Latin American epidemiologist and collective health scholar Jaime Breilh met with Outra Saúde during the SIMCOL conference, hosted by the School of Medicine at the University of São Paulo. Breilh presented his critical epidemiological studies, grounded in the belief that health must be understood as a social process rather than mere access to services.

His work offers a relentless critique of capitalism, a social metabolism that has destroyed cultures and knowledge systems around the world. This destruction is what many term “epistemicide”: the killing of ways of thinking that do not serve profit, a phenomenon that deeply affects the scientific field.

According to Breilh, by allowing themselves to be dominated by the reproductive logic of capitalism, the sciences have become Cartesian: focused on efficiency and practicality, while knowledge itself has become increasingly fragmented and alienated.

He calls on universities to renew their ethical commitment to humanity and to politicize scientific activity. For Breilh, this approach is urgently needed in a world that is visibly disintegrating while alienating people from meaningful action. His message to the scientific community is clear: they must take action now, because “we can no longer afford to live like this.”

Outra Saúde**:** Your work champions epidemiology as a critical science. As stated in your books themselves, it takes up an idea introduced in Brazil by Naomar Almeida Filho, according to which this field of knowledge has gone, after the pandemic, “from a timid science to a critical science.” What does this mean in practical terms?

Jaime Breilh: It’s a major dilemma because it puts pressure on universities and on the very way we think. It creates a teaching model that trains young people to think in terms of power, which tends to be linear. Epidemiology is a courageous science: a university must confront complex realities and independently define the needs of a population. We need universities, in all their areas of expertise, to fulfill the roles that societies have assigned to them.

The problem is that even international cooperation organizations remain stuck in another historical era: they were created in the 1940s to represent states and governments. That era is over. Today, the assumptions underlying international cooperation are completely controlled by large corporations.

Even when philanthropy is involved, it’s not innocent. It’s a philanthropy that seeks to condition everything, universities, the media, publications. It determines what gets funded, what doesn’t, what is off-limits, and what gets targeted.

OS: Another idea you strongly advocate concerns the limits of “Cartesian science” and its logical conclusions, which ignore the historical conditions of its objects and the contexts in which it is applied. How can we overcome this Cartesian science, which you explicitly describe as a “bubble”?

JB: We’re swimming against the tide, because all the economic forces are moving in the opposite direction. Cartesian science is used to operate only at the tip of the iceberg. What does this mean for health? It means treating people once they’re already sick. But illness doesn’t arise by chance: it has social determinants, and it affects certain groups and social classes much more severely.

In that sense, Cartesian science is good business. It assumes that its role is to study the sick. It develops very sophisticated mathematical models about this tip of the iceberg and determines which drugs and treatments lead to a cure. It proposes certain forms of prevention, yet manipulates them.

Even vaccines follow this logic. The pandemic was a scandalous example of that. The health crisis became a huge business opportunity for vaccines and antivirals, instead of inspiring a complete rethinking of what should have been done to prevent contagion or to prevent future pandemics.

From a sociological or social process point of view, this is a struggle shaped by powerful interests. This logic is becoming even more entrenched with the rise of artificial intelligence, digital health, and cybernetics. The threat has grown even greater, because Big Data also means big pressure and the power to define reality. But who owns this information? The population? Our countries?

Not even our governments control it. Governments are forced to defend themselves, even a large country like Brazil, which, fortunately, has a government that has begun to set some limits. But that’s not happening in the rest of the world, and possibly even Brazil can’t withstand all the pressure. Humanity is entering a very complex phase.

OS: But it’s worth noting that in the everyday discourse of governments, even progressive ones, and ordinary citizens, the right to health is often understood simply as the right to health services. Moreover, because the results of those services are more immediately visible, they tend to influence the entire political and administrative agenda in the health sector. How can we connect the discussion you’ve presented here to these more immediate issues in this area of social life?

JB: We need to understand the root causes and define the space and territory for action and management. Healing is important. Hospitals are essential. Everything done in health centers and through the SUS (Unified Health System) is absolutely vital. But that’s not the whole picture. For example, let’s take diseases caused by toxicity: we can’t just admit patients and expect to solve the problem inside hospitals. If we know there’s massive use of chemicals in agribusiness, that workers are exposed, that pesticides are used on a massive scale, ending up in food and reaching urban consumers, then we have to act on more fronts. This is one instance of the social determination of health.

