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THE STATE OF KNOWLEDGE IN PUBLIC HEALTH: EPISTEMOLOGICAL
REFLECTION
Adelcio Machado dos Santos1
Daniel Tenconi2
Abstract: This article presents an epistemological reection on the state of knowledge in Public
Health, articulating classical theoretical foundations and contemporary contributions to understand the
paradigms that structure the eld. The analysis begins with a historical overview of the development of
Public Health, from the predominance of the biomedical model to the incorporation of interdisciplinary
approaches and the social determination of health. This qualitative and exploratory research was
based on a systematic literature review and critical analysis of national and international scientic
publications, following Brazilian ABNT standards. The study identies trends in scientic production,
highlighting the growth of quantitative and epidemiological research, as well as the gradual appreciation
of qualitative methods and community knowledge. It argues that the advancement of Public Health
requires ongoing dialogue between different epistemological frameworks, integration between science
and public policies, and the enhancement of knowledge translation into social practice. It concludes
that understanding epistemological foundations is essential for guiding research, management, and
policy-making that effectively and equitably address contemporary health challenges.
Keywords: Public Health. Epistemology. Scientic production. Social determinants.
1 Doctor of Engineering and Knowledge Management (UFSC). Post-Doctorate in Knowledge
Management (UFSC). University of Alto Vale do Rio do Peixe (UNIARP)
2 Master’s degree in Development and Society from Uniarp. Federation of Industries and Com-
merce of Santa Catarina. Caçador, Santa Catarina, Brazil.
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INTRODUCTION
Public Health is a multidimensional eld of knowledge and social practice, located at
the interface between biological, social and human sciences. Its genesis dates back to the need to
understand and intervene on collective determinants of health, overcoming the restricted view centered
on the disease and the individual. Historically, the eld has been consolidated from interactions
between Preventive Medicine, Epidemiology and health policies, expanding to encompass social,
environmental, cultural and economic dimensions that inuence population well-being. In Brazil,
Public Health acquired particular contours from the second half of the twentieth century, incorporating
the perspective of Collective Health, marked by criticism of the hegemonic biomedical model and by
the valorization of interdisciplinary and participatory approaches.
At the international level, the evolution of the eld was marked by conceptual and normative
frameworks, such as the International Conference on Primary Health Care (Alma-Ata, 1978) and the
Ottawa Charter (1986), which expanded the scope of health promotion and reinforced intersectoriality
as a structuring principle. However, scientic production in Public Health continues to face signicant
epistemological challenges, such as the fragmentation of knowledge, the overlapping of paradigms,
and the difculty of articulating scientic evidence with community knowledge and local experiences.
In this scenario, the state of knowledge emerges as a methodological tool to systematize and
critically analyze what has already been produced on a given topic, allowing the mapping of trends,
gaps and potentialities. Unlike the state of the art, which privileges the most innovative theoretical
and methodological contributions, the state of knowledge seeks to gather, describe and interpret
the totality of the available production within a dened cut, be it temporal, geographic or thematic.
This approach is especially relevant for complex and dynamic elds, such as Public Health, where
knowledge is produced by different disciplines, institutional agents, and epistemological traditions.
Epistemological reection, in this context, plays a central role. It not only questions the
validity and internal coherence of the theories and methods employed, but also investigates the
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historical, political, and cultural conditions that shape the production of knowledge. It is, therefore,
a matter of recognizing that scientic knowledge is not neutral, but situated, marked by ontological
and methodological choices that reect disputes of meaning and power. In Public Health, this analysis
reveals how certain paradigms — such as the biomedical, the social or the ecological — gain hegemony
and guide policies, while others remain marginalized.
The study adopts the design of a literature review of the “state of knowledge” type, articulated
with an epistemological analysis. The choice for this type of approach is justied by its potential to
systematize what has already been published on the subject, allowing a panoramic view of theoretical
currents, research practices and persistent gaps.
