Rio+20, to be held in 2012, was preceded by the International Conference of Urban Health, by the Conference on Social Determinants of Health, in 2011, by the National Seminars of promotion of health and by the National Conference of Environmental Health. It highlights the relation between sustainable development and health by the perspective of the promotion of equity

The Sanitary Reform is a movement in defense of life. The possibility of continuation of life as we know it is threatened by the capitalist production. The dilapidation of nature and the increasing social inequities lead to the unsustainability of life and of the reproduction of the current production and consumption itself, in a context of a global, systemic and continuous crisis of the capital.

Major corporations and their strategic governmental and social networks already work with this situation, thus creating ideological, political and technological alternatives. The 'greening' of the capital, the mercantilization of ecosystem services, the technologies that soften the consequences (climate changes, hunger, thirst, pollution) and the exportation of risks to geopolitical spaces of lower resistance are some of these strategies.

On the other hand, a group of initiatives aim to respond to the practical and theoretical challenge of giving concrete answers to the constitution of sustainable and. health territories, thus supporting the promotion of social inclusion and sustainable human development. In common, they have the objectives of promoting access to citizenship, preserving the environment, promoting economic development and quality of life, intersectoral and participatory governance as a management tool and the territory as an element that puts its implantation into context.

Strategies of actors and networks that take over counter-hegemonic perspectives confirm the need to establish solidarity networks starting from dialogues and convergence of subjects, such as: agroecology, socio-environmental justice and health, solidarity economy, food security and feminisms, having the territory as a core element for these strategies, and the dialogue and intercommunicability between different types of knowledge, based on the social participation as the pedagogy of hierarchy of priorities and emancipator actions.

The sanitary movement can contribute with theoretical and conceptual knowledge, such as the social determination, the promotion of health and the production of individual and collective autonomy; and with practical knowledge, such as the universality, integrality, gratuity and social control However, it has to face issues that contradict such knowledge.

The productive complex of health reproduces the hegemonic logic of production in the organization of labor processes and the use of the workforce in the employment of 'brown' technologies, in the destination of waste, in the mechanisms of commercialization and the appropriation of profit and in the definition of research, investment and production priorities. 7his is the rule in the private sector, and even if important initiatives of the State have been taken in order to reverse this picture in relation to priorities, commercialization and profit, the other dimensions are hegemonic in these experiences.

The offer and the organization of health services have been significantly increasing, thus softening problems generated by the development model, such as massive migrations of populations that were expelled and/or attracted by major ventures, concentrated on the secondary and tertiary levels. 7his increases the costs and strengthens the doctor-hospital approach.

The contradiction between this picture and the perspective of the Sanitary Reform is clear. It is essential that the sanitary movement incorporate the sustainable development in its praxis picture, thus strengthening the critical thinking and the counter-hegemonic networks.

The Millennium Summit in 2015 may be an important mark in the dispute between antagonistic projects, articulating the economical, environmental and social pillars of sustainable development and evaluating the strategies of the Millennium Development Goals, in relation to the Sustainable Development Goals, which should be established in Rio+20, where these projects will be facing each other.

Both the Earth Summit (State) and the People's Summit (Civil Society) are dispute arenas in which the emancipatory thinking must struggle to reach distinct and complementary knowledge. Structurally conditioned by diplomatic rules, the challenge of the first is to avoid the regression of deals that have already been made, to develop mechanisms of multilateral, participatory and regulatory governance without the prevalence of the economical pillar, and to deepen the concept of green economy. The second event is characterized by the diversity of positions, and the challenge is to build a common project in the concept field, especially in the relation State - Society, and in the practical field, it should demonstrate the viability of the proposed models of socioeconomic organization.

Health can greatly contribute, due to its experience, in both arenas - State and Civil Society, in order to determine a counter-hegemonic project and its governance.

By this perspective, CEBES, through Revista Saúde em Debate, releases this special issue that is comprised of papers that put the approaches, as well as theoretical and practical challenges for the sustainable development and health into context, with the goal of providing subsides that assist the critical analysis of the initiatives and the intervention of the sanitary movement in Rio+20 and its branches. Never before has our historic guideline been so adequate to the current days. Life is threatened. In defense of life.

Edmundo Gallo

Editor convidado

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