Colonialism in the new digital health agenda

The advancement of digital technologies has stimulated immense excitement about the possibilities of transforming healthcare, especially in resource-constrained contexts. For many, this rapid growth presents a 'digital health revolution'. While this is true, there are also dangers that the proliferation of digital health in the global south reinforces existing colonialities. Underpinned by the rhetoric of modernity, rationality and progress, many countries in the global south are pushing for digital health transformation in ways that ignore robust regulation, increase commercialisation and disregard local contexts, which risks heightened inequalities. We propose a decolonial agenda for digital health which shifts the liner and simplistic understanding of digital innovation as the magic wand for health justice. In our proposed approach, we argue for both conceptual and empirical reimagination of digital health agendas in ways that centre indigenous and intersectional theories. This enables the prioritisation of local contexts and foregrounds digital health regulatory infrastructures as a possible site of both struggle and resistance. Our decolonial digital health agenda critically reflects on who is benefitting from digital health systems, centres communities and those with lived experiences and finally introduces robust regulation to counter the social harms of digitisation.

Developing an agenda for the decolonization of global health

Colonialism, which involves the systemic domination of lands, markets, peoples, assets, cultures or political institutions to exploit, misappropriate and extract wealth and resources, affects health in many ways. In recent years, interest has grown in the decolonization of global health with a focus on correcting power imbalances between high-income and low-income countries and on challenging ideas and values of some wealthy countries that shape the practice of global health. We argue that decolonization of global health must also address the relationship between global health actors and contemporary forms of colonialism, in particular the current forms of corporate and financialized colonialism that operate through globalized systems of wealth extraction and profiteering. We present a three-part agenda for action that can be taken to decolonize global health. The first part relates to the power asymmetries that exist between global health actors from high-income and historically privileged countries and their counterparts in low-income and marginalized settings. The second part concerns the colonization of the structures and systems of global health governance itself. The third part addresses how colonialism occurs through the global health system. Addressing all forms of colonialism calls for a political and economic anticolonialism as well as social decolonization aimed at ensuring greater national, racial, cultural and knowledge diversity within the structures of global health.

Investigating temporal bone variation of colonial populations from St-Lawrence Valley, Quebec: A 3D geometric morphometric approach

OBJECTIVES

In Quebec, genetic and genealogical research are used to document migratory events and family structures since colonial times, because bioarchaeological analysis is limited by poor skeletal preservation. This article aims to fill this gap by exploring past population structure in the St-Lawrence Valley from the French (1683-1760) and British (1760-1867) regimes using morphological variation of well-preserved temporal bones.

MATERIALS AND METHODS

3D geometric morphometrics shape data from seven populations (five Catholics of French descent and two Protestants of British descent; n = 214) were collected from temporal bones. Using Procrustes distances and both MANOVA and Discriminant Function Analysis, morphological differences were measured to calculate affinities patterns among populations. Shape variations were explored with between-group analysis, Mahalanobis distances and quantified by means of Fst estimates using Relethford-Blangero analysis.

RESULTS

Despite strong affinities between all Catholic cemeteries, all show divergent morphological regional diversity -especially Montreal and the fortified villages dedicated to its defense. Montreal exhibits low increase in morphological variance over three centuries. As our results show no morphological differences between the Catholic and the Protestant cemeteries in Montreal, this fact may highlight the potential presence of Irish or admixed individuals in Montreal cemeteries after the British takeover.

DISCUSSION

Patterns of morphological diversity highlighted that French colonists did not equally contribute to the descendant populations as reflected by significant interregional variation. Although historical records show that French and English-speaking populations did not tend to admix, morphological affinities between Protestants and Catholics in the beginning of the industrial era in Montreal could reflect the genetic contribution of Catholic Irish migrants.

RESEARCH HIGHLIGHTS

All Catholic cemeteries display distinct morphologies, highlighting differential contributions from French colonists and founder effects, which have increased regional differences. Montreal Catholic (French descent) and Protestant (English colonists) cemeteries show significant morphological affinities at the beginning of the industrial era. The Irish migration following the British conquest may explain morphological similarities observed between Catholic and Protestant cemeteries.