The SciELO, LILACS, PubMed, and Web of Science databases were selected as the
main sources, due to their relevance in the health area and the scope of national and international
publications. The time frame considered the period from 2013 to 2023, in order to contemplate the
most recent scientic production and capture transformations resulting from political changes, health
crises (such as the COVID-19 pandemic) and technological advances in the eld of health.
The descriptors used were “Public Health”, “Collective Health”, “State of Knowledge”,
“Epistemology” and “Scientic Production”, combined through Boolean operators (AND, OR)
according to the specicities of each database. The inclusion criteria included articles published
in peer-reviewed journals, written in Portuguese, English, or Spanish, and that presented explicit
discussions on theoretical, methodological, or epistemological foundations related to Public Health.
Studies of a merely technical-operational nature, book reviews, and institutional documents without
scientic analysis were excluded.
The analysis process followed three main stages: (1) Exploratory reading of the titles and
abstracts for initial screening; (2) Analytical reading of the full content of the selected texts, with
a record of the theoretical approaches, methods used, objects of study and main conclusions; (3)
Interpretative synthesis, guided by pre-dened categories (predominant theoretical paradigms,
interdisciplinary integration, gaps and perspectives).
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The epistemological dimension of the analysis was constructed from the comparison of the
references identied in the articles with classic and contemporary models of knowledge production in
health, according to authors such as Thomas Kuhn, Gaston Bachelard, Boaventura de Sousa Santos
and Naomar de Almeida Filho. This approach allowed us to examine not only the frequency of certain
paradigms, but also their internal coherence, compatibility with other perspectives, and capacity to
respond to concrete challenges in public health.
It is recognized that, although the state of knowledge is comprehensive, it has inherent
limitations, such as the dependence of indexing on the databases consulted and the possible exclusion of
relevant productions published in non-indexed vehicles or in gray literature. Even so, the methodology
adopted seeks to offer a solid and consistent panorama, capable of sustaining the epistemological
reection proposed in this article.
Thus, this article aims to carry out a brief epistemological reection on the state of knowledge
in Public Health, identifying the main theoretical and methodological trends, as well as the gaps
that persist. It seeks, with this, to contribute to a more integrated and critical understanding of the
eld, favoring the articulation between scientic and social knowledge, in line with the contemporary
demands of health and well-being.
PUBLIC HEALTH: CONCEPTS, EVOLUTION AND SCOPE
Public Health, as a eld of knowledge and social practice, is a multidisciplinary area focused
on the protection, promotion and recovery of the health of populations, based on the understanding of
the social, economic, cultural and environmental determinants that inuence collective well-being.
Although health is historically conceived as an individual attribute, the concept of Public Health
emerges from the need to address problems that transcend the individual sphere and that require
coordinated and collective actions (Rosemberg, 1995).
According to Winslow (1920), in one of the most classic denitions, Public Health is “the
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science and art of preventing disease, prolonging life, and promoting physical and mental health, through
organized community efforts for environmental sanitation, infection control, health education, and
the development of medical and nursing services” (Winslow, 1920). This formulation, still considered
a reference today, highlights three central dimensions: prevention, social organization, and the role of
scientic knowledge.
In Brazil, the contemporary conception of Public Health was strongly inuenced by the
Health Reform movement, which, from the 1970s and 1980s onwards, proposed a broader view
of health, understanding it as “the result of the conditions of food, housing, education, income,
environment, work, transportation, employment, leisure, freedom, access and possession of land and
access to health services” (Brasil, 1986). This formulation, enshrined in the Final Report of the 8th
National Health Conference, broke with the restricted logic of the biomedical model and inspired the
construction of the Unied Health System (SUS), established by the Federal Constitution of 1988.
The historical evolution of Public Health can be analyzed in three major periods. The rst,
between the eighteenth and nineteenth centuries, is marked by European Social Medicine and the rst
public hygiene actions, strongly linked to the control of epidemics and industrial urbanization (Rosen,
1994). At that time, approaches centered on sanitation and environmental inspection prevailed, with
emphasis on the contributions of John Snow, considered one of the founders of modern Epidemiology.
