Keywords
decolonization - epidemiology - health equity - power dynamic - inclusivity
Introduction
Decolonizing epidemiological research is an essential aspect of promoting social justice
and health equity on a global scale. In recent times, the need to advance health equity
is even more pertinent, and epidemiological research is key to understanding the distribution
and determinants of health and disease across populations.[1] This reifies that epidemiological research perpetuating any form of systemic racism
or imperialistic ideologies adversely affect our scientific understanding of disease
prevention and control. Like many other fields, epidemiology has a long history of
being shaped by colonial and imperialistic ideologies,[2]
[3] and as a result, it has often been perceived to further the agendas of the dominant
power structures. The practice of ignoring the historical context of colonialism,
racism, and other systems of oppression in epidemiological research is unfortunately
all too common.[3]
[4]
[5]
[6]
[7] Global public health experts have also long recognized that racism perpetuates health
disparities.[8]
[9]
[10]
[11] To decolonize epidemiological research, it is crucial to acknowledge and address
these historical and ongoing power imbalances. The aim of this article is to provide
an overview of the issue of decolonizing epidemiological research methods and offer
concrete suggestions for how to address it. It also aimed to engage and educate readers
on the importance of this issue and encourage them to act in support of decolonization
efforts.
What Is “Decolonizing” in the Context of Epidemiological Research?
What Is “Decolonizing” in the Context of Epidemiological Research?
There is not a single universally accepted definition of decolonizing epidemiological
research, as the concept of decolonization can be interpreted and approached in various
ways depending on the context.[3]
[6]
[7] In general terms, decolonizing epidemiological research involves acknowledging and
addressing the historical and ongoing influences of colonialism and imperialism in
shaping the field of epidemiology, as well as identifying and challenging the biases,
assumptions, and power imbalances that have resulted from these influences. This process
aims to promote more inclusive, equitable, and culturally sensitive research practices
that respect and involve the perspectives and needs of marginalized and underserved
communities. Moreover, it seeks to ensure that the benefits of research are equitably
distributed and that the research process itself does not perpetuate or exacerbate
existing health disparities. A critical aspect of decolonizing epidemiological research
is encouraging the inclusion of diverse voices and perspectives in the development
of research questions, methodologies, and the interpretation and dissemination of
results. In this article, the concept of decolonizing epidemiological research would
be viewed from these lenses.
The Issues
One of the key ways in which colonial and imperialistic ideologies have shaped epidemiology
is through the way that research has been conducted. Many early epidemiological studies
were conducted by Western researchers in colonized countries, often without the informed
consent or participation of the local communities. One example of an unethical epidemiological
study conducted in a colonized country is the longitudinal Tuskegee Syphilis Study,
which was conducted in the United States from 1932 to 1972.[3]
[12]
[13]
[14] While the Tuskegee Syphilis Study is not an example of Western researchers conducting
studies in colonized countries, it remains a significant example of unethical research
practices and exploitation of minorities populations, a product of unfortunate lesson
learned from colonization. The Tuskegee study was conducted on African American men
who were living in poverty and lacked access to healthcare, and they were not informed
of their diagnosis or offered treatment. This unethical research practice reflects
the power dynamic between the researchers, who were predominantly white, and the participants,
who were predominantly African American and from a marginalized community. This reflects
the history of racism and discrimination against African Americans in the United States,
which has its roots in colonialism and slavery.[15]
[16]
The Guatemala Syphilis Experiment, a nonconsensual human experimentation study with
a mix of observational and interventional components, was another notorious human
subject research project conducted between 1946 and 1948.[17]
[18]
[19] American researchers, led by Dr. John C. Cutler, collaborated with Guatemalan health
officials to carry out the study, which aimed to investigate the effectiveness of
penicillin in preventing and treating syphilis and other sexually transmitted infections.
