1Why bother imagining care in the Anthropocene? The fragility of human life and health challenges seem complicated enough on their own. Care takes place under unresolved conditions—why add neologisms to the mix? Even more so when we already have terms like “One Health,” “planetary health,” “community-oriented health,” and “collective health.” What would be the point of rethinking care in relation to the various crises of habitability that threaten lives and the very possibility of life on Earth?
- 1 A situated position of knowledge production that articulates geographical, social, historical, and (...)
2This text is a proposal that seems indispensable from my standpoint1 (understood as a position situated geographically, socially, historically, and existentially) to take responsibility for our actions on the planet, including the actions through which we preserve our lives. By imagining care in the Anthropocene era, I wish to bring into the conversation the crises of habitability and the unequal distribution of risks, treatments, and places of care. In other words, I wish to establish a link between care, the Anthropocene, and what we perceive as “our real health problems.” These problems depend to a large extent on who we are: if I live in France and have free access to the healthcare system in addition to reimbursement for healthcare costs, I might think that health problems are limited to medical deserts, hospital equipment, antibiotic resistance, and the working conditions of healthcare workers. However, even in countries with well-developed healthcare systems, certain populations face significant barriers to accessing biomedical services, while in other contexts these difficulties may be even more pronounced. Moreover, if I lived in a region like Cerro de Pasco, in Peru, where large-scale mining has led to long-term contamination with significant consequences for the health of local populations, I might tell the story differently. Perhaps the health issues I would highlight in that case would focus more on the effects of pollution, exposure to heavy metals, and the inequalities produced by global extraction networks that make high-tech hospital care possible. Thus, rethinking healthcare in light of crises of habitability is a necessity for everyone. Responses drawn solely from the field of biomedicine, modern science, or the Global North are not enough.
3That said, my standpoint is not the only factor shaping this reflection, and what follows does not claim to be a complete history of health or of resistance to biomedicine around the world. There is a tendency imposed by the coloniality of knowledge (Lander, 2000) that posits the possibility of generating universal, exhaustive, and encyclopedic explanations. This proposal is not modern; this text is constructed according to decolonial theory, in light of the intellectual history of my region, Latin America. This is our own history (Mignolo, 2003). That said, the fact that I am writing this text in French implies that I am also proposing a dialogue that extends beyond my own culture—where everything remains to be constructed—through relationships and exchanges (Glissant, 2009). There is a tension—one that can be fruitful—between respect for the particular and situated thought, on the one hand, and the imperatives of universalist thought, on the other. Epistemologically, I am confronted with a recurring question in crisis studies: how can we reconcile attention to local particularities with an understanding of the global dynamics that shape ecosocial crises?
4The Anthropocene marks a moment in Earth’s history when humans become a force whose actions threaten the Earth’s habitability—and even the very possibility of life on the planet. In this context, the Anthropocene functions as a concept-event in the sense that it ushers in new conversations and forms of dialogue (Lussault, 2018). It presents an opportunity to rethink the conditions under which lives and deaths—both human and nonhuman—are considered acceptable on a global scale.
5A second contradiction stems from the fact that, in my region (Latin America), most people are skeptical of the concept of the “Anthropocene” for several reasons. The most cited is moral: we are not all responsible for the crises (ecological, economic, climatic, colonial, among others). Although this has the merit of sparking an important discussion, my approach is more practical. For me, what matters is not so much determining who is responsible or what the correct overarching concept is for describing our era (Kaltmeier et al., 202б). I am joining this discussion with the aim of acknowledging the suffering and exploring alternatives to the “imperial way of life” (Brand & Wissen, 2021).
6Rethinking care in the Anthropocene is, in fact, an exercise in imagination and foresight driven by a desire for restoration. It involves questioning the ways in which we inhabit the Earth, particularly the effects that our conceptions of human life, health, and care have on the Earth System on a global scale. What matters are the actions that might follow this exchange rather than modern epistemic precision on the subject (Latour, 2015; Morton, 2013).
