Abstract

Ensuring democracy in establishing Global Health (GH) requires including health perspectives and actions of what is conventionally called “local”. Edging closer to the references of the Meeting of Knowledges to those of Coloniality, we address the implementation of Solidary Greengrocers by the initiative of small-scale fishermen in the South of Bahia, Brazil, in facing socioeconomic and health issues related to the COVID-19 pandemic. The triangulation of methods characterized the fieldwork based on ethnography, action research, and partnership with local stakeholders in analyzing the material. The search for simultaneous health, socioeconomic, environmental, and educational effects allowed for overcoming the risks in GH actions such as humanitarianism, controlism, neoliberalism, and colonialism. The initiative was managed by the political organization of the residents of the reserve, who raised and managed State and civil society resources with autonomy and solidarity, combining traditional knowledge with institutional and technological knowledge of the territory. So-called local experiences contain a complete vision of the world that should not be submitted to a totalizing category. Global Health can benefit from considering the several worlds underlying its object.

Key words:
Global Health; Colonialism; Knowledge; COVID-19; Cooperativism

Introduction

Globalization and the internationalization of the capitalist world have allowed for the emergence of a market without borders, influencing many current political processes¹1 Santos M. Por uma outra globalização: do pensamento crítico à consciência universal. 6ª ed. Rio de Janeiro: Record; 2001.. It imposes the universality of an ideology (liberalism), a currency (the dollar), an exchange tool (capitalism), a political system (democracy), a language (English)²2 Brunel S. Qu'est-ce que la mondialisation? Sci Hum 2007; 1085:129., and a way of thinking (the Eurocentric episteme). The structuring contradiction of the globalization discourse is the impossibility of equality between the parts and the whole, often masked by the assumption of rational agreement between individuals and social groups that would guarantee what is necessary and desired for each. However, this hypothetical consensus narrows the distance between inevitable disputes and society, leading to the disappearance of politics as a space for differentiation, contestation, and creativity³3 Rancière J. O desentendimento: política e filosofia. São Paulo: Editora 34; 1996.. In the case of Global Health (GH), there is an urgent need to confront the artifice of the intangible globalized consensus by highlighting local experiences and the disputes surrounding the very constitution of the area today.

Although it has already been considered a field, in the Bourdieusian sense of the term⁴4 Dias NX, Canelas T, Vasconcellos MP, Ribeiro H. Constructing the field of knowledge of Global Health and Sustainability at the Universidade de São Paulo in the Latin American context. Rev Bras Pos Grad 2017; 14(33):1-16., GH would more appropriately be a social space in formation and, therefore, the scene of disputes, as evidenced by the recurring efforts to establish its concept, object, and objectives⁵5 Salm M, Ali M, Minihane M, Conrad P. Defining global health: findings from a systematic review and thematic analysis of the literature. BMJ Glob Health 2021; 6(6):e005292.^,66 Garay J, Harris L, Walsh J. Global health: evolution of the definition, use and misuse of the term. Face A Face 2013; 12:1-18.. Preceded by “Colonial Medicine” and its offshoots “Tropical Medicine” and “International Health” in the 19^th and 20^th centuries⁷7 Holst J. Global Health - emergence, hegemonic trends and biomedical reductionism. Glob Health 2020; 16(1):42., GH is the subject of internal confrontation between reformist and transformative ideological perspectives⁸8 Shawar YR, Neill R, Kunnuji M, Manoj M, Shiffman J. Understanding resilience, self-reliance and increasing country voice: a clash of ideologies in global health. BMG Glob Health 2023; 8(1):e010895., questions about the suitability of its scholars for fieldwork⁹9 Borst RAJ, Wehrens R, Bal R. "And when will you install the new water pump?": disconcerted reflections on how to be a 'good' Global Health scholar. Glob Health 2023; 19(1):19., analysis of the new climate crisis challenges¹⁰10 Traore T, Shanks S, Haider N, Ahmed K, Jain V, Rüegg SR, Razavi A, Kock R, Erondu N, Rahman-Shepherd A, Yavlinsky A, Mboera L, Asogun D, McHugh TD, Elton L, Oyebanji O, Okunromade O, Ansumana R, Djingarey MH, Ali Ahmed Y, Diallo AB, Balde T, Talisuna A, Ntoumi F, Zumla A, Heymann D, Socé Fall I, Dar O. How prepared is the world? Identifying weaknesses in existing assessment frameworks for global health security through a One Health approach. Lancet 2023; 401(10377):673-687., and risks of updating colonialist relationships. This last aspect is of particular interest to us. It has been addressed by analyzing the contradiction of supposedly global discourses, but based on particular categories of a few institutions and journals¹¹11 Shiffman J. Knowledge, moral claims and the exercise of power in global health. Int J Health Policy Manag 2014; 3(6):297-299., criticism of the underestimated cognitive capacity of target populations and consequent epistemic injustice¹²12 Bhakuni H, Abimbola S. Epistemic injustice in academic global health. Lancet Glob Health 2021; 9(10):e1465-e1470.^,1313 Koum Besson ES. How to identify epistemic injustice in global health research funding practices: a decolonial guide. BMJ Glob Health 2022; 7(4):e008950., reflections on social inequality and hermeneutic injustice arising from the coloniality of power and knowledge¹⁴14 Richardson ET. On the coloniality of global public health. Med Anthropol Theory 2019; 6(4):101-118., and denunciation of technical control methods impervious to local conditions¹⁵15 Biehl J. Descolonizando a saúde planetária. Horiz Antropol 2021; 27(59):337-359..

