Decolonizing social determinants of health? South American perspectives and future challenges

This chapter aims to situate the discussion on the social determinants of health (SDoH) in South America, considering the cases of Brazil and Chile and paying attention to autochthonous conceptualizations and responses to the interphase between health and society. With a specific focus on Brazil and Chile, the authors want to challenge the fixed conceptualization of the “social” that underlies the SDoH, advocating instead for an approach that encompasses historical, cultural and political dynamics and variations. They focus on the intellectual and practical responses originating in the region under colonialism and imperialism, highlighting how they can enrich contemporary discussions. The chapter begins by delineating the multiple challenges to improving living conditions and achieving health equity in the region, including the destabilizing effects of military dictatorships in the consolidation of comprehensive health and social security regimes. They explore how scholarly-practitioner communities have engaged with the intersection of health, society, and politics, particularly through the frameworks of social medicine and collective health. They investigate the specific health policies of Brazil and Chile, emphasizing their innovative approaches to primary care, social participation mechanisms, and mental health reforms.