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Some people in global health are systematically subjected to epistemic wrongs, harms and injustices. And sometimes, with these epistemic wrongs, come more fundamental harms to their sense of self or dignity.
Each person has a moral right not to be treated as inferior. This moral right has found different forms of protection under dignity-based mechanisms. But these mechanisms do not extend, at least not explicitly, to epistemic wrongs, harms and injustices.
This article tries to pave the way for a dignity-based approach to epistemic repair in global health, specifically through the lens of human rights.
Introduction
For a while it has been evident that ‘common practices in academic global health (eg, authorship practices, research partnerships, academic writing, editorial practices, sensemaking practices, and the choice of audience or research framing, questions, and methods) are peppered with epistemic wrongs that lead to or exacerbate epistemic injustice’.1 One way to combat epistemic injustice in global health, or what can be called a method of ‘epistemic repair’, includes the nurturing of corrective virtues, that is, to individually cultivate the practice of giving higher degree of credibility to knowers and to avoid practices that erode the interpretive role of marginalised groups.1 This is an individualistic approach to correcting epistemic injustice, one that does not necessarily address the structural causes in the creation of social power and subsequent domination. In this article, I propose a strategic approach to viewing epistemic injustices and to sow the seeds for a structural remedy to combat epistemic wrongs in knowledge systems like global health. I look at epistemic repair through the lens of human rights. But before I outline this lens, I would like the readers to consider the following scenario:
A person of colour walks into a luxury store. The person is browsing through the items on display. Suddenly, the person sees the store security and some store employees rush towards her. In a matter of seconds, they are all over her, patting her down, searching her person and her belongings. A small crowd gathers, and some even take out their phones to document the scene unfolding before them. After a couple of minutes, the person is let go with a quick apology. The crowd disperses, and this person leaves the store feeling extremely humiliated.
This, of course, is not a scenario where an epistemic wrong is salient, and some might even wonder what this has to do with epistemic injustice. Except that this scenario depicts a dignitary wrong, which also entails one of the necessary conditions for the testimonial kind of epistemic injustice: identity-based prejudice.2 In a scenario like this, depending on the country, the person might have a legal remedy under a dignitary tort (where damages are awarded to a person for suffering some indignities)3 or the person could seek moral damages for damage caused to their dignity, honour, reputation, or emotions.4
But are epistemic wrongs that stem from epistemic injustice dignitary wrongs? If the answer to this question is in the affirmative, it opens a world of dignity-based reparative mechanisms to the victims of epistemic injustices. These mechanisms have not yet been considered as possible methods of epistemic repair as the cultivation of corrective virtues remains the predominantly theorised method for correcting epistemic injustice.5 In the next sections, I will outline why some important epistemic wrongs stemming from epistemic injustice are dignitary wrongs, which will also lay the foundation for looking at epistemic repair in global health through the lens of human rights.
Dignity-based approach towards epistemic justice
Dignity is a complex notion that, according to David Owen, has at least three different, but not mutually exclusive, understandings: it can be seen as (1) a normative status, (2) as sense of worth, and (3) as a mode of conduct or comportment.6 Dignity as a normative status includes the fundamentals of basic reputation or social standing that entitle individuals to be treated as equals.7 Essentially, this includes the moral equality of all human beings, which is expressed legally as universal human rights, and political equality that is expressed in terms of democratic citizenship.6 Dignity as a sense of worth refers to ‘a practical relationship to oneself as a person or citizen of equal moral or political value to other persons or citizens’.6 This practical relationship to oneself can either depend on the social recognition of moral and political equality, or on the respect shown by others for one’s normative status as an equal.6 Finally, dignity as a mode of conduct or comportment is conveyed and reproduced in not only when a person is treated with dignity, but also when they treat others with dignity.6
Given these senses of dignity, it can be unclear what it means to respect or to breach one’s dignity. To resolve this, Michael Rosen proposes that respect for dignity can manifest in two ways: ‘respect as observance’ and ‘respect as respectfulness’.8 Respect as observance would simply entail observing another person’s human or civic rights. It entails recognising the dignity of a person by not breaching their human or civic rights. Respect as respectfulness is an attitude with which people interact with another person. It is about acknowledging the dignity in another person by engaging respectfully with them.8 A person’s dignity is breached when either of the two senses of respect is lacking.
