Paradoxes and contradictions in health under the effect of global pressures: the case of the Portugal-Brazil-Africa geopolitical space

[...]disparities are not limited to the “old health problems” of AIDS, malaria or tuberculosis, but bear the so-called “double burden of disease”: epidemics that emerge and re-emerge (such as Ebola), cardiovascular diseases, diabetes, obesity, cancer and mental illness, as well as diseases resulting from climate change in contexts of poverty, hunger and malnutrition, infant and maternal mortality, low life expectancy at birth, without the ability to respond to health needs because the health services are fragile and human resources are scarce and badly paid, with huge gaps in scientific and technical training. [...]there are also other global players that reproduce this logic in the south, either from Brazil, in the cooperation established with the countries of South America (UNASUL Saúde) and the Pan American Health Organisation (OPAS), or from Brazil’s and Portugal’s joint cooperation, organised by CPLP (Community of Portuguese-speaking Countries), with the creation of the Strategic Plan for Cooperation in Health, in 1996, involving Brazil in the Americas, Portugal in Europe, East Timor in Asia, and five countries in Africa (Angola, Mozambique, Guinea-Bissau, Cape Verde and São Tomé and Príncipe). [...]it is also a 20th century concept that contains naturalised visions of the differential power between rich and poor countries and unequal development, which legitimise the ranking of the countries that help and the countries that are helped, according to the most common terms of “international aid”: most initiatives in international health are not shared between ‘equivalent’ nations; they reflect the international political and economic order, in which international ‘assistance’ is ‘provided’ by rich and industrialized nations and ‘received’ by poor and underdeveloped countries. [...] The concepts and ideas underlying health cooperation carry historical and ideological baggage that the idea of global health cannot overcome; for one thing, because there is no consensus on what global health is.