Sociology Mind
2012. Vol.2, No.4, 362-372
Published Online October 2012 in SciRes (http://www.SciRP.org/journal/sm) http://dx.doi.org/10.4236/sm.2012.24048
362
Knowledge Construction: Untapped Perspective
in Pursuit for Health Equity
Begna Dugassa
Department of Public Health, T oronto, Canada
Received July 22nd, 2012; revised August 24th, 2012; a c c epted September 7th, 2012
Background: Racism is one of the major pathogenic social conditions that contribute to health disparity.
Health disparities between blacks and whites are biological expressions of long-standing unjust social re-
lationships. Health disparities between blacks and whites are explained not only in terms of differences in
the socio-economic statuses but also by the impacts of epistemological racism. In health sciences, episte-
mological racism is manifested through the research questions asked, the research agendas framed, the
ways in which data are collected and interpreted as well as the ways research funds are allocated. Often
research questions are framed from the perspective of the researchers and the funders. Such a research
mainly solves the socio-economic health problems of the researchers, funders and the dominant and
leaves aside the need of the marginalized groups. Methods: Using Anti-racist theoretical framework I
critically examine the connections between knowledge, race and health disparity between different racial
groups and the pathogenicity of racism. Conclusion: Our health problems are unique to our culture and
social realities. Research that is intended to reduce health disparities between racial minorities and the
dominant groups need to frame research questions differently. Researchers need to realize that the con-
temporary epistemology of health sciences embodies the society that has produced it. Such knowledge has
critical limitation in understanding the need of racial minorities and in finding solutions. To reduce health
disparity we need to make the knowledge and experiences of different groups of people and their ways of
knowing part of the educational curricula. School should prepare students to see the world primarily in
their own perspective and define their needs and aspirations; facilitate conditions to widen their scope in
understanding the world and solve their social problems.
Keywords: Epistemological Racism; Health Disparity; Pathogenicity of Racism
Introduction
Knowledge and power are intertwined (Foucault, 1995). The
process of colonization requires both physical subjugation and
complete control of the mind and soul (Dugassa, 2011). Euro-
pean empire builders established and maintained their privi-
leges and powers by using their social, physical and biological
sciences knowledge. They used their knowledge to validate
their needs and perspectives. From the perspective of racial
minorities, Euro-centric knowledge altered their identity, dis-
torted their history, compromised their needs, worn-out their
dignity and exposed them to poverty and diseases. Furthermore
it has provided theoretical reasoning to the colonizers and slave
owners, to perpetuate harm against them (Smith, 2002). Hence,
Euro-centric knowledge cannot provide a theoretical framework
to understand their needs, foster their resiliency and grant them
healing.
Battiste and Henderson (2000) are indigenous scholars and
they have contributed a great deal to our understanding of the
colonial and political nature of education. They state that: “An
education that does not critique the connections or lack of
connections in knowledge is not education but indoctrination”.
The statement of these two scholars suggests that the essence
and purpose of education should be examined in terms of its
inclusion or exclusion practices in validating knowledge of
racial minorities and the absence or presence of racial minori-
ties in knowledge production. The statement also suggests the
importance of questioning whether or not education empowers
the people and helps them to solve their own problems and
improve the quality of life or facilitates the on-going nature of
the colonial power relation.
Education can either used to empower and prepare students
to solve the social problems of society, facilitate social changes
and avert health disparity, or to dis-empower, control, manipu-
late, legitimize social hierarchy and hinder social transforma-
tion, (Dugassa, 2011) as well as to widen health disparity. The
questions we need to ask and make effort to answer them are:
What we need to do, to make our teaching and learning institu-
tions produce critical minds (Freire, 2001) and liberated voices
(Hooks, 1989)? How can we make sure that the experiences
and the needs of racial minorities become the center of teaching,
learning and researching as well as the foundation of policy-
making processes? How can we create social and physical en-
vironments that not only promote good health but also equity in
health? What is required to develop an epistemology that can
successfully challenge the Euro-centric epistemology designed
to maintain the privilege of dominant group and to legitimize
poverty and misery among racial minorities? These critical
questions have received far too little attention. Much of the
focuses have been placed on treating the symptoms of diseases
rather than the causes.
Historically, most wars, genocide and other various forms of
violence have racial dimensions (Winant, 2000). Racist ideol-
ogy was and is responsible for racial slavery, colonialism,

B. DUGASSA
neo-colonialism, poverty and health disparity (Williams, 1997).
It supports a structure of inequality (Dei, 2000) at local and
global levels (Jalata, 2001). Racist thoughts and ideas have
been theorized and legalized, and they have been part of sci-
ence, law, art, and business. Race has been used to stereotype
and stigmatize. Race is produced and reproduced primarily by
fundamental political economic and ideological structures
(Moss, 1997) and is a component of the ideology of a capitalist
economy (Dei, 2000). Structural inequality leads inevitably to
disparities in the social well-being of people. Those people who
do not have political and economic power are more exposed to
diseases due to lack of adequate food, preventive health and
medical services. Therefore, promoting public health for all
section of society without discrimination is an aspect of social
justice and an essential element of human rights principles.
Public health is defined as “the science and art of promoting
health, preventing disease, and prolonging life through the
organized efforts of society” (WHO, 1998). The definition en-
compasses the concept of the organized efforts of society,
which include identifying health risks and setting strategic
plans to prevent diseases and promote health. To prevent dis-
eases, promote health and improve the quality of life require
aiming at producing sustainable changes at the individual,
community and national levels. To achieve this, communities
need to develop the capacity to identify their needs and solve
them. In public health, building capacity means helping indi-
viduals and communities develop their leadership, problem-
solving or team-building skills. This makes knowledge, teach-
ing and learning critical to the success of the public health ob-
jectives and to the elimination of health disparities. That is why
McKenzie (2003) argues that countering racism should be con-
sidered a public heal t h con c ern.
