Although one might believe that the effects of Western colonization still linger in cultural and social spaces, its most invisible impact can be found in science and healthcare. The current model of healthcare delivery is centered around evidence-based medicine (EBM), with some expanding it to evidence-based public health (EBPH). Evidence-based medicine is an implementation of clinical experience and patient values on the basis of the best available research evidence (Strong Medicine, 2016). However, one can see how the Western colonial knowledge system assumptions skew healthcare towards white hegemony over the field.
The given colonial rhetoric can be observed in literature pieces written by EBM advocates. The first example of hegemonic white system assumptions is universality. Brownson et al. (2009) call for “wide-scale dissemination of interventions of proven effectiveness to … assure that programs and policies are effectively implemented in states and local communities” (p. 176). The second example describes resistance as ignorance since Brownson et al. (2009) claim that participatory approaches present an obstacle for EBPH. Thus, the authors should stop describing non-white practices as ‘challenges,’ and they should revise the work by accounting for non-white knowledge system assumptions of approaches they critique.
The third example is that EBM is put on a pedestal as the only applicable and correct approach. Brownson et al. (2009) ignore measures used by non-Western cultures, traditions, and practices, such as community-based methods. It is stated that “higher education institutions today exclude many of the diverse knowledge systems in the world,” which is why community-based participatory research is critical to decolonizing knowledge systems (Hall et al., 2017). One should be aware that colonialism not only affected the economy, authority, and social elements but imposed control of subjectivity and knowledge as well (UW-SPHSC, 2020). A revision should be made to reverse white system assumptions, and it is imperative to infuse science implementation with the equity approach (Jorge Alarcon, 2023). In other words, the latter will address the systemic inequities in the healthcare system as a major part of the knowledge system.
References
Brownson, R. C., Fielding, J. E., & Maylahn, C. M. (2009). Evidence-Based Public Health: A Fundamental Concept for Public Health Practice. Annual Review of Public Health, 30, 175-201. Web.
Hall, B. L., & Tandon, R. (2017). Decolonization of knowledge, epistemicide, participatory research and higher education. Research for All, 1(1), 6-19. Web.
Jorge Alarcon. (2023). Leo Cabassa talk 1 [Video]. YouTube. Web.
Strong Medicine. (2016). An introduction to evidence based medicine [Video]. YouTube. Web.
UW-SPHSC. (2020). Minifie lecture 2020 panelist: Dr. Bonnie Duran, University of Washington [Video]. YouTube. Web.