Costa, 2021; Costa et al., 2022). The experience of multiple endings already experienced, of multiple “white” threats (among them diseases and the medical field), marked the “care” strategy.

For Public Health, the campaign described places a special twist on the requirement of “being present in a way that gives the decision its maximum degree of difficulty” regarding modern/humanist/white ways of producing science, politics, and their subjects (Stengers, 2010; De La Cadena, 2020) and Raciality (Ferreira da Silva, 2022). Similarly, through the massive increase in Affirmative Action processes throughout the 21^st century (Venturini et al. 2020), the modernity of the locus has been forced to address the presence of “surviving” perspectives of the pandemic, necropolitics, and biopolitics. Through their relationship with the language of “mental health”, these resolute, belligerent, and highly performative presences position Health and the Academy as yet another force producing violence and distress (Rosa; Facchini, 2022). This is stated in the “Manifesto of the First Meeting of Black Communities”, read collectively at the closing session of the 2022 ABRASCO Congress:

The arrival of Black bodies and consciousness at university is marked both by the realization of a dream and by the clash with institutions still structured by a bourgeois-classist-sexist-patriarchal-racist modus operandi, which ensures that only a small portion of society has access to higher education institutions and public, free universities. This reality is responsible for distress, erasure, silencing, and tensions reflected primarily in our mental health, impacting our continued existence, already threatened by the incipient or absence of internal policies that ensure and encourage the retention of Black students from the margins of society.⁷

These are increasingly unrepresented presences, lacking the necessary mediation or translation of scientists or managers, and located beyond the position of “users”, vulnerable, or in need of healthcare. These presences demand worlds, spaces of speech, and legitimacy for their knowledge and science; historical and epistemic reparation, anti/counter-colonial and antiracist consistency in their allies, among other things. These presences and their public expressions, anchored in a counter-colonial twist on raciality, comprise what Denise Ferreira da Silva (2014) calls Black Feminist Poetics. The connection of this idea to the cosmopolitical repertoire implies an important novelty, as it allows the thinking of ontological politics and the end of the world to give centrality to racism and gendered raciality in the joint movement of the decolonial and multiverse treatment of politics, knowledge, and care. On the other hand, Black Feminist Poetics allows us to connectively describe forms of political action based on the practices of Black and Indigenous bodies, among others, that exceed the legal and discursive forms of Modern epistemic-political representation. To conclude this section, I briefly address the latent (and empirically present) issue of “care”/care from this perspective.

Care is a key concept in the self-definition of Health and Public/Collective Health, mobilizing important investments in theoretical and practical reflections (Cruz, 2009; Ayres, 2009; Mehry et al., 2014). In this rich and heterogeneous production, care is strongly associated with scientific-technical notions of the health-disease process (including in some cases its “subjective and social dimensions”), with humanized professional work and with the institutional repertoire, even though in some elaborations the protagonism of family networks gains strength. On the other hand, care is recurrently analyzed by feminist studies, in diverse contexts, under categories such as work, inequality, and oppression (Hirata; Guimaraes, 2012). Analyses such as those proposed here, among others (Reis, 2020; Macedo, 2021; Olivar et al., 2021; Taddei, 2024), encourage reflection on the new demands and possibilities for Health to enter into a relationship of coordination and composition with these “other care models”.

Radically, care “has to be our way” (Vieira, 2019) and its living networks (Mehry et al., 2014) need to constitute a more-than-scientific and more-than-human relational ethic (Mol, 2008). Actively engaging in care networks cannot have inclusion in the given zones of being as its horizon; it cannot have technical-scientific reason, standardization, institutionalization, or productivity as its center.

We learned to understand care from multispecific perspectives (Baquero et al., 2021; Taddei, 2024) and beyond individualism, as a sympoetic capacity for creating worlds (Haraway, 2016). Regarding the Planet’s/World’s poor habitability conditions, the ways of resisting catastrophe and delaying collapse, this repertoire of praxis and theory enables us to think of care as the capacity to pay attention to the ordinary practices of Modernity and their effects, and, on the other hand, as the suspension of judgment (Stengers, 2015, 2018). This is a very contradictory dispute that exceeds the limits of any scientific field and institution and that cannot be defined solely in the grammar of well-being, work, and oppression (Puig De La Bellacasa, 2017).

Finally, from multi-feminist Black/Indigenous poetic perspectives, care can open up forms of self-defense (Dorlin, 2020) and solvency; in other words, care “that mediates the things that deteriorate (..) and makes the world of meanings, formulas, figures and remnants of power that every transition, as well as every decolonization, demands to be burned, settle in lava (Mombaça, 2021, p. 60).

(IN)CONCLUDING

Brazilian Collective Health has been challenged in several ways regarding its capacity for reinvention and readjustment to the health, political, and social demands of the (end-of-)world we inhabit today, 40 years into the Health Reform. This growing set of challenges cannot be ignored or translated into pragmatic policies of tolerance, inclusion, diversity, or ecumenical ecology. To put it bluntly: the problem is much deeper; the difficulty is greater.

A cosmopolitical approach to care and health implies making present, resonating “the unknown that affects our questions and that our political tradition runs the significant risk of disqualifying...” (Stengers, 2010, p. 355). Cosmopolitical understandings, reminds De la Cadena (2020, p. 303), can “force the ontological pluralization of politics and the reconfiguration of the political”, in the sense of multiverse politics. Therefore, “the challenge is to explicitly abandon the founding reference of our politics where there is politics” (Stengers, 2010, p. 359).

