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BACKGROUND: Demographic and epidemiological dynamics characterized by lower fertility rates and longer life expectancy, as well as higher prevalence of non-communicable diseases such as diabetes, represent important challenges for policy makers around the World. We investigate the risk factors that influence the diagnosis of diabetes in the Mexican population aged 50 years and over, including childhood poverty. RESULTS: This work employs a probabilistic regression model with information from the Mexican Health and Aging Study (MHAS) of 2012 and 2018. Our results are consistent with the existing literature and should raise strong concerns. The findings suggest that risk factors that favor the diagnosis of diabetes in adulthood are: age, family antecedents of diabetes, obesity, and socioeconomic conditions during both adulthood and childhood. CONCLUSIONS: Poverty conditions before the age 10, with inter-temporal poverty implications, are associated with a higher probability of being diagnosed with diabetes when older and pose extraordinary policy challenges.

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We develop an economic model of aging in which the susceptibility and severity of infectious diseases depend on the accumulated health deficits (immunosenescence) and the life history of infections affects the accumulation of chronic health deficits (inflammaging). Individuals invest in their health to slow down health deficit accumulation and take measures to protect themselves from infectious diseases. We calibrate the model for an average American and explore how health expenditure, life expectancy, and the value of life depend on individual characteristics, medical technology, and the disease environment. We then use counterfactual computational experiments of the U.S. epidemiological transition 1860-2010 to show that the decline of infectious diseases caused a substantial decline of chronic diseases and contributed more to increasing life expectancy than advances in the treatment of chronic diseases.

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Sub-Saharan Africa is undergoing an epidemiological transition driven by rapid, unprecedented demographic, socio-cultural, and economic transitions. These transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs). As NCDs rise, several attempts have been made to understand the individual level factors that increase NCDs risks, knowledge, and attitudes around specific NCDs as well as how people live and manage NCDs. While these studies are important, and enhance knowledge on chronic diseases, little attention has been given to the role of social and cultural environment in managing chronic NCDs in underserved settings. Using purposive sampling among persons living with Diabetes Mellitus (PLWD) and participating in diabetes programs from regional and municipal hospitals in the three underserved regions in Ghana (n = 522), we assessed diabetes management and supportive care needs of PLWDs using linear latent and mixed models (gllamm) with binomial and a logit(log) link function. The result indicates that PLWDs with strong perceived social support (OR = 2.27, p ≤ 0.05) were more likely to report good diabetes management compared to PLWDs with weak perceived social support. The built environment, living with other health conditions, household wealth, ethnicity and age were associated with diabetes management. Overall, the study contributes to wider discussions on the role changing built and socio-cultural environments in the rise of diet-related diseases and their management as many Low- and Middle-Income Countries (LMICs) experience rapid epidemiological and nutrition transitions.

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Background: The burden of Non-Communicable Diseases (NCDs) is rapidly increasing globally, and low- and middle-income countries (LMICs) bear the brunt of it. Tanzania is no exception. Addressing the rising burden of NCDs in this context calls for renewed efforts and commitment by various stakeholders. This paper highlights local initiatives and strategies to combat NCDs in Tanzania and provides lessons for countries with similar contexts. Methods: We reviewed published and grey literature and conducted policy analysis on NCDs in Tanzania to examine the burden of NCDs and the national response addressing it. The documents included National NCD strategic plans, NCD research agenda, and reports from the World Diabetes Foundation and the World Health Organization. Moreover, a scoping review of ongoing NCD activities and programs in other countries was also conducted to supplement the evidence gathered. Results: The rising burden of NCDs as a result of the epidemiological transition in Tanzania called for the launching of a dedicated National NCD Control and Prevention Program. The Ministry of Health collaborates with local, national, and international partners on NCD prevention and curative strategies. This led to the development of important guidelines and policies on NCDs, including strengthening the capacity of health facilities and healthcare workers, increased community engagement and awareness of NCDs, and increased advocacy for more resources in NCD initiatives. Strong governmental commitment has been vital; this is demonstrated by a renewed commitment to the fight through national NCD week and related advocacy activities conducted annually. To ensure multi-stakeholders' engagement and political commitment, all these activities are coordinated at the Prime Minister's office and provide strong lessons for countries with contexts similar to Tanzania. Conclusion: Multi-stakeholders' engagement, innovative approaches, and coordinated governmental efforts to address NCDs have shone a light on addressing the burden of NCDs and may be sustainable if aligned with locally available resources. Such initiatives are recommended for adoption by other nations to address the burdens of NCDs.