Public health makes a difference in population health in two
major ways. The first way is enquiring and identifying indi-
viduals and communities who are ill or at risk of becoming ill
through studying the conditions that put them at risk. The sec-
ond is through action plans—where necessary measures taken
to improve the health of the population (Mann et al., 1999).
One of the major reasons for health disparity to persist is the
conceptual framework of public health is framed in a Euro-
centric perspective (Kreiger, 2010). Scientists and policymakers
are not objective and independent thinkers (Kuhn, 1970). In
their works, scientists accept what they have been taught and
apply their knowledge in solving the problems that dictates
them. It is for the same reason that when the members of racial
minorities die from cancer, cardio-vascular diseases and infec-
tious diseases resulted from poverty, malnutrition and un-
healthy living conditions, scientists choose to name the symp-
toms as the causes. They avoid naming the true causes of the
problem.
The right to equal treatment is a fundamental human right.
Racism and discrimination causes social exclusion of members
of minority groups. Racial and ethnic disparities in health status
persist and are even increasing in some areas. Eliminating
health disparities should be a sustained, strategic priority of
public health organizations dedicated to improving the health
and well-being of people. Public health is not a newcomer to
the field of undoing injustice. However, when it comes to un-
doing discrimination and health disparities it is still functioning
in accordance to existing Euro-centric assumptions. As a result
disparities in health not only persist and in some cases it is even
increasing (Barnes, 2004).
Racism is a collection of attitudes, beliefs, behaviors and
practices that contribute to the long-standing health disparities.
These disparities are caused by overt and covert discrimination.
Racism affects health through a complicated set of direct phy-
siologic effects, most notably physiologic stress, and through
indirect pathways such as access to goods, services and oppor-
tunities. This makes the analysis of the health effects of racism
difficult, in part because race and racism are not easy to quan-
tify. The effects of racism are in part manifested intricately, and
interconnected through various pathways. The health effects of
racism and race-related exposures and experiences accumulate
over a lifetime.
Racism is one of the major social pathogenic conditions that
contribute to health disparity. Health disparities between the
racial minority and dominant group are biological expressions
of long-standing race relations (Hyman, 2009). Racial minori-
ties have more unmet health needs than the dominant groups;
these include diagnostic errors, adverse effects, unnecessary
tests and prolonged hospital stays (Balsa & McGuire, 2001).
The direct impacts of racism are manifested through emotional
stress such as anxiety, depression and lowered self-esteem,
which have direct effects on biological processes such as the
endocrine and immune systems (Williams, 1997). This paper
examines racism as a social problem and the harmful social
consequences linked to it. In doing that, it seeks to advance
anti-racist discourse in health and medical sciences. Hence, in
this paper I examine racism, its historical origin and its health
impact on racial minorities by closely looking at the ways in
which racist cultural, economic, political, ideological and epis-
temological systems are implicated to health disparities. In this
piece, I address five major issues. First, I explain why I am
interested in the connection between knowledge, race and
health. Second, I explore the historical origin of racism and its
consequences. Third, the issues of research in health disparity
and impacts of racism in health are explored. Fourth I address
the problem of representation and knowledge production in
health sciences. Fifth, I elaborate the issues of representation
and policy research and formulation. Finally, the challenges of
equity in health serv ices will be addressed.
Terms Defined
To prevent ambiguity and misunderstanding I define some of
the concepts I use in this paper. In this paper, the term racial
minority refers to people of Africa or African origin. The do-
minant race or group refers to people of Europe or European
origin. The word epistemology is derived from two Greek
words—episteme which means knowledge and logus, which
means reason or study. Hence, epistemology is reasoning or
studying about knowledge construction. It describes what we
know, how we know, what we know and what we may regard
as knowledge.
Why I Am Interested to This Topic?
As I discuss the relationships between theory and practice I
want to make my position clear. The word theory comes from a
Greek word “theoria” that means seeing, inward looking or
envisioning. Theory gives the concept on which we describe,
explain and address the health of a society. To borrow words
from (Kreiger, 2010) to theorize is to use our mind’s eye and
systematically observe and articulate the guiding principles of
actions. The production of theory is socially constructed and it

B. DUGASSA
is embedded in the culture, experience and worldview of the
society (Doucet & Mauthner, 2006).
Let me put my experience in perspective. I am not coming to
the discussion of knowledge, race and health and pathogenicity
of racism from politically neutral position—I know no neutral
researcher or policy maker. I was born and raised among the
Oromo people in the family of indigenous believers—Waqe-
faata. The Oromo Indigenous knowledge that I was taught at
home is different from the teaching I received from my formal
schooling. Things that are true and valid from the Oromo per-
spective are void in the formal education. For example, from
the Oromo perspective, black and blackness represent purity
and holiness. When the Oromos ask for clean water they would
say bishaan guraacha—black water. If they want to say Holy
God, they would say Waaqa Guraacha—Black God. However,
in European literature, black and blackness represent bad things
—Black Death, black market, black list and others. The Oromo
emblem is represented in three different colors -black, red and
white. Although the Oromo concept of blackness and whiteness
is different from that of Europeans, however, the concept of red
and redness is the same or similar. Red represents love and
aurora (Dugas sa, 2011).
The differences in concepts are not limited to color represen-
tation. The Oromo concept of health is intertwined with per-
sonal peace, peace with the neighborhood, and the natural en-
vironment as well as divine power. The Oromo concept of
health is wider than that set forth by the WHO, which defines
health as “a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity”. As
peace and health are central to the Oromo thinking, the Oromo
concept of excellence is built around these core ideas. The
Oromos value more collective work and peacemaking and team
workers are regarded well than others. However, the Euro-
centric schooling promotes more about individual’s efforts than
collective achievements.