The second period, at the beginning of the twentieth century, is characterized by the
institutionalization of Public Health as an academic discipline and the creation of international health
cooperation organizations, such as the Pan American Health Organization (1902) and the World
Health Organization (1948). In this phase, national health systems and mass vaccination strategies
are consolidated, still with the predominance of the biomedical paradigm, but already with increasing
attention to socioeconomic factors.
The third period, which extends to the present day, is marked by the conceptual expansion
and strengthening of Collective Health in Brazil and of integrative perspectives in the international
scenario, such as health promotion, equity and intersectoriality (BUSS; Pellegrini Filho, 2007).
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The Alma-Ata Conference (1978) and the Ottawa Charter (1986) were key events in this process,
reafrming the importance of primary care, social participation and intersectoral action as structuring
elements of health policies.
Currently, Public Health faces increasingly complex challenges, resulting from global
processes such as climate change, demographic and epidemiological transition, accelerated
urbanization, and economic globalization. Recent studies point to the need to overcome fragmented
models and incorporate systemic approaches that consider the interdependencies between human,
animal, and environmental health — a perspective known as One Health (Gibbs, 2014; Lerner;
Bergeson, 2020). This view reinforces that health cannot be understood in isolation, but as a product
of networks of ecological, social, and political interactions.
In the Brazilian context, the scope of Public Health is manifested in a wide spectrum of
actions, from epidemiological monitoring and control of communicable diseases to policies for the
prevention of chronic diseases, promotion of healthy habits and sanitary regulation. In addition,
the cultural and socioeconomic dimension of the country requires strategies adapted to regional
inequalities and the diversity of populations, including indigenous peoples, quilombola communities,
and populations in situations of urban vulnerability (Paim; Almeida Filho, 2014).
From the epistemological point of view, Public Health has a unique characteristic: it is
structured as a hybrid eld of knowledge, which integrates quantitative and qualitative methods,
technical and community knowledge, and combines biomedical, social and environmental approaches
(Almeida Filho; Jucá, 2002). This heterogeneity, far from being a problem, is a source of power, as
it makes it possible to understand complex problems from multiple perspectives. However, it also
imposes challenges to the formation of theoretical and methodological consensus, generating tensions
between disciplines and currents of thought.
The expansion of the concept of health and the incorporation of social and environmental
determinants reinforce the need for an interdisciplinary view. As Dahlgren and Whitehead (1991)
point out, the health status of a population is the result of a gradient ranging from individual factors
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and lifestyles to broad socioeconomic, cultural, and environmental conditions. This conceptual matrix
is fundamental to guide more effective and equitable public policies.
Nevertheless, contemporary Public Health is marked by an expanded conception, which
goes beyond the biomedical dimension and incorporates social, cultural, economic and environmental
determinants. Its historical development reects changes in the ways of understanding and intervening
in collective health, moving from hygienist actions focused on epidemic control to integrated and
participatory strategies, aimed at promoting health and equity. At the same time, the eld continues
to face epistemological, political, and operational challenges that require constant reection and
innovation. Thus, Almeida Filho and Jucá (2002) observe that understanding the concepts, evolution
and scope of Public Health are essential to critically analyze its state of knowledge, identify trends and
gaps, and guide research and intervention strategies capable of responding to the complex demands
of contemporary society.
STATE OF KNOWLEDGE: CONCEPT AND APPLICATION
The term “state of knowledge” refers to a specic type of literature review whose central
objective is to identify, systematize and critically analyze the totality of existing academic productions
on a given topic, in a previously dened time and geographic frame. It is a methodology that aims to
map what has already been produced, highlighting trends, theoretical approaches, methods employed,
gaps and potentials for future investigations (Morosini; Fernandes, 2014).
