On knowledge and racism: How do we know what we know?
In this blog post, Senior Knowledge Translation Specialist Sume Ndumbe-Eyoh shares key messages from two articles on racism, knowledge production and research.
For the past three years, the NCCDH has been engaged in an internal racial equity initiative that, among other things has had our team participating in group readings and discussions about racial equity. [1,2,3]
The first phase of learning started in 2016 and focused on developing an understanding of racism and organizational change. [4,5] Through the fall of 2018 and winter of 2019, the team learning had an emphasis on how we can transform our practice as a knowledge translation organization. We focused on readings related to knowledge production, knowledge translation, network development and relationship-building. In each discussion, we discussed implications for our organizational practice.
An overview of resources on knowledge production and research
In this article, I share key messages from two articles on racism, knowledge production and research. [6,7] The key messages are followed by highlights from the team discussion and my own reflections. The analysis reflects my position as a Black woman and my understanding of racism as a persistent structural and cultural force that creates policies and practices in the interest of building and protecting economic, social, cultural and political power along racial lines. 
Rethinking epistemology, methodology and racism: or, is White sociology really dead? 
A racial epistemology, or way of knowing about race, is a theory of what constitutes knowledge. It includes considerations of “who can know, how we know, and what counts as knowledge for our claims.” [6, p.120]
Sociologist Margaret Hunter describes five epistemologies, or racial ways of knowing, commonly used in research and knowledge production. These ways of knowing impact the research questions we ask, the analytic categories and theories we use, how we analyze data and, crucially, the knowledge and power relations we re/produce.
The ways of knowing and associated methodologies are summarized in the table below, which includes a brief description of the focus, who has authority to know, the process through which one knows and what counts as evidence.
As Hunter writes, this is not an exhaustive list and these ways are applied differently over time in different contexts. As such, the examples provided from health and Canadian contexts have been added for illustrative purposes.
While a diversity of ways of knowing is desirable, research and knowledge production is dominated by neoliberal positivist approaches with the other approaches more frequently being used by racialized peoples and receiving less legitimacy in public health. This limits the nature of questions that are explored, reinforcing racial inequities.
Hunter proposes critical reflexivity as a tool to help us uncover the default ways of knowing and address the “epistemological and discursive limitations” [6, p.132] of our approaches. She also emphasizes that we need broader structural changes for the ways of knowing generated and used by racialized peoples to be truly valued.
Table: Racial ways of knowing and associated methods in research and knowledge production
Click here to access the full-sized table.
The public health critical race methodology: Praxis for antiracism research 
In this article, Ford and Airhihenbuwa  discuss a model and process for public health critical race praxis grounded in critical race theory (CRT). As a theoretical approach, CRT undercovers and transforms the relationship between race, racism and power in the aim of eliminating racial inequities.
The authors outline four key characteristics of critical race theory:
- Understanding racialization
- Developing race consciousness
- The importance of social location
- Understanding and acting to disrupt racism
Applying this to public health, they propose a public health critical race praxis that blends “theory, experiential knowledge, science and action.” [7, p.1391] A critical race praxis in public health guides health equity researchers and practitioners in four areas of focus:
- Understanding contemporary racial dynamics
- Challenging knowledge production by considering how knowledge is socially constructed, using critical approaches and centring the voices of marginalized peoples
- Conceiving and measuring race and racism, with attention to race as a social construct and intersectionality and
- Using knowledge to disrupt racism
We recognized that our work is informed by our individual voice and social location. If we want to close racial inequities, we have to actively challenge racist ideas and knowledge production.
The team discussed how we could practice critical self-reflection and become more conscious of the ways of knowing that underpin our work. We noted that some ways to be deliberate and improve our practice included:
- actively engaging with people who bring a critical race approach to their work;
- building critical race theory into how we develop resources and into learning activities (e.g., conferences, workshops, webinars) for the public health field; and
- supporting accountability to change our practice with staff.
Knowledge production in public health
Knowledge production and research on race, racism and racialization is not and has never been neutral. These activities take place in societies and organizations with particular ideas about racism. Racism constantly transforms and reimagines itself, thus public health has to develop sophisticated analytical tools to understand and act to eliminate racism.
Hunter  presents ways of approaching research on race. While developed from a sociological lens, this work provides insights that resonate in public health contexts. Ford and Airhihenbuwa  deepen our understanding of how critical race theory, with an intersectional approach as a key feature, can be taken up public health. Together, both articles [6,7] above make the case for a more diverse knowledge base that is built on a variety of theoretical and epistemological approaches.
Particularly, an approach grounded in critical race theory as described by Ford and Airhihenbuwa  that addresses the social location and power dynamics of the researcher and those being researched has the potential to disrupt racial (and other) power dynamics in the knowledge production process and generate solutions to improve racial health equity.
This is a salient consideration for anyone engaged in collecting, analyzing and interpreting evidence and knowledge in various settings (e.g., academia, public organizations, communities etc.). Such an assertion includes people and organizations who handle population health information, and data on programs and policies.
Dearth of racism research in Canadian public health
Currently, mainstream Canadian health equity, social determinants of health and public health research, knowledge production and action pay little attention to the impact of race, racialization and racism on health. In practice, there has been an emphasis on other material determinants to the exclusion of racism.  The sentiment, “If we can eliminate poverty and income inequality, we would eliminate health inequities” is all too common in public health circles.
Coupled with a resistance to take racism seriously in mainstream/dominant public health, this sentiment has led to a dearth of knowledge being generated by public health organizations. For example, few public health organizations collect race-based data or produce publicly available information and health status reports that frame racism and racialization as legitimate concerns.
Indeed, the refusal to collect and analyse meaningful data on race is a salient manifestation of racism in the Canadian context.  While knowledge on racism and racialization needs to move beyond numbers, race-based data at the population level is an important component.
However, some promising deviations exist. In their chapter titled “Race” in Social determinants of health: The Canadian facts,  Mikkonen and Raphael discuss race and racism as determinants of health. Similarly, the Public Health Agency of Canada (PHAC) recently updated their list of determinants to explicitly name race and racism as determinants of health.  A recent report analysed data from the 2013 Canadian Community Health Survey on everyday discrimination. 
At the local level, Toronto Public Health has analysed data on racial health inequities  and Public Health Sudbury and Districts has launched a racial equity action plan that calls for the collection and analysis of race-based data. 
In a field that asserts the importance of data and evidence informed decision-making, the limited engagement with racism as a legitimate area of investigation is troubling. Imbuing knowledge production with a critical intersectional race analysis is an essential contribution for public health alongside broader structural changes. It is imperative that public health take racism seriously by actively contributing to knowledge and action projects that support a racially just society.
Photo credit: Emily Morter
[1.] Clement C. Becoming anti-racist: small steps along the way. [blog on the Internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2017 [cited 2019 October 21]. [3 screens]. Available from: http://nccdh.ca/blog/entry/becoming-anti-racist-small-steps-along-the-way
[2.] Clement C. Becoming anti-racist: An NCCDH initiative. [blog on the Internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2017 [cited 2019 October 21]. [3 screens]. Available from: http://nccdh.ca/blog/entry/becoming-anti-racist-an-nccdh-initiative
[3.] Ndumbe-Eyoh S. Insights from the NCCDH’s racial equity journey. [blog on Internet]. Antigonish (NS): National Collaborating Centre for Determinants of Health, St. Francis Xavier University; 2019 [cited 2019 October 21]. [3 screens]. Available from: http://nccdh.ca/blog/entry/insights-from-the-nccdhs-racial-equity-journey
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