7Epistemic precision drawn from Anthropocene studies underscores that the issue is not limited to disciplinary terms. It is not merely a matter for medicine, anthropology, or the sociology of health—but calls for a trans- or post-disciplinary perspective that involves a shift away from human health, which has historically been modeled, in fact, on the figure of the modern man of the Global North (Disdier & Herrmann, 2021; Kaltmeier et al., 202б; Lussault, 2024; Salamanca González, 2023).
8To develop this line of thought, I have chosen two classic themes in the field of healthcare. On the one hand, the interpretation of ailments and the construction of diagnoses; on the other hand, the construction of what will be interpreted and validated as therapeutic. Ultimately, to share a vision of healthcare in the Anthropocene from the perspective of collective health in Latin America.
9When we think of healthcare, what comes to mind? Illness? Hospitals? Treatments? What is the purpose of healthcare? To treat the sick? To cure diseases? To prevent them? To prolong life? To avoid death?
10In Latin America, following the perspective of social medicine and public health (Latin American Association of Social Medicine and Public Health, 1984; Granda, 2004), we believe it is important to distinguish between harm that is preventable and harm that is inevitable. Between what can be treated—and even cured—and what can only be alleviated. This allows us to focus our efforts and resources on what can be addressed, beyond the ethical imperative of establishing the preventability of harm as a criterion for public health (Hersch Martínez & Salamanca González, 2021).
11In this context, care will not seek to prolong life indefinitely, but we will need to imagine, create, and establish the conditions for what would constitute a livable life and what would constitute an acceptable death (Hersch Martínez & González Chévez, 2011). Conversely, it is a matter of defining what would not be considered livable and which deaths would be unacceptable. This implies that we cannot separate our conceptualization of care—and even less so its application—from the ethics it entails (Molinier & Paperman, 2020). Thus, the evitability of harm (Hersch Martínez], 2013) seems to us to be an important criterion for care; and the first inevitable harm requires accepting human vulnerability and mortality, accepting the end of life.
12What will be placed at the center of care will not be death or illness, but the experience of living. In Latin America, this moral value is recognized in the expression “we put life at the center” (Granda, 2000, 2004). In other words, this conceptualization of care has less to do with the incidence of death and illness than with the unique conditions and experiences of living, which opens the affective, symbolic, and ethical dimensions of care. By “experience of living,” I do not mean life in its phenomenological or even biographical dimension, but rather the historical, social, and imaginary configurations that shape the ways of inhabiting the world. The issue at stake is less the lived experience of individuals than the collective forms through which an era organizes the very possibilities of what it means to inhabit the earth humanely.
13To indicate the integration of the moral dimension, the affective dimension, and the work implied in caring activities, I use the English term “care” or “cuidado” in Spanish, which implies the affective and cognitive dimensions at work in the concern for paying attention, perceiving, and feeling—in the act of being affected by the situation (with regard to the people present, within the context)—as well as a second dimension of an appropriate response to detected needs and perceived expectations (Held, 200б; Molinier, 2013).
14I emphasize the perceptual dimension of care because, for both the person experiencing pain and the caregiving staff, an ailment can only be treated if it is perceived (Molinier, 2022). Consequently, the most powerful strategy for withholding care—the antonym of “care”—is not to inflict harm directly, but rather a lack of attention, the lack of “care,” which has been conceptualized as the indifference and irresponsibility of the privileged (Tronto, 1993)—those who may, precisely, fail to perceive the needs of others, particularly those who are different or more vulnerable (Molinier, 2013, 2018).
15Which illnesses will be studied? Which cultural criteria for interpreting suffering will be recognized? For example, in many indigenous nations in the Americas, there is no distinction between physical and emotional ailments. It is possible to become ill—and even to die—from anger, shame, or despair (Hersch Martínez & González Chévez, 2011).
