A key approach for the analysis of the relationship between development, inequalities and international cooperation in health is to admit that the problems associated with inequalities between countries at different stages of development could be mitigated through international cooperation. However, a critical appraisal of these historical processes points to two paradoxes.

The first contradiction concerns the more development/more inequality synergy, as international disparities increase with global scientific, technological and economic advances, separating the few beneficiary countries of full development from the others, which are affected in an iniquitous way by this process. The discrepancies have increased over time and are projected on world health, contradicting the ideology of progress, which should have a positive meaning in terms of economic production and the well-being of all.

The second paradox is revealed in the tension between international solidarity and national interests in the scientific, technological, economic, industrial and financial sectors that effectively define geopolitical and military accords between countries. Power struggles between governments affect this field of relations, under the influence of large private companies, often to the detriment of the collective interest, a key factor in the generation of inequalities and injustices that divide the world between the most affluent and the most underprivileged, with negative repercussions in terms of health.

The intention of the organizers of this thematic issue of C&SC was to gather critical contributions on international cooperation for development vis-à-vis health inequalities by considering four interconnected perspectives on the meanings of health and cooperation in vogue in the historical context of the United Nations.

The first concerns the interpretations of health enshrined in the classical concept of the causality of diseases, in line with their recognition as a transcendent value and fundamental human right that is projected in public policies of State.

The second viewpoint refers to the concept and practice of cooperation for development in the context of the United Nations, as the frame of reference for understanding international cooperation in health, with emphasis on the so-called South-South cooperation process and especially its redefinition proposed by the term structuring cooperation, disseminated by Fiocruz as the PAHO/WHO Collaborating Center in Global Health and South-South Cooperation.

The third perspective refers to State regulation to deal with the problems of health in a world scale through action on an international level, in areas of strong connection with the genesis of these problems. The emphasis on this aspect comes from issues which are often beyond the reach of authorities and other actors of the health sector.

The debate on these issues is of interest to the whole of society and must therefore transcend the academic institutions, the bureaucratic apparatus of the state and especially the industrial and financial sectors. Therein lies the importance of a fourth way of addressing the issue in question, based on the field of communication, in its ambivalence in the liberation-domination dynamics between the actors of these different fields of interest. This is needed in order to revise concepts, strategies and tools capable of motivating the interest and the mobilization of broad social segments around the demands of health in the international context.

We trust that this compilation of texts represents a valuable contribution to those interested in this subject, to instigate discussion and encourage studies from the key approach adopted in the organization this edition of C&SC in collaboration with Nethis/Fiocruz.

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