Psychiatric colonialism, PTSD and the Western psychiatric diagnostic tradition . . . is one man's food another man's poison?

Sadly, much of the world is no stranger to Psychological Trauma, particularly in poorer areas with poor health infrastructure. Western Aid Organisations frequently deploy to such areas bringing with them a western psychiatric tradition of nosology and therapy which may not be appropriate in other cultures. We argue that imposing a western system of diagnosis and treatment may not only undermine local culture but may also be bad for the patient. We discuss this with reference to the WHO's Mental Health Gap initiative (MHGap).

Non-Indigenous and Indigenous food-related interactions: How does the transmission of a normativity perpetuate colonialism?

OBJECTIVES

Type 2 diabetes has been considered an epidemic among Indigenous Peoples in Canada. They also suffer more from obesity than non-Indigenous people in the country, a condition that is considered an epidemic worldwide. Various public health and social services professionals are working in Indigenous communities across the country to raise awareness about certain lifestyle habits. The main objective of this article is to analyze the food normativity transmitted to an Indigenous population and to examine its reception. More specifically, the aim is to understand the opportunities of transmission (content and format) and the relational dynamics that these encounters between mostly non-Indigenous professionals and Indigenous Peoples imply.

METHOD

The analysis is based on an ethnographic fieldwork in the Anicinabe community of Lac Simon (Abitibi, Quebec). Conducted with a relational approach, interviews and participant observation were carried out.

RESULTS

It appears that the Anicinabek have a great knowledge of the "good" eating habits as defined by a biomedical food normativity. A reflexive analysis of my presence in the community as a non-Indigenous anthropologist and an analysis of the Anicinabek's responses to food recommendations lead me to argue that a form of food colonialism, inscribed in welfare (assistance) colonialism, persists while food surveillance seems to be integrated by the Anicinabek. This food normativity is the bearer of a biomedical conception of food and the colonial history of the country colours its transmission to Indigenous Peoples.

CONCLUSION

Greater autonomy, namely Indigenous food sovereignty, seems necessary to deconstruct this food assistance structure.

Genomic footprints of (pre) colonialism: Population declines in urban and forest túngara frogs coincident with historical human activity

Urbanisation is rapidly altering ecosystems, leading to profound biodiversity loss. To mitigate these effects, we need a better understanding of how urbanisation impacts dispersal and reproduction. Two contrasting population demographic models have been proposed that predict that urbanisation either promotes (facilitation model) or constrains (fragmentation model) gene flow and genetic diversity. Which of these models prevails likely depends on the strength of selection on specific phenotypic traits that influence dispersal, survival, or reproduction. Here, we a priori examined the genomic impact of urbanisation on the Neotropical túngara frog (Engystomops pustulosus), a species known to adapt its reproductive traits to urban selective pressures. Using whole-genome resequencing for multiple urban and forest populations we examined genomic diversity, population connectivity and demographic history. Contrary to both the fragmentation and facilitation models, urban populations did not exhibit substantial changes in genomic diversity or differentiation compared with forest populations, and genomic variation was best explained by geographic distance rather than environmental factors. Adopting an a posteriori approach, we additionally found both urban and forest populations to have undergone population declines. The timing of these declines appears to coincide with extensive human activity around the Panama Canal during the last few centuries rather than recent urbanisation. Our study highlights the long-lasting legacy of past anthropogenic disturbances in the genome and the importance of considering the historical context in urban evolution studies as anthropogenic effects may be extensive and impact nonurban areas on both recent and older timescales.

Colonisation and its aftermath: reimagining global surgery

Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession ('non-specialists', non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.