16How do such ailments develop? How can they lead to death? In the Anthropocene era, how can we allow the Earth to remain polluted—a situation that calls into question the very habitability of the planet—while repeating the slogan that being realistic implies conforming to market logic (Comas, 2015), which even dominates access to and affordability of healthcare worldwide? How does this constitute a public health problem? In what sense is the impact of the Anthropocene—insofar as it poses a threat to life on Earth—a public health problem? Although I do not use the future tense, because the ills linked to habitability crises—which could be categorized as Anthropocene—are killing and have killed, and are already making so many populations sick all over the world (Kitmann et al., 2025). Extreme heat waves cause deaths, exacerbate cardiovascular and respiratory diseases, and particularly affect the most vulnerable populations. Droughts, floods, and tropical cyclones destroy homes, health infrastructure, and livelihoods, while contributing to forced population displacement and food insecurity (Lussault, 2024; Raju et al., 2022). The report on the State of Global Climate of the World Meteorological Organization highlights that the climate-related hazards that occurred in 2024 led to the highest number of new displacements recorded in six years and contributed to the worsening of food crises in several regions of the world (World Meteorological Organization, WMO, 2025).
17For Latin American sociocultural epidemiology, it is necessary to focus on coloniality as a mechanism of power that entails a naturalized hierarchy (Castro Gómez, 2000). This hierarchy structures the attention given to ailments and suffering, as well as their treatment, based on criteria such as age, nationality, place of residence, social class, skin color, and ethnicity. Coloniality acts as a structural pathogenic mechanism (Hersch Martínez, in press), which inflicts certain harms based on social criteria, which public health considers to be social determinants of health that generate inequities in care.
18The question posed—“What would care look like in the Anthropocene?”—therefore requires us to examine what we will pay attention to: what ailments will be perceived, recognized, and thus treated? Which diagnoses will be impossible to make? Can one be recognized as sick from living in a toxic environment? Can one be recognized as sick from a lack of time? Can one be recognized as sick from extractivism? Can one be recognized as sick from eco-anxiety? Can noise make us sick? Can smells make us sick? And furthermore, do the deaths of activists defending threatened territories and life constitute a problem that will demand our attention? In other words, which forms of suffering are likely to attract our attention and potentially prompt us to address and treat them, and, conversely, which forms of suffering will we ignore, normalize, and consequently overlook?
19Rethinking the construction of diagnosis in the Anthropocene era involves reevaluating suffering based on people’s sensibilities and the contexts from which they speak. If “care” involves adapting to variable circumstances—not only on a biological or material scale, but also in ways that are specific because they are emotionally charged—then personalization of diagnostics is a promising course of action for care in the Anthropocene. This personalization involves the emotional and cultural adaptation of care actions and decisions (Kleinman, 1988, 200б, 2013; Kleinman and Benson, 2004).
20For this section, I propose a different approach. Let’s start by asking ourselves: What actually heals? Is it the active ingredients? Placebos? The therapeutic gestures? Total extracts? Attention? Therapeutic adherence? The answer will depend on what we consider to be the goal of care. Is it to prolong life, prevent death, or improve the quality of life? Depending on the objective of care, the remedies and the context in which to offer them will take shape and be determined. For example, what will be the best settings for care? Is it the private home as the primary space for care, or is it rather the rise of public spaces and clinics (Barúa Caffarena, 2023)?
21Furthermore, rethinking therapeutic approaches in the Anthropocene involves linking multiple scales, and this requires breaking with established habits to reflect on these issues (Granda, 200б). For example, this requires taking biological and cultural diversity seriously once again as fertile ground for diverse responses to the phenomenon of human suffering (Hersch Martínez, 2000, 2012; Hersch Martínez & González Chévez, 2011). It could also involve taking the accessibility of the remedies themselves seriously as a criterion for judging therapeutic efficacy (by asking who will have access to the purported solutions) (Hersch Martínez, 2000). It could also involve reflecting on the potential for exceeding planetary boundaries (Steffen et al., 2015) when envisioning “the future” of healthcare: are there sufficient materials available for high-tech hospital care to consider this path as the future of therapeutics? Furthermore, what are the costs of extractivism and pollution—which generate risk factors for disease in the Global South—that this entails?
