This op-ed piece is part of a series written by Fellows of the Salzburg Global Seminar program “Public Policy New Voices Europe”
This op-ed was written by Edwin Kwong, Cherukéi Wobo, Sophia Tawonga Longwe, Manuela Engelbert, and Emmanuel Baba Aduku
“Neutral knowledge does not exist. Knowledge production or what and how we understand ‘reality’ or ‘truth’ is an extremely political process. What is ‘reality’ or ‘truth’? How do we know this ‘reality’? Is there only one reality or many of them?” -Sylvia Tamale
In this article, we explore the concepts of coloniality and epistemic justice to understand the historical and future contexts in which we think about public policy. It, of course, does not happen in a depoliticized vacuum, but is shaped by what we consider knowledge, data, and information. When creating policies that are intended to be evidence- and science-informed, it is essential to consider what we regard as legitimate knowledge, reality, or truth. To make these socio-political constructs that inform public policies more tangible, we will illustrate our case with two examples from the domain of health policy.
But before we dive in, what exactly do we mean by coloniality and epistemic (in-)justice?
Coloniality refers to the control and management of knowledge by “universal” viewpoints of Eurocentrism and whiteness. It is a highly salient concept here, relating to the subjectivity of knowledge generation. Sylvia Tamale writes that the impact of coloniality on constructing identity categories is essential to scrutinize in this process. We suggest that it is appropriate to adopt a pluriversal approach, which highlights the existence of multiple realities and epistemologies.
When discussing the matter of justice in public policy making, we then asked ourselves the following questions: Whose knowledge counts? And whose voices matter?
We believe that it is necessary to re-center knowledge systems from the Majority World historically considered inferior to Eurocentric epistemologies. There is a prevailing assumption that Eurocentric knowledge systems are of higher quality and that the knowledge generated by the rest of the world is inferior. In the case of health, knowledge systems are dominated by Western biomedicine, and basing medical practices purely on one set of knowledge has life-and-death repercussions for racialized and marginalized patients. This of course also has global and systemic impacts.
Case Studies
The United Kingdom
The Marmot Review in England highlighted the social and economic health inequalities present within the country and included robust evidence-based recommendations for action. The follow-up report published 10 years later revealed that these health inequalities had worsened, and stronger initiative was still needed to tackle these inequalities. Despite this knowledge, ethnic minority groups continue to be disproportionately affected by socio-economic deprivation and other systemic and structural factors, such as racism. Historically, minority groups in the UK have been failed by the medical system due to colonial attitudes and power dynamics within the patient-doctor relationship.
In the case of sickle cell disease, a widespread genetic condition affecting more than 15,000 people in England, and especially common in people of African, Middle Eastern, and Asian descent, there have been various injustices leading to poorer health outcomes and preventable deaths. The ‘No One's Listening’ report, an All-Party Parliamentary Group on Sickle Cell and Thalassaemia (SCTAPPG) inquiry, was triggered by a coroner’s note on the preventable death of 21-year-old Evan Smith in a North London hospital. This incident highlighted the lack of understanding by healthcare staff of sickle cell disease, the battles that patients must go through to obtain proper treatment, and the deadly consequences of such institutional failures. Key findings of the inquiry also pointed out that there were “frequent reports of negative attitudes towards sickle cell patients and…that such attitudes were often underpinned by racism”. This is a clear example of racism and epistemic injustice that are present in the UK health system, and the systemic issues surrounding the treatment of sickle cell disease.
Australia
Looking beyond the boundaries of Europe, we can witness the harmful consequences of epistemic injustice in many Indigenous communities globally. The myriad impacts of colonization linger long after the departure of the original colonizers. In Australia, for example, Indigenous scientific knowledge has long been disregarded and dismissed as inferior, which is also seen in the devaluing of traditional Indigenous health practices. For Indigenous Australians, good health is a holistic concept, going beyond the purely physical health of an individual, and considering also the social, emotional, spiritual, and cultural wellbeing of the entire community. Importantly, the connection to Country (a term Indigenous Australians use to describe a complex set of ideas relating to not only the land, waters, and seas they are connected to but also “complex ideas about law, place, custom, language, spiritual belief, cultural practice, material sustenance, family and identity”) is highly significant for one’s health.
The practices of British colonists, and then subsequently the Australian government, in removing Indigenous peoples from Country, brutally separating children from their families during the “Stolen Generations”, in addition to the aforementioned devaluing and dismissal of Indigenous knowledge and practices, have caused incredible generational trauma for Indigenous people across the continent. On the matter of health specifically, due to the lacking infrastructure in some remote Indigenous communities, people who need secondary or tertiary healthcare are still routinely brought from Country into urban centers in order to receive the necessary treatment. This ignores the importance of the connection to land and Country for many Indigenous people and is but one example of the way the predominant biomedical and positivist approach to healthcare in Australian health institutions continue to marginalize Indigenous patients and dismiss their needs and experiences.
There have been some efforts at addressing past wrongs from the federal and state governments in Australia, and universities across the country have begun to incorporate more material on Indigenous health and traditional knowledge into their health curricula. Yet, much remains to be done if true (epistemic) justice is to be achieved, from Indigenous health practices and knowledge being recognized and respected as legitimate, to ultimately reparations and the return of land.
Recommendations
The two examples presented demonstrate the significant and real impacts of epistemic injustice. The UK case highlighted how ethnic minority groups continue to be treated differently and wrongly, due to Eurocentric and racist beliefs within healthcare staff. Similarly, the Australian example revealed how Indigenous Australian health knowledge and practices are routinely and continuously dismissed and devalued, leading to ongoing negative health impacts for both the individual and the community at large. To achieve true equity and epistemic justice for marginalized peoples, we must ensure that their knowledge and lived experiences are valued as equally as the dominant Western narrative so that future policies can be just and even emancipatory.
It goes without saying that enshrining epistemic justice into our health systems and policy environments would require a great deal of work, and far beyond the scope of what a single article can offer, but nevertheless, below are some practical proposals for policymakers to consider:
- Establish genuine, inclusive, and open consultation processes for policies.
- Revise (medical) schools’ curricula to expand beyond a Eurocentric knowledge base.
- Reconsider how medical professionals are trained and what skills and competences are considered necessary.
- Ensure equity in the allocation of resources for medical research and development.
- Set baseline requirements for academic and medical research (e.g. ensuring race and sex-disaggregated data, or research teams with diverse backgrounds and experiences).
Epistemic justice is not simply a catchphrase but involves real, practical, and attainable changes to how we live our lives and how public policies are created. At its core, epistemically just policymaking recognizes historical wrongs, addresses them truthfully in the here and now, and walks with optimism towards pluriversal futures.