A visionary platform for decolonization: The Red Deal

In this study, we discuss the colonial project as an eliminatory structure of indigenous ways of knowing and doing that is built into Canadian social and health institutions. We elaborate on the role nursing plays in maintaining systemic racism, marginalization and discrimination of Indigenous Peoples. Based on historical practices and present-day circumstances, we argue that changing language in research and school curriculums turns decolonization into what Tuck and Yang call a 'metaphor'. Rather, we propose decolonization as a political project where nurses acknowledge their involvement in colonial harms and disrupt the assumptions that continue to shape how nurses interact with Indigenous people, including knowledge systems that perpetuate colonial interests and privilege. Decolonization requires nurses to understand the colonial practices that led to dispossession of land, erasure of knowledge, culture and identity, while upholding indigenous ways of knowing and doing in health, healing and living. As a political manifesto that liberates indigenous life from oppressive structures of colonialism and capitalism, The Red Deal is presented as a visionary platform for decolonization. The aim of this study is to articulate three dimensions of caretaking within The Red Deal as a framework to decolonize nursing knowledge development and practice. Based on the philosophical dimension embedded in The Red Deal that revoke norms and knowledge assumptions of capitalism that destroy indigenous ways of knowing and doing, we underscore an approach toward decolonizing nursing. Our approach rejects the apolitical nature of nursing as well as the unilateral western scientific knowledge approach to knowledge development and recognition. A critical emancipatory approach that addresses the socio-political and historical context of health care, recognizes dispossession of land and adopts a 'multilogical' vision of knowledge that gives space for representation and voice is needed for true decolonization of nursing.

The shadow side of occupational therapy: Necropower, state racism and colonialism

BACKGROUND

In the Global North, advances in occupational therapy benefitted unduly from the oppression, disablement and suffering of thousands of people in the South (and beyond). To prevent the recurrence of these injustices, history must be unveiled and occupational therapists urged to come to terms with their own involvement and responsibility.

OBJECTIVE AND METHOD

Utilising Achille Mbembe's concept of necropolitics, this academic essay blends select historical and philosophical perspectives to explore occupational therapy's concealed role in manifestations of institutionalised violence.

RESULTS

By examining its roles in World War II and France's colonisation of Algeria, we make visible the development of occupational therapy's distinct 'shadow side'. In Nazi Germany's Euthanasia Programme, it became a tool for identifying which lives were deemed 'worthy of living' and which were not, which indirectly contributed to the killing of 200,000 disabled persons. Under France's colonial medical system, occupational therapy imposed Western standards that alienated and completely depersonalised Algerian patients.

CONCLUSION AND SIGNIFICANCE

Entrenched in a (bio)economy that has endured beyond these events, occupational therapists must exercise vigilance, remaining mindful of the potential to unintentionally overlook individuals labelled as 'unproductive'. This requires confronting the profession's assumptions of inherent 'goodness' and acknowledging and addressing its shadow side.

Decolonizing a Wretched Healthcare System: The African Public Health Practitioner Case

Introduction

Over the past two years, public health practitioners in African countries have worked actively to combat the Coronavirus Disease 2019 (COVID-19) pandemic with relatively low fatality rates. This pandemic has forced healthcare professionals to re-think and redesign the healthcare system within their own country.

Methods

Using the Afrocentric PEN-3 framework and a letter style, the purpose of this commentary was to describe the positive, existential, and negative socio-cultural values associated with African healthcare systems. The commentary also highlights socio-cultural factors affecting public trust in African healthcare systems and their health agencies and how systematically decolonizing them may decrease foreign reliance and empower efficient locally based solutions.

Results

We, as African public health practitioners, make three key points in this commentary. First, African public health practitioners have developed resilience within under-resourced healthcare systems. Secondly, oral tradition in African societies and its byproduct (social media) is the means through which people connect and share what they know about any topics (COVID-19). Thirdly, African leaders have particularly contributed to the high level of distrust in their countries' healthcare systems in favor of the healthcare systems of industrialized countries.

Conclusion

This commentary concludes with implications for encouraging African public health practitioners to cultivate the resilience that has led to contributing to the wellness of millions of Africans during this COVID-19 pandemic.