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This review's main objective is to discuss how demographic and epidemiological transitions relate to the burden of adolescent healthcare in sub-Saharan Africa (SSA). The review explicitly discussed the burden of adolescent healthcare, the current African policies on adolescent healthcare, and gaps in the African policies compared with Europe and North America. We also examined how adolescent healthcare policies evolve and documented the recommended essential part of the policy for enhancing its sustainability. The burden of adolescent health is high in SSA with diseases and reproductive health-related problems prevailing among adolescents. However, variations exist in the burden of adolescent healthcare across countries in the region. While some SSA countries are currently undergoing demographic and epidemiological transition processes concerning adolescent health care, the majority are either at an early stage of the transition or yet to commence the process. Policy-makers should consider effective ways to improve adolescents' health in SSA through preventive mechanisms and a multi-dimensional approach.

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In South Africa, there are a limited number of population estimates of the prevalence of diabetes and its association with psychosocial factors. This study investigates the prevalence of diabetes and its psychosocial correlates in both the general South African population and the Black South African subpopulation using data from the SANHANES-1. Diabetes was defined as a hemoglobin A1c (HbA1c) ≥6.5% or currently on diabetes treatment. Multivariate ordinary least squares and logistic regression models were used to determine factors associated with HbA1c and diabetes, respectively. The prevalence of diabetes was significantly higher among participants who identified as Indian, followed by White and Coloured people, and lowest among Black South Africans. General population models indicated that being Indian, older aged, having a family history of diabetes, and being overweight and obese were associated with HbA1c and diabetes, and crowding was inversely associated with HbA1c and diabetes. HbA1c was inversely associated with being White, having higher education, and residing in areas with higher levels of neighborhood crime and alcohol use. Diabetes was positively associated with psychological distress. The study highlights the importance of addressing the risk factors of psychological distress, as well as traditional risk factors and social determinants of diabetes, in the prevention and control of diabetes at individual and population levels.

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BACKGROUND: There is no source of data on causes of death in Senegal that covers both community and hospital deaths. Yet the death registration system in the Dakar region is relatively complete (>80%) and could be expanded to provide information on the diseases and injuries that led to death. METHODS: In this pilot study, we recorded all deaths that occurred over 2 months and were reported in the 72 civil registration offices in the Dakar region. We selected the deaths of residents of the region and administered a verbal autopsy to a relative of the deceased to identify the underlying causes of death. Causes of death were assigned using the InterVA5 model. RESULTS: The age structure of deaths registered at the civil registry differed from that of the census, with a proportion of infant deaths about twice as high as in the census. The main causes of death were prematurity and obstetric asphyxia in newborns. Meningitis and encephalitis, severe malnutrition, and acute respiratory infections were the leading causes from 1 month to 15 years of age. Cardiovascular diseases accounted for 27% of deaths in adults aged 15-64 and 45% of deaths among adults above age 65, while neoplasms accounted for 20% and 12% of deaths in these two age groups, respectively. CONCLUSIONS: This study demonstrates that the epidemiological transition is at an advanced stage in urban areas of Dakar, and underlines the importance of conducting regular studies based on verbal autopsies of deaths reported in civil registration offices.