22In other words, we are not all “modern” (Latour, 1991), which means that we cannot all be reduced to Western biomedicine. This is not only because we interpret life, death, and pain differently, but also because access to resources for treatment is not the same everywhere. In the Anthropocene, we must make explicit the fact that we do not have a planet capable of sustaining hospital-based biomedical projects in the same way everywhere in the world, and that the implementation of health technologies in the Global North comes at a cost—in terms of health—for the Global South.
23The conditions under which care work is performed must be urgently rethought to place life—all lives—at the center of our collective projects (Molinier, 2013). What is the ideal duration for a consultation—not the one considered profitable, but the one necessary to provide care, to provide good care? How, then, can healthcare staff work continuous shifts? How much is care worth? What kind of human relationships within the administrations of healthcare institutions will enable care? What truly matters in care? (Pierron et al., 2018).
24Reimagining therapeutic practice in the Anthropocene also involves clearly defining value systems. Therapeutic practice must be conceived at the individual level to meet the specific needs of the person being cared for, but at the same time, we cannot separate individual choices and actions from their potential global effects (Lussault, 2018). We must take responsibility, on a collective and global scale, for our therapeutic choices.
25Finally, in Latin America, we are witnessing that other forms of therapy are possible. I am referring to what is called “traditional medicine”—a term coined by the colonial framework of knowledge, which assumes that Western biomedicine is not rooted in tradition. All too often, this indigenous medicine has been interpreted as backward, ineffective, obsolete, and insufficiently proven (Hersch Martínez, 2000). Within this framework, the resilience, existence, and lives of communities—which have been abandoned by biomedicine—are not considered sufficient proof of the therapeutic efficacy of their healing practices. One of the strategies employed by these communities—which have managed to survive against the express intent to exterminate them—has been to turn to their local biocultural knowledge and resources to sustain their lives and cope with both local diseases and, moreover, imported diseases. It is important to emphasize that therapeutic diversity, as well as a return to local resources (both for interpreting and addressing harm), can offer pathways to sustain human lives while preserving the planet’s habitability (Hersch Martínez, 2000; Hersch Martínez & González Chévez, 2011).
26Reimagining care in the Anthropocene era involves moving beyond disciplinary frameworks; it involves imagining the integration of the socio-environmental context—not only in the areas of food, ways of inhabiting the planet, and approaches to interpreting suffering or therapeutic approaches, but also to envision their distribution in ways that go beyond criteria of geography, class, ethnicity, and so on… (Prévot et al., 2024)
27Making the effort to rethink care in the Anthropocene requires an intellectual shift that may seem contradictory: on the one hand, we must take into account the potential global effects of our decisions, and on the other, situated thinking is also indispensable (Haraway, 1988; Ribeiro, 2023). That said, decolonial thought invites us to move beyond the Eurocentric universalism of knowledge—that is, to break with the imperative of a single, totalizing history (Antonacci, 201б; Lander, 2000; Quijano, 1992). This text does not aim for a globalizing historical perspective but rather seeks to open a discussion that—if we share a sense of the urgency of these crises—proves pressing, in the hope of imagining ways of life compatible with planetary boundaries (Steffen et al., 2005, 2015). In other words, its focus is directed toward the future that can be built through dialogue, and the first suggested step is to establish epistemic justice that allows for the plurality of possible futures for the many lives on Earth (Salamanca González, 2023).
28To imagine futures, we can draw inspiration from sociocultural epidemiology, which, from its inception, has posited such integrations to identify health risks and their distribution (Granda, 200б). What I propose here goes even further: it involves linking the individual experience of suffering, the local dimension of care, and their possible global effects (and perhaps causes). This requires a reconceptualization of the diversity of perceptions of harm and the diversity of remedies. In short, between sociocultural epidemiology and Anthropocene studies, I propose that we take human diversity into account.Finally, another avenue for this reflection would be to ask ourselves the question “What is care?” If we take the vulnerability of life on the planet and widespread interdependence as our starting point.