Refusing epigenetics: indigeneity and the colonial politics of trauma

Environmental epigenetics is increasingly employed to understand the health outcomes of communities who have experienced historical trauma and structural violence. Epigenetics provides a way to think about traumatic events and sustained deprivation as biological "exposures" that contribute to ill-health across generations. In Australia, some Indigenous researchers and clinicians are embracing epigenetic science as a framework for theorising the slow violence of colonialism as it plays out in intergenerational legacies of trauma and illness. However, there is dispute, contention, and caution as well as enthusiasm among these research communities.In this article, we trace strategies of "refusal" (Simpson, 2014) in response to epigenetics in Indigenous contexts. Drawing on ethnographic fieldwork conducted in Australia with researchers and clinicians in Indigenous health, we explore how some construct epigenetics as useless knowledge and a distraction from implementing anti-colonial change, rather than a tool with which to enact change. Secondly, we explore how epigenetics narrows definitions of colonial harm through the optic of molecular trauma, reproducing conditions in which Indigenous people are made intelligible through a lens of "damaged" bodies. Faced with these two concerns, many turn away from epigenetics altogether, refusing its novelty and supposed benefit for Indigenous health equity and resisting the pull of postgenomics.

My Parents, My Grandparents Went Through Residential School, and All this Abuse has Come From it: Examining Intimate Partner Violence Against Canadian Indigenous Women in the Context of Colonialism

While the global rates of intimate partner violence (IPV) for Indigenous women have been acknowledged as substantial, few studies have incorporated an analysis of the impacts of colonization in the context of IPV. This secondary mixed-methods analysis explored the experiences of 40 Indigenous women from the Canadian prairie provinces who were abused by their intimate partners. The women discussed the impact of colonization, including the use of residential schools, to break down family life, spiritual beliefs, and languages, at times linking this to IPV. Of the 40 women, 38 described male partners as the abusers and two identified female abusive partners. Consistent with the literature, many of the male partners physically assaulted the respondents so severely that the women were injured and were at risk of death. Almost half of the men (47.4%) used sexually coercive strategies and/or sexually assaulted the women. Implications include the importance of professionals considering the broader historical experiences and possible trauma of Indigenous women who seek assistance for IPV from abusive partners.

Coloniality and Ethnic Variation in Psychological Distress Among US Latinx Immigrants

To address ethnic variation and potential cross-cultural measurement error in diagnostic criteria, this study extends on the racialized ethnicities framework to examine how Latinxs' self-reported psychological distress differ among ethnic groups. Utilizing data from the National Health Interview Survey, logistic regression models and partial proportional odds models assessed differences in likelihood of self-reporting frequent anxiety, depression, and psychological distress among Mexican, Puerto Rican, Cuban, Dominican, and Central and South American immigrants. Membership in Caribbean Latinx ethnic groups, and the Puerto Rican ethnic group in particular, was significantly associated with higher predicted probabilities of frequent anxious and depressive feelings, and severe psychological distress, relative to membership in non-Caribbean Latinx ethnic groups. This work highlights the need for research on Latinxs to disaggregate among ethnic groups, and proposes the existence of a gradient of exposure to the psychosocial consequences of US coloniality that might explain some of these variations.

Confronting Colonialism in Canadian Dietetics Curricula

Many Canadian universities have committed to becoming more accountable to Indigenous Peoples by confronting the systemic, historical, and ongoing colonialism and anti-Indigenous racism that shape their campuses. In this Perspective in Practice piece, we invite the field of dietetics to consider how colonialism has shaped dietetics research, teaching, and practice. We also consider how we might transform the field of dietetics in ways that accept settler responsibility for interrupting racism and colonial harm; support the resurgence of Indigenous food and health practices; and recognise the connections between struggles to ensure that Indigenous Peoples can access culturally appropriate food and health care, and struggles for Indigenous sovereignty and self-determination. We do this by reviewing the history of the dietetics field, examining critical responses to existing Indigenisation and decolonisation efforts, and reflecting on recent changes to required dietetics competencies. We argue that curricula in dietetics programmes must teach the history of the colonial food system and equip students to identify and interrupt the individual and institutional colonial dynamics that contribute to the ongoing dispossession of Indigenous Peoples' lands and food sources and negatively impact Indigenous patients.

Pathways and processes to the embodiment of historical trauma secondary to settler colonialism

AIM(S)

This discursive article aims to examine how systemic factors of settler colonialism influence health outcomes among Indigenous peoples in the United States through pathways and processes that may lead to the embodiment of historical trauma.

DESIGN

Discursive paper.