Although often confused with the “state of the art”, there are important distinctions between
the two. The state of the art emphasizes works, theories and methodologies that are more innovative or
have a greater impact on the eld, while the state of knowledge seeks to encompass the set of available
production, not being restricted to works considered “reference” or “pioneering” (Ferreira, 2002).
This difference is relevant, because the breadth of the state of knowledge allows for a panoramic and
comprehensive view, which is fundamental for areas of knowledge in constant expansion, such as
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Public Health.
Historically, the practice of knowledge synthesis dates back to the rst systematic reviews
in Medicine and the Social Sciences, but the use of the term “state of knowledge” was consolidated
in Brazil from the 1990s onwards, especially in the area of Education, when researchers began to
use this approach to map scientic production in theses and dissertations (Romanowski; Ens, 2006).
Since then, its application has expanded to other areas, including Collective Health, as a strategy to
understand not only the volume of publications, but also the epistemological and methodological paths
taken by researchers.
From the methodological point of view, the state of knowledge presents some central stages.
The rst consists of a clear denition of the object of study, delimiting key concepts, target population,
thematic area, time and geographic cut. This step is essential to avoid dispersion and ensure internal
coherence to the analysis (Pizzani et al., 2012). Next, the selection of information sources is carried
out. In the health area, the most used databases include SciELO, LILACS, PubMed, Web of Science,
and Scopus, as well as repositories of theses and dissertations, such as the Brazilian Digital Library
of Theses and Dissertations (BDTD). The choice of sources must be judicious, considering criteria of
relevance, comprehensiveness and reliability.
The third step involves the development of a search strategy, usually combining controlled
descriptors — such as Health Sciences Descriptors (DeCS) or Medical Subject Headings (MeSH)
terms — with Boolean operators to rene document retrieval (Haddad; Pereira Neto, 2015). The
reproducibility of this strategy is an important aspect to ensure the transparency of the process. After
collection, the material is sorted, applying previously established inclusion and exclusion criteria. In a
state of knowledge, the objective is not to restrict the sample to studies of high methodological quality,
as in systematic reviews, but to include all the relevant production for the topic. Therefore, studies of
a theoretical, empirical, methodological or documentary nature can be incorporated, as long as they
meet the dened criteria.
The analysis of documents can be conducted through different approaches, such as content
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analysis (Bardin, 2011), bibliometric analysis or thematic mapping. This stage aims to identify
patterns, trends, and gaps in scientic production. In epistemologically-based studies, such as the
present one, the theoretical perspectives adopted, the predominant scientic paradigms and the
possible asymmetries in the valorization of different types of knowledge are also examined. The
application of the state of knowledge in the area of Public Health is particularly relevant. As it is an
interdisciplinary eld, with strong production both in the academic and institutional spheres, the
mapping of its scientic production contributes to understanding how different areas interact, which
methods are most used, and how research agendas evolve (Almeida Filho; Jucá, 2002).
In addition, the state of knowledge provides subsidies for the formulation of public policies
and decision-making in health. By revealing which themes are being prioritized in scientic
production, it allows the identication of neglected areas that need greater investment in research.
For example, a survey may indicate that certain population groups — such as indigenous peoples or
riverine populations — receive little attention in epidemiological studies, highlighting the need to
expand inclusive approaches (Paim; Almeida Filho, 2014).
The potential of this methodology for analyzing the epistemological inuences that permeate
scientic production is also a relevant aspect to be considered. According to Costa et al. (2021),
the process of examining which theories, paradigms, or conceptual frameworks are most cited and
applied, allows the researcher to identify hegemonies and absences. For example, the prevalence of
a biomedical focus to the detriment of socio-environmental perspectives may indicate the need to
promote greater epistemological diversity in the eld.