The experiment involved intentionally exposing vulnerable populations, including Guatemalan
soldiers, prisoners, and mental health patients, to syphilis, gonorrhea, and chancroid
without their informed consent.[18] The participants were not adequately informed about the risks and potential consequences
of the study.[19] Many of those who were infected did not receive proper treatment, even when it was
available.[17]
[18]
[19] The Guatemala Syphilis Experiment is considered one of the most egregious examples
of unethical medical research in history.[17]
[18] It highlights the issues of power imbalances and the exploitation of vulnerable
populations by Western researchers in colonized or developing countries.
Over the past two decades, researchers in colonized countries have advocated for an
indigenous approach to epidemiology that incorporates local knowledge, community-based
participatory research, and indigenous research methodologies, while enhancing capacity
by training more indigenous epidemiologists and supporting indigenous self-determination.[20]
[21] However, this approach has yet to receive sufficient attention. To understand how
geopolitics perpetuates inequities and how integrating local knowledge can help reduce
such inequities, we must also address the disciplinary preference for quantitative
epidemiological research.[10] This preference reinforces the belief that quantitative research is more rigorous
and authoritative than qualitative research, despite the potential of qualitative
approaches to provide valuable insights into the social, cultural, and contextual
factors that contribute to health disparities.[22] This preference for quantitative research is evident in the default thinking that
epidemiological research primarily entails quantitative research, while qualitative
research is often underappreciated. This underappreciation of qualitative research
ignores its potential to offer valuable insights into health disparities and social
determinants of health.[22]
An example of class-based oppression in epidemiological research can be seen in studies
conducted on environmental health disparities.[23]
[24]
[25]
[26] Low-income and working-class communities, often with a high proportion of racial
and ethnic minorities, are disproportionately exposed to environmental hazards such
as air pollution, contaminated water, and toxic waste.[27] These communities are often located near industrial facilities, landfills, or major
highways, which contribute to poor air quality and other health risks. If epidemiological
research fails to account for these social determinants of health, it may overlook
or underestimate the effects of environmental hazards on the health outcomes of individuals
in these communities.[3] This lack of attention to class-based disparities can result in inadequate policy
responses and interventions, further exacerbating health inequities. In addition,
class-based oppression in epidemiological research can manifest in the exclusion of
low-income communities from decision-making processes, study design, or dissemination
of research findings. This exclusion can lead to a lack of culturally sensitive and
contextually appropriate interventions, perpetuating the cycle of health disparities
and social injustice.
Furthermore, big data has the potential to revolutionize epidemiological research
and practice,[28] but it is important to recognize and address the ways in which power imbalances
and colonial and imperialist ideologies can shape the use of big data. For instance,
the coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of
big data in global health research and practice,[29] but it has also drawn attention to the unequal distribution of power and resources
in the collection, analysis, and use of data related to the pandemic.[30] These power imbalances can occur at multiple levels, including within and between
countries, and can have significant consequences for the effectiveness of COVID-19
responses and the distribution of benefits and harms.[30] Addressing these power imbalances is important for ensuring that data-driven interventions
are effective and equitable, and for building trust and confidence in the use of data.
This can involve efforts to increase the capacity and expertise of low- and middle-income
countries (LMICs) to collect and analyze data, as well as efforts to ensure that data-driven
interventions are transparent, inclusive, and accountable.[31]
[32]
Decolonizing big data in global health, including in the context of COVID-19, involves
acknowledging and addressing these power imbalances and working to create a more diverse
and inclusive research environment. This can include collaborating with political
leaders and advocacy groups to use big data to promote policies and practices that
benefit marginalized communities, increasing the proportion of researchers from these
communities, and incorporating traditional knowledge and practices into epidemiological
research. It is also important to recognize and value the expertise of traditionally
underserved populations, and to ensure that big data are used ethically and responsibly,
with appropriate safeguards in place to protect the privacy and security of individuals.
The COVID-19 pandemic has brought these issues to the forefront and has underscored
the importance of decolonizing big data in global health to address health inequities.[29] A decolonized epidemiological data infrastructure should center on the knowledge
of indigenous and marginalized populations and focus on intersectionality and interdependence.