In Brazil, some movements of organized traditional peoples have been at the forefront of discussions on GH¹⁶16 Guajajara SB, Alarcon D, Pontes ALM. Entrevista com Sonia Guajajara: O movimento indígena frente à pandemia da Covid-19. Cien Saude Colet 2022; 27(11):4125-4130., but they still need to represent the diversity of peoples and existing conditions. We need more studies in specific territories that, on the one hand, highlight the distinct and creative local ways of addressing global health issues, as in the case of the COVID-19 pandemic, and that, on the other hand, establish conditions for the full recognition of the intellectual authorship of these practices, confronting head-on epistemic and hermeneutic injustices and other aspects of the coloniality of knowledge¹⁷17 Quijano A. Colonialidade do poder, eurocentrismo e América Latina. In: Lander E, organizador. A colonialidade do saber: eurocentrismo e ciências sociais. Buenos Aires: CLACSO; 2005. p. 107-130.. Thus, we will analyze the Solidary Greengrocer (SG) - an initiative led by small-scale fishermen, shellfish gatherers, and small farmers, which was an essential local reaction to the harm caused by the COVID-19 pandemic - led by a coalition of fifteen local associations within a Conservation Unit and Extractive Reserve on the southern coast of Bahia. The SG associated healthcare with the principles of Solidary Economy¹⁸18 Andrada CF, Esteves EG. Sonho, história, loucura? Economia Solidária: um movimento de resistência no mundo do trabalho. In: Rasera EF, Pereira MS, Galindo D, organizadores. Democracia participativa, estado e laicidade: psicologia social e enfrentamentos em tempos de exceção. Porto Alegre: ABRAPSO; 2017. p. 169-187., unfolding in food safety actions, cooperative work, fair trade, and solidary finance¹⁹19 Silva SP. Economia solidária e finanças de proximidade: realidade social e principais características dos empreendimentos de finanças solidárias no Brasil. Brasília: Ipea; 2017. to protect against the spread of the virus and mitigate socioeconomic harm. The collection of data and information and the analysis and discussion in this study counted on the direct participation of those responsible for implementing and conducting the proposal, and this partnership is reflected in the composition of this text’s authorship. We assume that highlighting successful local experiences that positively affect health conditions and recognizing their respective authors is a prerequisite for establishing GH that, as a field, overcomes the risks of homogenization and colonization found in the approach to transnational issues²⁰20 Furtado JP, Chioro dos Reis AA, Comparato BK, Souza LR, Nakano AK. Participação e diversidade - a construção pluriepistêmica da Saúde Global. Cien Saude Colet 2022; 27(11):4085-4090.. We adopted a framework consisting of the debate on knowledge coloniality and the proposal of the Meeting of Knowledges to provide theoretical support for this journey.

