During the COVID-19 pandemic, we observed the international flow of guidelines, recommendations, regulations and health monitoring under the concept of global health security. According to the US CDC, health security means “the existence of strong and resilient public health systems that can prevent, detect and respond to infectious disease threats, wherever they occur in the world”. This definition opens up questions such as; what does strong and resilient health systems mean? What are world threats? How to react to such threats? I add one more question; how have authorization and legitimacy been constituted – in this example, by the US CDC – to formulate global responses in the health field?
Another example that evokes these questions is the Global Fund’s definition of resilient and sustainable systems for health as a system that “relies on data”. But who is actually able to define the parameters that count to gather ‘quality health data’, and what would be considered ‘efficient and effective’ in terms of resource allocation? What are the limits and problems raised by the techno-politics of health – in this example, promoted by the Global Fund – through the use of apps, algorithms, and metrics of systems for data collecting, surveillance and report?
I invite you to reflect on the geopolitics of knowledge in global health. That is to reflect on questions such as what are the power hierarchies that historically operate in health. How do the encounters that contest the validation of knowledge, the stratification of science and the coloniality of practices take place? I draw on Latin American social scientists from many areas like the Argentinian semiotic researcher Walter Mignolo, the Peruvian sociologist Aníbal Quijano, the Colombian philosopher Santiago Castro-Gómez, and the anthropologist Arturo Escobar. They practice ‘epistemic disobedience’ to Eurocentrism and ethnocentrism through a decolonial grammar deeply engaged with local history and reality.
Geopolitics of knowledge – what is that?
Walter Mignolo defines the geopolitics of knowledge in his 2002 article The geopolitics of knowledge and the colonial difference:
There can be no others’ inscribed a conceptualization of knowledge to a geopolitical space (Western Europe) and erased the possibility of even thinking about a conceptualization and distribution of knowledge ‘‘emanating’’ from other local histories (China, India, Islam, etc.). (...) Another logic (or border thinking from the perspective of subalternity) goes with geopolitics of knowledge that regionalizes the fundamental European legacy, locating thinking in the colonial difference and creating the conditions for diversity as a universal project (Mignolo 2002: 59/91).
Aníbal Quijano elaborates on the concept of coloniality of power and provides a historical explanation about how race has been at the epicenter of the coloniality of world capitalist power:
The racial classification of the population and the old association of the new racial identities of the colonized with forms of unpaid control of work, developed among Europeans or whites the specific perception that paid work was a privilege of whites. (…) This coloniality of labor control determined the geographical distribution of each of the forms integrated into world capitalism (Quijano 2000: 539).
What we see in global health today is precisely a persistent top-down imposition – from the North International to the South Local – of the colonial reason as a universal metrics of knowledge and power. When legitimized in decision-making spaces, coloniality causes the epistemicide of traditional knowledge and local forms of problem-solving. Turning to the implementation processes, it often triggers geo-cultural clashes, contestation and resistance to capitalist medicine´s measures, as well as the escalation of pandemic outbreaks.
Epistemologically speaking, health is a site of contestation. The Local is the geo-cultural space where the regime of authorization and legitimation of knowledge in health is constructed in everyday redefinition of healing and care tactics. It is also where counter-hegemonic resistance takes place. It is only by looking at how such processes develop – considering territorial and temporal dimensions of different Locals – that we are able to resize global health in our own terms, overcoming exclusions and subverting pure neo-colonial, neo-liberal and necro-capitalist goals on behalf of survival. This is a decolonizing act, which also generates a self-decolonization of mentalities, in a co-constitution of identities and the field through health.
Marcos Cueto, a notable Peruvian historian at Fiocruz in Brazil argues that local doctors and scientists were not developing a peripheral science, relegated to the margins of the global production of knowledge but, on the contrary, were establishing a “scientific excellence in the periphery”.
Social Determinants of Health as a starting point
So, how to decolonize power and knowledge hierarchies in global health to achieve health equity? I propose to take the Social Determinants of Health (SHD) as the starting point to think backwards: how to implement the SDH without decolonizing global health? How else can global health governance and institutions achieve a comprehensive political design to ensure prevention of pandemics and zoonosis out of the SDH?
SDH configures the sum of local knowledge, individual self-determination, and human rights: it is not a consequence of medical intervention. People are agents not objects of global health equity which, in turn, is not an abstract phenomenon but a collective social construction that demands ownership. A first concrete move is to think about medical cultures instead of medical systems, so we can provincialize biomedicine as one act towards decolonizing global health. By placing more attention to SDH, we have a powerful lens through which more equitable public and foreign policy goals can be pursued.
Join me and other Latin American social scientists in practicing ‘epistemic disobedience’ to Eurocentrism and ethnocentrism through a decolonial grammar deeply engaged with local history and reality. Let's talk about the geopolitics of knowledge in global health: the power hierarchies that historically operate in health. How do the encounters that contest the validation of knowledge, the stratification of science and the coloniality of practices take place?