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Background: China's rapid economic and social development since the early 2000s has caused significant shifts in its epidemiological transition, potentially leading to health disparities across regions. Objectives: This study employs Life Expectancy (LE) to assess health disparities and trends among China's eastern, central, and western regions. It also examines the pace of LE gains relative to empirical trends and investigates age and causes of death mortality improvement contributing to regional LE gaps. Data and methods: Using a log-quadratic model, the study estimates LE in China and its regions from 2004 to 2020, using census and death cause surveillance data. It also utilizes the Human Mortality Database (HMD) and the LE gains by LE level approach to analyze China and its regions' LE gains in comparison to empirical trend of developed countries. The study investigates changes in LE gaps due to age and causes of death mortality improvements during two periods, 2004-2012 and 2012-2020, through the LE factor decomposition method. Results: From 2000 to 2020, China's LE exhibited faster pace of gains compared to developed countries. While men's LE growth gradually aligns with empirical trends, women experience slightly higher growth rates. Regional LE disparities significantly reduced from 2004 to 2012, with a marginal reduction from 2012 to 2020. In the latter period, the changing LE gap aligns with expected trends in developed countries, with all Chinese regions surpassing empirical estimates. Cardiovascular diseases and malignant neoplasms emerged as the primary contributors to expanding regional LE gaps, with neurological disorders and diabetes playing an increasingly negative role. Conclusion: LE disparities in China have consistently decreased, although at a slower pace in recent years, mirroring empirical trends. To further reduce regional LE disparities, targeted efforts should focus on improving mortality rates related to cardiovascular diseases, neoplasms, neurological disorders and diabetes, especially in the western region. Effective health interventions should prioritize equalizing basic public health services nationwide.

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Resumo O Brasil é um país marcado por forte desigualdade socioeconômica entre as regiões, que, por sua vez, se traduz em diferenciais regionais de mortalidade. Para um bom monitoramento desses diferenciais, é importante uma análise não apenas dos níveis médios de mortalidade, mas também da variação da idade à morte na população. Esse artigo analisa a contribuição das causas de óbito sobre as mudanças na esperança de vida e na dispersão da idade à morte no Brasil e grandes regiões entre 2008 e 2018. Os resultados sugerem aumento dos diferenciais regionais na esperança de vida ao longo da década analisada. No entanto, as diferenças regionais na dispersão da idade à morte se mantiveram praticamente constantes. As mudanças na mortalidade por causa impactam de maneiras diferentes a dispersão da idade à morte em cada região: a redução da mortalidade por causas externas contribui substantivamente para diminuir a variação da idade à morte nas regiões Sul e Sudeste, enquanto a contribuição das mortes por afecções originadas no período perinatal foi substantiva apenas na região Nordeste. Por fim, reafirmamos a importância dos indicadores de dispersão da idade à morte para se ter uma visão mais ampla dos diferenciais regionais de mortalidade no Brasil.

Abstract Brazil is a country marked by substantial socioeconomic inequality among regions, which translates into regional differentials in mortality. For better monitoring these differentials, it is important to analyze not only population average mortality levels, but also the age at death variation. This article analyzes cause-of-death contributions to changes in life expectancy and age-at-death variation in Brazil and its regions between 2008 and 2018. Our results suggest an increase in regional inequalities in life expectancy over the decade. However, regional differences in age-at-death variation remained nearly constant. Changes in mortality by cause impact the age-at-death variation differently in each region: the reduction in mortality from external causes substantially contributed to decreasing the variation in age at death in the South and Southeast regions, whereas the contribution of deaths from conditions originating in the perinatal period was substantive only in the Northeast region. Finally, we reaffirm the importance of age-at-death dispersion indicators to have a broader view of Brazil's regional differentials in mortality.

Resumen Brasil es un país marcado por fuertes desigualdades socioeconómicas entre sus regiones, lo que traduce a su vez se en diferencias regionales en la mortalidad. Para un buen seguimiento de estos diferenciales es importante analizar no solo los niveles medios de mortalidad, sino también la variación de la edad de la muerte en la población. Este artículo analiza la contribución de los grupos de causas de defunción sobre los cambios en la esperanza de vida al nacer y la dispersión de la edad al morir en Brasil y las grandes regiones entre 2008 y 2018. Nuestros resultados sugieren un aumento de las diferencias regionales en la esperanza de vida a lo largo de la década. Sin embargo, las diferencias regionales en la dispersión de la edad al morir se mantuvieron prácticamente constantes. Los cambios en la mortalidad por causas repercuten de forma diferente en la dispersión de la edad al fallecer en cada región: la reducción de la mortalidad por causas externas contribuyó de forma sustantiva a disminuir la variación de la edad al morir en las regiones Sur y Sureste, mientras que la contribución de las muertes por afecciones originadas en el período perinatal fue sustantiva en la región Noreste. Por último, reafirmamos la importancia de los indicadores de dispersión de la edad al morir para tener una visión más general de los diferenciales regionales de mortalidad en Brasil.

