There was an interesting talk last Thursday at ITM about the institutional decolonization of global health, knowledge and practices. We heard from Dr. Seye Abimbola, Dr. Özge Tunçalp, Yvon Englert, Adriana Moreno Cely and Prashanth Srinivas. The session made me think of two points – as always closely connected.
My first point is on the eternal question of who should decolonize whom. My idea is that scientists in public health should focus on epistemic transformation. For as Prasanth rightly pointed out, decolonisation is “in the mind”. It requires dismantling the many hierarchies that privilege certain forms of knowledge, certain institutions, and certain actors, who are not confined to one group or another. We need to transcend boundaries such as geography, class, gender, coloniality, privilege and socioeconomic factors to address inequalities.
How colonial rule operated through control of knowledge was already noted by people like Edward Blyden in 1887 and José Martí in 1891. The notion that decolonising global health requires redistributing epistemic power has been explained by Seye Abimbola and others.
Decolonizing epistemic power means recognising diverse knowledge systems, valuing lived experience, and refusing to treat dominant knowledge systems as the only legitimate ones, without losing their value. As Abimbola and Adriana Moreno Cely emphasised, decolonisation is not about replacing one centre with another, but about pluralising knowledge, creating equitable partnerships, and transforming the structures through which global health knowledge is produced and validated.
But to do that, I think the urgent first step is to overcome the weird hierarchy between quantitative and qualitative research that is persistent within public and global health. Quantitative research is usually considered scientific and policy-relevant, while qualitative research is often reduced to a nice ‘extra’ in terms of context, politics, or illustration. This dichotomy is epistemologically untenable, because all decent research necessarily has both a quantitative and a qualitative dimension. The fact that public health schools continue to reproduce this distinction – even if perhaps not as blatantly as a few decades ago – is a direct result of colonization: and that is my second point.
Public health schools emerged in the late 19th and early 20th centuries as instruments of colonial power where physicians and administrators where trained to protect European elites, troops, and trade routes. Tropical medicine produced Eurocentric, utilitarian knowledge, focused on vector control, quarantine, and environmental management, to control disease and safeguard economic and military interests. Results in e.g. disease control legitimized colonial dominance – but these results were not aimed primarily to improve health of local populations.
This methodological approach developed in close conjunction with the rise of epidemiology, statistics, and government in the late 19th and early 20th centuries. Knowledge at that time was strongly influenced by positivist ideals and primarily consisted of identifying measurable, generalizable laws. Health was conceptualized as an objectively measurable state, assessed through standardized epidemiological indicators such as incidence, prevalence, and mortality.
This epistemological legacy continues to influence public health school curricula till today. Epidemiology, biostatistics, and causal inference remain central in most public health schools, whereas the opposite is true for philosophy of science, interpretive methods, and meaning-making theory. The real difference is not so much methodological but epistemological: the quantitative approach seeks to measure and control reality, while the qualitative tradition seeks to understand (verstehen) how reality is experienced. Within such a framework, qualitative research quickly appears less robust: it produces no data, is difficult to scale, and appears less suitable for quick policy decisions. This also explains why so-called mixed methods studies are often only superficially mixed: qualitative research is used to “contextualize” quantitative findings, not to challenge fundamental assumptions. The qualitative functions as an appendix, not as an equivalent form of knowledge.
However, the assumption that quantitative research would be objective and value-free has been refuted for decades. Normativity lies not only in interpretation, but already in problem selection: in the choice of what to measure, how to measure and who becomes visible in data. Variables, categories and outcome measures are not natural givens, but the result of previous, qualitative decisions about what is relevant, desirable or problematic. In other words, quantitative research is always qualitative before it becomes numerical. The operationalization of “health,” “risk,” or “compliance” implies normative assumptions about human behaviour, social order, and desired life. The fact that these assumptions are rarely made explicit does not mean that they are absent — on the contrary, they are all the more powerful because they are taken for granted.
Put differently, qualitative research can be considered political because it reveals what quantitative methods systematically conceal: meaning, power, and normativity. The difference between quantitative and qualitative research is between explicit and veiled normativity. Qualitative research makes visible what quantitative methods implicitly assume.
The future of public health does not call for fewer numbers, but for more epistemological reflexivity: a recognition that numbers always speak within worlds of meaning, and that science cannot ignore those worlds without undermining itself. And that includes 21st century public health schools and “tropical institutes”. Which brings me back to the topic of the seminar last Thursday!