[The colonization of epidemiological knowledge: a decolonial reading of the contemporaneity of the COVID-19 pandemic]. / A colonização do saber epidemiológico: uma leitura decolonial da contemporaneidade da pandemia de COVID-19.

This paper makes a critical assessment of epidemiology with the COVID-19 pandemic as a social event. It examines the philosophical reflection in which Agamben defines as contemporary those able to stand back to see the dark side of their own era. In the light of decolonial criticism, the concept of "epidemiological transition," with its theory of transcendence of "social determinants of health" and binarism of epidemiological variables as supports of the biomedical and quantitative structuring of the epidemiology of risk factors is queried. The scientific ambition to dominate nature and the engendering of a linear and evolutionary historical time, beginning in western modernity, contextualizes the epistemicides of popular wisdom and the coloniality of epidemiological knowledge. The theoretical constitution of decolonial thought is historically analyzed, highlighting its greater critical potential to reveal the structural colonization of epidemiological knowledge. The post-pandemic future is considered and Prigogine's idea of bifurcation - as elaborated by Sousa Santos - and Paulo Freire's untested feasibility are related with the concept of time as the creation and expectation of social transformation.

O ensaio epistemológico relaciona criticamente a epidemiologia com a pandemia de COVID-19 enquanto evento social. Explora-se a reflexão filosófica em que Agamben define contemporâneo como quem é capaz de se afastar e enxergar o lado escuro do seu tempo. À luz da crítica decolonial, questionam-se a ideia de "transição epidemiológica", com sua transcendência na teoria dos "determinantes sociais de saúde", e a disposição binarista das varáveis epidemiológicas, como suportes da estruturação quantitativa e biomédica da epidemiologia dos fatores de risco. A pretensão científica de domínio da natureza e o engendramento de um tempo histórico linear e evolutivo, que inicia com a modernidade ocidental, contextualizam os epistemicídios dos saberes populares e a colonização do saber epidemiológico. Historiciza-se a constituição do pensamento crítico decolonial e pontua-se seu potencial para a revelação do caráter estrutural da colonização do saber epidemiológico. Considera-se o futuro pós-pandemia e relacionam-se as ideias de bifurcação, originada de Ilya Prigogine e elaborada por Boaventura de Sousa Santos, e inédito viável, de Paulo Freire com a concepção do tempo como criação e a expectativa de transformação social.

Colonization and decolonization of global health: which way forward?

Despite taking on several forms throughout history such as colonial medicine, tropical medicine, and international health, the field of global health continues to uphold colonialist structures. History demonstrates that acts of colonialism inevitably lead to negative health outcomes. Colonial powers promoted medical advancements when diseases affected their own people, and only did so for locals when in the colonies' best interests. Numerous medical advancements in the United States also relied on the exploitation of vulnerable populations. This history is critical in evaluating the actions of the United States as a proclaimed leader in global health. A significant barrier to progress in the field of global health is that most leaders and leading institutions are located in high-income countries, thereby defining the global standard. This standard fails to meet the needs of most of the world. In times of crisis, such as the COVID-19 pandemic, colonial mentalities may be more evident. In fact, global health partnerships themselves are often ingrained in colonialism and may be counterproductive. Strategies for change have been called into question by the recent Black Lives Matter movement, particularly in evaluating the role that less privileged communities should have in their own fate. Globally, we can commit to evaluating our own biases and learning from one another.

Racism, colonialism and the implications for nursing scholarship: A discussion paper.

AIM: A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry. DESIGN: Discussion paper. DATA SOURCES: A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022. IMPLICATIONS FOR NURSING: The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing. CONCLUSION: Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship. NO PATIENT OR PUBLIC CONTRIBUTION: The paper is a discursive paper using pertinent nursing literature. IMPACT: For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.

From 'making up' professionals to epistemic colonialism: Digital health platforms in the Global South.