It should prioritize community-centered approaches, invest in diverse local leaders
and scientists, and build algorithmic transparency and accountability. Consent from
the population must be emphasized, ensuring that individuals have control over their
data and its usage. To address the digital divide, facilitating access and communication
for all members of the population is essential, and a clear and shared understanding
of decolonization and data sovereignty is necessary to create an effective and equitable
epidemiological data infrastructure.
In addition, the way that research has been conducted has often been shaped by the
biases and assumptions of the researchers, leading to a lack of cultural sensitivity
and a failure to consider the unique experiences and perspectives of different communities.[33] Another way in which colonial and imperialistic ideologies have shaped epidemiology
is through the way that the results of research have been used.[34]
[35]
[36] In many cases, the results of epidemiological research have been used to justify
policies and practices that disproportionately affect vulnerable communities. For
example, epidemiological research has documented the harmful effects of lead exposure
on cognitive development and other health outcomes, particularly in children.[37]
[38]
[39] However, policies and practices related to lead abatement and remediation have not
always been applied equitably, and marginalized communities such as low-income and
racial/ethnic minority populations may be disproportionately exposed to lead hazards.[3]
[40] This has contributed to a legacy of discrimination and injustice within the field,
and it is essential that efforts are made to ensure that research is used in a more
equitable and just manner.
Indigenous knowledge has been consistently undermined by colonialism, which elevates
Eurocentric science as superior.[40]
[41]
[42]
[43] In the current COVID-19 pandemic response, epidemiology has not challenged this
hierarchy of knowledge but rather reinforced it.[44]
[45] Epidemiology was rapidly and widely valued as a discipline and a group of experts
without much questioning. This may be because the nation has long prioritized Westernized
science since colonization, promoting the belief that it can save us from ourselves.
Epidemiologists are seen as “expert knowers” and their science is viewed as unbiased,
objective, and neutral. Even though in recent time many epidemiological researchers
are careful not to conduct unethical studies to avoid sanctions, it is important to
go beyond simply avoiding unethical practices and actively work to decolonize the
field.
Ethical and Respectful Research Practices
Ethical and Respectful Research Practices
Ethical and respectful research practices are crucial in ensuring the decolonization
of epidemiology and promoting inclusivity and equity. One of the fundamental aspects
of ethical research is obtaining the full participation and informed consent of the
communities being studied. To achieve this, researchers should work with local partners
and community leaders to design and conduct research in a way that is sensitive to
the needs and perspectives of the community.[46] Such efforts may involve engaging with the community to identify their priorities
and concerns and involving them in the research process in a meaningful way.[47] Additionally, researchers should adapt research methods and protocols to be culturally
appropriate and respectful of local customs and beliefs.[3]
[48] This may include modifying data collection methods, involving community members
in research design, and adjusting interpretation and dissemination of findings. By
providing concrete examples and fostering meaningful community engagement, researchers
can conduct culturally sensitive and scientifically rigorous research.
Another essential aspect of ethical research is ensuring that the benefits of the
research are shared with the community.[49] This means sharing the results of the research with the community in a way that
is accessible and understandable and working with the community to ensure that the
findings are used to address their needs and concerns. For instance, in a study conducted
in rural Kenya, researchers worked with local partners and community leaders to design
and conduct research on the impact of a new water treatment technology on child health.[50] The researchers engaged with the community to identify their needs and concerns
and involved them in the research process, including training community members to
collect data. The researchers also shared the results of the study with the community
and worked with them to identify ways to use the findings to improve child health
in the community. During the Ebola outbreak in West Africa from 2014 to 2016, Western
researchers from various institutions and organizations worked closely with local
communities and governments to understand and respond to the outbreak.[51]
[52] Such efforts included conducting epidemiological research to understand the spread
and impact of the disease, working with local healthcare providers to develop and
implement treatment and prevention strategies, and engaging with local communities
to address their concerns and needs. These efforts required close collaboration and
communication between Western researchers and local partners and were critical to
the successful response to the outbreak.
