An 18-authored paper funded by the WHO was recently published; a Cochrane review concluded that undernutrition is a risk factor for Tuberculosis (TB). Excluding the fourth author, an Argentinian, the rest were Europe-based, including WHO staff.
India and China have the largest burdens of TB. There is a wealth of evidence explicating the links between TB and food insecurity, including the recently concluded Rations Study by Indian researchers, funded by the Indian government that unequivocally showed that access to nourishing food reduced the incidence of TB. For those of us who live in countries where poverty is endemic, it is common knowledge that the poor are often malnourished which makes them highly susceptible to many illnesses including TB and other opportunistic infections. The late anthropologist and physician Paul Farmer described these as the “…biological reflections of social fault lines” (p 5 Infections and Inequalities). While Cochrane reviews can be valuable for setting programmatic guidelines, researchers like me who work and live in an LMIC like India might be forgiven for asking in the context of this review: did we need such an expensive study to tell us the obvious?
Gender-based violence, including intimate partner violence (IPV), an area that I have researched and advocated for over two decades also faces similar problems. One study demonstrated that domestic violence reduces marital quality in the long run; a GoogleScholar search of the phrase ‘links between domestic violence and reproductive health’ churns out 406,000 hits, the earliest dating back to the late 1990s, all of which are depressingly familiar in their findings: adverse impacts on women, babies and children, and families. For a long time, we have identified factors that increase women’s risks for domestic violence and they are remarkably similar across countries. Studies have also identified interventions that mitigate such violence if not prevent it altogether.
Despite this mountain of evidence, we observe a trend of studies whose aim appears to demonstrate methodological sophistication and not prevention or mitigation of IPV and are tiresomely repetitive in their findings. For instance, a PLOS study using machine learning inferred “…a need for community programs to reach out to women trapped in abusive relationships, as well as the importance of women’s social and economic connectedness”. Decades (1, 2, 3, 4) of work by an Indian organisation whose programs have been scaled up as the Dilaasa model and other earlier research have argued the same; however the PLOS study did not cite these papers despite these predating its publication. Citational injustice plagues academic research and may also partly explain why we see an abundance of research spitting out identical information, especially from authors based in HICs with study populations located in LMICs.
Further, it is baffling that the centre that sponsored the PLOS study and received a chunk of its funding from the BMGF thought that this was a wise use of its resources. The indigenous researcher Linda Tuhiwai-Smith put it quite bluntly in the context of such research by outsiders or settlers “It told us things already known, suggested things that would not work, and made careers for people who already had jobs (2012:3).”
Of course, global health is not alone in producing such inane information that is at best a misdemeanour, and at worst, a criminal waste of resources. Economics arguably has a heavier cross to bear with ethically dubious research that originates in HICs. Note two examples: 1) a sophisticated study conducted by UK-based researchers that used RCT and game theory concluded that female Filipino migrant workers experienced lower risks of sexual abuse and wage theft if they gave a gift to their employers (in the Middle East and Hong Kong) as a token and a conversation starter along with a picture of their families. This was supposed to have humanised them by reducing the social distance between them and their employers. 2) a 2020 study by US-based researchers with the National Bureau of Economic Research, a nonprofit think tank conducted an RCT along with Nairobi Water to assess the political consequences and financial impacts of cutting off water services to non-paying tenants in 97 of 327 informal settlements in Nairobi with high mortality rates from poor sanitation and water shortages. Such studies have led to ethical debates surrounding RCTs in development economics, regarding informed consent and the balance of potential benefits and harms to participants suggesting that its genesis lies in the coloniality of knowledge.
Who is producing knowledge, who is consuming it, and who is ultimately benefitting are questions that lie at the heart of debates surrounding decoloniality within academic knowledge production. Echoes of this can also be found in Aristotlean perspectives on wisdom which he explains is “…concerned with things just and fine and good for a human being” and embeds good judgment (gnome), comprehension (sunesis)) and practical intelligence (nous) under its ambit. Aristotle contends that praxis (using knowledge for action ethically) is a higher form of knowledge than techne (craft, technical know-how).
Knowledge production in global health cannot be about techne (craft) alone but must include praxis and phronesis (the ability to further good ends in the most appropriate ways). What is worse is that some of the examples included in this commentary do not further either. At the minimum not stating the obvious is the least we owe to the communities and the people we work with/for, even if wisdom might be some distance away.
About the author: Sreeparna Chattopadhyay is a medical anthropologist and a Professor of Practice at TAPMI, Manipal Academy of Higher Education, Bangalore, and is a Visiting Faculty member at FLAME University, Pune.
Competing interest: None
Handling Editor: Neha Faruqui