The COVID-19 pandemic, declared in 2020, was the sixth Public Health Emergency of International Concern declared by the World Health Organization (WHO) and one of the greatest challenges faced by humanity in recent history, in addition to crises such as the climate emergency and the loss of biodiversity. These crises can be defined as: (i) condition of contemporaneity and results of dominant socio-spatial-ecological relations; (ii) side effects of financial and economic global systems, which are based on a limited (and outdated) paradigm that values economic growth at any cost; (iii) socially produced systemic risks or uncertainties that, when materialized, define situations of social threats, reformulate institutional relations, (re)establish relations of domination, and become priorities in the definition of the political and public agenda, in order to reorient values, strategies, power, and responsibilities.

Globally and locally, the COVID-19 crisis illustrated the close intertwining of critical factors that are at the root of both its causes and its uneven effects. In the field of global health, this crisis strongly highlighted the need to implement and evaluate measures aimed at reducing social vulnerabilities and increasing the consistency and permanence of response actions to public health emergencies (Ventura, Di Giulio, Rached, 2021VENTURA D. F. L.; REIS, R. A linha do tempo da estratégia federal de disseminação da Covid-19. Direitos na pandemia: mapeamento e análise das normas jurídicas de resposta à Covid-19 no Brasil. n. 10, p. 6-31, 2021.). The COVID-19 crisis also shed light on the need to adopt a critical perspective in global health studies, which would help demonstrate how the COVID-19 situation and other characteristic crises of this century resulted from complex interactions between the environment and social actions, and why their synergistic and cumulative effects make it necessary to profoundly transform the patterns of civilization.

A critical perspective in global health studies is aligned, above all, with the recognition of the political dimensions in the problems that underlie ongoing crises, going beyond dominant and homogenizing views. Within this movement, tensioning the continuous production of inequality, the circulation of power, and the production of relations of domination and neglect is fundamental in achieving robust analyses, both at the macro and micro levels. If, on the one hand, it is essential to understand the role of neoliberal capitalism in the production of systemic risks that, as evidenced by the pandemic, transgress borders and have cascading effects that aggravate inequalities between countries, communities, and social groups; on the other hand, it is urgent to situate how this health emergency and other ongoing crises disorganize and reorganize daily routines in a multidimensional way.

This dossier follows this path and aims to give visibility to the analytical contributions aligned with the field of global health. It is part of a set of activities celebrating the 10th anniversary of the Global Health and Sustainability Graduate Program, based at the School of Public Health (FSP) of the University of São Paulo (USP), and brings together a collection of articles that are based on contributions to the book “As múltiplas dimensões da crise de covid-19: perspectivas críticas da Saúde Global e Sustentabilidade” (Di Giulio; Ribeiro; Ventura, 2023)DI GIULIO, G. M.; RIBEIRO, H.; VENTURA, D. F. L. As múltiplas dimensões da crise de Covid-19: perspectivas críticas da Saúde Global e Sustentabilidade. São Paulo: Universidade de São Paulo, 2023.. Created in 2013, exclusively for PhD graduates, the Global Health and Sustainability Graduate Program has made efforts to contribute to the advancement of technical-scientific knowledge on complex, urgent, emerging, re-emerging, and threatening issues, such as the COVID-19 pandemic.

From a critical and interdisciplinary perspective, this dossier gathers contributions from researchers working at the interfaces between Global Health and Sustainability, to give rise to reflections on the multiple dimensions of the COVID-19 crisis. Thus, it seeks to integrate analytical efforts into the critical approaches to the Global Health field, which highlight the need to focus on the interdependence between health, economic development, governance, human rights, international solidarity, and sustainability, to understand the interactions between political norms, regulatory frameworks, collective actions, and individual perspectives, as well as their effects and consequences. By analyzing the COVID-19 pandemic, the articles in this dossier seek to situate the field of global health and its tensions; the outbreak of this health emergency and its multiple effects and dynamics; the discursive frameworks and complex interactions between science and politics; the scientific efforts and dynamics of global policies to provide the population with vaccines and safety; and the food insecurity crisis, in the current global syndemic and pandemic scenario.

