Lula’s Victory and the Possibility of Change from the Global South: Economic Injustice, Health Inequity and the Search for a New Ethics of Sustainable Human Development

IN A NUTSHELL
Author's note
The re-election of Luiz Inácio Lula da Silva as President of Brazil on 25 October 2026 provides an opportunity to reconsider whether political and intellectual renewal towards greater economic justice, health equity and ecological sustainability might emerge from the Global South. This article examines the structural connections between wealth concentration, unequal access to the determinants of health, ecological overshoot and the concentration of financial, military and digital power. Drawing on international evidence and the conceptual contributions of the Sustainable Health Equity Movement (SHEM), particularly its approaches to Wellbeing in Sustainable Equity (WiSE) and Sustainable Health Equity (SHE), it argues that conventional indicators of economic growth and national development are insufficient and even fall in contradiction, to evaluate human progress. A more comprehensive framework should assess how societies transform available resources into dignified, healthy and environmentally sustainable lives, both within and between countries and across generations. The article proposes a political and ethical agenda that transcends the conventional left–right divide without disregarding the distributional consequences of public policy. It also explores the potential contribution of the Global South to reforming international institutions, advancing a universal right to live in harmony with nature, and developing cooperative alternatives to extractive economic models. Lula’s victory is interpreted not as evidence that such a transformation has occurred, but as a possible opening for broader democratic and transnational action

By Juan Garay  

Co-Chair, Sustainable Health Equity Movement (SHEM)

Professor and Researcher in Health Equity, Ethics and Metrics

Founder, Valyter Ecovillage

By the same Author on PEAH: HERE

Lula’s Victory and the Possibility of Change from the Global South

Economic Injustice, Health Inequity and the Search for a New Ethics of Sustainable Human Development

 

1. Introduction: Can change come from the Global South?

On 25 October 2026, Luiz Inácio Lula da Silva was re-elected President of Brazil with 51.79% of valid votes, against 48.21% for Flávio Bolsonaro. The result followed a closely contested election in a deeply divided society and marked an important moment in Brazil’s democratic and political trajectory (Tribunal Superior Eleitoral, 2026).

The significance of this result extends beyond Brazil’s borders. In a world facing widening economic disparities, democratic tensions, geopolitical conflict and accelerating ecological disruption, it raises a broader question: could the Global South become an important source of political, intellectual and social renewal in the pursuit of a more equitable and sustainable model of human development?

This possibility should not be confused with a prediction or an endorsement of any particular government. Electoral victories do not automatically translate into structural transformations, and countries of the Global South are neither politically homogeneous nor immune to inequality, extractivism, authoritarianism or the concentration of wealth. Brazil itself faces the challenge of reconciling social protection, economic development, environmental conservation and democratic coexistence.

Nevertheless, the election provides an opportunity to examine a fundamental contradiction in the contemporary world order. A primary source if inequity is the artificial divide of countries and the inequity of biocapacity, wealth amd GDP (financial and other excahnge flows). Even countries and communities with substantial natural resources, human capacities and cultural knowledge may continue to experience preventable illness, premature mortality and deprivation, while economic and technological systems concentrate the benefits of production in relatively small populations.

This contradiction cannot be understood exclusively through the traditional division between left and right. It requires an analysis of how resources, opportunities, risks and decision-making power are distributed, and of how these arrangements influence the health of populations and the ecological conditions on which human life depends.

The Sustainable Health Equity Movement (SHEM) has developed a framework for examining these relationships. Its work on Wellbeing in Sustainable Equity (WiSE), Sustainable Health Equity (SHE), global health metrics, financial speculation, digital power and community-based alternatives seeks to connect health outcomes with the broader economic, political and ecological structures that shape them.

This article develops that perspective around three questions:

  1. How does economic injustice contribute to inequities in health and premature mortality?
  2. Why are conventional models of development and political classification insufficient to address the combined challenges of social inequality and ecological limits?
  3. What role could the Global South, working with movements and communities worldwide, play in advancing a new ethic of sustainable human development?

2. Economic inequality and the unequal distribution of health

2.1. Wealth concentration in an unequal world

Economic inequality remains one of the defining characteristics of the global economy. According to the World Inequality Report 2026, the richest 10% of the global population own approximately three-quarters of total wealth, while the bottom 50% own only about 2%. The poorest half of the population receives less than 10% of global income (World Inequality Lab, 2026) and below the dignity threshold that ensures the right to health /best feasible level (see SHEM articles and webinars on the geographical distribution of injustice).