Coloniality and Meeting of Knowledges as references

Aníbal Quijano (1930-2018) emphasizes the intrinsic relationship between the Modern Era, colonialism, and Europeans’ consequent racialization of humanity. The Peruvian sociologist argues that the colonization of knowledge usurped the valuable knowledge for the developing capitalism, repressed the intellectual production and symbolic universe of the colonized peoples, and forced the dominated people’s assimilation of the dominators’ culture in order to relegate Indigenous people and Africans to a peasant and illiterate subculture, underestimating their intellectual heritage¹⁷17 Quijano A. Colonialidade do poder, eurocentrismo e América Latina. In: Lander E, organizador. A colonialidade do saber: eurocentrismo e ciências sociais. Buenos Aires: CLACSO; 2005. p. 107-130.. The persistent colonial power structures and domination have been called coloniality, characterized by preserving racial order with economic and epistemological consequences to benefit local elites and central countries, even after the formal independence of the former colonies²¹21 Quijano A. Colonialidad y modernidad/racionalidad. Peru Indig 1992; 13(29):11-20..

In Brazil, knowledge coloniality was also expressed in creating universities in the early 20^th century. According to José Jorge de Carvalho, Brazilian universities inherited the German reform of higher education in the 19^th century, inspired by Humboldt, implemented without any adaptation of its epistemic principles to our society, favoring the white elite and excluding most of the population and their knowledge, consolidating a Eurocentric and monoepistemic standard of knowledge²²22 Carvalho JJ, Flórez J. Encuentro de saberes: huellas de memoria pluriversa y descolonización de la universidad contemporánea. Arx Sociol 2018; 39:143-150.^,2323 Carvalho JJD, Flórez-Flórez J. The Meeting of Knowledges: a project for the decolonization of universities in Latin America. Postcolonial Stud 2014; 17(2):122-139.. The proposed Meeting of Knowledges (MoK) is grounded on the movement to increase access to public universities for Black and Indigenous people. The incorporation of these societal segments highlighted the lack of epistemic inclusion in these institutions, leading to the movement for the incorporation of masters from traditional peoples and popular cultures to guarantee the epistemological enrichment of the universities²⁴24 Carvalho JJ. Encontro de saberes, descolonização e transdisciplinaridade. In: Tugny RP, Gonçalves G, organizadores. Universidade popular e encontro de saberes. Salvador: EdUFBA; 2020. as university professors in regular subjects. The MoK has several ruptures, and those of an ethnic-racial, pedagogical, and epistemic nature are of particular interest in this study as they create practical conditions for overcoming epistemic injustice²⁵25 Carvalho JJD. Notório Saber para os Mestres e Mestras dos Povos e Comunidades Tradicionais: Uma Revolução no Mundo Acadêmico Brasileiro. Rev Universidade Fed Minas Gerais 2021; 28(1):54-77.. As a result, dialoguing with establishing Global Health (GH) from knowledge coloniality and the Meeting of Knowledges implies considering different epistemes, relativizing the consensus around the hegemonic technical-scientific, and biomedical discourse as the only parameters for understanding and intervening, opening up to consolidated knowledge that operates in several more or less distant locations.