To read this dossier, we invite the readers to reflect on three concepts that are intrinsically interconnected in the context of the pandemic: risk, emergency, and sustainability. Confronting the dominant conceptualizations and frameworks of these notions is an opportunity to consider the potential of ruptures, both for the understanding of the dynamics of COVID-19 and other ongoing crises and for studies on global health.

Regarding the notion of risk, we noticed that the current predominant technocratic framework, circumscribed to a functional relationship calculated by the amount and probability of occurrence of damage, has been frequently adopted in analyses of global health security, with important reverberations. The pandemic revealed that this framework tends to reinforce power relations and the dominance of privileged groups, diverging attention from inequities, vulnerabilities, and their causes. Thus, we argue that there is a need for a broader and more complex conceptualization of risk, starting from a socio-constructivist perspective, which describes risk as a contextual, socially constructed phenomenon that exists both in perceptual and experiential planes. In the technocratic approach to risk, the predominant methodologies use limited scientific parameters and cost-benefit analyses to evaluate complex problems and multifaceted risks, often justifying a moral imperative to act, within a discourse that is covered in neutrality and impartiality. The socio-constructivist perspective, on the other hand, seeks to uncover the negotiation processes that define how risks are described, perceived and faced (Giddens, 1999GIDDENS, A. Risk and responsibility. The Modern Law Review, v. 62, n. 1, p. 1-10, 1999.; Boyne, 2003BOYNE, R. Risk (Concepts in the Social Sciences). Buckingham: Open University Press, 2003.; Renn, 2008RENN, O. Risk governance: coping with uncertainty in a complex world. London: Earthscan, 2008.; Beck, 2010BECK, U. Sociedade de Risco: rumo a uma outra modernidade. São Paulo: 34. 2010.). The constructivist notion makes it possible to understand how risk, a relationship between concepts and reality, presents itself in the everyday life experiences that involve impacts on the environment, economy, and health, as well as social constraints (such as stigma) and loss of human lives. These connections between concept and reality are shaped-as the COVID-19 pandemic revealed-by social relations, powers, hierarchies, cultural beliefs, individuals’ trust in institutions, scientific knowledge, experiences, emotions, discourses, practices, and collective memories (Boyne, 2003BOYNE, R. Risk (Concepts in the Social Sciences). Buckingham: Open University Press, 2003.; Hannigan, 2006HANNIGAN, J. Environmental Sociology. London: Taylor & Francis, 2006.; Beck, 20210; Schweizer, 2021SCHWEIZER, P. J. Systemic risks-concepts and challenges for risk governance. Journal of Risk Research, Abingdon, v. 24, p. 78-93, 2021. DOI: 10.1080/13669877.2019.1687574
https://doi.org/10.1080/13669877.2019.16... ; Di Giulio et al. 2023DI GIULIO, G.M. et al. 2023. Risk governance in the response to global health emergencies: understanding the governance of chaos in Brazil’s handling of the Covid-19 pandemic. Health Policy and Planning, Oxford, v. 38, n. 5, p. 593-608, 2023. DOI: 10.1093/heapol/czad016
https://doi.org/10.1093/heapol/czad016... ).

When based on the socio-constructivist perspective of risk, the field of global health can give visibility to the significant sociocultural and political aspects (resistance, controversies, negotiations, negligence) of the production of risks, thus facilitating the emergence of analyses of how these aspects shape the perceptions of individuals and social groups and investigations about how individuals respond to risks, which factors interfere in their responses, and how they respond to social dimensions in real-life situations, define risks, feel affected by them, and imagine facing them.