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Resumo Este trabalho se propõe a verificar o impacto das concessões à iniciativa privada dos serviços de saneamento sobre o acesso à água e ao esgoto tratados, bem como sobre as tarifas cobradas por esses serviços. O presente estudo se faz relevante à luz das recentes alterações legislativas no setor, à guisa da Lei n. 14.026/2020, e da necessidade de universalização do saneamento. Como método, foi utilizado o modelo diferenças em diferenças, para dados de 3.536 municípios brasileiros retirados do Sistema Nacional de Informações sobre Saneamento (SNIS), abrangendo o período de 1998 a 2019. Os resultados mostram impacto positivo e estatisticamente significativo dos prestadores privados (em relação aos públicos) sobre o acesso aos serviços de água, esgoto e tratamento de esgoto. Ademais, foi observado impacto positivo e estatisticamente significativo na tarifa praticada quando da concessão à iniciativa privada dos serviços, em comparação aos preços cobrados por prestadores públicos.

Abstract This paper aims to verify the impact of water and sewer services privatization on access and the tariffs charged for them. This paper is relevant mainly due to the sector's recent legal changes that resulted in Law n. 14.026/2020 and the need to universalize sanitation services in Brazil. The differences-in-differences method was employed to estimate the impact, using data from 3.536 Brazilian municipalities extracted from SNIS, the Brazilian National Sanitation Information System, for the years 1998-2019. The results show private sector operators' positive and statistically significant impact (compared to their public peers) on water and sewage services - including sewer treatment. Also, it detected a positive and statistically significant effect on the tariffs charged for those services once privatization occurs, compared to the prices charged by public sector operators.

Resumen Este trabajo se propone evaluar el impacto de las concesiones a la iniciativa privada de los servicios de saneamiento en el acceso al agua y al alcantarillado y su tratamiento, así como en las tarifas que se cobren por estos servicios. El trabajo se hace relevante a la luz de los recientes cambios legislativos en el sector, como la Ley n.o 14.026 de 2020 y de la necesidad de universalizar el saneamiento. Para el análisis se utilizó el modelo de diferencias con datos de 3536 municipios brasileños extraídos del Sistema Nacional de Información sobre Saneamiento (SNIS) que cubren el período 1998-2019. Los resultados indicaron un impacto positivo y estadísticamente significativo de los proveedores privados (en relación con los públicos) en el acceso a los servicios de agua, alcantarillado y tratamiento del alcantarillado. Además, se observó un impacto positivo y estadísticamente significativo en la tarifa cuando los servicios se concesionaron a la iniciativa privada en comparación con los precios que cobraban los proveedores públicos.

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BACKGROUND: Despite being two Baltic countries with similar histories, Estonia and Lithuania have diverged in life expectancy trends in recent years. We investigated this divergence by comparing cause-specific mortality trends. METHODS: We obtained yearly mortality data for individuals 20 + years of age from 2001-2019 (19 years worth of data) through Statistics Lithuania, the Lithuanian Institute for Hygiene, and the National Institute for Health Development (Estonia). Using ICD-10 codes, we analyzed all-cause mortality rates and created eight major disease categories: ischemic heart disease, cerebrovascular disease, all other cardiovascular disease, cancers (neoplasms), digestive diseases, self-harm and interpersonal violence, unintentional injuries and related conditions, and other mortality (deaths per 100,000 population). We used joinpoint regression analysis, and analyzed the proportional contribution of each category to all-cause mortality. RESULTS: There was a steeper decline in all-cause mortality in Estonia (average annual percent change, AAPC = -2.55%, 95% CI: [-2.91%, -2.20%], P < .001) as compared to Lithuania (AAPC = -1.26%, 95% CI: [-2.18%, -0.57%], P = .001). For ischemic heart disease mortality Estonia exhibited a relatively larger decline over the 19-year period (AAPC = -6.61%, 95% CI: [-7.02%, -6.21%], P < .001) as compared to Lithuania (AAPC = -2.23%, 95% CI: [-3.40%, -1.04%], P < .001). CONCLUSION: Estonia and Lithuania showed distinct mortality trends and distributions of major disease categories. Our findings highlight the role of ischemic heart disease mortality. Differences in public health care, management and prevention of ischemic heart disease, alcohol control policies may explain these differences.