Methods

Bruno Bringel and Renata Versiani have called militant research a field of theorizing and practicing popular struggles, gathering intellectuals, researchers, and social movements, reflected in works by Orlando Fals-Borda and Paulo Freire, Carlos Rodrigues Brandão, and Michel Thiollent, providing several combinations in research-action binomial²⁶26 Bringel B, Varella RVS. A pesquisa militante na América Latina hoje: reflexões sobre as desigualdades e as possibilidades de produção de conhecimentos. Rev Digit Direito Adm 2016; 3(3):474-489.. Together with ethnography²⁷27 Angrosino M. Etnografia e observação participante. São Paulo: Artmed; 2009., the adaptation of ideas in militant research, especially Fals-Borda’s participant-action research²⁸28 Fals-Borda O. El problema de cómo investigar la realidad para transformarla por la praxis. In: Farfán NAH, Guzmán LL, organizadores. Ciencia, compromiso y cambio social: Textos de Orlando Fals-Borda. 2ª ed. Montevideo: Lanzas y Letras; 2014. p. 213-239., guided part of our fieldwork. MoK supported the inclusion of border epistemologies in fieldwork, in which knowing, feeling, and doing coexist in historical and conflictual resistance practice²⁹29 Mignolo WD. Colonialidade: o lado mais escuro da Modernidade. Rev Bras Ci Soc 2017; 32(94):1-18.. As a result, the MoK gathered agents responsible for the Solidary Greengrocers (SG) and those from academia to work together, resulting in an interwoven and in-depth participation, considering the criteria for assessing the quality of participatory processes proposed by King et al.³⁰30 King JA, Cousins JB, Whitmore E. Making sense of participatory evaluation: Framing participatory evaluation. New Dir Eval 2007; 114:83-105..

The field

This work is nested in the research Participation and Diversity - the inclusive and multi-epistemic construction of Global Health conducted through immersion in different territories of the so-called Teia dos Povos³¹31 Pimentel SK. Teia dos Povos: afetos-encantos afro-indígenas-populares numa coalizão cosmopolítica. Tellus 2021; 21(46):253-282.. Teia dos Povos is a Bahian coalition of rural social movements, Indigenous peoples, and traditional communities based on the agroecological transition, promoting good living, and structuring economic alternatives beyond capital in their territories³²32 Oliveira JF. As lutas existem pela nossa terra. Belo Horizonte: Escola de Arquitetura da UFMG; 2021.. This paper highlights the “Federal Sustainable Use Conservation Unit - Canavieiras Extractive Reserve” (Resex Canavieiras), located on the southern coast of Bahia, which is part of the Teia dos Povos. The Extractive Reserves are a policy geared to the means of subsistence of a given traditional population and its culture, overcoming protectionism and enabling the proper use of the territory and natural resources by the communities that have long been settled there³³33 Costa PCPD. Reservas extrativistas marinhas: reflexões sobre desafios e oportunidades para a cogestão em áreas marinhas protegidas. Desenvolv Meio Ambiente 2018; 48(ed. esp.):417-431.. Resex Canavieiras was established in 2006. It has an area of 100,650 hectares spread over the municipalities of Canavieiras, Una, and Belmonte, of which 83,650 ha are marine and 17,000 ha are continental, the latter comprising an extensive area of mangroves (8,000 ha), sandbanks (5,000 ha), and Atlantic Forest (4,000 ha). The natural resources of this Sustainable Use Unit are the subject of dispute between 2,400 families living there, in 15 different nuclei, who make a living from agro-extractivism and fishing, and real estate speculation, plus agro- and hydro-business, which are constantly growing in the surrounding area³⁴34 Pereira GP, Oliveira MLR, Costa BAL. Mobilização e atuação das populações tradicionais na criação da Reserva Extrativista Marinha de Canavieiras-BA (Brasil). Rev Espac 2017; 38(41):13.. These communities are organized through local community associations, which, in turn, form a coalition called the Mother Association of Resex Canavieiras Extractivists (Amex), created in 2009, which participates in the Resex management by sitting on its Deliberative Council.