This is precisely the challenge for politically rethinking and restructuring health through the current depletion. Any attempt at decolonization, explains Ferreira da Silva (2019), implies active and careful processes of dismantling the world-as-we-know-it that enable the full return of the extracted riches. This is the refusal to unconditionally defend the rural region, as Jurema Werneck did in the central scene of this text.

Thinking carefully and from the end of the world about political ecology requires the delicacy and creativity of not simply favoring the ongoing fascist and capitalocene destruction. One thing is one thing. In her reflection on solvent care in transitions and decolonization processes, Mombaça (2021) asks:

[..] how to integrate [these] processes into the dynamic and intensive apparatus of preserving the germs of people still without a name in the flesh, of people whose name has been denied; how to involve, in each transition that is announced, the ancestry of people whose land was stolen, as pollen and seed of people whose land is yet to be made?

In this sense, the end of the world can constitute a fertile perspective: at the same time, assuming the planetary catastrophe as a starting point, assuming that our World constantly annihilates other worlds, recognizing that there is a multiplicity of bodies and knowledge to deal in different ways with the different endings, and that the need for The World to come to an end so that multiple Black, Indigenous, divergent worlds can flourish with or without “us.” Imagining the end of the world as a perspective constitutes a kind of ethical-political-affective and intellectual provocation device, based on the construction of a multi-frontier, “radical” and virtually ultimate scenario, from which to reorganize what we understand by Politics, Democracy, Science, and Health.

Finally, we understand that the analyses presented here can encourage us to think about Public/Collective Health from a logic of onto-epistemological and counter-colonial multi-versality. This is different from shifting, as a result of the academic-intellectual work of an author or group, from a more right-wing to a more left-wing perspective, or from a more traditional author to a more alternative one, within the same line/world, for example. It is about stripping away the value of a single, universalizing point of view and the very path we follow. The speculative possibility that opens up is to venture into seeing and recreating with and from multiple, diverse perspectives, adopting from the outset the ontological multiplicity of subjects/worlds/relations to/of health (denying the humanist, individualist, modern-civilizing, racial temptation), the epistemic multiplicity (denying the temptation of Modern Science as the reason for truth), and the multiple political praxis and speculations (denying the temptation of Politics as usual, of the centrality of the State). Also, we believe that this must be done in a logic of presence without representation (as a principle), multilinguistic and pluri-epistemic, which grants the most significant degree of difficulty and implies having as a starting point for reconstruction people, networks, territories and bodies that were the others of Modernity and that are not reducible to categories of Reason nor reducible to each other.

This repertoire then generates infinite questions and possibilities about how to stimulate the production and communication of knowledge and multi-epistemic research; about spaces, bureaucracies, curricula, and assessment systems based on political ecologies of knowledge and care; about multi-centered administrative imaginations that can address ontological multiplicity. This is a starting point for the discussion with and within the scientific-academic field of Collective Health; it is still being developed, and its fruitfulness will depend on the same requirement described here.

• 1
  This proposal emerges from the project. Cosmopolitics of care in the end of the world: gender, borders, and pluri-epistemic assemblages with public health, FAPESP grant 2021/06897-9.
• 2
  Analyses of localized social experiences and their implications for the field of Health and for scientific-academic production are not the subject of this essay. Some of these analyses are mentioned above, others are underway in theses and dissertations, and others are yet to be completed. See the research.
• 3
  See, among many others: http://www.cofen.gov.br/a-pandemia-do-coronavirus-e-o-brasil_78004.html; https://www1.folha.uol.com.br/equilibrioesaude/2020/05/sanitarista-gonzalo-vecina-neto-defende-fila-unica-de-leitos-do-sus-e-da-rede-privada.shtml Access: November 4, 2024.
• 4
  See: https://www.abrasco.org.br/site/eventos/congresso-brasileiro-de-saude-coletiva/jurema-werneck-equidade-abrascao-22/70357/. Access: November 4, 2024.
• 5
  See: Ilana Lowy (2020). In this sense, see the distance between two public interventions. The first, in early 2020 (https://www.tramadora.net/2020/05/03/entrevista-do-observatorio-de-analise-politica-em-saude-com-ricardo-teixeira/), and the second, in November 2020 (https://www.abrasco.org.br/site/eventos/congresso-brasileiro-de-politica-planejamento-e-gestao-em-saude/fortalecimento-da-aps-modelo-de-gestao-e-resposta-comunitaria-a-pandemia-sao-abordadas-em-oficina/54108/ ). Access: November 4, 2024.
• 6
  It is impossible, within the limits of this essay, to provide an in-depth description or compile a review; much Brazilian and global anthropology has already devoted itself to studying and analyzing the notions of body, person, and relationship in Amerindian socialities, including those of Rio Negro. I suggest reading: Huge-Jones (2011); Baniwa, F., 2020.
• 7
  See: https://www.abrasco.org.br/site/wp-content/uploads/2021/02/Manifesto-coletivo.docx_05_12.pdf

Data Availability Statement

The research data are available within the main text of the article.

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• Editors:
  Carinne Magnago

Publication Dates

• Publication in this collection
  15 Dec 2025
• Date of issue
  2025

History

• Received
  06 Nov 2024
• Reviewed
  11 Feb 2025
• Accepted
  21 Mar 2025