In contemporary times, the state of knowledge also benets from the advancement of digital
tools for data analysis and text mining, which make it possible to process large volumes of publications
in a more agile and detailed way. Software such as VOSviewer, Bibliometrix, and NVivo allow you to
visualize collaboration networks, maps of keyword co-occurrence, and temporal evolution of themes,
enriching analyses and expanding the capacity for synthesis (Costa et al., 2021). Therefore, the state
of knowledge is a methodological approach that, by bringing together breadth and systematicity,
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becomes an essential tool for understanding complex scientic elds such as Public Health. According
to Almeida Filho and Jucá (2002), its application enables the descriptive mapping of production, as
well as a critical reading that considers the epistemological and sociopolitical dimensions of science.
In the context of this article, this methodology will be mobilized to identify the main theoretical
and methodological trends in recent scientic production on Public Health, as well as the gaps and
challenges that persist.
EPISTEMOLOGY AND PUBLIC HEALTH
The relationship between epistemology and Public Health is central to understanding how
knowledge is produced, validated, and applied in this eld, as well as to recognizing the historical,
political, and cultural conditioning factors that guide its practice. Epistemology, understood as the
critical study of the foundations, methods, and validity of knowledge (Chalmers, 1999), provides
tools to analyze the conceptual basis of Public Health, questioning its assumptions, methods, and
social implications. In the context of health, this means reecting on the nature of the knowledge
that sustains it, the modes of production and circulation of this knowledge, and its interactions with
different scientic and social paradigms.
Historically, thinking in Public Health has been shaped by a predominance of the biomedical
paradigm, based on the positivist conception of science that emerged in the nineteenth century. This
paradigm, inuenced by authors such as Auguste Comte and by the tradition of experimental medicine
of Claude Bernard, prioritized quantitative methods, linear causality, and the search for universal
laws applicable to the prevention and control of diseases (Rosen, 1994). From this perspective, valid
knowledge was that which was measurable and reproducible, with a focus on objectivity and scientic
neutrality. Although it has contributed to signicant advances in the control of infectious diseases and
in the extension of life expectancy, this reductionist model has proven to be insufcient to deal with
health problems of a multifactorial and complex nature.
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From the second half of the twentieth century, driven by social epidemiology and the social
sciences applied to health, a movement of criticism and epistemological expansion emerged. Thomas
Kuhn (1998) and Imre Lakatos (1978), although coming from the philosophy of science, inspired
reections on the changes in paradigms and research programs that directly affected Public Health.
Kuhn (1998) highlighted that science does not evolve cumulatively, but through paradigmatic ruptures,
which is evident in the transition from a strictly biomedical view to broader and more interdisciplinary
approaches. Lakatos (1978), in turn, contributed by proposing that scientic theories are developed
in research programs that can be progressive or degenerative, a useful concept for understanding the
evolution of practices in collective health.
In this process, Public Health has gradually incorporated critical and constructivist
approaches that recognize the inuence of social, cultural, economic, and environmental factors on
the health-disease process. Critical epistemology, inuenced by authors such as Paulo Freire (1987)
and Boaventura de Sousa Santos (2006), brought to the eld the notion that knowledge in health is
not neutral, but situated, permeated by power relations and disputes of meaning. Santos (2006), in
proposing the “Epistemologies of the South”, argues that scientic production must dialogue with
popular and traditional knowledge, recognizing epistemic plurality and combating the monoculture
of hegemonic scientic knowledge. This perspective is particularly relevant for Brazilian Public
Health, given the sociocultural diversity and the need to incorporate indigenous, Afro-Brazilian, and
community knowledge into health policies and practices.
The growing complexity of contemporary health problems – such as pandemics, chronic non-
communicable diseases, environmental crises, and social inequalities – requires an epistemological
framework capable of integrating multiple references. In this sense, the theory of complexity,
formulated by Morin (2011), proposes a way of thinking that overcomes disciplinary fragmentation
and articulates biological, psychological, social and ecological dimensions. Morin argues that
understanding health requires considering the interactions and interdependencies between systems,
recognizing uncertainty and unpredictability as inherent elements of complex phenomena.