But how do we behave now? We treat it as the responsibility of a single ministry, whether health, agriculture, or environment. In other words, there has not yet been a clear, comprehensive health policy, because health is still conceived only in terms of hospitals, clinics, therapies, and treatments. We remain stuck in the logic of business, both in the industries that sell food and in those that sell medicines and other health services.

For example, we conducted a study in a banana-producing region of Ecuador, the world’s largest producer of this fruit. Bananas can be grown using an agroecological model or through the intensive use of pesticides, which, it must be said, is often imposed on producers. And there we made some important observations.

How many boxes of bananas does an agroecological farm produce compared to a large export company? Let’s say the former yields 20 boxes per hectare per month, and the latter 60. The latter is considered “better.” But it has contaminated entire ecosystems with pesticides that harm human health. And who pays for that damage? If we calculate the externalities of both production models, we see that the agroecological model, which produces less, is actually superior. Yet such metric doesn’t exist. The dominant narrative insists that we must be productive and competitive, always accompanied by the argument that the profits of a few benefit the entire country.

We need to rebuild the very logic of how policies are conceived and developed, in the state, in the public sphere, and in universities, when they design their programs, create their departments, define their disciplines, and decide what to do with the knowledge they produce.

OS: What is public health in the 21st century, given the interaction of multiple crises, especially the climate crisis? Is it possible to talk about public health without explicitly placing capitalism at the center of its critique?

JB: Yes, capitalism is the name of the society we live in. Why capitalism? Because the social reproduction of Brazil, Ecuador, or any capitalist country is based on the accumulation of capital, and that determines everything. From the economy to culture, it shapes all aspects of life.

Today’s capitalism is extremely aggressive, it’s not just neoliberal. It’s a mistake to keep calling it neoliberalism, as if we were still in the last century. What we’re facing now is a very aggressive, accelerated, highly technological capitalism that operates in alliance with a small group of corporate owners, the giants who control Big Data.

In this context, Big Data means knowledge, practically all of humanity’s information, captured and commodified by a handful of actors who make trillions of dollars from it. That is what capitalism is today: a system that produces and reproduces inequality, deepens social problems, concentrates wealth and power, and thereby leads to even more exclusion and migration. The world seems to be completely preoccupied with migration, it no longer knows what to do with it. But migration is a product of the system itself. We are living in a profoundly violent, unjust society, and it’s getting worse by the day.

OS: Is this where the “epistemological change” you advocate comes in?

JB: People who don’t study these issues don’t fully realize what’s happening. They go to the mall, play tennis, and go to class. They don’t stop to reflect. They keep buying whatever’s on the shelves. They just want to stop at Starbucks and have a coffee. That’s the so-called “normal world.” But it’s falling apart. And those who study these issues can see the problem.

We need courage to put an end to this madness. That’s what awareness means. And universities must help young people build that awareness. It’s often said that youth is the hope of the people, because new ideas come from the young. That’s fine. But what about the hegemonic culture shaping youth today? There’s a powerful force pushing us toward extreme individualism. Many young people no longer have children. They might have two dogs or three cats, but not a child. Why? Because it’s too much responsibility, one they’re not ready to take on. That’s a sign of the times, and it’s worrisome. It reflects the notion that those who have children cannot have a good life. Instead, the prevailing idea is: “I have to focus on my career.”

Even romantic relationships have come to reflect this logic: You have your life, I have mine. You have your work, I have mine. You have your world, I have mine. When we feel like it, we get together, we travel, we have fun. If not, goodbye. From my perspective on life, I say: what a pity.

We’re losing a vast and beautiful part of what it means to be human, and humanity itself is entering a crisis. Because as young people assimilate into this way of life, they become ever more subservient to corporate interests. There’s no public life anymore, everyone works from home, earns money, but no longer sees the world. Is this what our culture will become?

OS: What role can public health play in this scenario?

JB: Its role is to study what’s happening, to investigate, to promote awareness, and to encourage young people to bring about change. When the leadership of an educational institution becomes conscious of these issues and fosters an internal movement, young people respond because they have that sensitivity, that ethical instinct (which is later lost within the logic of the world we’re criticizing here).

There are many ways to help young people learn to appreciate and love their country, their place in the world. Why do we still believe that everything better lies in the North? This is devastating for a culture, for a country, for a society. A mindset of general dependence, cultural, political, and otherwise, continues to dominate. As a result, others keep dictating what we should do. We can no longer afford to live like this.

The interview with Jaime Breilh was conducted by Gabriel Brito and Gabriela Leite, and published in Portuguese on Outra Saúde. It was slightly edited for length.

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch*. For more articles and to subscribe to People’s Health Dispatch, click* here.

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