These figures describe more than differences in consumption or personal income. Wealth confers unequal capacities to influence political decisions, access education and healthcare, withstand economic crises, avoid environmental hazards and shape the distribution of future opportunities.

The accumulation of financial and productive assets can support innovation and investment towards global public goods. However, when ownership becomes highly concentrated and the returns to capital are persistently distributed more unequally than the opportunities to participate in economic life, wealth concentration can reproduce itself across usable and direct human might and genius to the benefit of a few.

This matters for health because the resources that protect people from illness are unequally distributed. Adequate nutrition, safe housing, education, clean water, sanitation, secure employment, social protection and timely access to healthcare depend partly on household resources, but also on public investment, labour relations, social institutions and the distribution of political power.

Economic inequality is therefore not simply a background characteristic of societies. It can influence the conditions under which people are born, grow, work, age and die. (Seee Michael Marmot work on health equity and the WHO report and WHA resolution on the social determinants of health, 2010).

2.2. The magnitude of health inequities

The World Health Organization’s 2025 review of social determinants of health reports that the difference in life expectancy between countries with the highest and lowest levels can reach 33 years. It also estimates that eliminating wealth-related inequalities within low- and middle-income countries could potentially save 1.8 million children’s lives each year (WHO, 2025). SHEM estimates that excess mortality caused by international inequity has remained for some 30 years above 16 million annual deaths.

These estimates illustrate the scale of avoidable differences in health. They also demonstrate why national averages can be misleading. A country’s overall life expectancy or health expenditure may improve while large differences persist between social groups, territories, ethnic communities and income categories.

The relationship between economic resources and health is complex. Income influences individual opportunities, while taxation, social protection, public services, environmental regulation and labour-market institutions shape the extent to which those opportunities are shared. Political instability, conflict, discrimination, geography and the capacity of health systems also affect outcomes.

Consequently, the relationship should not be reduced to a simple claim that every difference in health results directly from income inequality. Rather, economic inequality interacts with social and institutional mechanisms that determine exposure to health risks and access to protection.

A central implication follows: the assessment of development must consider not only how much wealth a society generates, but how effectively and fairly it converts available resources into healthy lives.

2.3. From unequal resources to preventable mortality

Health systems are essential, but healthcare alone cannot compensate for all the disadvantages generated by unequal living conditions. Medical treatment may reduce the consequences of disease, yet it cannot independently eliminate inadequate housing, food insecurity, hazardous work, polluted environments, educational exclusion or the loss of livelihoods caused by ecological disruption.

Nor is the availability of medical knowledge sufficient to ensure that its benefits are distributed fairly. Scientific discoveries, vaccines, medicines and digital technologies can improve population health, but access depends on affordability, production capacity, intellectual property arrangements, public financing, infrastructure and political priorities.

SHEM’s work approaches these issues through the relationship between available resources, the capacity to transform them into human wellbeing, and the sustainability of the resulting outcomes. This perspective encourages researchers to examine not only health expenditure or service coverage, but also the distribution of health outcomes relative to the resources and opportunities available.

Such an approach can help distinguish between scarcity that is genuinely unavoidable and deprivation that reflects institutional choices, unequal bargaining power or an inadequate allocation of collective resources.

It also places preventable mortality within a broader ethical and political discussion. When effective interventions and sufficient resources exist, avoidable deaths raise questions about social priorities, the organisation of institutions and the distribution of responsibilities across countries.

Estimating the precise number of deaths attributable to global economic injustice nevertheless requires explicit counterfactual assumptions, transparent methods and careful separation of direct causation from statistical association. The ethical importance of the issue does not remove the need for methodological rigour. If and when achieved, the burden of health inequity may become the most revealing barometer of social justice and act as a compass towards sustainable equity.

3. Ecological injustice and the unequal conditions for healthy life

Economic and health inequities cannot be separated from the ecological foundations of human wellbeing.

Climate change, air pollution, biodiversity loss, soil degradation, water insecurity and the disruption of food systems affect health through multiple pathways. They influence infectious disease patterns, heat-related mortality, nutrition, respiratory and cardiovascular disease, mental wellbeing, displacement and the resilience of health services.