Conducting epidemiological research in an ethical and respectful manner involves working
with local partners and community leaders to design and conduct research that is sensitive
to the needs and perspectives of the community and ensuring that the benefits of the
research are shared with the community.[53] This approach fosters inclusivity, equity, and trust between researchers and the
community, which are essential to decolonizing epidemiology.
Diversity and Inclusion in Epidemiological Research
Diversity and Inclusion in Epidemiological Research
Another important step is to increase the diversity of the field itself. Epidemiology
has traditionally been dominated by Western researchers,[54]
[55]
[56] and it is important to ensure that a wider range of voices and perspectives are
represented within the field. This includes increasing the representation of researchers
from marginalized communities, such as indigenous communities, people with disabilities,
and communities of color among others. One way to increase the diversity of the field
is by actively recruiting and supporting researchers from these communities and providing
them with the resources and support they need to succeed. This could include providing
mentorship and professional development opportunities, as well as offering financial
support and other resources. It is also important to ensure that the research being
conducted is relevant to the needs and experiences of marginalized communities.[57] This may involve working with these communities to identify their research priorities
and ensuring that the research addresses these priorities.[58] For example, if a community is concerned about access to clean water, researchers
could conduct studies on the impact of water quality on health outcomes and work with
the community to identify solutions to improve access to clean water.
In addition to increasing the diversity of the field, it is also important to ensure
that the results of epidemiological research are used in a more equitable and just
manner. This may involve working with policymakers and advocacy groups to ensure that
research is used to inform policies and practices that benefit marginalized communities,
rather than being used to justify policies that disproportionately affect these communities.[59] For example, if research has shown that certain policies or practices disproportionately
impact indigenous communities, researchers could work with indigenous advocacy groups
and policymakers to identify alternative policies that would be more beneficial to
these communities. This could involve advocating for policies that prioritize the
rights and needs of indigenous communities, such as policies that protect traditional
lands and resources. Although involving researchers in policy making is essential,
it is crucial to address potential conflicts of interest or biases that may arise
from their involvement. Ensuring transparency and objectivity in research will maintain
the credibility and integrity of the research process.
Power Imbalances in Epidemiological Research
Power Imbalances in Epidemiological Research
Recognizing and addressing the ways in which power imbalances have shaped the way
that health and disease have been understood and studied is an important aspect of
decolonizing epidemiological research. Power imbalances, such as those based on colonialism,
imperialism, and globalization (political factors), have had a significant impact
on the way that health and disease have been understood and studied.[60]
[61]
[62] One way in which power imbalances have shaped the way that health and disease have
been understood and studied is through the allocation of research funding.[63]
[64] For example, many diseases that are considered to be major health problems in the
global North (such as heart disease and cancer) may receive a disproportionate amount
of research funding and attention, while diseases that disproportionately affect marginalized
communities (such as infectious diseases and neglected tropical diseases) may receive
far less attention. This can lead to a lack of understanding and effective interventions
for these diseases, and it is important to ensure that research funding and attention
are more equitably distributed. In the context of the COVID-19 pandemic, power imbalances
have been particularly evident in the distribution of resources and attention.[65] For example, wealthier countries and research institutions have often had greater
access to funding and resources, which has enabled them to conduct more extensive
research on the virus and its impacts. This has led to concerns about the potential
for global health inequities, as the needs and experiences of poorer countries and
communities may not be adequately represented in the research being conducted.[66]
Another way in which power imbalances have shaped the way that health and disease
have been understood and studied is through the way that research is conducted, and
knowledge is produced.[67] For example, many early studies on health and disease were conducted by Western
researchers in colonized countries, and this has led to a focus on Western perspectives
and a lack of attention to the experiences and perspectives of marginalized communities.[68] In some cases, power imbalances can manifest in the way that research questions
are framed and studied.[69] For example, if research questions are driven by the interests of those in positions
of power, the needs and experiences of marginalized communities may be overlooked
or ignored.[69] This can result in research that does not accurately represent the experiences of
those most affected by a particular health issue. It is important to ensure that research
is conducted to promote the inclusion of diverse perspectives in research and decision-making.[70] Overall, recognizing and addressing the ways in which power imbalances have shaped
the way that health and disease have been understood and studied is an important step
in decolonizing epidemiological research and creating a more inclusive and equitable
approach. This involves ensuring that research funding and attention are more equitably
distributed and promoting the inclusion of diverse perspectives in research and decision-making.
