Neocolonial epidemiology

Abstract

The relationship between public health practice and the fulfilment of the right to health is often assumed to be synergistic. With the goal of understanding how exactly this relationship happens, I studied the everyday practice of epidemiology in Guatemala, seeking to understand how it shapes and is shaped by the notion of health as a human right. Here I present findings from my ethnographic investigation of the Guatemalan Centro Nacional de Epidemiología (National Epidemiology Center), created in 2004 with the explicit mission of contributing to fulfilling the right to health for the inhabitants of Guatemala. While the relationship between epidemiological practice and the right to health is influenced by the specific configuration of local and transnational flows (bureaucratic, economic, ideological, political, scientific, social, and symbolic), epidemiologists also play an important mediating role. There are four intermediate social mechanisms that shape the relevance of epidemiological practice to fulfilling the right to health in Guatemala. Given how the country's economic and social inequalities translate into enormous health inequities, an epidemiological practice committed to the right to health should aspire to transform, rather than reproduce, the social hierarchies underlying such inequalities. The mechanisms I identified shape how epidemiological practice contributes to the reproduction or transformation of such hierarchies. These mechanisms shape what I call 'neocolonial epidemiology', and include: institutional chaos, disciplinary conformism, global health international relations, and social relations at the national level.

Ethnography and quantification: Insights from epidemiology for Indigenous health equity

“…While challenging such positivist illusions is clearly needed, centering ethnographic questions on how quantitative research reproduces quantitative privilege can also draw attention away from complexities in the experiences and perspectives of quantitative professionals in the evidence‐based era. Ethnographic studies of epidemiology, for example, frequently document how positivism and reductionism shape the production of knowledge in the profession (e.g., DiGiacomo 1999; Shim 2014)—often in order to highlight how racialized and other deeply troubling forms of injustice can result (e.g., Briggs and Mantini‐Briggs 2016; Cerón 2019; Davis 2017; Smith‐Morris 2017; Richardson 2019). Through this lens, epidemiologists often figure as subscribing to, fueling, and/or benefiting from narrowly positivist illusions about numerical data (e.g., Mason 2020).…”

Reworking the Social Determinants of Health: Responding to Material‐Semiotic Indeterminacy in Public Health Interventions

“…The brutal U.S.‐aided military general Efraín Ríos Montt, was born and raised here, and the techniques of physical and psychological abuse that he honed during his scorched earth campaign at the height of Guatemala's violence in the 1980s continue to be pervasive. That the established political parties do not value Indigenous life and frequently sanction health projects that have no beneficial health impact is widely recognized, by both academics (Cerón 2019; Velásquez Nimatuj 2019) and highlanders alike. The sociality here at stake is that the very fact of working for better health poses a challenge to powerful economic and state interests who will, in turn, work to make health projects ineffective or to shut these efforts down.…”

On the coloniality of global public health

“…The distinctions between epidemiology as an unbiased scholarly endeavor and epidemiology as an accomplice to contemporary imperialism are a matter of how one gathers facts ( Ake 1982 ; Cerón 2019 ). This quintessential discipline of public health is involved in worldly, historical circumstances that it has tried to conceal behind a speciously rigorous scientism ( Said 1979 ; Adams 2016 ).…”