Critical epidemiology in action: Research for and by indigenous peoples

Abstract

Global social justice movements, including transnational activism for indigenous rights, are working to promote health equity by transforming public health research and policy. Yet little social scientific research has examined how professional epidemiologists are figuring within such efforts. Discussions are unfolding, however, in critical sectors of epidemiology about how to improve the profession’s input into advocacy. Findings from a multi-sited ethnographic study of epidemiological research for and by indigenous peoples in three settings (Aotearoa/New Zealand, the continental U.S., and Hawai’i) demonstrate how researchers/practitioners connect epidemiology and advocacy by: (1) linking the better-known legitimacy of quantitative methods to a lesser-known causal framework that positions colonialism as a sociopolitical determinant of health, (2) producing technical critiques that aim to improve the accuracy and accessibility of indigenous population health statistics, and (3) adopting a pragmatic flexibility in response to the shifting political conditions that shape when, whether and how epidemiological findings support advocacy for indigenous health equity. Attending closely to the credibility tactics at hand in this work, and to the skills and sensibilities of its practitioners, charts new directions for future research about epidemiology’s contributions to advocacy for health equity.

Consolidated criteria for strengthening reporting of health research involving indigenous peoples: the CONSIDER statement

“…There is minimal evidence that these criteria are being widely implemented in research praxis. The criteria provide the opportunity for researchers, research governing institutions and research funders to ensure an accountable ‘closing of the research loop,’ to increase research accountability [5, 43]. Greater adherence to the criteria will strengthen the research process and have a positive impact on research relationships with Indigenous Peoples.…”

Integrating climate in Ugandan health and subsistence food systems: where diverse knowledges meet

“…In this way, we allow for extractive approaches in practice that disregard alternative, and sometimes divergent, ways of knowing embedded in diverse (non-western scientific) knowledge systems [33,40]. Applying conventional approaches to surveillance in this way, without deliberate consideration of the broader contextual, cultural, historical, social and political processes, can lead to the remarginalization of peoples and the reproduction of inequalities in power between groups of people [22][23][24]. We present some of the core insights that have emerged from this case study and how this work moves to fill the practice gap of meaningfully engaging local communities, Indigenous peoples, and diverse knowledge holders to drive equitable and integrated surveillance initiation.…”

“…Social network analysis was used as a methodological approach to explore how information flows between knowledge holders as well as the power and agency that is involved in knowledge production and exchange processes. We considered the intended nature of participatory processes in research more broadly, which attempt to offer ethical, adaptive, inclusive, and reflexive methodologies for empowering the holders of multiple and diverse knowledges [22,23,[72][73][74][75][76]. Throughout the entire research processes, a reflexive research journal was kept by the lead investigator to reflect on positionality-as non-Indigenous, mostly non-local, researchers-and how this may have influenced the process and these findings.…”

“…Existing surveillance systems and conventional epidemiological approaches, however, do not always consider broader contextual, cultural, historical, social and political processes of health inequities, and thus have the tendency to further discriminate against and omit marginalized groups of people [22][23][24][25][26]. Place-and community-based forms of monitoring and response are important in underpinning the development of both an integrated as well as equitable evidence base that will inform our understanding of climate-health impacts [27][28][29][30][31][32].…”

An allied research paradigm for epidemiology research with Indigenous peoples

“…In doing so, I present an outline for an allied research paradigm and six key principles for consideration based on my own experiences. My hope is that I can contribute to epidemiology work that promotes health equity and use what has been described as “credibility tactics” to leverage well-accepted epidemiology methods to address social, political and colonial determinants of health [12].…”