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: Childbirth is commonly viewed as difficult in human females, encompassed by the 'Obstetrical Dilemma' (OD) described by early palaeoanthropologists as an evolved trade-off between a narrow pelvis necessitated by bipedalism and a large-brained fetal head. The OD has been challenged on several grounds. We add to these challenges by suggesting humans likely squatted regularly during routine tasks prior to the advent of farming societies and use of seats. We suggest that habitual squatting, together with taller stature and better nutrition of ancestral hunter-gatherers compared with later Neolithic and industrial counterparts, obviated an OD. Instead, difficulties with parturition may have arisen much later in our history, accompanying permanent settlements, poorer nutrition, greater infectious disease loads and negligible squatting in daily life. We discuss bioarchaeological and contemporary data that support these viewpoints, suggest ways in which this hypothesis might be tested further and consider its implications for obstetrical practice. Lay Summary: Human childbirth is viewed as universally difficult. Evidence from physical therapies/engineering and studies of living and ancestral humans illustrates habitual squatting widens the pelvis and could improve childbirth outcomes. Obstetrical difficulties emerged late in prehistory accompanying settled agriculture, poorer nutrition and less squatting. Specific physical exercises could improve obstetrical practice.

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El índice de masa corporal (IMC) elevado marcaría hoy una nueva etapa dentro de la transición epidemiológica, siendo posible develar el origen social del nuevo perfil de morbimortalidad. Esta revisión busca integrar diferentes conceptos teóricos para explicar los mecanismos a través de los cuales lo social se incorpora en el individuo, delimitando su comportamiento en salud y con ello, su estado nutricional. Las estructuras que representan los determinantes sociales de la salud operarían de manera sistemáticamente distinta sobre las personas, generando posiciones más o menos ventajosas dentro del campo de juego sanitario. Este patrón traduce una realidad que se encarna (embodiment) de manera inconsciente y duradera a través de un habitus, favoreciendo prácticas sociales diferenciadas que terminan por construir clases de cuerpos como expresión biológica de la desigualdad. La toma de decisiones estratégicas en salud dependerá de capacidades y libertades individuales primeramente restringidas por aquellos contextos sociales, entendiéndose estos como las causas estructurales de la salud poblacional(AU)

A high body mass index (BMI) would characterize a new stage in the epidemiological transition, making it possible to reveal the social origin of the new morbidity and mortality burden. This review seeks to integrate different theoretical concepts to explain the mechanisms through which the social is incorporated into the individual, delimiting their health behavior and with it, their nutritional status. The structures that represent the social determinants of health would operate systematically differently on different social groups, generating positions that are more or less advantageous in the playing field of health. This pattern translates a reality embodied unconsciously and long-lasting through a habitus, favoring differing social practices that result in the construction of bodily classes as a biological expression of social inequality. Strategic decision-making in health will depend on individual capacities and freedoms, which are firstly restricted by those social contexts, being those understood as the structural causes of population health(AU)

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BACKGROUND: Health at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases older adults in India are at a greater risk for multimorbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian older-adults aged 45 and above. METHODS: Using the sample of 72,250 older adults, this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of older-adults having one or more than one disease risks. RESULTS: Our results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups (AOR = 1.932; 95% CI = 1.824- 2.032). Similarly women were more likely to have a multimorbidity (AOR = 1.34; 95% CI = 1.282-1.401) as compared to men among the older adults in India. CONCLUSION: Our results confirm an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.

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The importance of reference osteological collections is unquestionable. However, the development of methodologies is more reliable the closer the collection is socioeconomically, demographically, and genetically to the population under study. The purpose of this study is to characterize and contextualize a new Portuguese reference collection. The collection of identified skeletons from the University of Évora comprises 201 adults of both sexes and seven non-adults, deceased between 1870 and 1993 and born between 1790 and 1969. It consists almost exclusively of individuals who were born and died in inland Alentejo, being the only Portuguese collection with this characteristic. The collection was built following all current legal and ethical obligations. Due to its characteristics, the collection constitutes a fundamental tool for forensic and bioarchaeological research in the inland regions of Portugal. In addition to the possibility offered to develop and validate methodologies in both sciences, the available complete hospital archives for research make this collection unique for health studies before, during, and after the epidemiological transition.