These effects are distributed unequally. People with fewer resources often have less capacity to avoid environmental hazards, relocate from dangerous areas, protect their livelihoods or obtain timely treatment. At the same time, the benefits of environmentally damaging production and consumption may accrue disproportionately to groups with greater purchasing power and ownership of capital.

The United Nations Environment Programme’s Emissions Gap Report 2025 estimated that warming over this century could reach approximately 2.8°C under policies then in place. Even full implementation of national climate pledges was projected to leave warming substantially above the Paris Agreement’s temperature goals (UNEP, 2025). These are model-based projections, not certainties, and subsequent policy developments can change the trajectory. Their significance lies in the scale of the gap between existing commitments and the reductions required. Such trend may mean excess mortality of over 210 million during the century, mainly in populations with low carbon and ecological footprint (see Garay, PEAH, Climate chnge : third world war with no guns).

The problem is not consumption as such. Adequate food, housing, energy, mobility and healthcare are indispensable to human dignity. The challenge is to distinguish consumption that meets essential needs from resource-intensive consumption that adds relatively little to wellbeing while imposing substantial ecological costs.

Likewise, economic growth cannot be evaluated independently of its distribution and environmental consequences. Growth that improves nutrition, sanitation, education and access to essential services may support health equity. Growth that depends on destructive extraction, hazardous working conditions or the depletion of resources essential to future generations may generate benefits that are unequally shared while transferring costs to other populations and periods.

This suggests the need for a combined assessment of social sufficiency and ecological limits: ensuring that everyone has access to the material foundations of a dignified life while reducing unnecessary resource use and environmental damage.

SHEM’s approach to sustainable health equity seeks to place these objectives within a common framework. A society cannot be considered fully equitable if its current wellbeing depends on systematically undermining the health and life opportunities of other populations or future generations. Hence the SHEM index of wellbeing in sustainable equity.

4. The concentration of financial, military and digital power

4.1. Debt, speculation and the distribution of public resources

Public borrowing can finance essential infrastructure, healthcare, education and climate adaptation. Private credit can support productive investment and household security. Financial markets can facilitate the allocation of capital and the management of risk.

However, the consequences of debt depend on its terms, purpose, distribution and governance. When debt-service obligations absorb a large share of public revenue, governments may face difficult choices about healthcare, education, social protection and ecological investment. When financial returns are prioritised over social outcomes, economic activity can become increasingly disconnected from the needs of populations.

The issue is therefore not debt or finance in themselves, but the conditions under which financial claims are created, distributed and enforced.

PEAH article, Debt, Financial Speculation and Artificial Intelligence: The Emerging Architecture of Inequity,  examines how debt, speculative finance and algorithmic systems can interact to reshape the distribution of wealth, power and opportunity. The analysis argues for evaluating these systems according to their contribution to human dignity, sustainable wellbeing and planetary health (Garay, 2026a).

From a health-equity perspective, this implies examining the opportunity costs of financial arrangements: what resources remain available for primary healthcare, nutrition, sanitation, social protection and climate resilience after debt obligations and other competing claims have been met?

It also implies greater transparency in financial governance, fairer taxation, international cooperation against illicit financial flows and a stronger capacity for governments to protect essential social investment.

4.2. Military expenditure, conflict and health

Armed conflict produces immediate mortality, injuries, displacement and the destruction of healthcare infrastructure. Its longer-term effects include interrupted vaccination, food insecurity, psychological trauma, reduced access to education and the deterioration of the social determinants of health.

Military expenditure also raises questions about competing public priorities. Yet it would be misleading to assume that every unit of military spending could automatically be redirected to health or that all security expenditure has identical consequences. Countries face different security conditions, and the effects of reallocating resources depend on context.

A more useful approach is to examine whether security policies reduce threats to human life or intensify the conditions that produce insecurity. Human security should encompass not only protection from armed violence, but also access to essential services, freedom from extreme deprivation and the preservation of the environmental systems on which societies depend.

This broader understanding is consistent with SHEM’s efforts to connect peace, global justice and sustainable health equity.

4.3. Digital technology and artificial intelligence

Artificial intelligence and digital infrastructure can improve diagnosis, disease surveillance, scientific research, logistics and the allocation of health resources. They can also reproduce discrimination, concentrate informational power and increase dependence on private providers when ownership, access and accountability are inadequately governed.

The central question is not whether technology is inherently beneficial or harmful. It is who controls it, whose interests it serves, who can scrutinise its decisions, and how its benefits and risks are distributed.