Understanding certain phenomenon using a different para-
digm of thinking can have significant implications. As Gold-
berg (1999) argued, power is exercised epistemologically in
naming and evaluating social issues. Researchers conduct their
studies based on the research questions they ask, and policy-
makers rely on the mission and objective of the institution. For
example, in Canada, native Canadians suffer from diabetes
more than any other racial groups (Hanely et al., 2003). Clinical
science researchers have conceptualized that these group are
genetically defective in metabolizing carbohydrates (Hegele et
al., 2003). They have found the gene that is responsible for
carbohydrate metabolism. At the conceptual level, these re-
searchers took themselves to be the standard group (those who
can effectively metabolize carbohydrate), and categorized those
who cannot as having defective genes. Such research victimizes
the victims—who had been conditioned to abandon their eating
habits. At the same time, the data produced frees the Canadian
government from being responsible for caring for native Cana-
dians. If the native Canadians were politically, socially and
cultural dominant over others, the idea of what constituted the
standard eating habit in Canada would have been totally differ-
ent. If the native Canadians were the dominant group, they
would have been the researchers and in that case those who can
metabolize carbohydrate more effectively would have been
seen as having defective genes.
As an African-Canadian and public health practitioner and
researcher, I made a political choice to examine race in the
relation to knowledge construction and its impact on the health
of racial minorities. I have observed the lives of racial minori-
ties studied and theorized within the dominant lenses. Racial
minorities experiences are measured within survey designed by
the dominant group within the Euro-centric perspective. Racial
minorities are expected to fit into the dominant theories and
experiences.
As a public health practitioner running educational work-
shops, I repeatedly note that the Canada’s Food Guide, which is
available for me to share with my African-Caribbean and Asian
participants, is designed by and for the dominant group. For
example, discussing the importance of calcium for bone, teeth
development, and immune system; I encourage them to drink
milk. Then I find that many of them are lactose intolerance.
When I talk about the relationships between consumption of
sodium and blood pressure among the blacks, very often the
question that follows the discussion is why the regulatory agen-
cies are not mandating the reduction of sodium in foods. This is
even clearer when I discuss about vitamin D deficiency and in
relation to skin color. In Canada, USA and many European
countries, blacks are one of the groups that are at risk of vita-
min D deficiency (Reis et al., 2008). Due to their skin pigmen-
tation, blacks synthesize vitamin D slowly. This means that in
the northern hemisphere where sun light is inadequate, vitamin
D deficiency is more common among blacks as compared to the
dominant group. Canada’s Food Guide does not take such
physiological differences into consideration.
Through teaching, learning and researching we can solve our
social problems. Our social problems are usually unique to our
culture. Teaching, learning and researching are conducted with
a specific paradigm of thinking or epistemology. If we teach,
learn and conduct research in the Euro-centric paradigm, we
learn to see black and blackness in negative terms—as a result
the poverty and misery in which the black people live are seen
as natural and acceptable and consciously or unconsciously we
convince ourselves that there is no need to make efforts to ad-
dress them. Racism produces falsehood and consequently dis-
torts and undermines the needs of racial minority groups. It also
legitimizes the Euro-centric knowledge as universal and impar-
tial knowledge. Racism persists because the Euro-centric para-
digm of thinking is ingrained in the teaching, learning and re-
searching of Western societies. It is part of the culture, legal
system and the way of life in the Western World. Black and
white children learn this paradigm of thinking in schools. To
reduce health disparities, we need to ask the following ques-
tions and make an effort to answer them: Does the paradigm of
thinking or epistemology influence the research questions we
ask, the ways we collect and interpret data and set up policies?
If the answer is yes, why do we not teach our children in multi-
ple paradigms of thinking and prepare them to interrogate racist
epistemolog y and promote equit y?
Race and Racism: An Historical Perspective
It would be difficult to examine the health disparities result-
ing from racism without understanding the construct of race
and the construction of the racist mindsets. It is argued that race
is a social construct rather than a biological classification (Omi
& Winant, 1993; Lopez, 1995). Although race is a socio-po-
litical construct, racism is real in terms of material and social
consequences (Dei, 2000). Race is used to classify people based
on skin color, geographic origin, ethnological background and
364

B. DUGASSA
culture. The term racism refers to an ideology that legitimizes
the domination of one group of people over another, and justi-
fies both social avoidance and discrimination of certain groups.
Historically, racism created norms that assigned racial minori-
ties different social and economic statuses and differential
treatment.
The racist paradigm of thinking influences our daily activi-
ties in several different ways. It determines whose knowledge
and culture are used to validate, subsidize and commercialize. It
determines whose health problems are worth of careful investi-
gation and whose require little or no attention. It determines
whom to feed and what to feed, whom to shelter and whom not
to shelter. It decides the value of individuals’ work, who should
live in certain neighborhoods, and who should perform and be
responsible for certain jobs. Racist thinking influences who
should have access to higher education and research institutions,
and participate in policy-making processes. Racist thinking is a
socially constructed and it is subjected to both reconstruction
and demolition.
When European colonizers met the indigenous people of Af-
rica, Asia, North and South America and Australia, they exhib-
ited racist mindsets and they started to question whether or not
indigenous people possessed souls, could be offered salvation,
whether or not they were educable, and whether or not they
could be offered schooling (Smith, 2002). Hall (1992) argues
that categorizing and classifying is not simply descriptive; it is
also evaluative. Problems of classification arise when people
begin to evaluate others solely on the basis of their worldviews.
Categorizing depends heavily on societal experiences, values,
and social norms. Indeed, racism goes beyond the categoriza-
tion of people; it is about the power relations that it creates.
Understanding that race and racism are a social construct, it
is important to examine how and why they are constructed, and
why the idea of such social construction remains unchanged.
William F. Tate IV (1997) suggests that for a theory to become
acceptable, it must be consistent with other representations or
belief systems that reflect the prevailing cultural ethos of peo-
ple. Belief systems are mechanisms by which humans setup
social norms and values. People use their believes to integrate
these artificial or symbolic models rather than on the basis of
genetic modes to classify people. Racism places considerable
emphasis on racial differences in determining policy and inter-
preting events.
