Decolonizing the NTD Knowledge Ecosystems: Power, Knowledge, and Justice – A Freireian Analysis
Analyzing the movement to decolonize Neglected Tropical Disease knowledge ecosystems using Paulo Freire's concepts in "Pedagogy of the Oppressed"
After reading that using LLMs like ChatGPT to do your writing makes you “dumber” (Arxiv preprint here), I decided that I should be writing more, and writing more often. Even if it was with a little push from the LLMs! As part of that decision, I wanted to start with my thoughts on a piece written by Soumyadeep Bhaumik, a dear friend and colleague-in-arms. He published a thought-provoking essay in PLOS Neglected Tropical Diseases (NTDs). So, if you have a minute, head on over to PLOS NTDs, and check out his essay first.
In this intriguing essay, Bhaumik argues that epistemic injustice is deeply prevalent in NTD research, highlighting the historical context of tropical medicine as a tool to maintain colonial power structures. He emphasizes that despite the end of colonial rule, the NTD research ecosystem maintains a “feudal structure” that continues to marginalize experts from LMICs where these diseases are most prevalent. If you are inclined to learn more about his reasonings behind calling the current global health research ecosystem as a feudal one, please check out his essay in BMJ Global Health.
The PLOS NTD paper provides several examples of this feudal structure in action:
Funding bias: Unsurprisingly, a disproportionately large amount of NTD research funding goes to institutions in non-endemic countries, perpetuating a power imbalance.
Helicopter research: Researchers from high-income countries often conduct research in LMICs without meaningfully involving local experts. LMIC or local experts are often relegated to the roles of data collectors, without much intellectual or experiential involvement in the processes.
Devaluation of local knowledge: Knowledge generated in LMICs and published in local journals is often seen as less credible.
Limited leadership opportunities: The lack of opportunities for LMIC experts to lead NTD projects impacts their careers and reinforces their perceived lack of credibility in the global research space.
Narrow definition of NTDs: The current definition, which emphasizes neglect and the link between disease and poverty, may incentivize actors to maintain a certain level of neglect and prioritize diseases amenable to “magic bullet” solutions, potentially sidelining crucial areas of research. I loved this particular point, because this syncs well with my pet peeve that the discussion around AMR is too often around antimicrobial agents, and not often enough around human behavior.
As I was reading this piece, I realized that Paulo Freire’s “Pedagogy of the Oppressed” provides a valuable lens for analyzing Bhaumik’s arguments, exploring the interplay between power, knowledge, and liberation. Freire argues that true liberation requires a “problem-posing” approach to education that empowers the oppressed to become critical thinkers and agents of their own transformation. In my opinion, this perspective directly connects with Bhaumik’s call for decolonizing the NTD research ecosystem.
The Banking Model of Research
Bhaumik’s critique of the current NTD research ecosystem echoes Freire’s condemnation of the “banking” model of education, where knowledge is deposited into passive recipients (Ah! Medical School!). Just as Freire argues that students should be active participants in the learning process, Bhaumik advocates for researchers in endemic countries to be recognized as knowledge creators and leaders in NTD research. The current system, characterized by helicopter research and the devaluation of local knowledge, perpetuates the “culture of silence” Freire describes, where the voices of the oppressed are silenced.
Dialogue and Collaboration
Freire’s emphasis on dialogue as a tool for liberation resonates with Bhaumik’s call for co-design and co-production of research. Freire believes that genuine dialogue, marked by respect and mutual learning, is essential for transforming oppressive structures. Similarly, Bhaumik suggests that equitable collaboration, where researchers from both endemic and non-endemic countries work together as equals, is crucial for producing more relevant and impactful NTD research.
Conscientização and Action
Both Freire and Bhaumik emphasize the importance of critical consciousness (conscientização) in challenging oppressive systems. Freire argues that the oppressed must recognize the reality of their oppression and actively participate in their liberation. Bhaumik, through the lens of epistemic justice, highlights the need for researchers in endemic countries to be empowered to challenge the existing power structures within the NTD research ecosystem. The paper’s call for diversifying leadership, restructuring capital flows, and enhancing transparency in research processes aligns with Freire’s concept of praxis—the integration of reflection and action to transform the world.
Beyond Methodological Solutions
While Bhaumik offers suggestions for addressing epistemic injustice, like diversifying leadership and adopting deliberative epistemic repair, Freire’s work cautions against relying solely on methodological solutions. In a personal message to Bhaumik, I complained that his piece remains too theoretical, and I think Freire could have helped him overcome this! In “The Pedagogy of the Oppressed”, Freire argues that true transformation requires a fundamental shift in consciousness and a commitment to challenging the underlying power dynamics. Applying this perspective to Bhaumik’s paper, decolonizing the NTD research ecosystem necessitates not just changes in practices but a genuine commitment to recognizing and valuing the knowledge and expertise of those in endemic countries.
Epistemic Injustice as a Form of Oppression
Bhaumik’s central argument—that epistemic injustice is woven into the fabric of NTD research—can be seen as a specific manifestation of the broader concept of oppression that Freire dissects. Freire analyzes the various mechanisms through which the oppressor maintains control, including the suppression and distortion of the oppressed’s knowledge and experiences. Similarly, Bhaumik argues that the historical power imbalance between high-income countries and LMICs continues to shape the NTD research landscape, leading to the devaluation and silencing of knowledge and expertise from endemic regions. He brings up Miranda Fricker’s theory on epistemic injustice, and brings them to life with wonderfully visual examples, which helps the reader understand the overly verbose descriptions of Fricker.