When a small number of companies control critical digital infrastructures, data and computational resources, their decisions can influence public institutions and essential services. Where automated systems are used to determine eligibility, allocate resources or assess risk, insufficient transparency and weak accountability may reinforce existing social inequalities.

A sustainable health-equity agenda therefore requires public-interest research, independent evaluation, meaningful human oversight, data protection, equitable access to digital infrastructure and democratic accountability.

These concerns also reinforce the wider argument: the distribution of power is itself a determinant of health. Economic, political, military and digital power should be assessed not only by their capacity to generate returns or increase national influence, but by their effects on human capabilities, health and ecological integrity.

5. Beyond the conventional left–right divide

The traditional distinction between left and right remains relevant to understanding political traditions, electoral competition and policy choices. Parties differ in their approaches to taxation, public services, labour regulation, markets, migration, environmental protection and the role of the state.

However, ideological labels alone are insufficient to evaluate whether a political system advances sustainable health equity. Governments that describe themselves as progressive can continue extractive practices, tolerate excessive wealth concentration or fail to protect ecosystems. Governments that describe themselves as conservative can adopt policies that strengthen public health, social cohesion or environmental stewardship.

The relevant task is not to erase political differences, but to assess concrete policies and their consequences.

A comparative framework should examine, among other dimensions:

  • The progressivity and effectiveness of taxation.
  • The distribution of public expenditure on healthcare, education, housing and social protection.
  • Access to essential services and differences in health outcomes between social groups.
  • Labour rights, income security and the distribution of economic power.
  • The ecological footprint of production and consumption.
  • The protection of civil liberties and democratic accountability.
  • The concentration of financial and digital ownership.
  • The treatment of migrants and minorities.
  • The distribution of environmental risks between populations and generations.

Such an approach would permit comparison across governments without assuming that political identity determines policy outcomes in advance.

The objective would be to identify which institutional arrangements and policy combinations are associated with greater equity, improved health and lower ecological damage, while recognising the influence of national income, history, demographics, productive structure and international constraints.

A new political ethic would begin by asking whether economic and political institutions enable people to live healthy, dignified lives within ecological limits. It would not require agreement on every aspect of economic organisation. It would require a shared commitment to reducing avoidable deprivation, limiting the conversion of private wealth into unaccountable power, and protecting the conditions necessary for life.

6. The contribution of SHEM: WiSE and Sustainable Health Equity

The Sustainable Health Equity Movement seeks to broaden the understanding and measurement of equity by connecting human wellbeing with the fair and sustainable use of available resources.

Its work on Wellbeing in Sustainable Equity (WiSE) and Sustainable Health Equity (SHE) proposes that development should be evaluated not only by economic output, average income or the availability of services, but also by the capacity of societies to transform territorial resources, human capabilities, institutions and shared global public goods into healthy and sustainable lives.

In Sustainable Health Equity: A Scientific Framework for Strengthening Human Development Drawing on Cuba’s Experience and Contemporary Challenges, a framework that considers three interconnected dimensions: resource endowment, transformation capacity and sustainable wellbeing is proposed (Garay, 2026b).

This framework raises several questions relevant to international comparison:

  1. What resources and capabilities are available to a society?
  2. How effectively and equitably are these resources converted into health, education, social protection and human development?
  3. Are the resulting outcomes environmentally sustainable and replicable for future generations?

The distinction between resource availability and transformation capacity is important. Two societies with comparable resources may achieve different health outcomes because of differences in public institutions, social organisation, access to knowledge, economic distribution and political priorities.

Conversely, a society with limited financial resources may achieve important health gains through preventive care, education, community participation and the effective use of public goods. Such outcomes do not eliminate material constraints, but they demonstrate why income alone is an incomplete measure of development.

SHEM’s approach also highlights the need to examine the sustainability of these achievements. Human wellbeing cannot be considered secure if it depends on ecological depletion, externalising environmental costs or denying other populations access to essential resources.

The framework should be understood as a contribution to ongoing scientific discussion rather than as a fully validated universal index. Its indicators, thresholds, weighting methods and comparative applications require transparent specification, empirical testing and independent assessment.

The Global Health Equity Atlas and related SHEM initiatives offer a basis for further work on the distribution of health opportunities and the avoidable consequences of inequity. Their scientific value will depend on the clarity of their methods, the traceability of their data, the treatment of uncertainty and the reproducibility of their results.