METHODS

We completed a comprehensive search of empirical and grey literature between September 2022 and January 2023 in PubMed, CINAHL and Google Scholar. Using these articles as a foundation, we explored factors related to the pathways and processes leading to the embodiment of historical trauma rooted in settler colonialism.

RESULTS

A conceptual framework of the pathways and processes of the embodiment of historical trauma secondary to settler colonialism was developed, and is presented.

CONCLUSION

The societal and historical context for Indigenous peoples includes harmful settler colonial structures and ideologies, resulting in stressors and historical trauma that impact health outcomes and disparities through the phenomenon of the process of embodiment.

IMPLICATIONS FOR NURSING

To provide holistic nursing care, nurses must be aware of settler colonialism as a determinant of health. They must be attuned to the pathways and processes through which settler colonial exposures may impact health among Indigenous peoples. Nurses must challenge existing structural inequities to advance health equity and social justice.

H - 46 The Importance of Cultural Context and Colonialism in the Bilingual Neurocognitive Advantage Debate: a Systematic Literary Review

Using an adaptation of the PRISMA checklist, this interdisciplinary systematic literary review synthesizes forty peer-reviewed research papers and neuropsychological theoretical publications about the bilingual cognitive advantage debate. The objectives of this study were to (1) analyze the neurocognitive and methodological discussion behind bilingualism studies, and (2) explore how a better understanding of cultural context and colonialism can help contribute to the bilingual cognitive advantage debate. Research with quantitative and qualitative designs were considered, as long as they studied the bilingual population (regardless of what languages the participants knew or their age). Although most papers were from the field of cognitive neurosciences, articles from different scientific disciplines were considered for analysis. Results showed that there doesn't appear to be a consensus on bilinguals holding a significant cognitive advantage over monolinguals, yet some studies found that bilinguals had higher scores in inhibitory control and cognitive flexibility. While bilinguals show an increase in grey matter and activity in areas of the frontal lobe, the precise mechanisms of control between languages have yet to be identified. However, most of these studies did not have diverse samples and showed methodological discrepancies when measuring bilingualism. Although heritage language of immigrated people is a known factor in this area of study, linguistic cultural sensibilities of colonized lands haven't been properly assessed in the cognitive advantage debate. Based on these findings, a research proposal and scale regarding executive functioning and the perceptions of Puerto Rican bilingualism are in development.

A scoping review of frameworks utilized in the design and evaluation of courses in health professional programs to address the role of historical and ongoing colonialism in the health outcomes of Indigenous Peoples

Indigenous education curriculum has been implemented in health professional programs as a potential solution to addressing commonly held false beliefs, as well as negative social attitudes and behaviours. As such it is important to map and analyze the current literature on educational initiatives that teach about historical and ongoing colonialism as a determinant of health to identify commonly used theoretical frameworks and outcomes assessed, as well as the intended and unintended short- and long-term outcomes on health professional learner's beliefs, attitudes and behaviours. This scoping review follows the framework by (Peters et al., JBI Evidence Synthesis 18:2119-2126, 2020). Six databases (MEDLINE, CINAHL, PsychInfo, Sociological Abstracts, ERIC, and ProQuest Dissertations and Theses) were searched with grey literature included through hand-searching of Indigenous journals and citation searching for papers published up until 2022 based on an established search criterion. Two reviewers independently screened articles. In total, 2731 records were identified and screened; full text was assessed for 72 articles; 14 articles were identified as meeting all the inclusion criteria and included in the final review. Commonly- used theoretical frameworks were transformative learning and cultural safety, with a variety of evaluation tools used and post-intervention outcomes measured across the studies (e.g., knowledge, beliefs, attitudes, behaviour and general learner feedback). Indigenous education interventions require longitudinal evaluation studies to address shortcomings in the design and evaluation of outcomes associated with teaching about colonialism as a structural determinant of health. It is critical that we identify and monitor the intended and unintended consequences of such curriculum as we look to develop solutions to changing health professional learners' false beliefs and attitudes, in hopes to inform their future care practices.