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From the methodological point of view, this epistemological broadening implies recognizing
the value of both quantitative and qualitative methods, overcoming the dichotomy between “hard
sciences” and “human sciences”. The triangulation of methods, recommended by Denzin and Lincoln
(2011), allows us to capture the statistical and objective dimension of health problems, as well as their
social and cultural meanings. This hybrid approach is essential to build more effective policies, as it
makes it possible to understand not only the epidemiological distribution of diseases, but also the life
contexts of the affected populations.
Another relevant aspect is the epistemology of practice, which analyzes the way scientic
knowledge is translated into concrete actions in the eld of Public Health. Schön (2000) highlights that
the professional works in situations of uncertainty and singularity, which requires practical-reective
knowledge capable of adapting general guidelines to specic contexts. In the context of public health,
this means that protocols and policies need to dialogue with local realities, avoiding the mechanical
application of universal models.
Public Health also benets from the contributions of feminist epistemology, which denounces
gender biases in the production and application of knowledge. Haraway (1988) and Harding (1991) argue
that scientic objectivity should be rethought from the notion of “situated knowledge”, recognizing
that all knowledge production starts from a particular perspective. This approach expands the capacity
of Public Health to respond to the specic needs of historically marginalized groups, such as women,
LGBTQIA+ populations, and peripheral communities.
In the Brazilian context, the integration between epistemology and Public Health nds
expression in the eld of Collective Health, which articulates interdisciplinary practices, social criticism
and community participation. Paim and Almeida Filho (1998) highlight that Collective Health is not
just a practice, but a political-epistemological project that seeks to understand health as the result of
a social process, overcoming the dichotomy between prevention and care. This conception breaks
with the idea of neutrality and recognizes that the production of knowledge in health is immersed in
ideological disputes and economic interests.
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The strengthening of this perspective also requires the development of a transdisciplinary
epistemology, capable of integrating scientic and non-scientic knowledge in the formulation of public
policies. Nicolescu (2002) argues that transdisciplinarity is not just a method, but an epistemological
posture that seeks to understand reality from multiple levels and logics. Applied to Public Health, this
vision implies the dialogue between epidemiology, anthropology, economics, environmental sciences
and traditional knowledge, building more comprehensive and sustainable responses.
In this sense, epistemology applied to Public Health shows that the production of knowledge
is neither neutral nor linear, but situated, plural and permeated by disputes. Chalmers (1999) observes
that the evolution of the eld demonstrates a paradigm shift from the positivist biomedical model to the
incorporation of critical, constructivist and complex approaches, with an emphasis on interdisciplinarity
and social participation. This movement is fundamental to face contemporary challenges, as it allows
for the construction of practices and policies that consider not only the biological dimensions of
diseases, but also their social, cultural, and environmental roots. By recognizing epistemological
plurality and valuing dialogue between different ways of knowing, Public Health strengthens its
ethical and political commitment to the promotion of equity and social justice.
AN OVERVIEW OF SCIENTIFIC PRODUCTION IN PUBLIC HEALTH: EPISTEMOLOGI-
CAL TRENDS
Scientic production in Public Health, especially since the end of the twentieth century, has
been showing a signicant growth, both in volume of publications and in thematic and methodological
diversity. This phenomenon is the result of the consolidation of the area as an interdisciplinary eld,
articulating knowledge from the biomedical, social, and environmental sciences, and responding to
complex global challenges such as climate change, demographic and epidemiological transitions, and
health inequalities (Buss; Pellegrini Filho, 2007). The analysis of this panorama allows us to identify
not only the predominant themes, but also the epistemological trends that shape the development of
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knowledge in the area, revealing the power dynamics, paradigmatic orientations and persistent gaps.
In high-income countries, scientic production in Public Health has historically focused on
epidemiological modeling, large-scale clinical studies and evidence-based interventions (Sackett et
al., 1996). This approach, strongly aligned with the positivist paradigm, favors quantitative methods
and linear causal logic, reinforcing the notion that health problems can be solved through technically
accurate and replicable interventions. While this approach has provided signicant advances, such as
the control of infectious diseases and increased life expectancy, it has also been criticized for reducing
the complexity of social and cultural determinants of health to statistical variables (Krieger, 2011).