A central research objective is to develop indicators capable of distinguishing between three situations: insufficient resources, unequal distribution of available resources, and institutional limitations in converting resources into sustainable wellbeing. These conditions may overlap, but they require different responses.

7. Can the Global South open a new horizon?

The Global South is not a single political or economic entity. While most countries have gone through Western colonization, the Global South includes countries with different levels of income, political systems, social institutions and international interests. Some have achieved significant improvements in health and education; others face severe deprivation, inequality or environmental destruction. Many experience both progress and persistent structural limitations.

Nevertheless, countries of the Global South occupy an important position in debates about international justice. Their experiences expose the limitations of development models that treat high consumption as a universal aspiration while overlooking ecological constraints, unequal access to resources and the historical distribution of economic power.

The potential of the Global South should not be understood as replacing one hegemony with another. Nor should the South be idealised as inherently more equitable or sustainable. The opportunity lies in building alliances across countries, communities and political traditions around shared principles of human dignity, health equity, democratic participation and ecological responsibility.

Brazil provides a particularly relevant context for this discussion because of its scale, social diversity, scientific capacity, public-health experience and ecological importance. The Amazon and other Brazilian ecosystems have global significance, while the country’s social inequalities make the relationship between economic development, environmental protection and public wellbeing especially consequential.

Lula’s re-election could create political space for initiatives that prioritise social protection, public health, international cooperation and ecological stewardship. Whether this potential becomes reality will depend on policy choices, institutional constraints, democratic negotiation and measurable outcomes. An election result cannot substitute for that assessment.

The wider opportunity is to develop cooperation among countries of the Global South, alongside partners in the North, around practical questions: how to expand access to essential medicines and technologies; how to reduce the fiscal constraints that undermine public services; how to protect forests and biodiversity while improving local livelihoods; how to strengthen climate adaptation; and how to ensure that scientific knowledge serves populations rather than only those who can pay for it.

The Global South may also contribute to a more plural conception of development. Diverse cultural traditions, indigenous knowledge, community-based resource management and experiences of collective provision can inform alternatives to the assumption that wellbeing depends on continuously increasing material consumption.

Such contributions should be assessed critically and respectfully. Local traditions are not automatically equitable, and community autonomy does not remove the need for universal rights, public accountability or protection against discrimination. The aim is to combine diverse forms of knowledge with scientific evidence and democratic principles.

The possible turning point, therefore, is not simply a change in the geographical centre of political power. It is a change in the criteria by which power and development are judged.

8. Towards a universal ethic of intergenerational equity

The pursuit of sustainable health equity requires an ethical framework that connects the rights and needs of present populations with the conditions of life available to future generations.

Several philosophical traditions offer resources for this task. John Rawls’s theory of justice raises the question of fair institutions and obligations between generations. Hans Jonas emphasises responsibility for the long-term consequences of human action. Aldo Leopold’s land ethic expands moral concern to the wider community of life. Elinor Ostrom demonstrates the importance of institutional arrangements through which communities can govern shared resources. Kate Raworth’s doughnut economics connects a social foundation for human wellbeing with an ecological ceiling.

These approaches differ in their assumptions and methods, but each helps challenge the idea that economic performance can be evaluated independently of social justice and ecological limits.

A related ethical question concerns the relationship between human dignity and nature. The right to health is inseparable from access to clean air, safe water, adequate food, secure housing and a habitable environment. Protecting these conditions requires more than individual responsibility: it requires collective institutions capable of regulating economic activity, preventing environmental harm and distributing resources fairly.

A possible contribution would be the development of an international declaration recognising the right of present and future generations to live in harmony with nature, understood as a community of life that includes human beings. This would build on existing international human-rights and environmental frameworks rather than imply that such a comprehensive, autonomous right is already universally recognised in international law.

Such a declaration could establish principles including:

  • Universal access to the material conditions of a dignified and healthy life.
  • Protection of ecosystems and biodiversity as foundations of present and future wellbeing.
  • Fair distribution of the benefits and burdens of economic activity.
  • Responsibility for the long-term and transboundary consequences of public and private decisions.
  • Democratic and transparent accountability for concentrated economic, financial, military and digital power.
  • Protection against discrimination, forced displacement and avoidable deprivation.
  • International cooperation in the research, discovery and equitable provision of essential public goods.
  • Respect for cultural diversity, local autonomy and universal human rights.

