Rocinha, Brazil’s largest favela, stretches high up the Rio hillside
Favela da Rocinha, Brazil’s largest favela, stretches high up the Rio hillside.

Though the COVID-19 pandemic has affected the entire world simultaneously, nations’ governments have taken varying approaches to mitigating the emergency. In nations where government response has been lacking, the pandemic has revealed unexpected resources in traditionally overlooked areas that have worked better to keep people safe. Ordinary citizens without public health expertise have stepped up to fill the void that governments have left, working without the usual big budgets and research investments backing them. These differing approaches have exposed gaps in understanding how public health measures should be deployed—particularly in low-resource settings—while creating opportunities for developing best practices.  

An article just published in The Lancet explains how community organizers in Brazil’s favelas have been forced to fill the urgent need for a comprehensive pandemic response in the absence of national government intervention. The authors of the article are Dominique Behague, director of undergraduate studies and associate professor of medicine, health, and society (and in the summer term, reader at Kings College London), and Francisco Ortega, research professor at the Catalan Institution for Research and Advanced Studies and at the Medical Anthropology Research Center of the University of Rovira I Virgili in Tarragona, Spain. Through mutual aid and solidarity among neighborhood groups and local journalists, this example of collective social medicine challenges the assumptions that public health experts should implement policies recommended by governments and global health institutions in a top-down approach. 

“Investment in public health is vital, but over the past two or so decades we have also seen a growing number of distinct initiatives and funding streams, which can lead to duplication of efforts, lack of coordination and unnecessary hyper-specialization,” Behague said. “Favela community organizers are showing us that effective public health action can take shape at a local level in a synergistic and multi-pronged way. This begs the question of why the public health community has not been more effective at the national and global levels with all the resources they bring to bear.” Public health has become increasingly driven by disease-specific programming and centralized decision-making. Activists in the favelas are not constrained by these limitations and have thus been able to be more nimble and agile in organizing help where it is most needed.  

“Favela community organizers are showing us that effective public health action can take shape at a local level in a synergistic and multi-pronged way. This begs the question of why the public health community has not been more effective at the national and global levels with all the resources they bring to bear.”

Community activists in the favelas are implementing health prevention policies, defying the traditional practice of implementing short-term health interventions concentrated on a few high-impact solutions. Instead, these activists use a multi-pronged approach with actions that both target COVID-specific issues and tackle upstream, structural factors affecting health across society—unemployment, mental health, food security. Their work is decentralized and shared collectively among various local groups and actors, including journalists who help distribute food while continuing to report and counter misinformation about COVID-19.  

Traditionally, community members are rarely involved in collecting data for government- or NGO-managed public health programs. Favela activists have created their own data collection systems, which are essential in building infrastructure and management systems that can function independent of government roadblocks. By collecting their own data, activists have been able to get an accurate bird’s-eye view of the local COVID-19 emergency and respond rapidly, from monitoring and distributing donations to managing volunteers to countering disinformation.  

This social medicine approach has exposed entrenched socioeconomic and health disparities caused by unregulated capitalism, political corruption and authoritarianism. The broad, holistic view of the COVID-19 emergency considers factors such as discrimination and power hierarchies, which do not typically feature in traditional targeted public health interventions.  

Through building community-oriented, inclusive alliances that reject individualism, hierarchical leadership models and political polarization, community activists in favelas are fighting COVID-19 in a way that is far more equitable. These unorthodox approaches not only are effective in mitigating the pandemic but also demonstrate that social medicine is a model for reimagining public health—not just in the favelas of Brazil but also around the world.  

The publication is part of a special series titled “Revitalising global social medicine,” edited by Michelle Pentecost, Vincanne Adams, Rama Baru, Carlo Caduff, Jeremy A Greene, Helena Hansen, David S Jones, Junko Kitanaka and Francisco Ortega. The series will be appearing in The Lancet over the next several months.