On the field

Between April 2022 and March 2023, one of the authors of this article took up temporary residence in the Terra Vista settlement, which houses Teia dos Povos leaders. From Terra Vista, where he stayed for 185 non-consecutive days, the author lived with some of the Teia member communities, including the Resex, 85 km away. Interacting with leaders and members of some of the Resex communities occurred through joint work at the Teia and, in a more focused way, during four stays in the reserve. The on-site work was characterized by participation in political activities at the ordinary meetings of two associations, meetings between Terra Vista settlement and Resex leaders, strategic planning meetings, and collaboration in everyday activities such as parties and lunches, the latter providing informal interactions. At the same time, a professional cameraman produced dozens of hours of video recordings, including five interviews with locals and leaders, which resulted in a documentary about the territory, the editing of which included the respondents. A field diary recorded the experiences and activities performed together. Another critical stage in the field was to revisit the material initially collected to delve deeper into the conceptual, theoretical, political, and organizational aspects involved in the implementation and operation of the SG. In this stage, an academic researcher and another from the initiative met twice in person, followed by another three online meetings with the whole group of five researchers (two of whom were directly linked to the initiative and three academics) in order to validate and supplement the material collected and define the writing process. Chart 1 summarizes the fieldwork undertaken. This research was approved by the Ethics Committee of the Federal University of São Paulo (UNIFESP) under protocol No. 0687/2022 and CAAE 60943622.4.0000.5505.

Results

The Solidary Greengrocers (SG) initiative is nested in a broader context in which Amex is tackling environmental and health issues, such as the oil spill off the Brazilian coast in October 2019, when they removed 40 tons of mineral oil from the beaches and the high seas in the Resex territory, and in significant floods in the south of Bahia in late 2021. In both events, Amex led collective efforts to raise and distribute monetary aids, objects, food, and direct aid to the people affected, coordinating work 24 hours a day during acute moments, impacting the social and health aspects. Amex actions, including SG, are occurring within a political framework of disputes and clashes with the municipal governments, ongoing since the implementation of Resex and Amex. The latter believes that the local government does not serve the interests of most of the population of fishermen and shellfish gatherers, justifying political and practical actions, especially in times of urgency, given the risk of imminent and irreparable material and human losses.

Regarding the pandemic, Canavieiras, with 32,000 inhabitants, had 1,570 confirmed cases of COVID-19 and 75 deaths between March 2020 and December 2021³⁵35 Brasil. Ministério da Saúde (MS). Covid 19 no Brasil. Município de Canavieiras-BA [Internet]. 2023 [acessado 2023 abr 21]. Disponível em: https://infoms.saude.gov.br/extensions/covid-19_html/covid-19_html.html.
https://infoms.saude.gov.br/extensions/c... . SG was one of the strategies to guarantee health and food security for the residents of part of the Resex communities during the pandemic, where the drastic reduction in small-scale fishing activity affected the income of the 2,400 families who live directly or indirectly from fishing and shellfish gathering. Amex has tackled health issues stricto sensu by protecting vulnerable people and those from communities far from general social contact and has also cooperated in making thousands of anti-virus fabric masks under the leadership of the Fisherwomen’s Network. Amex has also worked from the perspective of what can be considered health promotion through food security and solidary economy actions, selling food at subsidized prices, using social currency, and exchanging fish for agricultural products. The SG also sold fish and gathered shellfish at the conventional market, increasing their cash flow and, thus, extending the duration of the initiative, as we will detail later. As was stated on the posters displayed in each of the SGs, it was a

SG was implemented in five of the fifteen existing associations at the onset of the pandemic, operating at their respective headquarters from July 2020 to November 2021, daily from 8 am to 11 am, benefiting 1,600 people throughout this period. Food products were bought, sold, or exchanged there, using the social currency (Moex) previously issued during the Amex Community Bank’s previous period of operation, from 2012 to 2016. In the day-to-day running of each SG, a pair of teenagers or young scholarship holders were in charge of receiving, stocking, passing on the products, and performing other tasks, which served their technical and political training strategy and occupation during school retrenchment. Considering the rotation, 40 students underwent the experience, and a central treasury monitored their work. The non-repayable fund of BRL 50,000 used to support the initiative derived from the reallocation of funds earmarked for strengthening fishing communities from the Protected Marine and Coastal Areas project of the Global Environment Facility (GEF-Mar), coordinated by the Ministry of the Environment, financed by the World Bank, with the Brazilian Biodiversity Fund (Funbio) as financial manager. Obtaining authorization for this reallocation was fundamental to ensuring agility and speed in implementing the SG at a delicate moment in the pandemic, given the lack of vaccine resources.