The United Nations could provide an essential forum for advancing this agenda. However, institutional reform would need to address both representation and accountability. Greater representation for underrepresented regions, abolishment of the anachronic and antidemocratic vetonpower of a few, stronger mechanisms for protecting future generations, improved international tax cooperation and more effective oversight of transnational risks could help strengthen global governance.

Reform should not create an unaccountable central authority. Global institutions should operate through democratic, transparent and multilevel arrangements that preserve local participation while addressing problems that no country can resolve independently.

The question of borders requires similar care. National institutions continue to play important roles in democratic accountability, social protection and the provision of public services. Yet the unequal circumstances of birth, restrictive migration systems and the uneven distribution of global opportunities raise profound questions of justice.

A gradual approach could strengthen the protection of migrants’ rights, expand safe and regular migration pathways, reduce arbitrary exclusion from essential services and develop international arrangements that share responsibility more fairly. The long-term aspiration would be a world in which borders dilute and birthplace imposes fewer to none unjustified constraints on access to dignity, health and opportunity, while cultural diversity and democratic self-government remain protected. In a way, universal rights are not compatible with artificial national borders restricting or filtering the natural flow of people, knowledge, goods and means.

9. From principles to measurable change

Ethical commitments need to be translated into indicators, policies and institutions capable of demonstrating whether progress is occurring.

A research agenda informed by SHEM could develop a Sustainable Intergenerational Equity framework that assesses the relationship between resource availability, distribution, health outcomes and ecological sustainability.

Such a framework might include the following domains:

Economic justice: income and wealth concentration, tax progressivity, public revenue, debt-service burdens and access to essential goods.

Health equity: life expectancy, healthy life expectancy, avoidable mortality, child mortality, financial protection and differences in outcomes between socioeconomic groups.

Social foundations: nutrition, housing, education, water, sanitation, social protection and secure employment.

Ecological sustainability: greenhouse-gas emissions, material consumption, ecological footprint, air quality, biodiversity protection and exposure to climate risks.

Democratic and institutional conditions: civil liberties, public accountability, participation, corruption controls and the concentration of financial and digital power.

Intergenerational responsibility: public investment in future capabilities, ecological liabilities, long-term health risks and the distribution of benefits and costs between generations.

The purpose would not be to compress every dimension of human development into a single score without adequate justification. Composite indices as the burden of health inequity and the wellbeing in sustainable equity index can be useful for communication and comparison, but they may conceal important trade-offs, methodological assumptions and inequalities within countries.

A robust framework should therefore publish its indicators and data sources, explain the treatment of missing information, test the sensitivity of results to alternative weighting methods, and present disaggregated findings alongside any composite measure.

Comparative research could examine whether countries that reduce economic inequality, strengthen public services and protect ecosystems achieve better health outcomes relative to their available resources. It should account for differences in income, demographics, productive structure, conflict exposure, institutional history and external economic constraints.

Longitudinal analysis would help distinguish correlation from causal effects. Where possible, researchers should evaluate specific policy changes, compare relevant populations and test whether improvements in health are accompanied by reductions in ecological pressure.

The framework could also be applied at community level. Initiatives involving food sovereignty, preventive health, shared resources, renewable energy, care networks and participatory governance may offer practical settings in which to test how different social arrangements contribute to sustainable wellbeing.

Such experiments cannot replace public institutions or universal social protection. They can, however, generate knowledge about complementary forms of cooperation and demonstrate how ethical principles can be translated into everyday practices.

The ultimate purpose is to make sustainable equity empirically assessable: to determine not merely whether societies become wealthier, but whether their resources produce healthier lives, whether the benefits are fairly shared, and whether these achievements can be maintained without undermining the conditions of life elsewhere or in the future.

10. Conclusion: A possible turning point, not a predetermined future

Lula’s re-election creates an opportunity to reconsider the contribution that Brazil and other countries of the Global South might make to international debates on economic justice, health equity and ecological sustainability. It does not establish that a new global direction has begun, nor does it guarantee that Brazil’s policies will resolve the structural contradictions discussed here.

The significance of the moment lies in the questions it makes possible. Can economic resources be directed more effectively towards health, education and social protection? Can financial and technological innovation be governed in the public interest? Can development improve material conditions without reproducing ecological destruction? Can international institutions distribute responsibilities and decision-making power more fairly? And can political movements build cooperation beyond established ideological divisions without abandoning democratic accountability or the analysis of inequality?