It is reported that white economic gains are made at the ex-
pense of black and indigenous people losses resulted from ra-
cial discrimination (Goldberg, 1999). Racist ideas serve the
politically dominant group in maintaining profit, power, and
privilege. As with race, “knowledge” is also a social construc-
tion. Even the research processes, as well as the subjective ex-
periences of researchers, that are considered to be neutral, are
currently the subjects of much debate. It is argued (Okolie,
2002) that there are different ways of knowing the world; how-
ever, the present educational system is dominated by a Euro-
centric way of knowing. This knowledge does not validate the
knowledge of racial minorities. This pushes aside the knowl-
edge of all other less powerful social groups into the periphery
and even categorizes them as “outsiders” or “others”.
It is argued that the past informs the present and the present
informs the future (Said, 1999). Our present social conditions
are the web results of the social constructs of the past, and the
social status of our children and grandchildren are established
or determined by the current social constructs. Along the same
lines, Freire (1992) argues that tomorrow is the pure repetition
of today, or that tomorrow is something “predated”. To trans-
form society and overcome all systems of oppression and ine-
quality, we have to relentlessly interrogate the dominant
knowledge and social structure. Otherwise, as Freire (1992: p.
101) himself clearly states: “The future of which we dream is
not inexorable. We have to make it, produce it, else it will not
come in the form that we would more or less wish it to”.
History repeats itself. Racism is something that human be-
ings have constructed and it has been passed on from genera-
tion to generation through the educational system. If the history
of racism is left un-examined critically and not challenged at all
levels, it will continue perpetuating the damage it has been
doing for centuries. Critical education is a useful tool to unlearn
such mindsets. Let us now explore the connection among re-
search, knowledge, and health disparity.
Research in Health Disparity
Knowledge is a social construction. Science and ethics of the
society influence construction of our reality. According to
Johnsson (2009) science is descriptive and it deals with what it
can be accomplished. However, ethics is normative and it deals
with what should or ought to be carried out. Theory influence
practice and practice influence theory. Jonsson (2009) describe
the relationships between theory and practice as “one lacks full
meaning without the other”. Einstein’s famous statement says,
“it is the theory that determines what we can see”. Reconfirm-
ing that theory determines what we see and do Einstein’s an-
other statement says, “we cannot solve problems by using the
same kind of thinking we used when we created them” (see
Brainy Quote). These cite make clear that science is influenced
by the theory, ethics and value of the society. The ways re-
search agendas are framed, data are collected, interpreted and
the ways social policies are framed are not value free. In a rac-
ist society, it is unlikely to find a neutral science. However, the
Euro-centric knowledge presents the term “science” as a uni-
versal body of knowledge through which we can only come to
the truth and explain al l th e phenomena.
Anti-racist educators argue that scientific knowledge is a
cultural product and that there are no fundamental differences
between science and other forms of knowledge. Scientists,
therefore, are the social cadres who work as knowledge pro-
ducers and validators within the arena of cultural and ideologi-
cal norms. The construction of social disciplines such as eco-
nomics, health, science, law, education and others reflect the
dominant values, norms, and social needs of the politically
dominant group. Critical race theorists (Bank, 1995, 2002) and
feminists (Mohanty, 1990) argue that the way public problems
are defined influence the ways laws and policies are con-
structed and interpreted. Decolonizing pedagogical practices
insist on making a critical analysis of the ways in which ex-
periences are named, constructed, and legitimated in academia.
Most of the contemporary anti-racist literatures categorize
racism into three levels: personally mediated, institutional and
internalized. However, the fourth category of racism, which
manifest at an epistemological level has discussed by few au-
thors such as Scheurich, and Michelle (1997). Institutional ra-
cism is responsible for differential access to goods, services and
opportunities. Institutional racism explains the differences in
the socio-economic status of people. Personally mediated ra-
cism explains differential assumptions about the abilities, mo-

B. DUGASSA
tives, and intent of people from their racial backgrounds. This
includes physical disrespect such as teacher devaluation and
disease misdiagnoses. Internalized racism is acceptance of neg-
ative messages about ability and intrinsic worth. Epistemologi-
cal racism is the deep negative assumption about racial groups.
Epistemological assumption is deeply rooted in the culture and
worldview of the society. It determines whether or not the is-
sues that are relevant to certain racial groups are recognized as
a problem and whether the causes of the problems are named.
Health disparity is biological expressions of unjust race rela-
tions’ or manifestation of unmet needs caused by discrimina-
tory practices (Hyman, 2009). Most of the researches in health
disparity and unmet needs can be categorized into two areas.
The first category looks at the ways racism affect health
through social determinants of health. The second category is a
direct biological process where racism causes unwanted psy-
chological stress, alters endocrine, immune and nerves system.
Although it is well known that the philosophical underpinning
of health research is to solve the outstanding health problems
that the society faces, until recently researchers and practitio-
ners never questioned whether or not their prejudice against
racial minorities are implicated to the health disparity.
Racism and prejudice are attitudes and cognitive processes.
Hence, knowledge produced in a racist culture cannot be value
free. However, science is presented to us as a neutral and objec-
tive knowledge, which dictates how the public should under-
stand the world. Guilfoyle and colleagues (2008) write about
prejudice in medicine. These authors are physicians and they
are courageous enough to state that the currently emphasized
evidence-based medicine, clinical treatment and health policy
development are not based on value free research. For example,
Kumanyika (2006) argues that racial minorities have higher
rates of nutrition-related health problems. This is not by acci-
dent—it is resulted from a complex interplay of cultural impo-
sitions—eating habits, economic exploitation—poverty and
marginalization of the need of racial minorities. Kumanyika
suggests the need to develop unique nutritional assessment
methods, dietary guidelines and other nutrition interventions for
racial minorities.