Regarding the concept of emergency, we argue that the predominant technocratic framework, commonly adopted in analyses of global health security, reinforces the idea that certain phenomena-such as the COVID-19 pandemic-must be characterized and addressed according to their degree of immediacy, exceptionality, and, to a certain extent, by how new they are and by the threat they pose to the survival of a given group or community. Thus, these phenomena tend to be permeated by excessively deterministic narratives and frequently have ramifications marked by authoritarian approaches to confrontation, which contribute to the implementation of anti-democratic and technocratic measures, the silencing of other types of knowledge (local, traditional), and the further oppression of vulnerable groups, socially labeled as minorities (Nunes, 2014NUNES, J. Questioning health security: Insecurity and domination in world politics. Review of International Studies, Cambridge, v. 40, n. 5, p. 939-960, 2014., ²⁰²⁰NUNES, J. A pandemia de COVID-19: securitização, crise neoliberal e a vulnerabilização global. Caderno de Saúde Pública, Rio de Janeiro, v. 36, n. 5, 2020. DOI: 10.1590/0102-311X00063120
https://doi.org/10.1590/0102-311X0006312... ). When this securitization bias prevails, emergencies-as revealed by the pandemic-tend to be approached from a perspective of conflict and national security, which attempts to justify the implementation of extraordinary measures and to diverge attention from critical issues that, in most cases, are at the root of the problems in focus. In other words, the securitization approach produces negligence, which, in turn, perpetuates the vulnerability of certain social groups (Nunes, 2022)NUNES, J. Neglect and resistance in Brazil’s pandemic. Current History, Oakland, v. 121, n. 832, p. 50-56, 2022. DOI: 10.1525/curh.2022.121.832.50
https://doi.org/10.1525/curh.2022.121.83... .

Thus, we argue that a new, appropriate framework on emergencies should come from a socio-constructivist perspective, understanding emergencies as socially constructed processes in which experiences, perceptions, and information about the threats at stake are shared and negotiated among individuals, social groups, and decision-makers. In the technocratic framework, a discourse that characterizes emergency as a reaction seems to prevail, and the typical result after a crisis is resolved is the return to pre-existing conditions-through the socio-constructivist approach, though, there seems to be more room to use emergency discourses as a strategy, which would reinforce the unsustainability of the status quo (Patterson et al., 2021)PATTERSON et al. The political effects of emergency frames in sustainability. Nature Sustainability, Berlim, v. 4, p. 841-850, 2021. DOI: 10.1038/s41893-021-00749-9
https://doi.org/10.1038/s41893-021-00749... . The framing of climate change and biodiversity loss as emergencies, according to Patterson et al. (2021)PATTERSON et al. The political effects of emergency frames in sustainability. Nature Sustainability, Berlim, v. 4, p. 841-850, 2021. DOI: 10.1038/s41893-021-00749-9
https://doi.org/10.1038/s41893-021-00749... , are concrete examples of this attempt to create an exception to the norm, a strategy of political intervention to make a situation visible.

In the field of global health, the socio-constructivist perspective can drive the creation of analyses that understand emergencies as more than mere health challenges, reinforcing that they should be understood starting from broader social and political contexts and implications, which require States and societies to concretely address the socioeconomic determinants at the root of problems and to prioritize creative and integrated approaches to governance. This perspective also makes it possible to clarify how negligence, in its multiple dynamics of omissions, obstructions, and deliberate actions (Nunes, 2022NUNES, J. Neglect and resistance in Brazil’s pandemic. Current History, Oakland, v. 121, n. 832, p. 50-56, 2022. DOI: 10.1525/curh.2022.121.832.50
https://doi.org/10.1525/curh.2022.121.83... ), is key to the production of emergencies, expands damage, and is an important factor in the reproduction of vulnerabilities.