The choice of the five communities, given the limited resources, was based on three combined criteria: greater distance from local businesses, the presence of young people or teenagers who could lead the SG, and the need to avoid the project generating competition and risk of bankruptcy for the members’ micro-businesses in some communities. The establishment of priorities generated dissatisfaction, given the expectation of some residents to access the SG, although they were aware of the criteria. If, on the one hand, the non-conformities with the criteria pointed to the need to overcome the individualism still present in community actions, on the other, the demand for access highlighted the recognition of the importance of SG even by those who could not access them. Other limitations faced by the proposal were the impossibility of serving residents in the urban area of Canavieiras, which gathers the most significant number of fishermen and collectors, due to the fiscal and tax requirements imposed by the municipality, which prevented the implementation of SG in the city, and insufficient logistics of distributing perishable products, causing limitations in distribution and jeopardizing the maintenance of the proposal beyond the pandemic period.

Discussion

The preponderant focus on the experiences of large urban centers and central countries during coronavirus pandemic years can make invisible what is experienced in small communities spread across the country and other regions of the planet, neglecting inspiring alternatives in possible future pandemics. The SG evidenced the ability to formulate complex responses to identical problems, highlighting the polymathy inherent in masters³⁶36 Carvalho JJ. Transculturality and the Meeting of Knowledges. In: Hemetek U, Hindler D, Huber H, Kaufmann T, Malmberg I, Saglam H, organizers. Transkulturelle Erkundungen: Wissenschaftlich-künstlerische Perspektiven. Wien: Böhlau Verlag; 2019. p. 79-94. - understood as the unique ability to articulate knowledge with transdisciplinarity as the closest equivalent in academia - simultaneously affecting health, socioeconomic, environmental, and educational aspects. All this was facilitated by omnipresent negotiation, imbued with well-established ethical and political references between people, institutions, technologies, knowledge, and ecosystems, which are advances vis-à-vis the “isms” potentially present in GH actions such as humanitarianism, controlism, neoliberalism, and colonialism, pointed out by João Biehl³⁷37 Biehl J. Theorizing global health. Med Anthropol Theory 2016; 3(2):127-142.. It was an initiative conceived and managed through the political organization of the residents, who fundraised and managed resources from the state and civil society with autonomy and solidarity, using and updating traditional knowledge combined with the institutional and technological knowledge in the territory.

This initiative reveals other meanings and ways of characterizing global and local, exceeding notions under which the former would be the whole and the latter one of its components, differing from each other only in scale and breadth: the global necessarily large and the local inevitably small. The difference is qualitative, with one category not containing or being within the other but alongside it, thus allowing for different and complete visions and conceptions of the world and their practical developments¹⁷17 Quijano A. Colonialidade do poder, eurocentrismo e América Latina. In: Lander E, organizador. A colonialidade do saber: eurocentrismo e ciências sociais. Buenos Aires: CLACSO; 2005. p. 107-130.. The local is a complete world vision and contains a world in itself³⁸38 Guy JS. O que é global e o que é local? Uma discussão teórica sobre globalização. Cad Adenauer 2015; 4:41-69..

The polysemy attributed to SG’s solidary trade by the residents and the ability to extract different and synchronous effects from it reveal an awareness of the imbricated issues brought about by the pandemic and the ability to act on them in combination, which has broadened the range of issues addressed and streamlined the resources allocated. Assuming such a level of awareness of both the particularities and the juxtaposition of needs derived from the communities, followed by the agile development of interrelated responses, was facilitated, to a large extent, by the circulation of traditional knowledge and newly developed strategies (such as the community bank), inserted in a political struggle based on recognition and trust in their ways of knowing (epistemology), thus creating a complete, albeit not isolated, world where forms of coloniality, including those of power and knowledge, are effectively relativized²²22 Carvalho JJ, Flórez J. Encuentro de saberes: huellas de memoria pluriversa y descolonización de la universidad contemporánea. Arx Sociol 2018; 39:143-150. in order to formulate projects to address emergencies in the territory.