Impact of Racism on Health
It was reported that in the United States, health disparities
among racial groups have continued during the past twenty
years despite socio-economic gains. The difference in life ex-
pectancy between whites and blacks was reported to be 6.0
years in 1997. The differences are even greater in males. Black
males are expected to live 67.2 years as compared to 74.3 years
for white males (Olivia 1999). In addition to health discrepan-
cies existing as a result of socio-economic differences, they too
exist amongst groups of similar socio-economic status along
racial lines (Kendall & Hatton, 2002). The theoretical explana-
tion for such disparities, in terms of socio-economic status,
does not account for this. The disparities are explained in terms
of inferior medical care and discrimination in quality, quantity,
and access to health services (Dries, 1999).
The WHO concept of health is wider than that used by bio-
medical sciences. If we conceptualize health as “a state of com-
plete physical, mental, and social well-being” it can never be
met unless racial inequity is resolved. Even if we conceptualize
health exclusively from a biomedical perspective, health deter-
minants are believed to consist of a web of “causation”. These
health determinants include geographical, biological, environ-
mental conditions and health behaviors that are also dependent
on socio-cultural and socio-economic factors. Social and eco-
nomic statuses are important to achieve better health. As argued
here, racism affects these health factors. If racism persists in
our society minority groups cannot have the state of complete
physical, mental and social well-being. If the research issues
that are relevant to racial minorities are left without careful
investigation and working solutions are not found, health dis-
parities will persist. According to Williams (1997), African
Americans have death rates that are higher than those of whites.
For example, people who originate from a given geographic
region have a body system that is better adapted to certain bio-
logical, chemical, and physical agents than the others. Williams
shows that biological and geographic origins have their effects
on health via mediating variables such as socio-economic status,
and demographic characteristics such as age, gender and mari-
tal status.
The pathogenic effect of racism is mainly noticeable as it
shapes socio-economic status of racial minorities. Fanon (1968)
discussed the social status of colonized people in relation to the
colonizers stating that, “you are rich because you are white,
you are white because you are rich”. Socio-epidemiological
studies have shown the link between socio-economic-envi-
ronmental conditions and the health status of individuals and
groups. It is a well-established historical fact that racially dis-
criminatory laws and practices have enabled profit ratios to be
maintained or increased both at micro and macro levels (Gold-
berg, 1999). Mann and his colleagues writing on the role of
respect for human rights in public health made it clear when
they said:
Discrimination against ethnic, religious, and racial mi-
norities, as well as on account of gender, political opinion,
or immigration status, compromises or threatens the
health and well-being and, all too often, the very lives of
millions. In its most extreme forms, prejudice or the de-
valuation of human beings because they are classified as
“others” has led to apartheid, ethnic cleansing, and geno-
cide. Discriminatory practices threaten physical and men-
tal health and result in the denial of access to care, inap-
propriate therapies, or inferior care.
(Mann M. Jonathan et al., 1999)
The history of public health shows that there is always a
close relationship between socio-economic status, environ-
mental factors and physical health. The ability of a population
to maintain a given standard of health is always directly related
to its capacity to maintain and control the material means of
production (Rosen, 1993). Colonial expansion, driven by ra-
cism, was key in bringing about the destruction of vital social
and ecological structure that usually enabled people to maintain
quality of life. It also destroyed the social well-being of local
populations on an unprecedented scale.
Health care professionals, researchers, and policy-makers
have believed that access to health care is at the center of eli-
minating disparities in health for racial, ethnic, and social class
groups (Cooper et al., 2002). However, in Canada, where health
care is accessible to all its residents, this has not brought about
the elimination of disparities in health status for racial minority
groups. Those populations that live in poor social conditions
are at a disproportionate risk of injury and ill health (Auer &
Ragnar, 2001).
366

B. DUGASSA
Racism is an important social factor, which leads to the de-
velopment of epistemology and it shapes and reshapes social
structures. It is racism, rather than race, that is responsible for
differences in social status and lack of accessibility to higher
education that we observe in our societies. It is the obligation of
public health students and political leaders to address society’s
interests and make efforts to ensure conditions in which all
people can be healthy. If we do not contribute to public health
knowledge, to initiate discourse needed to ensure optimum
conditions whereby all people may live healthy and dignified
lives, the idea of equity remains just a theory. A question of
interest, at this point, is “what portion of current health dispari-
ties between the dominant groups and black communities are
attributed to social status, income, and education?” and, “what
portions of such disparities are attributed to epistemological
racism in health and medicine?” These questions are remained
unanswered, and are recommended for future research explora-
tion.
Representation and Knowledge Production in
Health Sciences
Scholars and researchers less centered in the mainstream
tend to have different epistemologies, in part because
change and reform, rather than maintenance of the status
quo, more frequently serves their social, cultural, political
and economic interest. (Banks, 2000)
The impact of interrogating the epistemology of health and
medicine, as well as representation and knowledge production,
is enormous. Historically, the construction of knowledge in
science is a cultural product. Science that has developed the
standards and boundaries of what is acceptable and unaccept-
able knowledge and practices (Garvin, 2001) is not value-free.
The culture and ideology of a society defines what knowl-
edge-based science we should seek. The infamous Tuskegee
syphilis research, that I will briefly discuss later, was conducted
on African Americans is one of the many examples of episte-
mological racism.
Traditionally, contingent relations between institutions,
groups, and social classes define the reliability of newly ac-
quired knowledge. Research agendas are, in a large measure,
set by those who have chosen careers in investigation. Individ-
ual and institutional curiosity depends on socio-economic status
and political perspectives. People’s views and research initia-
tives depend largely on their particular cultural, ethnic, and
conventional filters. Diversity is needed to set an appropriate
comprehensive research agenda—an agenda that targets the
needs of minorities that the dominant researchers consciously
or unconsciously are often reluctant to address.
The major goal of human beings is to live a life of “good”
quality and health. Individuals and institutional investigations,
however, tend to do research on problems that they see threaten
their own quality of lives. Peoples’ cultural and racially ethnic
backgrounds filter these perceptions (Cohen, 1997). Recogniz-
ing all of these realities leads to the theory that finding solu-
tions to specific health problems, or even being able to concep-
tualize those problems, requires a research work-force that is
racially and ethnically diverse. Establishing such diverse learn-
ing and teaching conditions should be the priority of higher
education.