Social and Economic Factors in Epidemiological Research
Social and Economic Factors in Epidemiological Research
Recognizing that the social and economic factors that contribute to health and disease
are often shaped by colonialism and other forms of oppression[71] is an important aspect of decolonizing epidemiological research. It is important
to acknowledge and address these underlying factors, rather than simply focusing on
individual behaviors or risk factors, to create a more inclusive and equitable approach.
One example of how colonialism has shaped the social and economic factors that contribute
to health and disease is in indigenous communities.[72] Indigenous communities may experience higher rates of certain diseases,[72] such as diabetes and heart disease, due to the impact of colonization on their traditional
ways of life and access to healthcare. For example, the forced removal of indigenous
communities from their traditional lands and the disruption of their traditional practices
and ways of life may contribute to the development of certain health conditions.[73] Additionally, indigenous communities may have limited access to healthcare due to
discrimination and other barriers, such as geographic isolation and lack of transportation.[74]
[75] Another example is the way that structural racism and discrimination contribute
to health disparities in communities of color.[76] Communities of color may experience higher rates of certain diseases, such as hypertension
and obesity, due to factors such as lower income and education levels, lack of access
to healthy food options, and exposure to environmental toxins.[76] Structural racism and discrimination may also impact access to healthcare and contribute
to poorer health outcomes.[77]
Decolonizing epidemiological research involves acknowledging and addressing these
underlying social and economic factors, rather than simply focusing on individual
behaviors or risk factors. This may involve working with communities to identify the
root causes of health disparities and addressing these causes in a holistic and culturally
appropriate manner. It may also involve advocating for policies and practices that
address structural inequalities and promote health equity. For example, to address
the higher rates of diabetes and heart disease in indigenous communities, researchers
could work with these communities to identify the root causes of these health disparities
and develop interventions that address these causes in a culturally appropriate manner.
This could involve working with the community to promote traditional practices and
ways of life, such as traditional diets and physical activity, as well as addressing
barriers to healthcare access.
To address the health disparities experienced by communities of color, researchers
could work with these communities to identify the root causes of these disparities
and develop interventions that address these causes. This could involve advocating
for policies and practices that address structural inequalities, such as addressing
environmental toxins and promoting access to healthy food options, as well as addressing
barriers to healthcare access. It is generally accepted that investment in social
epidemiology is important in the modern world.[78]
[79] Social epidemiology is a field that focuses on the social and economic factors that
contribute to health and disease in populations.[80] These factors include things like income, education, housing, and access to healthcare,
and they are often shaped by structural inequalities such as racism, discrimination,
and colonialism.[81] By studying these factors, social epidemiologists aim to understand the root causes
of health disparities and develop interventions to address them. Given the ongoing
challenges of health inequities and social injustice, many experts believe that increasing
investment in social epidemiology is necessary to address these issues and promote
health equity.[79]
[80]
[81] Overall, recognizing and addressing the social and economic factors that contribute
to health and disease, and the ways in which these factors are shaped by colonialism
and other forms of oppression, is an important step in decolonizing epidemiological
research and creating a more inclusive and equitable approach.