In Latin American contexts, scientic production has been characterized by a critical tradition
that, from the 1970s onwards, strongly incorporated the perspective of the social determination
of the health-disease process, inuenced by the works of Breilh (2006) and Laurell (1982). This
epistemological approach breaks with the fragmentation between biological and social, advocating an
integral and interdisciplinary approach, in which health is understood as a product of historical and
structural processes. This perspective contributed to the fact that Public Health research in Brazil,
especially in the eld of Collective Health, was aligned with principles of social justice and community
participation, inuencing public policies and primary care strategies.
From the 2000s onwards, there has been an increase in scientic production focused
on emerging topics such as environmental health, the impacts of climate change, chronic non-
communicable diseases and, more recently, digital health and the use of big data in epidemiological
surveillance (Razzouk; Zorzetto, 2010). This thematic expansion reects the growing complexity of
health problems and the need for intersectoral approaches, in which dialogue between disciplines is
not only desirable but indispensable. However, such interdisciplinarity, although frequently evoked, is
not always achieved in a balanced way, and there is still a predominance of biomedical approaches to
the detriment of cultural and subjective dimensions (Gómez; Minayo, 2010).
From the epistemological point of view, it is possible to identify, in recent literature, a tension
between two major trends: on the one hand, the maintenance of a positivist hard core, centered
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on the production of quantitative evidence and the hierarchization of methods according to their
supposed robustness; on the other hand, the valorization of constructivist, critical and participatory
approaches, which recognize the plurality of knowledge and the importance of the historical and
social contextualization of health phenomena (Popper, 2008; Kuhn, 2013). This tension is not merely
theoretical, but is expressed in the denition of research agendas, in the selection of methodologies
and in the evaluation of scientic merit itself.
In the Brazilian case, the bibliometric analysis of reference journals such as Cadernos de
Saúde Pública and Revista de Saúde Pública shows that, although quantitative research continues
to predominate, there is a consistent growth of qualitative and mixed-methods studies, especially
focused on the analysis of public policies, community experiences, and program evaluation (Pereira
Neto; Lucena, 2015). This change suggests an advance towards integrating different epistemological
perspectives, albeit in an asymmetrical way.
Another relevant aspect is the internationalization of scientic production in Public Health.
The increasing indexing of Latin American journals in databases such as Scopus and the Web of
Science has increased the international visibility of studies produced in the region, but has also brought
challenges related to the adoption of hegemonic editorial and linguistic standards, often aligned with
Eurocentric visions of science (Santos, 2014). This can generate a tension between the need for global
dialogue and the preservation of critical and contextually rooted approaches.
The advent of the COVID-19 pandemic, starting in 2020, catalyzed signicant changes in
the scenario of scientic production in Public Health. The urgency of the health crisis has driven
the accelerated publication of studies, the adoption of preprint platforms, and the massive use of
real-time data for epidemiological modeling (Lancet, 2020). Epistemologically, this moment exposed
both the power and the weaknesses of contemporary science: the capacity for rapid response and
international cooperation coexisting with problems of methodological quality, conicts of interest,
and the circulation of non-validated information. In addition, the perception of the need to integrate
social, economic, and political dimensions in the understanding of global health phenomena was
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reinforced.
Current epistemological trends point to a transitional scenario. There is a movement towards
open science, the valorization of shared data, and interdisciplinary collaboration, while inequalities
persist in access to the production and use of knowledge. In addition, there is a growing recognition
of the importance of plural epistemologies, capable of dialoguing with indigenous, community and
traditional knowledge, especially in facing environmental and health problems related to sustainability
(Escobar, 2016).