For example, a statement from the American Sociological
Association made clear the importance of collecting data and
conducting social scientific research addressing issues of race.
According to this statement, failure to conduct research of this
kind seriously affects our society’s progress towards equity
(American Sociological Associations, 2003). In the same light,
denial of representation in teaching/learning is problematic.
While being treated with respect and dignity, racial and cultural
differences within our society must be noted. Denial of equal
representation would simply result in the maintenance of ine-
qualities.
One of the ways to challenge epistemological racism is by
having a racially diverse human agency. For example, as a re-
sult of affirmative action programs, US universities produced
black doctors to address, the health needs of their communities.
According to Ready (2001) and Cohen (1997), minority doctors
are more likely to practice in underserved communities and
address the health-care needs of the minority and disadvantaged
patients than other doctors. They better understand their cul-
tures, beliefs, and concerns. The work of Ready (2001) Cohen
(1997) suggests that racial and ethnic diversity in health and
medical schools is needed to ensure that minorities are not ex-
cluded from leadership and decision- making processes.
In health science literatures, it is well documented that the
health professional’s attitude toward the patients determines the
type and the quality of treatment that patients receive. Very
often health professionals’ attitudes towards patients depend on
their cultural resemblance between them. Vulnerable popula-
tions who live in disadvantaged socio-economic situations will
benefit most from dealing with minority health professionals
(Ready, 2001). It is clear that racial minority health profession-
als communicate better with racial minority patients. This sig-
nificantly improves towards the quality of services that such
patients receive.
By recognizing and respecting that there are different ways
of knowing, we can effect a positive change in teaching/learn-
ing practices and in doing so broaden health and medical sci-
ence knowledge, and improve health care efficiency. Student
diversity enhances the teaching and learning of health and
medicine for all students and such inclusive schooling is one
step towards preventing health disparity. The other area where
equity in health can be achieved in our community is through
representation in leadership. Racial and ethnic diversity in
health and medical schools is needed to ensure that minorities
participate in research and in policy-making decisions. Again,
here higher education can play a crucial role in bringing theory
into practice via appropriately training future health practitio-
ners, researchers, and policy-makers.
Education is the center for knowledge production and dis-
semination. In general terms, it has been widely accepted that
access to education is an important measure in the fight against
colonialism and racism. To increase the effectiveness of health
care in our society, we need to improve the cultural competence
of health professionals. Cultural competence is understood as a
set of congruent attitudes, behaviors, and policies that come
together in a system- individual, or among professionals—that
enables effective work in cross-cultural situations (Brach &
Fraserirector, 2000). Arguably, this culturally competency of
the professional depends on the social and cultural knowledge
of patients.
There are good reasons to attest that health, and medical sci-
ences, because it represents the society that produced it and
they are not neutral. It is reported that racist ideas prioritize and

B. DUGASSA
influence the kind of science that is actually studied and the
kinds of effects that necessarily follow. The case of sickle cell
anemia, which mostly affects people from geographic regions
in which malaria prevails, provides a striking example of pri-
oritization in research. Historical evidence in sickle cell re-
search clearly shows that sickle cell anemia was being ignored,
and that less significant diseases were funded and researched
(Barash, 1998). This makes clear that research agendas are
framed in accordance with the dominant interests. Until re-
cently the research agenda in health sciences are less about the
impact of the disease than it is about social and medical politics
(Michaelson, 1987).
It is well known that medicine had been racialized. In the
past, medicine used terms such as Drapetomia (irrational and
pathological desire of slaves to run away) and Dysaethesia
Aethopica (rascality) (Bhopal Raj, 1997). For example, when
pregnant black women suffer from iron and calcium deficiency
and crave clay, the term Cachexia Africana is used to explain
the cause of the problem which is thought of as mental and
cultural inferiority, rather than imposed poverty (Gonzalez et al.,
1982). The Tuskegee syphilis study is another good example of
race-oriented health science. The Tuskegee syphilis study ex-
amined the natural course of syphilis in 600 poor black Ameri-
cans in Alabama, denying them effective treatment and causing
many deaths (Gray, 1998).
Foucault (1976) suggests that historical analyses reveal the
rules of current practices. As discussed above racist medicine
considered the aspirations of brave men and women to live free
and independently as merely pathologic desires, which Linda
Smith refers to as “disciplining the colonial mind” (Smith,
2002). The numbers of black students dropping from high
school are reported to be high, but Dei (1996) argues that they
have not dropped out; rather, they have been pushed out. The
numbers of black prisoners are disproportionately high in both
Canadian and US. Here it is important to ask how many of the
imprisoned are a result of racism in policing, and/or judging;
how many of them imprisoned for resisting individual, institu-
tional, societal and epistemological racism. Essentially, the
desire of racial minorities to be free from racist hegemony has
been criminalized. It is important to ask how many of these
men and women would have been part of a higher educational
system and would have contributed to the ongoing knowledge
production and the social, economic and cultural transformation
of our society.
A recent HIV/AIDS vaccination experiment is another ex-
ample of the political nature of medicine. The experiment
looked into developing a vaccine against type-B HIV though it
is not the major cause of AIDS worldwide. Type-A and C HIV
are common in sub-Saharan Africa, India and China, whereas
type-B is widespread in North America, Europe, and Latin
America. Though 95 percent of AIDS patients are infected with
either type-A or C, the vaccination experiment was conducted
against type B HIV—conducted along global racial and politi-
cal power relations. When the result of the experiment was
reported, the vaccine appeared to be 78.3 percent effective in
blacks and 68 percent effective in Asians and only about 4 per-
cent effective in whites (Eaton, 2003). This displeased the stock
market. Soon after the findings of the vaccination trial were
reported, the company’s stock value dropped by 85 percent,
implying that a white company was not willing to finance a
project that only works for blacks and Asians (USA Today,
2003).
