Nowadays the Protestant Reformation of sixteenth- and seventeenth-century Europe is taught as an important episode in the history of Christianity, but it also marked the first concerted effort to democratize knowledge production in the West, specifically by devolving religious authority from the Church of Rome.
—Steve Fuller, Post-Truth: Knowledge as a Power Game (2018)
This book represents a call to democratize knowledge production in the See of Global Health. It is avowedly ironist in that it subscribes to a notion of truth whereby different ways of fact gathering all vie for epistemic status. And it is “dialogic,” in the Bakhtinian sense, in that it informs and is informed by the previous literature1—especially the cited epidemiological studies.i
Compared to the Catholicism that stunted the minds of Europeans throughout the Dark Ages up to the time Luther posted his ninety-five theses in 1517, the coloniality that has permeated our intelligence ever since is more encompassing (and global) in its reach. As such, a similar democratization of knowledge—an Epistemic Reformation—must occur, specifically by devolving scientific authority from “centers of calculation”2 in the Global North.
i That is to say, these epidemiological studies are as altered by my dialogue with them as this book is.
ii This is actually an interpretation of Nietzsche’s thought, not a direct translation.
iii The retreat from this role has limited most of anthropology’s relevance to the academy.
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How does this modern/colonial racist/patriarchal system3 that was incepted circa 1492 continue to operate today? Contemporary phenomena like far-right movements,4 hyperincarceration,5 gender-based violence,6 crimes against humanity,7 structural adjustment,8 predatory accumulation by dispossession,9 social entrepreneurship/philanthropy,10 and low-income-country dependency11 are some of the more salient processes.
There are less conspicuous—and thus all the more insidious—mechanisms at work, however: the very institutions we employ for the study of human beings—social science departments, poverty action labs, humanitarian initiatives, and institutes for health metrics, for example12—can also be traced to human rights failings. Through carnivalesque13 subversions of the coloniality of global health “science,” this pseudomonograph has attempted to demonstrate the distinctions between epidemiology as an unbiased scholarly endeavor (as it is often imagined to be) and epidemiology as an accomplice to contemporary imperialism.14 This quintessential discipline of public health has concealed violently seized privilege behind a speciously rigorous scientism.15 Again, the continuation of disproportionate mortality from communicable pathogens in the Global South is not the result of an intractable problem thwarting our best efforts to prevent and cure disease; we do have the means. Rather, moral detachment in an intelligentsia subservient to protected affluence16—a subservience sculpted by the categories and methods supplied in academic training—allows for etiolated approaches to the study and achievement of global health equity.17
The pragmatist relinquishes the identity of social scientist who produces empirical studies about this postmodern world. He or she becomes a social critic, a critic of cultural and social formations that work against locally (and globally) defined democratic ideals.
—Norman K. Denzin, Post-Pragmatism (1996)
The jester, the oppositional intellectual, works at the margins and sometimes (but not necessarily) from the outside, pulling at loose threads, deconstructing key concepts, looking at the world from a topsy-turvy position in order to reveal the contradictions, inconsistencies, and breaks in the fabric of the moral order without necessarily offering to “resolve” them.
—Nancy Scheper-Hughes, Three Propositions for a Critically Applied Medical Anthropology (1990)
The Foucauldian genealogist has been described as a “diagnostician who concentrates on the relations of power, knowledge, and the body in modern society.”18 This book has attempted to clinically examine epidemiology as an ideological apparatus, one that provides quasi-salubrious devices that are otherwise effective in organizing the Global South’s voluntary submission to the contemporary colonial matrix of power (by interpellating the destitute sick as beneficiaries of the Global North’s aid-science multiplex).19
But once the ideological distortions are diagnosed, how do we delink such knowledge production from the neo(colonial) matrix of power? Critical pragmatism provides a means of making the Euro-centered epistemology20 hidden in public health science more transparent. Each of the preceding chapters [sic] has attempted to do this, by redescribing social phenomena in a more just fashion.
All social phenomena are subject to interpretation; whichever interpretation prevails at a given time is a function of power and not truth.
—Friedrich Nietzsche, Notes (1888)ii
The interpretation of social phenomena that currently prevails is what the Global North calls Social Science.
—Privilege-exerciser, “Corollary to Nietzsche” (2020)
The disciplinary tendency toward conservative parsing of phenomena that I have critiqued in this book is not limited to epidemiologists: economists are at best political philosophers with an aptitude for “mathiness” and at worst neoteric astrologers;21 bioethicists scant the role of predatory accumulation in health disparities;22 political scientists provide the forecasting equivalent of “dart-tossing chimps”;23 and anthropologists were long complicit in the maintenance of colonial exploitation.iii24 As such, and to be consistent with the neo-Kantian tradition that separates sciences of nature and studies of human behavior,25 I second the motion that we cease referring to social inquiry as a science. As Lansing and Kremer note, “It is precisely the introduction of human agency into natural ecologies that blunts the tools designed for the study of mindless processes.”26 The quest for objectivity that has infiltrated social inquiry allows disciplines from economics to epidemiology to be co-opted for the benefit of protected affluence, hence their coloniality.
Were we to embrace supradisciplinarity and view the social sciences (including epidemiology) as modes of interpretivism, cultural politics, and curation of facts,27 we could shed the unachievable quests for objectivity, freeing ourselves to entertain more emancipatory, pluriversal forms of truth justification: namely, solidarity—or the achievement of intersubjective agreement on ever more just redescriptions of social phenomena (a praxis reminiscent of Wamba dia Wamba’s “communalist palaver”).28 The problem with conceiving of interpretative social inquiry as natural science is that it will always be inferior to physics, chemistry, and the like,29 since Giddens’s train will never arrive. Liberated from the conservative-incremental validation criteria of Kuhnian normal science,30 pluriversal knowledge ecologies can stand on their own as equally worthy forms of world-understanding.
This will to science is foundational to the coloniality of epidemiology (and other forms of social inquiry); it suppresses life, vitiates creativity, and allows for conservative interpretations to flourish. We should welcome the death of social science as a way to unsettle coloniality’s grip on how people perceive the world around them. Through a pluriversal embrace of disparate ecologies of knowledge, from Dreamtime to Deconstruction, we can begin to contain the epidemic of illusions that allows coloniality to thrive (with the reminder from Nietzsche that truths are illusions about which one has forgotten that this is what they are).31
We see practices of earlier ages as cruel and unjust only because we have learned how to redescribe them.
Vocabulary shifts are . . . the motor of history, the chief vehicles of intellectual and moral progress.
—Nancy Fraser on Richard Rorty, in Unruly Practices: Power, Discourse, and Gender in Contemporary Social Theory (1989)
Being mindful that we do not “displace an activist culture with a textual culture,”33 how can we resocialize future public health endeavors? First, public health research requires a greater commitment to reflexivity (i.e., the systematic and self-critical practice of examining the fundamental value orientations encoded in one’s work).34 Second, as interpretivist-curators, epidemiologists should recognize that the truth value of the categories they employ is a contingent process based on negotiation.35 Third, by tracing human rights failings to the impoverished discursive infrastructure of objectivist epidemiology,36 we can transform global health by transforming its representations.
In short, we can redress symbolic violence through epistemic reconstitution and a commitment to decoloniality. Let us decenter social scientific discourse and forge more just vocabularies for representing the world.