When applied to the field of sustainability, the prevailing technocratic framework, which was consolidated by the publication, in 1987, of the report entitled Relatório Nosso Futuro Comum (Our Common Future), and which has been commonly used in global health studies, reinforces an anthropocentric perspective that only considers natural ecosystems valuable if they help satisfy human needs. Clémençon (2021CLÉMENÇON, R. 2021. Is sustainable development bad for global biodiversity conservation? Global Sustainability, Cambridge, v. 4, p. 1-12. DOI:10.1017/sus.2021.14
https://doi.org/10.1017/sus.2021.14... ) points out that this framework, when integrated into a neoliberal market rationality, is politically promoted under the label of eco-modernity, especially through the paradigm of sustainable development. In practice, the technocratic framework has increased the greenwashing of corporate policies and agendas, and to the co-opting of the sustainability agenda by certain groups and sectors, in an attempt to maintain or increase profits and/or political influence. Because of this dominating framework, sustainability has become a rather vague term used to denote an accommodation that allows the status quo to continue to exist, without effectively acknowledging the paradoxes and fundamental limits of contemporary socio-economic and political organization. Although the COVID-19 pandemic resulted directly from human activity, particularly that of the financial and economic global systems that envision economic growth at any cost, its multiple impacts were not sufficient to reverse the model of predatory exploitation that threatens contemporary society (Di Giulio, Nunes, 2022NUNES, J. Neglect and resistance in Brazil’s pandemic. Current History, Oakland, v. 121, n. 832, p. 50-56, 2022. DOI: 10.1525/curh.2022.121.832.50
https://doi.org/10.1525/curh.2022.121.83... ).

Therefore, we argue that the creation of a new, appropriate framework on sustainability is necessary and we must find new ways to strengthen transformative trajectories, allowing society to abandon the political, social, and economic New Deal (Morin, 2020MORIN, E. A mundialização é uma interdependência sem solidariedade. [Entrevista cedida a] David Le Bailey e Sylvain Courage. Le Nouvel Observateur, Paris, 2020.), and to redefine its position within the biosphere. With a socio-constructivist framework, sustainability would permeate multiple dimensions: social, ecological, economic, spatial, ethical, political, institutional, and cultural ones. Such a framework would incorporate discussions on issues (understandings, practices, decisions) related to equity, the distribution of goods and income, equal rights, and concrete relationships of respect and solidarity with nature and its biodiversity. Besides, it would highlight the urgent need for a profound review of contemporary production and consumption models, addressing the impacts of the accelerated globalization process and of urban lifestyle, and how these impacts manifest themselves in decision-making processes, normative and regulatory arrangements, and everyday life.

In studies on global health, this growing technocratic version of the sustainability agenda-or this “lighter” version of sustainability-tends to gain even more visibility with the concept of planetary health, which has gained strength in recent years (Di Giulio et al. 2021)DI GIULIO, G.M. et al. Global Health and Planetary Health: Perspectives for a transition to a more sustainable world post COVID-19. Ciência & saúde coletiva, Rio de Janeiro, v. 26, n. 10, p. 4373-4382, 2021. DOI: 10.1590/1413-812320212610.14332021
https://doi.org/10.1590/1413-81232021261... . This concept seeks to convey the need for a health governance approach that recognizes the centrality of climate change and other environmental challenges in determining human health. In this sense, incorporating a socio-constructivist perspective on sustainability into the field of global health can help emphasize the need to deeply understand how environmental crises are intertwined with human health, and can also contribute to the critical understanding of ongoing transition processes (such as the energy transition and the transition to sustainable food systems) and their effects. Understanding the multiple interactions between humans and the non-human world, the struggles for power and between ways of living, the need to radically decentralize the human, as well as recognizing the multiple non-Western and posthumanist forms of knowledge, and critically analyzing experimentation and learning processes, are urgent processes in global health studies.

Acknowledgments

The authors and organizers of the dossier thank the researcher João Nunes for his comments and dialogues that enriched this text, and the editors of the Saúde e Sociedade journal for accepting the proposal for this special issue. Gabriela Di Giulio also thanks the CAPES (CAPES-PRINT - Opinion No. 88887.569693/2020-00) and the CNPq (Opinion No. 311503/2020-9).

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