THIS SPECIAL ISSUE OF THE JOURNAL ‘SAúDE EM DEBATE’, entitled ‘Sustainable and Healthy Territories’, celebrates the five years of the Institutional Program for Sustainable and Healthy Territories (PITSS), which comprises the Vice-Presidency of Environment, Care and Health Promotion (VPAAPS) and the FIOCRUZ Strategy for the 2030 Agenda (EFA 2030) of the Oswaldo Cruz Foundation (FIOCRUZ). Through this issue, we intend to give visibility to experiences that sought to promote health and sustainability in the territories, bringing alternatives for emancipatory actions and building futures.

Through debates in its technical chambers, seminars, participation in conferences, and induction of knowledge production and dissemination, the VPAAPS has been progressively challenging itself on the need for public health and collective health action in vulnerable territories. In its internal conferences, its highest planning body, FIOCRUZ has consecrated ‘health, environment, and sustainability’ as one of its structuring axes, beginning to see the need to establish an initiative that articulates knowledge and practices on the socio-environmental determination of life and health in the context of the aspirational integrality of the 2030 Agenda, which aims to ensure quality of life, health, and sustainability in the territories^{11 Fundação Oswaldo Cruz. Programa Institucional de Territórios Sustentáveis e Saudáveis (PITSS): termo de referência conceitual e metodológico e proposta de governança [Internet]. Rio de Janeiro: Fiocruz; 2019 [acesso em 2024 maio 30]. Disponível em: https://portal.fiocruz.br/documento/tr-pitss-programa-institucional-de-territorios-sustentaveis-e-saudaveis
https://portal.fiocruz.br/documento/tr-p...} .

In this context, and following an intense debate, the PITSS was established in 2019, through Ordinance of the Presidency of FIOCRUZ No. 5,555, when assumptions and a model of a logical-institutional framework were developed that seek to reference the institution’s actions. Since then, among the main initiatives of the PITSS, the following stand out: the articulations between FIOCRUZ units and offices, the formation of the technical-scientific advisory Working Group with representatives of those units and offices (GT PITSS), the mapping of experiences of Sustainable and Healthy Territories (TSS) within the institution, and the organization of a call for proposals in partnership with the FIOCRUZ Innovation Promotion Program (Inova FIOCRUZ). The call for proposals, launched in 2020, aimed to support territorialized strategies for living with COVID-19, which would be used to overcome the socio-environmental vulnerability of populations living in peripheral urban areas and in rural, forest, and water areas, and serve as references for application in post-pandemic contexts. This call for proposals received 60 projects, 13 of which were approved, covering research from 11 FIOCRUZ units.

This special issue presents some of the contributions of those projects, which can be seen in the following articles, selected after peer review: ‘From Lagoa do Boi Morto to Barragem da Toldinha: water as a central element for the construction of sustainable and healthy territories in the Middle Jequitinhonha’, ‘Suddenly, everything shut down: care network for Homeless Population in the COVID-19 pandemic’, ‘Agroecology and food sovereignty: Struggles for justice and healthy food in urban peripheral territories’, ‘Reflections of the COVID-19 pandemic on food sales in farmer’s markets in Maciço de Baturité-CE’, ‘Socioenvironmental vulnerabilities in small-scale fishing: challenges and achievements for Healthy and Sustainable Territories in Pernambuco’, ‘Performance of a municipal health secretariat in the face of the oil disaster-crime in Pernambuco’, and ‘People taking care of people: Popular Agents in promoting more sustainable and healthy territories’.

In total, this issue has brought together 27 published works, including original articles, essays, opinion pieces, and experience reports. They present successful experiences in the field of TSS, such as the implementation of courses and training processes involving communities, the development of social technologies and new forms of governance, the establishment of partnerships and articulations with local managers, and the development of new methodologies and communication strategies. Anchored in the theoretical and conceptual bases of TSS, they demonstrated the importance of the Unified Health System (SUS) for improving life in the territories, as well as pointing out the need for support and strengthening of the care network and integration with other sectors.

The set of works in this issue brings together the results of research carried out in different Brazilian states (Amazonas, Bahia, Ceará, Distrito Federal, Mato Grosso, Minas Gerais, Pernambuco, and Rio de Janeiro) and in Latin American countries (in addition to Brazil, Chile, and Colombia). The regional distribution and diversity of experiences allow for the enrichment of the sharing of territorialized experiences and the presentation of new theoretical and methodological perspectives in works that denounce socio-environmental conflicts arising from different contexts, such as agribusiness, oil spills, and the implementation of wind farms, as well as experiences of confronting the systemic climate and food crises, intensified during the COVID-19 pandemic. At the same time, they present solutions to those issues, based on epistemologies, cosmologies, and emancipatory practices.

They also work with different populations, such as those living on the streets, quilombolas, fishermen, farmers, community health agents, indigenous students, mental health professionals, and activists from different social movements. A common characteristic among many of these works is the participation of these populations in different stages of the studies, and in many of them as protagonists, highlighting a more direct link between territorial needs and emancipatory research.

FIOCRUZ plays a crucial role in promoting health and scientific research in Brazil. As an institution that mobilizes science for life, its challenge is to maintain ongoing dialogue with the diverse territories and populations that make up our country, such as urban peripheral populations and indigenous and traditional peoples. It is in this context that the implementation of the PITSS in the VPAAPS/FIOCRUZ began. Continuing with the Program will require the institution, its researchers, and workers to make efforts to conduct research and actions that seek to contribute to the strengthening of the SUS, especially in vulnerable territories.

Some of the challenges faced are institutional, such as limited funding, which makes it difficult to invest in long-term programs, and the need for intersectoral integration and different health surveillance, care, and promotion policies that contribute to the construction of TSS from a socio-environmental perspective. Other challenges are related to the territorial context, such as changes in political priorities, which can affect the continuity and consistency of health and sustainability programs, as well as democratic territorial governance processes that are essential for the development of transformative processes. Working in historically vulnerable territories requires the collaboration of various actors in the management of local and territorial political issues, requiring joint work and effective coordination to ensure that initiatives are successful and meet the needs of communities. Socioeconomic inequalities are another significant factor that impacts the lives of populations, and overcoming them is essential for the success of any TSS program.

FIOCRUZ therefore faces the challenge of overcoming various barriers when implementing programs aimed at promoting health and socio-environmental sustainability, requiring strategic partnerships, innovation, human resource training, and adaptation to specific local contexts. These efforts will certainly require political reflection, hard work in the territories, and the development of solutions based on science and traditional and popular knowledge, as demonstrated by many of the studies published in this special issue.

Thus, we hope to provide a fruitful debate on experiences, theoretical-methodological issues, and public policies aimed at promoting health and sustainability for the emancipatory transformation of territories.

We hope you enjoy the reading!

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