Escobar (2016) also reiterates that the panorama of scientic production in Public Health
presents a eld in expansion and transformation, in which different epistemological matrices coexist
and dispute legitimacy. It is possible to observe a process of strengthening critical and interdisciplinary
approaches, as well as the expansion of dialogue with non-hegemonic knowledge, representing a
promising path for the construction of a more robust, contextualized and socially committed knowledge.
However, for this transition to be consolidated, it will be necessary to face structural challenges
related to research funding, the training of researchers, and the overcoming of epistemological and
institutional barriers that still limit the plurality of the eld.
FINAL CONSIDERATIONS
The present study sought to offer an epistemological reection on the state of knowledge in
Public Health, articulating a conceptual, historical and methodological overview with the analysis
of trends in scientic production and the theoretical and practical challenges faced by the area. The
discussion revealed that Public Health, as a eld of knowledge and social practice, is intrinsically
linked to historical processes of social organization, scientic advances and political transformations,
being permeated by multiple paradigms that coexist, dialogue and, sometimes, enter into tension.
The theoretical analysis and the literature review pointed out that Public Health, since its
modern constitution in the nineteenth century, has been strongly associated with the biomedical
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paradigm, with a focus on disease control and social hygiene. However, throughout the twentieth
century, especially from the formulations of collective health in Latin America and the movement
for the social determination of health, there was an expansion of the conceptual and methodological
scope of the area, incorporating social, cultural, economic and environmental dimensions. This
epistemological transformation is fundamental to understand the current trends in scientic production,
which are progressively oriented towards interdisciplinarity and integrated health approaches (Buss;
Pellegrini Filho, 2007).
From the epistemological point of view, the study showed that contemporary Public Health
operates in a eld of paradigmatic pluralism, in which quantitative, qualitative, mixed and participatory
perspectives coexist. This scenario allows for a greater range of analysis and intervention, but also
brings challenges related to theoretical coherence, the integration of different levels of analysis, and
the valorization of non-hegemonic knowledge, such as traditional and community knowledge. Such
questions refer directly to the need for a more effective dialogue between science, public policies
and social practices, reinforcing the role of epistemology as a critical tool for the orientation and
legitimation of the knowledge produced.
The systematization of the panorama of scientic production revealed a signicant growth
in the literature on Public Health, especially from the 2000s onwards, driven by the consolidation
of specialized journals, the expansion of graduate studies, and the greater availability of funding for
health research. It was observed that the most recurrent themes include epidemiological surveillance,
public health policies, health promotion and social determinants. However, there is still a predominance
of studies with a quantitative design and biomedical focus, which indicates the need for greater
encouragement of qualitative and interdisciplinary research, capable of capturing the complexity of
health phenomena.
From a practical point of view, the ndings suggest that the production of knowledge in
Public Health needs to advance in order to break with disciplinary fragmentation and adopt integrated
perspectives that dialogue with different epistemological matrices. This implies recognizing that
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health is a multidimensional phenomenon, which demands articulated approaches between biology,
social sciences, economics, ecology and culture. Such recognition is essential to face contemporary
challenges, such as climate change, pandemics, social inequalities, and new demographic and
epidemiological congurations.
Another relevant point is the need to value and institutionalize knowledge translation
practices, so that the results of research are not restricted to the academic environment, but effectively
reach managers, health professionals and communities. This dimension of transfer and application
of knowledge, often neglected, is central for scientic production to fulll its social role, promoting
concrete changes in the health and living conditions of the population.
Thus, it is concluded that epistemological reection on Public Health is not only a theoretical
exercise, but a strategic instrument to guide research, professional training and the formulation of more
effective and equitable policies. It is urgent that researchers and institutions recognize the importance
of understanding and mapping the paradigms that guide the area, identifying their potentialities and
limitations, so that we can move towards a more inclusive, critical, and socially committed science.
In this sense, this study reinforces that the strengthening of Public Health in Brazil and in the world
depends on the ability to integrate multiple knowledges, promote social justice and face, with rigor
and creativity, the complex challenges that characterize health in the twenty-rst century.
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