The Sustainable Health Equity Movement offers one framework for addressing these questions. By connecting the availability of resources, the capacity to transform them into human wellbeing, the distribution of health outcomes and the ecological sustainability of development, SHEM seeks to broaden the criteria by which societies assess progress.

The challenge is not to replace one political or geographical hegemony with another. It is to create institutions and social arrangements that limit the concentration of unaccountable power, ensure universal access to the conditions of a dignified life and protect the ecological foundations of health for present and future generations.

The Global South could contribute significantly to this transformation, not by claiming moral superiority, but by helping to build alliances grounded in shared evidence, plural knowledge, democratic participation and practical cooperation. The same responsibility applies to societies in the Global North and to movements, institutions and communities everywhere.

A new ethic of human development would begin with a simple but demanding principle: the prosperity of one population should not depend on avoidable deprivation elsewhere, and the wellbeing of the present generation should not be secured by destroying the possibilities of life for those who come after us.

The decisive change will therefore be measured not only by elections or declarations, but by whether people live longer and healthier lives, whether inequalities in opportunity and avoidable mortality decline, whether ecological damage is reduced, and whether power becomes more accountable to the communities whose lives it shapes.

Lula’s victory may be one opening among many. Whether it becomes part of a broader turning point will depend on the capacity of people, institutions and movements across the world to turn the principles of sustainable equity into measurable and enduring change.

References

Garay, J. (2026a). Debt, Financial Speculation and Artificial Intelligence: The Emerging Architecture of Inequity. PEAH – Policies for Equitable Access to Health. https://www.peah.it/2026/10/debt-financial-speculation-and-artificial-intelligence-the-emerging-architecture-of-inequity/

Garay, J. (2026b). Sustainable Health Equity: A Scientific Framework for Strengthening Human Development Drawing on Cuba’s Experience and Contemporary Challenges. PEAH – Policies for Equitable Access to Health. https://www.peah.it/2026/07/

Garay, J. (2026c). A New Horizon: From Broken Systems to Living Communities. PEAH – Policies for Equitable Access to Health. https://www.peah.it/2026/05/a-new-horizon-from-broken-systems-to-living-communities/

Garay, J. (2026d). The Health, Equity, Peace, and Planetary Value of “Unplugging”: Cortisol Dysregulation as a Biological “Plug-Indicator” of Immersion in Extractive Systems. PEAH – Policies for Equitable Access to Health. https://www.peah.it/2026/05/16138/

Garay, J. (2026e). The Progressive Power of Data and Algorithms, and Their Effect on Human Life Loss Due to Geopolitical Tensions, Military Spending, and Global Injustice. PEAH – Policies for Equitable Access to Health. See the author’s 2026 publications at https://www.peah.it/

Jonas, H. (1984). The Imperative of Responsibility: In Search of an Ethics for the Technological Age. University of Chicago Press. (Original work published in German in 1979)

Leopold, A. (1949). A Sand County Almanac, and Sketches Here and There. Oxford University Press.

Ostrom, E. (1990). Governing the Commons: The Evolution of Institutions for Collective Action. Cambridge University Press.

Rawls, J. (1971). A Theory of Justice. Harvard University Press.

Raworth, K. (2017). Doughnut Economics: Seven Ways to Think Like a 21st-Century Economist. Chelsea Green Publishing.

Tribunal Superior Eleitoral. (2026, October 26). Presidente do TSE anuncia reeleição de Lula e faz balanço do 2º turno das Eleições 2026. https://www.tse.jus.br/comunicacao/noticias/2026/Outubro/presidente-do-tse-anuncia-reeleicao-de-lula-e-faz-balanco-do-2o-turno-das-eleicoes-2026

United Nations Environment Programme. (2025). Emissions Gap Report 2025: Off Target—Continued Collective Inaction Puts Global Temperature Goal at Risk. Nairobi: UNEP. https://www.unep.org/resources/emissions-gap-report-2025

World Inequality Lab. (2026). World Inequality Report 2026. https://wir2026.wid.world/insight/executive-summary/

World Health Organization. (2025). Social determinants of health. https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health

World Health Organization. (2025). World Report on Social Determinants of Health Equity. https://www.who.int/teams/social-determinants-of-health/equity-and-health/world-report-on-social-determinants-of-health-equity