Missing and murdered Indigenous women, girls, and Two Spirit people: a paediatric health crisis

Indigenous children and adolescents across the USA and Canada experience increased emotional, physical, and sexual violence resulting from the longstanding effects of colonialism and historical trauma. There is a substantial lack of research exploring these issues and scarce efforts outside of Indigenous communities to support victims. However, the association between exposure to violence and abuse and adverse health outcomes among Indigenous children and adolescents is clear. In this Viewpoint, we explore this association, discuss historical context, highlight important work by governments and community organisations, and suggest actions for paediatricians and paediatric health-care providers.

Vaccine Inequities and the Legacies of Colonialism: Speculative Fiction's Challenge to Medicine

New vaccines to prevent COVID-19 and malaria underscore the importance of scientific advances to promote public health globally. How is credit for such scientific discoveries attributed, and who benefits? The complex narrative of Amitav Ghosh's The Calcutta Chromosome, both historical and speculative, demonstrates how medicine has come to value particular kinds of advances over others, prompting readers to question who controls access to resources and at what cost to global populations. In Ghosh's imagined world, scientific discovery is evaluated and rewarded-and ultimately deemed necessary-for its ability to serve communal, public health needs.

Towards a bidirectional decoloniality in academic global health: insights from settler colonialism and racial capitalism

This Viewpoint considers the implications of incorporating two interdisciplinary and burgeoning fields of study, settler colonialism and racial capitalism, as prominent frameworks within academic global health. We describe these two modes of domination and their historical and ongoing roles in creating accumulated advantage for some groups and disadvantage for others, highlighting their relevance for decolonial health approaches. We argue that widespread epistemic and material injustice, long noted by marginalised communities, is more apparent and challengeable with the consistent application of these two frameworks. With examples from the USA, Brazil, and Zimbabwe, we describe the health effects of settler colonial erasure and racial capitalist exploitation, also revealing the rich legacies of resistance that highlight potential paths towards health equity. Because much of the global health knowledge production is constructed from unregenerate contexts of settler colonialism and racial capitalism and yet focused transnationally, we offer instead an approach of bidirectional decoloniality. Recognising the broader colonial world system at work, bidirectional decoloniality entails a truly global health community that confronts Global North settler colonialism and racial injustice as forcefully as the various colonialisms perpetrated in the Global South.

Placing diverse knowledge systems at the core of transformative climate research

We argue that solutions-based research must avoid treating climate change as a merely technical problem, recognizing instead that it is symptomatic of the history of European and North American colonialism. It must therefore be addressed by decolonizing the research process and transforming relations between scientific expertise and the knowledge systems of Indigenous Peoples and of local communities. Partnership across diverse knowledge systems can be a path to transformative change only if those systems are respected in their entirety, as indivisible cultural wholes of knowledge, practices, values, and worldviews. This argument grounds our specific recommendations for governance at the local, national, and international scales. As concrete mechanisms to guide collaboration across knowledge systems, we propose a set of instruments based on the principles of consent, intellectual and cultural autonomy, and justice. We recommend these instruments as tools to ensure that collaborations across knowledge systems embody just partnerships in support of a decolonial transformation of relations between human communities and between humanity and the more-than-human world.

Re-Imagining Reproduction: Citation and Chosen Kin

Reproduction is political. Citation is political. In this essay, I link the anthropological concept of reproduction (biological and social), which is closely tied to kin-making, to citation. I suggest that citation can be viewed as "academic" reproduction and kin-making. To make this argument, I describe my professional and intellectual journey as a Black woman anthropologist based in the global South. I show how the amalgamation of the various contexts in which I was immersed brought up questions of race, nationality, colonialism, profession, and gender and influenced the direction my research took, as well as my scholarly position and engagement. In the article, I lay bare the academic stakes of the path that I have chosen. [citation, reproduction, scholarship, politics, anthropology].

Health care and black women: notes on coloniality, re-existence, and gains

We reflect on Black women's health as part of a narrative produced by the exercise of coloniality and the forces that contribute toward defining and imposing the place of a subaltern since the objectified and racialized body notion informs it. Black women are represented in the worst health indicators. We propose to look at collective health from the perspective of care as a political, social, and intersubjective technology, in whose encounters with the aesthetic-political body of Black women are traversed by unique exclusion experiences. Moving beyond suffering, we also address agency, resistance, and the construction of an agenda of struggle based on the Black people's leading roles.