Authorship in Epidemiological Research and Journal Editorship
Authorship in Epidemiological Research and Journal Editorship
Decolonizing authorship in epidemiological research refers to efforts to ensure that
research is conducted and led by a diverse group of researchers, including those from
traditionally underserved or marginalized communities. This is an important issue,
as power imbalances and inequities in authorship in epidemiological research have
been a longstanding concern,[82]
[83]
[84] with research often being led and conducted by researchers from dominant or privileged
groups, while the contributions of researchers from marginalized or underserved communities
have been underrepresented or unrecognized. This disparity is evident in a study of
882 papers involving 10,570 authors across 61 LMICs. Compared with authors with high-income
country (HIC)-only affiliations, authors with LMIC-only affiliations were less likely
to hold first or last authorship positions, while those with mixed HIC/LMIC affiliations
had greater likelihood.[84] Furthermore, the proportion of senior authors with LMIC-only affiliations was lowest
in the highest impact journals and in multicountry studies compared with single-country
studies, highlighting the ongoing challenges in addressing inequities within the research
landscape.[84]
Decolonizing authorship in epidemiological research can help to create a more inclusive
and equitable field and can also have several other benefits. One reason why decolonizing
authorship in epidemiological research is important is that it can help to ensure
that research is more relevant and meaningful to a wider range of communities. Researchers
from marginalized or underserved communities may have unique insights and perspectives
that can inform the design and conduct of research and can help to ensure that research
addresses the needs and concerns of these communities.[85] Involving researchers from these communities can also help to build trust and confidence
in the research among local communities, which can be critical for the success of
research studies and for the uptake of research findings.[85] Another reason why decolonizing authorship in epidemiological research is important
is that it can help to increase the impact and influence of research. Research that
is conducted and led by a diverse group of researchers is more likely to be representative
of the populations it seeks to study and is more likely to be relevant and applicable
to a wider range of contexts.[86]
[87] This can help to increase the generalizability and usefulness of research findings
and can also increase the likelihood that research findings will be used to inform
policies and practices that benefit marginalized or underserved communities.
There are several ways in which authorship in epidemiological research can be decolonized.
One important strategy is to promote diversity and inclusion in research training
programs and career development opportunities.[88] This can involve providing financial and other forms of support to researchers from
marginalized or underserved communities, as well as creating opportunities for these
researchers to gain experience and build their skills and networks. It can also involve
creating more inclusive and supportive research environments and working to address
structural barriers and biases that may prevent researchers from these communities
from participating fully in the research process. Researchers from marginalized communities
face barriers and biases such as limited access to education, resources, funding,
and networking opportunities, as well as implicit discrimination and underrepresentation
in decision-making processes. These challenges hinder their ability to fully participate
in and contribute to epidemiological research, perpetuating disparities in authorship.
Another important strategy is to support the development of research capacity in marginalized
or underserved communities. This can involve providing resources and support to help
these communities conduct their own research, as well as building partnerships and
collaborations between researchers from these communities and researchers from more
privileged groups. It can also involve working with local organizations and institutions
to help them develop the skills and resources they need to conduct and use research
effectively.
While decolonizing authorship in epidemiological research has many benefits, it is
crucial to acknowledge potential limitations and challenges. Some concerns include
tokenism, where researchers from marginalized communities may be included solely to
meet diversity requirements, rather than genuinely valuing their perspectives and
contributions.[89] Additionally, promoting diversity may initially slow down research processes due
to the need for additional resources and time to ensure proper representation and
collaboration. Academic institutions should be aware of these potential issues and
implement measures to address them. For instance, they could establish guidelines
and protocols to ensure genuine engagement with diverse researchers and communities,
rather than mere tokenism.[86] Institutions should also allocate sufficient resources and time to support meaningful
collaborations, recognizing that the long-term benefits of more inclusive research
outweigh the initial investment.
In addition to the ongoing discussion surrounding the decolonization of authorship
in epidemiological research, there is a growing emphasis on the need to decolonize
editorship in epidemiological journals and other global health journals.[90]
[91] In response to this, a study presents a new scoring system called the Composite
Editorial Board Diversity Score (CEBDS) to evaluate the diversity of editorial boards
in terms of three parameters—gender, country income-level, and geographic region.[92] The diversity of the editorial boards of 27 specialty global health journals was
analyzed, revealing that of 303 editors, 40% were females, 68% were based in HICs,
34% in Europe and Central Asia, and 30% in North America. Among editors-in-chief,
27% were females and 73% were based in HICs. Only 26% of journals achieved the highest
possible score in the gender diversity domain (40–60% female editors), 11% in the
country income-level domain (at least one editor in all country income groups), and
7% in the geographic region diversity domain (at least one editor in all six regions).