Arguably, when people, groups and institutions refuse to respectfully engage with knowers and afford them lower credibility (as in testimonial injustice), they are in breach of dignity as a mode of conduct where respect as respectfulness is lacking in their comportment. When marginalisation affects a person’s or a marginalised group’s capacity to present and define themselves as themselves (as in hermeneutical injustice), then that too is a breach of dignity as a practical relation to oneself. Therefore, when researchers from dominant groups in global health refuse to respectfully engage with knowers owing to identity-based prejudices and when marginalised groups in global health cannot make sense of their experiences due to a lacuna in collective interpretive resources, or when their interpretive tools are ignored, their dignity is breached.9 Consequently, epistemic wrongs stemming from epistemic injustices can be dignitary wrongs. The next section looks at how this conclusion bears on epistemic repair in global health through the lens of human rights.
Epistemic rights as human rights
Human rights are based on the respect of the dignity and moral equality of persons.10 Some define them as entitlements that human beings possess by virtue of their dignity.11 While others base human rights on the idea of moral equality of human beings, where such equality entitles them to not be treated as inferiors.12 When knowledge held by local experts is not considered legitimate by journal editors, peer-reviewers, and other members of dominant groups, they treat such knowers as inferiors. When marginalised groups or local experts are not seen as producers and audience of global health research, they are treated as inferiors. When local experts are excluded from scientific or theoretical aspects of research or given authorship positions that do not indicate their intellectual contribution, they are treated as inferiors. When researchers extractively use communities and local experts as fodder for self-promotion in academia and beyond, the communities and local experts too are treated as inferiors. Consequently, when victims of epistemic injustice are treated as inferiors and have their dignity breached, their human rights are violated.
Here the specific human rights that appear to be violated are epistemic rights. Previous work on epistemic rights has been limited to the ‘right to know’13 or ‘right to be known’.14 This has been used by some scholars to demand epistemic reparations in cases of gross violations and injustices, like the Japanese denialism of ‘comfort women’.15 But I use the term ‘epistemic rights’ more broadly. Epistemic rights include the right to be a knower and the right to produce, use, and disseminate knowledge.
Detailing the implications of broadening the scope of human rights to include epistemic rights, as I understand them, is part of my ongoing work. But for the present purposes, it is sufficient to establish that there is an interesting case to be made for redressal of epistemic injustices through dignity-based mechanisms, like human rights. As an example to demonstrate the human rights approach to securing epistemic justice, I will take the unavailability or inaccessibility of valuable health research in countries or regions where the research was carried out. Respecting, protecting, and fulfilling epistemic rights in this case would entail the provision of epistemic goods to the wronged. The accountability to remedy the breach of these rights would be on the parties whose actions are supposed to redress these wrongs and on governments or states. This means that if health research is carried out by researchers in a country outside of their own, that research must be made accessible to the people of the research country. Securing this, under a human rights approach, would not simply rest on the goodwill of publishers and funding agencies, but would instead require active government involvement in passing legislation or making regulations and policies to make such research open access.
Conclusion
Knowledge systems, as social systems, tend to produce and retain hierarchies. But the continuation of these hierarchies only serves to weaken our collective pool of knowledge. Respect for dignity within these systems does not need to remain an abstraction—it is workable—as is demonstrated in Seye Abimbola’s invitation for evidence-based practice to come together with dignity-based practice.9 In this article, I have argued that instances of epistemic injustice or practices that exacerbate epistemic injustice in global health can lead to the breach of a knower’s dignity. Such breach of dignity also involves the violation of a knower’s right to not be treated as an inferior. Every human being has the epistemic right to be a knower, to produce knowledge, to use knowledge and to disseminate knowledge. These rights need further work and conceptual refinement for them to be included in the systematic human rights framework, but the larger point here is that we should not have to beg for these rights. To modify Bal Gangadhar Tilak’s clarion call: ‘knowledge is our birthright, and we shall have it!’16
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Footnotes
Twitter @HimaniBhakuni_
Contributors The author confirms sole responsibility for this article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.