Platforms have been studied in terms of their impact on knowledge production and generation of social value. Little however is known about the significance of the knowledge they transfer to the recipient communities-often in faraway countries of the Global South-or its potential perceived colonizing effects. Our study explores the question around digital epistemic colonialism in the context of health platforms involved in knowledge transfer. Using a Foucauldian lens, we study digital colonialism as a phenomenon that emerges from platforms' underpinning power/knowledge relations. Drawing upon a longitudinal study of MedicineAfrica-a nonprofit platform intended to offer clinical education to healthcare workers and medical students in Somaliland-we discuss interview findings from two phases: (a) with Somaliland-based medical students who studied MedicineAfrica as part of their medical studies, and (b) with medical professionals who attended a MedicineAfrica Continuing Professional Development (CPD) course on Covid-19 treatment/prevention. Our study shows how the platform 'makes up' healthcare professionals by offering opportunities for learning and skill development whilst instilling work values and ethos resembling Western medical identities. The platform was also perceived to produce subtle colonizing effects as its content embodies knowledge that (a) presupposes medical infrastructures that are absent in the recipient country; (b) is presented in English instead of participants' mother tongue; and (c) neglects the idiosyncrasies of the local context. The platform sets its tutees in a colonial condition in which they cannot fully practice what they learn; they cannot entirely engage with the subject they learn, taught as it is in a different language, and they do not necessarily learn about the medical conditions and the patients they encounter. This alienation from their local context, embraced by the platform's underpinning power/knowledge relations, is at the heart of digital epistemic colonialism and comes together with the social value the platform generates.

How Is Colonialism a Sociostructural Determinant of Health in Puerto Rico?

Puerto Rico is experiencing a public health crisis driven by effects and processes of US colonialism in the archipelago, such as the exclusionary application of federal health policy, an exodus of health care professionals, and the long-term effects of unequal distribution of health care funding in the unincorporated territories. Compound effects of multiple disasters, including Hurricane María, repeated earthquakes, and the COVID-19 pandemic, as well as relentless privatization and fragmentation of the health care system, have led to very poor health outcomes. Puerto Rico's case clearly shows the negative effects of colonialism on public health. This article specifies what decolonization requires from a public health standpoint to promote health equity.

Puerto Rico atraviesa una crisis de salud pública debido a los efectos y procesos del colonialismo estadounidense en el archipiélago, como la aplicación excluyente de la política sanitaria federal, el éxodo de los profesionales de la salud y los efectos a largo plazo de la distribución desigual de la financiación sanitaria en los territorios no incorporados. Los efectos combinados de múltiples catástrofes, como el huracán María, los repetidos terremotos y la pandemia del COVID-19, así como la constante privatización y fragmentación del sistema de atención médica, han propiciado resultados de salud muy deficientes. El caso de Puerto Rico muestra claramente los efectos negativos del colonialismo en la salud pública. Este artículo especifica lo que requiere la descolonización desde el punto de vista de la salud pública para promover la equidad sanitaria.

Endemic fatalism and why it will not resolve COVID-19.

OBJECTIVE: The main objective of this commentary is to provide historical insight into the term endemicity and to demonstrate why framing COVID-19 as endemic in early 2022 is a misguided approach. STUDY DESIGN: The history of epidemiology as well as current data on COVID-19 as provided by the United States Centers for Disease Control, the World Health Organization, and the Johns Hopkins COVID-19 Resource Center was surveyed. METHODS: Records of the Epidemiological Society of London for the period 1850-1900 were analyzed, and several key publications on how infectious diseases were considered endemic were identified. RESULTS: The term endemicity has a long and twisting history, changing from its meaning in the mid-nineteenth century until our use of it today. The concept has long been tied to historical patterns of colonialism. CONCLUSION: Framing COVID-19 as an endemic disease in early 2022 is a misguided attempt and a result of cultural and political forces.

Addressing The Interlocking Impact Of Colonialism And Racism On Filipinx/a/o American Health Inequities.

Within the monolithic racial category of "Asian American," health determinants are often hidden within each subgroup's complex histories of indigeneity, colonialism, migration, culture, and socio-political systems. Although racism is typically framed to underscore the ways in which various institutions (for example, employment and education) disproportionately disadvantage Black/Latinx communities over White people, what does structural racism look like among Filipinx/a/o Americans (FilAms), the third-largest Asian American group in the US? We argue that racism defines who is visible. We discuss pathways through which colonialism and racism preserve inequities for FilAms, a large and overlooked Asian American subgroup. We bring to light historical and modern practices inhibiting progress toward dismantling systemic racial barriers that impinge on FilAm health. We encourage multilevel strategies that focus on and invest in FilAms, such as robust accounting of demographic data in heterogeneous populations, explicitly naming neocolonial forces that devalue and neglect FilAms, and structurally supporting community approaches to promote better self- and community care.

To return or not to return: on post-Anthropocene and the pandemic.