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Nutrition and the incidence of diseases during early life are considered environmental factors that determine people's height when they become adults. While there is extensive literature focusing on the relationship between physical growth, general mortality and infant mortality rates, few studies analyse the impact of certain disease groups on the final height of historical populations. Using regional mortality rates by causes of death, the main objective of this study is to determine the onset of the disease environment during early life for populations born in Spain between 1916 and 1930, and its relationship with the stature reached at 21 years of age. A population-averaged model is performed on epidemic-infectious, gastrointestinal, and congenital diseases during the gestation period and first year of life. The disease burden in early life had a statistically significant negative effect on adult stature. These results support the premise that an improvement in the disease environment could lead to a greater number of short children surviving and therefore a decrease in the average height.

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The global epidemic of noncommunicable diseases (NCDs), such as cardiovascular disease and diabetes, is creating unsustainable burdens on health systems worldwide. NCDs are treatable but not curable. They are less amenable to top-down prevention and control than are the infectious diseases now in retreat. NCDs are mostly preventable, but only individuals themselves have the power to prevent and manage the diseases to which the enticements of modernity and rising prosperity have made them so susceptible (e.g., tobacco, fat-salt-carbohydrate laden food products). Rates of nonadherence to healthcare regimens for controlling NCDs are high, despite the predictable long-term ravages of not self-managing an NCD effectively. I use international data on adult functional literacy to show why the cognitive demands of today's NCD self-management (NCD-SM) regimens invite nonadherence, especially among individuals of below-average or declining cognitive capacity. I then describe ways to improve the cognitive accessibility of NCD-SM regimens, where required, so that more patients are better able and motivated to self-manage and less likely to err in life-threatening ways. For the healthcare professions, I list tools they can develop and deploy to increase patients' cognitive access to NCD-SM. Epidemiologists could identify more WHO "best buy" interventions to slow or reverse the world's "slow-motion disaster" of NCDs were they to add two neglected variables when modeling the rising burdens of disease. The neglected two are both cognitive: the distribution of cognitive capacity levels of people in a population and the cognitive complexity of their health environments.

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Resumo O ensaio epistemológico relaciona criticamente a epidemiologia com a pandemia de COVID-19 enquanto evento social. Explora-se a reflexão filosófica em que Agamben define contemporâneo como quem é capaz de se afastar e enxergar o lado escuro do seu tempo. À luz da crítica decolonial, questionam-se a ideia de "transição epidemiológica", com sua transcendência na teoria dos "determinantes sociais de saúde", e a disposição binarista das varáveis epidemiológicas, como suportes da estruturação quantitativa e biomédica da epidemiologia dos fatores de risco. A pretensão científica de domínio da natureza e o engendramento de um tempo histórico linear e evolutivo, que inicia com a modernidade ocidental, contextualizam os epistemicídios dos saberes populares e a colonização do saber epidemiológico. Historiciza-se a constituição do pensamento crítico decolonial e pontua-se seu potencial para a revelação do caráter estrutural da colonização do saber epidemiológico. Considera-se o futuro pós-pandemia e relacionam-se as ideias de bifurcação, originada de Ilya Prigogine e elaborada por Boaventura de Sousa Santos, e inédito viável, de Paulo Freire com a concepção do tempo como criação e a expectativa de transformação social.

Abstract This paper makes a critical assessment of epidemiology with the COVID-19 pandemic as a social event. It examines the philosophical reflection in which Agamben defines as contemporary those able to stand back to see the dark side of their own era. In the light of decolonial criticism, the concept of "epidemiological transition," with its theory of transcendence of "social determinants of health" and binarism of epidemiological variables as supports of the biomedical and quantitative structuring of the epidemiology of risk factors is queried. The scientific ambition to dominate nature and the engendering of a linear and evolutionary historical time, beginning in western modernity, contextualizes the epistemicides of popular wisdom and the coloniality of epidemiological knowledge. The theoretical constitution of decolonial thought is historically analyzed, highlighting its greater critical potential to reveal the structural colonization of epidemiological knowledge. The post-pandemic future is considered and Prigogine's idea of bifurcation - as elaborated by Sousa Santos - and Paulo Freire's untested feasibility are related with the concept of time as the creation and expectation of social transformation.

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