The SG advent must also be understood within the relationships established by Amex with the State and its respective governments. As far as the state and federal governments are concerned, it seeks to establish tactical alliances to gain access to redistributive policies and guarantee the usufruct of the territory it has gained, while being markedly critical and independent. With the municipal government, it has been characterized by intense and permanent confrontation since the outset when setting up Resex and Amex, as illustrated by the marches promoted by the Municipality³⁹39 Fundação Oswaldo Cruz. Mapa de Conflitos, Injustiça Ambiental e Saúde no Brasil. BA - Ameaças de morte e de perda de emprego de familiares são utilizados para oprimir a população e desmontar a Reserva Extrativista de Canavieiras [Internet]. 2013 [acessado 2023 maio 1] Disponível em: https://mapadeconflitos.ensp.fiocruz.br/conflito/ba-ameacas-de-morte-e-de-perda-de-emprego-de-familiares-sao-utilizados-para-oprimir-a-populacao-e-desmontar-a-reserva-extrativista-de-canavieiras/.
https://mapadeconflitos.ensp.fiocruz.br/... , campaigning for a reversal in the characterization of the Extractive Reserve as an environmental protection area (APA), the latter being less restrictive to the interests of agro- and hydro-business and real estate speculation. The clash between short-term commercial interests and the preservation of the territory of the reserve and its communities involves sums that can reach hundreds of millions of BRL in land and business “opportunities”, establishing antagonistic interests between businessmen and the fishing community which, at particularly aggravated stages, reach the personal level of those involved, with records of death threats to fishermen who are Amex members.

There are frequent complaints and reports of boycotts and postponements of the demands of Amex and its communities, such as the local government’s slow referral of patients from Resex to other municipalities, which seems to explain the invisibility of equipment linked to the municipality’s Unified Health System (SUS) in the statements and actions of Resex leaders and other residents. Actions that require urgency, such as guaranteeing food security and social distancing contained in the SG proposal, call for the members’ leadership precisely because of the mistrust that the municipal response would not arrive in time to guarantee the subsistence and protection of part of the communities. Thus, to a large extent, Amex’s relationship with the idea of the state aligns with the propositions of seeking autonomy or, more specifically, sovereignty over water, food, work, income, education, and energy guiding the Teia dos Povos, whose one of its fundamental principles, besides the struggle for land and territory, is “working to build autonomous communities that can manage their destiny and start the hard work of organizing beyond capital”³²32 Oliveira JF. As lutas existem pela nossa terra. Belo Horizonte: Escola de Arquitetura da UFMG; 2021. (p.124).

As already stated, the assimilation of Solidary Economy agendas represents an updating of the agenda of the social movements⁴⁰40 Leal LP, França Filho GC. Solidariedade Democrática em Movimento: respostas à grande crise da pandemia de Covid-19. NAU Soc 2020; 11(21):281-291.. Structuring the distribution of foodstuffs and the purchase of fishery products around the principles of Solidary Economy, which was already part of Amex’s struggle and resistance strategies, was deliberate in highlighting the community and solidary nature of the whole proposal. Hence the revival and subsequent privilege given to social currency in the SG. Furthermore, the process included the exchange of part of the fishing products for those from neighboring small farming communities, with fair exchanges with the Terra Vista settlement, which received fish and sent a significant amount of plantains, pumpkins, cassava, and other agricultural products that were passed on, free of charge, to the SG beneficiaries. Opting for fair trade, cooperation networks, solidary finance, and the effects of this alternative way of circulating goods and wealth, instead of the familiar path of donating foodstuffs, has given the resources initially invested a new lease of life through the inflow of money from the sale of foodstuffs (bought from wholesale chains) and part of the fish products, substantially extending the duration of the SG from the three months initially planned to sixteen months. As stated by an Amex founder and manager,

This expansion attests to the effectiveness of how financial resources are managed but also to the legitimacy and recognition the proposal has gained as a survival strategy in the face of the restrictions and precautions imposed by the pandemic. One of the consequences of the success of the SG experience was the encouragement and reinforcement of Amex’s decision to implement a cooperative, which had been under consideration, to market fishing products from the territory and sell fishing materials and other products of interest to the community based on the principles of Solidary Economy.