Some studies indirectly link the pandemic to the Anthropocene. However, this brief essay identifies the Anthropocene as a Western-bred phenomenon, which has evolved from Europe's colonial past. Pandemics are not new to settler colonialism, for instance. In this broader framework, the Covid-19 pandemic comes at a time when the West is confronting a new challenge to its global influence, i.e. the climate emergency resulting from a long history of colonial experiments, successes and failures.

Brazil: hate and intolerance in times of pandemic in a mixed-race country.

This paper intends to analyse the current political and social situation in Brazil and show how this context has influenced the management of the public health crisis generated by the COVID-19 pandemic. To this end, the authors conducted an investigation into Brazil's historical roots, which have not only engendered deep class differences but, also, social psychopathologies such as dissociation and perversion. Finally, this paper presents a symbolic analysis of social exclusion and how the mythical figure of Sophia can inspire a renewed movement of inclusion and tolerance.

Cet article se propose d'analyser la situation politique et sociale actuelle au Brésil et de montrer comment ce contexte a influencé la gestion de la crise sanitaire publique générée par la COVID-19. Dans ce but, les autrices ont conduit une enquête approfondie sur les racines historiques du Brésil, racines qui ont engendré non seulement de profondes différences de classes mais également des psychopathologies sociales, telles la dissociation et la perversion. Cet article présente en conclusion une analyse symbolique de l'exclusion sociale et montre comment le personnage mythique de Sophia peut inspirer un mouvement renouvelé d'inclusion et de tolérance.

El presente trabajo intenta analizar la situación actual política y social en Brasil y muestra como este contexto ha influenciado el manejo de la crisis de la salud pública generada por la pandemia del COVID-19. A este fin, las autoras llevaron a cabo una investigación sobre las raíces históricas de Brasil, las cuales, no solamente han generado profundas diferencias de clase, sino también psicopatologías sociales como disociación y perversión. Finalmente, el presente trabajo presenta un análisis simbólico de la exclusión social y cómo la figura mítica de Sophia puede inspirar un movimiento renovador de inclusión y tolerancia.

Decolonising global health in the time of COVID-19.

The persistent influence of coloniality both from external actors and from within threatens the response to COVID-19 in Africa. This essay presents historical context for the colonial inheritance of modern global health and analyses two controversies related to COVID-19 that illustrate facets of coloniality: comments made by French researchers regarding the testing of BCG vaccine in Africa, and the claims by Madagascar's president Andry Rajoelina that the country had developed an effective traditional remedy named Covid-Organics. Leveraging both historical sources and contemporary documentary sources, I demonstrate how the currents of exploitation, marginalisation, pathologisation and saviourism rooted in coloniality are manifested via these events. I also discuss responses to coloniality, focussing on the misuse and co-optation of pan-Africanist rhetoric. In particular, I argue that the scandal surrounding Covid-Organics is a reflection of endogenised coloniality, whereby local elites entrench and benefit from inequitable power structures at the intersubjective (rather than trans-national) scale. I conclude with a reflection on the need for equity as a guiding principle to dismantle global health colonialism.

The Rejuvenation of the Withering Nation State and Bio-power: The New Dynamics of Human Interaction.

The outbreak of COVID-19 comes at the time when a shrinking public sector healthcare is an acknowledged fact in post-colonial societies. The policies adopted by the apparatus of most nation states for the past thirty years or more reveal that providing healthcare to all sections of societies is not a priority. The gradual process of economic liberalization has established "market" as the only legitimate mechanism of the distribution of goods/services as per the efficiency principle. The financial markets are globalized in such a manner that nation states are constantly losing their capacity to perform redistributive functions. State withdrawal from the provision of welfare rights is undermining its moral authority to impose any normative imperative to the people who are being left alone at the mercy of market forces. But the spread of COVID-19 on a global scale has provided an opportunity to the nation state. With the help of healthcare systems, the State has reasserted itself as the ultimate archangel to define human beings and their respective status in the newly emerging nomenclature of the public sphere. In this paper, the rejuvenation of the nation state with respect to bio-power will be discussed in the postcolonial context.

COVID-19 and Moral Imperialism in Multinational Clinical Research.

A TV debate in April 2020 between two French doctors regarding the benefits of testing a coronavirus vaccine in Africa where there are no masks or treatments available has led to international criticism. This case highlights a problematic ethical double standard in multinational clinical research: trials that would be considered unethical in high income countries (e.g., placebo-controlled where there is an existing treatment) are nonetheless justified in low-and-middle-income countries because the existing standards of care are less (i.e., no access to a treatment). Underlying this ethical double standard in some multinational clinical trials is a moral imperialism and persistent colonialist thinking that must be rejected.