Racism determines whom to feed and whom to leave to
starve. It also determines relief agenda-settings, determining
what to feed people and whom to feed in cases where perhaps
relief foods are needed. As a result of the colonial legacy, many
people in several African countries are affected by famine. The
US government offered genetically modified foods to several
African countries (Associated Press, 2002), despite the fact that
the health effects of genetically modified foods (GMFs) are not
well known.
Representation and Policymaking
As Lorde (1984: p. 11) states “The master’s tools will never
dismantle the master’s house” to positively effect change in our
society and eliminate health discrepancies, it is important that
we provide an alternative to the Euro-centric ways of knowing.
As far as we know, the Euro-centric knowledge maintains an
interest in Euro-centric issues; it upholds the social, economic,
and ideological interests of the societies that have produced it.
The concept of policymaking is even more interesting when we
examine it in terms of race relations. When it comes to pol-
icy-making, knowledge can be used for purposes other than that
for which it was initially pursued. Though knowledge is power,
power is more important than knowledge in policy-making. As
argued before in this paper, science is a cultural product and it
protects the interests of the dominant group. When it comes to
policymaking, the application of information produced by re-
searchers is used for political and ideological purposes. Poli-
cymaking takes into consideration the culture and institutional
structures, and the processes underlying of decision-making. It
takes place in negotiation with the dominant actors. Hence po-
licymaking is more about political ideology than science.
In policy-making, understanding given phenomena and rec-
ognizing explicit values are influenced by the ideology (Garvin,
2001). The political nature of knowledge construction clearly
guides the use of the acquired knowledge in the policy-making
process. In policymaking, evidence and information are judged,
and even the broad definition of what constitutes evidence is
looked at from the perspective of socio-cultural and ideological
constructs. Let me offer a specific example. In Canada, the
provincial government provides social assistance to low-income
families. In general, the assistances that the low-income fami-
lies receive are geared to the number of family members.
However, given that shelter is the major expense, individuals
receive more money if they live in separate housing rather than
when they live together. In order to have their own apartment
many poor individuals prefer to live separately. This has con-
tributed to an increase in the number of single parents among
black communities. If this social policy were designed from the
perspective of black communities, couples that live together
and raise young children would have been rewarded and those
who choose to be separate would be penalized. If that were the
case, Canada would have reduced the number of single parents
and prevent public health issues that go with it.
Evidence and knowledge in policymaking are another area
where epistemological racism manifests itself. An agent, with-
out intending to discriminate, might apply reasonable deci-
sion-making rules that in practice lead to unequal treatment of
members of minority groups. Balsa and McGuire (2001) argue
that the dominant employers do not observe true productivity of
the minority groups. This results from the epistemological view
that racial minorities are required to serve the dominant group
368

B. DUGASSA
(Fredericks, 2009). It is also reported that health professionals
do not cater to the true health needs of racial minorities. Culture
and ethnicity have been shown to affect the interpretation of
health conditions and other aspects of health care. In addition
racial and cultural discordant physician-patient relationships
affect symptom communication and recogni t i on.
Many scholars such as Abma, 2002; Smith, 2002; Foucault,
1976 forcefully argue that, knowledge production is not a neu-
tral enterprise; it is a sociopolitical affair in which the power to
establish a dominant meaning plays a crucial role. For these
scholars, knowledge representation refers to the ways in which
researchers present their findings and share their information.
This is more than a matter of style. Representation includes the
choice of order used to connect parts and items, the portrayal of
people, and the perspective from which the account is told.
Epistemology toward Equity in Health Services
Constructionist theory suggests that knowledge is not essen-
tially obtained by objective means but constructed through
social discourses. In such thinking no single point of view is
universally valid (Jones, 2006). Feminist scholars (Doucet &
Mauthner, 2006) have developed three major powerful argu-
ments. The first point is all observations and fact-findings are
value tinged and the initial judgment play critical role whether
or not we conduct rigorous inquiry. Second, all scientific evi-
dences are sensory evidences. Third, knowledge is not acquired
individually but by communities and science communities are
epistemological communities. The anti-racist, indigenous and
feminist scholars emphasize the critical importance of epis-
temic agency and equal representation in teaching/learning and
researching the complex social problem of our world. They
propose that to bring a meaningful change in our world, the
ways in which we obtain knowledge about our social reality
and the procedures of research inquiry should be diverse and
compatible.
For this reason, under the epistemology of equity in health, I
promote the need to examine how studies in health and medi-
cine are conducted. Specifically, I suggest scholars to examine
the following: 1) how research methods are framed; 2) how
structures of knowing are planned; 3) how the knowledge pro-
duced is validated; 4) who contributes to the knowing process;
5) how research agendas are prioritized; and 6) how inclusive is
the knowledge that is produced.
According to Scheurich and Young (1997), racism is a com-
plex social problem, which they categorize into individual,
institutional, societal, and civilizational racism. By civiliza-
tional racism they imply that the ways assumptions are con-
structed about the nature of the world, and the way that experi-
ences are framed, are confined to a specific group. According to
these authors, most of the members of a given society are not
conscious that their views of the world are based primarily on
their own experiences. They do not know that their acquired
knowledge is not the only truth. These assumptions are deeply
embedded in how these members think, in the ways they define
“the world”, or in the ways they categorize and conceptualize
events. For this reason, Euro-centric civilization constructed the
world from its own perspective and assumptions, categorizing
other knowledge as unimportant and as uncivilized and subor-
dinate—a so-called secondary culture. The dominant group
made their home the center of the universe and they conceptu-
ally framed all other thoughts as invalid knowledge. They cre-
ated or constructed “the world” in their own image, their own
ways and from their own social historical experience.
Scheurich and Young (1997) consider civilizational racism to
be one of the worst forms of racism. For centuries civilizational
racism was invisible to both the colonized and the colonizers. It
is invisible to their lenses and is the one that many people par-
ticipate in without consciously knowing or intending to do so.