Overall, a mere 11% of journals had high CEBDS (≥8). Further studies are needed to
understand the enablers and barriers of diversity in journal editorial boards, and
affirmative action and organizational good practices for improving diversity, inclusion,
and belongingness must be implemented to ensure diversity in the editorial boards
of epidemiology and global health journals.
Traditional Knowledge and Practice in Epidemiological Research
Traditional Knowledge and Practice in Epidemiological Research
Part of the effort to decolonize epidemiological research must emphasizes the unique
role of both qualitative and quantitative research as key components in the field.
By recognizing and valuing the contributions of diverse methodological approaches,
researchers can develop a more inclusive, equitable, and comprehensive understanding
of public health issues and health inequities.[20]
[93]
[94] While mixed-methods research combines qualitative and quantitative approaches and
can contribute to a more comprehensive understanding of public health issues, it was
not initially set up explicitly to decolonize epidemiological research. However, embracing
mixed-methods research can be an important step in the decolonization process, as
it fosters a more inclusive and equitable research environment by valuing diverse
perspectives and methodologies. This approach can help dismantle the hierarchies that
have been established in the field and promote research practices that better serve
the needs of marginalized and underserved communities. This shift in perspective can
help promote more culturally sensitive research practices that respect and involve
the perspectives and needs of marginalized and underserved communities. In the context
of local communities, researchers may face the dilemma of balancing respect for traditional
values while addressing practices that negatively impact public and personal health.
Navigating this challenge requires engaging in open and respectful dialogue with community
members, acknowledging their expertise, and collaboratively developing culturally
sensitive interventions. This approach promotes mutual understanding and encourages
the adoption of healthier practices while respecting cultural values and beliefs.
Many indigenous communities have a rich history of traditional medicine and healing
practices,[95]
[96] and it is important to recognize and incorporate this knowledge into research and
healthcare practice. This involves acknowledging the value of traditional knowledge
and practices and working with traditional healers and community leaders to design
and conduct research. Traditional knowledge and practices refer to the cultural, historical,
and experiential knowledge and practices that are passed down through generations
within a particular community or culture.[97] This includes knowledge and practices related to health, wellness, and the natural
environment, as well as social and cultural practices and traditions.
Incorporating traditional knowledge and practices into epidemiological research offers
a multitude of benefits, particularly in indigenous or marginalized communities where
such knowledge plays a pivotal role in health and well-being. As global health expert
Dr. Seye Abimbola points out, there has been an ongoing epistemic injustice that distances
us from the valuable knowledge found at the periphery, often due to colonial legacies.[98] By integrating traditional knowledge and practices into research, we can ensure
that it is not only relevant and meaningful to local communities but also takes into
account their cultural and historical context. This respectful and responsive approach
to research is more likely to be accepted and utilized by local communities, increasing
the uptake and effectiveness of research findings. Furthermore, acknowledging, and
valuing knowledge from the periphery helps to repair the damage caused by colonialism
and promotes mutual understanding and respect between researchers and local communities.
By working together and sharing knowledge and expertise, both parties can learn from
each other, building stronger partnerships and collaborations, and ultimately challenging
the colonial conceit that has perpetuated epistemic injustice.
Conclusion
It is important to recognize that decolonizing epidemiological research is not a one-time
process, but rather an ongoing journey. Decolonizing epidemiological research is a
crucial step in creating a more just and equitable world and involves acknowledging
and addressing the ways in which colonial and imperialistic ideologies have shaped
the field and working to increase the diversity and inclusivity of the field. It also
involves recognizing and addressing the underlying social and economic factors that
contribute to health and disease and valuing the knowledge and expertise of marginalized
communities. By taking these steps, we can ensure that epidemiology is used to benefit
all members of society, rather than being used to further the agendas of the dominant
power structures.