Decolonization as a Liberatory Praxis
Freire’s call for a pedagogy of the oppressed that dismantles the banking model of education and empowers the oppressed to become agents of their own liberation directly parallels Bhaumik’s advocacy for decolonizing the NTD research ecosystem. Both authors emphasize the need to challenge and transform the existing structures that perpetuate inequality and injustice. Bhaumik’s recommendations for restructuring funding flows, promoting diverse leadership, and fostering genuine collaborations echo Freire’s notion of praxis—the cyclical process of reflection and action necessary for achieving liberation.
Bhaumik emphasizes that simply including researchers from LMICs is insufficient if the underlying power structures remain unchallenged; genuine change requires a fundamental shift in how knowledge is produced and valued. This aligns with Freire’s argument that true liberation necessitates a transformation of consciousness and cannot be achieved through superficial adjustments or handouts from the oppressor.
Both authors advocate for a move away from the “banking” model, where knowledge is seen as a commodity to be deposited by those in power, towards a dialogical approach that recognizes the oppressed as co-creators of knowledge. Bhaumik’s examples, such as helicopter research and the focus on diseases amenable to “magic bullet” solutions, exemplify how the current system prioritizes control and efficiency over genuine collaboration and understanding of local needs.
Freire argues that dialogue, characterized by humility, love, and mutual trust, is fundamental for the oppressed to critically examine their reality and develop a plan for transforming it. Bhaumik’s call for co-design and co-production of research, transparency in research processes, and genuine partnerships between researchers in endemic and non-endemic countries reflects this need for dialogue and co-creation.
Challenging the “Culture of Silence”
Freire’s concept of the “culture of silence,” where the voices of the oppressed are silenced and their knowledge and experiences are deemed irrelevant, provides a framework for understanding the epistemic injustice prevalent in NTD research. Bhaumik highlights how the existing research ecosystem marginalizes experts from endemic countries, devalues their perspectives, and limits their opportunities for leadership and recognition. This silencing not only perpetuates inequalities but also hinders the development of more effective and relevant solutions to NTDs, as it disregards the valuable insights of those most affected by these diseases.
Transformative Potential of Research
Both Freire and Bhaumik see knowledge production as a powerful tool for social transformation. Freire believes that a problem-posing approach to education can empower the oppressed to challenge and change their reality. Bhaumik, in advocating for a more just and equitable NTD research ecosystem, suggests that research can be a force for positive change, not only by generating effective solutions to diseases but also by fostering empowerment and agency among those in endemic regions.
Bringing in Miranda Fricker’s model of epistemic injustice Bhaumik further enriches this discussion. Fricker’s work, which focuses on the ethical and social dimensions of knowledge production, helps to unpack the specific ways in which individuals and groups are marginalized and silenced in their capacity as knowers. She distinguishes two primary forms of epistemic injustice:
Testimonial Injustice
This occurs when a speaker receives less credibility than they deserve due to prejudices held by the hearer. In the context of NTD research, this manifests in the devaluation of knowledge generated by researchers in endemic countries and published in local journals. The entrenched power imbalances lead to a systematic discounting of perspectives and expertise from the Global South, hindering both scientific progress and the development of effective solutions for the communities most affected by NTDs.
Hermeneutical Injustice
This arises when prejudices embedded in the shared interpretive resources of a community prevent individuals from making sense of their social experiences. Bhaumik’s paper illustrates this through the narrow definition of NTDs and the prioritization of diseases amenable to “magic bullet” solutions. This framing, often driven by funding priorities and the agendas of institutions in high-income countries, can obscure the complexities of NTDs and neglect crucial areas of research that may not fit neatly into existing paradigms.
Addressing Epistemic Injustice: A Call for Dialogical Transformation
Both Freire and Fricker, in their respective ways, point towards dialogue as a crucial element in dismantling oppressive structures and fostering epistemic justice. Freire emphasizes the transformative potential of genuine dialogue, marked by humility, love, and mutual trust, as a means for the oppressed to gain critical consciousness and challenge the dominant narratives. Fricker advocates for “deliberative epistemic repair,” which involves actively recognizing and countering the prejudices that lead to testimonial and hermeneutical injustice. This includes giving greater weight to the testimonies of marginalized knowers and challenging the dominant interpretive frameworks that obscure their experiences.
Bhaumik’s recommendations for decolonizing the NTD research ecosystem resonate with these ideas. Diversifying leadership, restructuring capital flows, and enhancing transparency in research processes create the structural conditions necessary for more equitable participation. Co-design and co-production of research, along with the adoption of anti-oppressive teaching practices, cultivate the dialogical space for genuine collaboration and mutual learning.
The insights from Freire, Fricker, and Bhaumik converge on a powerful message: decolonizing the NTD research ecosystem is an ethical imperative, a scientific necessity, and a critical step towards achieving health equity and global justice. We can see how decolonizing the NTD research ecosystem is not merely about adopting new methods or including more researchers from LMICs. It requires a deeper commitment to dismantling the power structures that perpetuate inequality and to creating a research environment where the knowledge and expertise of all participants are valued and respected. True decolonization, like true liberation, necessitates a fundamental shift in consciousness and a commitment to genuine collaboration and co-creation of knowledge.