GH can become more effective because it is a space for fostering diverse ways of thinking and acting on the health challenges permeating the entire planet. However, it is necessary to assume that the notion of the global, contrary to what is commonly implied, does not mean a cloak under which peoples and territories must inexorably take shelter. As Basile⁴¹41 Basile G, Reyes AH, coordinadores. Refundación de sistemas de salud en Latinoamérica y el Caribe: descolonizar las teorías y las políticas. Buenos Aires: CLACSO; 2021. has developed, geopolitics and GH’s hegemonic neoliberal perspective (and its offshoots, such as Pan-Americanism, vis-à-vis Latin America) imply theoretical and political dependencies in national health systems, which leads the author mentioned above to propose what he calls an epistemology for re-founding Latin American health systems in the 21^st century.

In this context, the peculiar and complex ways of life, struggle, and commitment to the land, the territory and its preservation, and the solutions to the health problems, as shown in the initiative analyzed here, must gain prominence in the global debate on GH and the very shape of the national, state, and municipal health systems. This inclusion should ensure that sophisticated thinking is a quality recognized by all communities, including those subordinated by the colonial process and the capitalist production mode, avoiding the imposition of supposed solutions disconnected from the peoples and their territories and, for this very reason, have a limited, if not harmful, reach.

Conclusion

Achieving global health equity involves considering the interactions between nature and society and their offshoots, configuring the so-called social determination in health, as shown by studies of the relationships between the biological aspect and how societies are organized (especially regarding access to the wealth produced) and their repercussions on the health-disease process of human communities⁴²42 Breilh J. Las tres 'S' de la determinación de la vida 10 tesis hacia una visión crítica de la determinación social de la vida y la salud. In: Nogueira RP, organizador. Determinação Social da Saúde e Reforma Sanitária. Rio de Janeiro: CEBES; 2010. p. 87-125.. The desire for global equity must also include a commitment to guaranteeing the coexistence of differences - which is fundamental to building and keeping democracy - with the several peoples and their respective territories that make up the planet and fostering openness to the proposals and health solutions that originate there. The paradigm responsible for today’s substantial planetary crisis is, in essence, the hegemonic production mode and expected permanent growth, together with the unbridled labor exploitation, which has primarily stimulated internationalized exploitation and the universal imposition of an ideology. The climate crisis, the most recent epidemics and pandemics, and unemployment (or underemployment) are often seen as epiphenomena of this system, which, as has been shown, will not be the source of the solution to the problems it generates. Creative and effective alternatives can emerge from certain “places” and “worlds in themselves”, committed to solidarity-based ways of existing, as discussed here and aligned with what native peoples and the African diaspora have been showing for over five hundred years in the case of Latin America. These people continue to cultivate their ways of knowing and sustain systematic resistance, nurturing the active hope of “reaching a specific day when the Brazilian State will recognize more value in an area that is home to a hundred productive families than in that used by a businessman and his 10,000 cattle heads”, as stated by one of the leaders interviewed.

This work has focused on GH as an interlocutor. With its characteristics and way of structuring itself on Brazilian soil, the SUS is an obligatory passage and a source of modulations and adaptations of health system actions. It can filter out the risks pointed out in initiatives that purport to be global. The SUS networks and services, represented by their workers, by recognizing and fostering the capacities present in the territories - among which we highlight the ways of showing solidarity, resisting, knowing, and proposing health solutions - will contribute to developing skills in the community confrontation of severe and intricate issues in the most different Brazilian territories.

The limitations of this study are the fact that it does not go into greater depth on other initiatives that converged with the SG, such as the mask-making workshops run by the Fisherwomen’s Networks; from an evaluative perspective, the lack of detail on the potential presence of issues among the SG beneficiaries; the failure to include the viewpoint of the initiative’s partner communities. However, we should underscore the invaluable inputs by two leading figures included in the process as co-authors of the text to broaden the scope and depth of this study and its drafting.

References

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