The current knowledge in health sciences is the products of sum
of centuries old research works planned to solve the needs of
the dominant group. Such knowledge unravels and serves the
dominant group. As we know, the life expectancy of blacks is
shorter than the life expectancy for the whites. The logic I am
trying to employ, at this point, is that euro-centric knowledge
theorized and made the African knowledge and culture inferior
to the Europeans, and discounted their health needs both with
and without awareness.
Most of the contemporary academic discourses are influ-
enced by racist discourse. Several discourses provided legiti-
macy to the European colonial policy that affected social
well-being of colonized people in a social Darwinian theory.
Darwin’s theory was a powerful tool for the colonizers. They
believed that the colonized and enslaved people were inherently
weak and therefore, at some point, would die out. Darwinian
social theory suggests that the shorter life expectancy of colo-
nized and enslaved people is due to their natural weakness, not
racism, exploitation and discrimination.
Foucault (1977) argued that knowledge is used as a tool of
domination, which is at work in schools as part of science, art,
and history. As such, dominant societies situate themselves as
the epistemological authority placing their community at the
center and the rest at the periphery. Because of institutional
racism, racially disadvantaged groups have fewer educational
opportunities, have poorer housing options, work for lower pay,
and live and work in high health-risk occupations.
As education plays a central role in coping with socio-eco-
nomic and environmental changes, it is timely to interrogate the
teaching, learning, and researching process. Education should
promote individual and community interest in solving social,
economic, environmental, and health problems. The future
educational system should promote the idea that to learn is to
construct and to reconstruct, as well as to critically observe the
word and the world. The decoding of the world, in turn, always
precedes the decoding of the words (Freire, 1970). Thinking
critically and examining the practices of yesterday and today
makes possible the improvement of tomorrow’s practices. It is
important to make use of history to guide the future.
It is important to realize that knowledge is used for the dis-
tribution of power. Slavery, colonialism, and neocolonialism
and health disparities are intrinsically linked to racial thinking.
As we know from animal science studies, the way farmers care
for animals depends on the products that they intend to harvest
from them. Often as they intend to harvest a high quality and
quantity of products, they compromise the health needs of these
animals. As in the past, the current capitalist economic theory is
dominated with seductive terms such as “efficiency”, “produc-
tivity”, and “profitability”. It is important to question whether
or not the idea of efficiency, productivity, and profitability
discount the health needs of racial minorities. We need to criti-
cally examine how research agendas are framed and prioritized,
and how the concept of efficiency, productivity, and profitabil-
ity influence research agendas in health and medicine.
There are good reasons to argue that education can take a

B. DUGASSA
central role in coping with change. The conventional methods
in which public health have been used were through health
education that encouraged people to live a healthy lifestyle and
encouraged behavioral changes. Lately, it has been shown that
life experiences that reinforce a sense of inferiority, powerless-
ness, and hopelessness severely limit the degree to which cer-
tain preconditions for health behaviors can be met (Sanders-
Phillips 2002).
Racist ideas are part of science, law, art, and business. As
such, education, which is supposed to be about choice and crit-
ical inquiry, has been used as an insidious device to indoctri-
nate people into accepting and supporting the attitudes and
outlooks of the dominant group (Ozmon, 1999; Dugassa, 2011).
Winanat (2000: p. 179) writing on the objectives of conven-
tional education said: If the inequality among racially defined
group was to be overcome, then this would require not only
interracial solidarity, but also race-conscious programs de-
signed to remedy the effects of discrimination.
Indigenous, anti-racist and feminist scholars have provided
us the background to rethink about pedagogy and research me-
thods. The ideas of these separate disciplines are that research
should not just advocate for tolerance between races and gen-
ders, but that it should help us create the conditions needed to
prevent discrimination and exploitation. It has been argued that
the educational plans for students and teachers’ expectations of
them might not be based on students’ performance but rather on
the status rankings of racial and ethnic groups (Li, 1988). White
teachers knowingly and unknowingly spend more time with
white students than racial minority groups. It is also known that
some white teachers devalue the knowledge and experience of
racial minorities. The logic I am employing is that in a socially
stratified society, the research objective, its methodology, and
the results of research must be widened. Only through such
research we can begin to see beneath the appearances created
by an unjust social order, and see the true reality of how this
social order is in fact constructed and maintained.
Power and politics always influence education and intellec-
tual work. The process of research, as well as the subjective
experiences and worldview of researchers, influences the ob-
jective, the methodology, and even the interpretation of the
research results. Institutions of a society serve the material,
political, and ideological interests of the society. Science and
scientists are bound to the social, economical, and cultural
norms in which they function. Banks (1995) argues that aca-
demic and public opinion leaders construct knowledge about
race; in turn, the ideas, assumptions, and norms of the culture in
which they are a part influence them. Higher education and its
research, and teaching and learning practices should be criti-
cally scrutinized to make sure they serve as a means of em-
powering all student body and community at large. However,
the current higher education system that was founded on the
Euro-centric knowledge is mainly re-enforcing the existing
hegemonic power relations.
Science and scientists are bound to the social, economic, and
cultural norms in which they function. For example, there are
substantial divisions between European, American, and
third-world scientists when it comes to the impact of Geneti-
cally Modified Foods (GMFs) on health. Many of third world
countries are facing enormous challenges to guarantee food
security to their citizens. In those countries scientists are in-
tended to increase their yield and accept biotechnology that
would increase yields. European scientists disapprove biotech-
nology in a fear of known and unknown risks. The position of
American scientists lies between the two groups. This clearly
shows the political nature of science and policymaking.
The processes of research as well as the subjective experi-
ences of researchers are currently subjects of much debate. We
know that most of the research that has transformed our mate-
rial world has been done with profit in mind. Such objectives
compromise and exploit the health needs of workers and racial
minorities. It is from this perspective that the dominant racial
groups often devalue the work done by racial minorities.
Discussions and Conclusion
Racism is a major global social problem. As it is part of
many academic fields, it is embedded in the epistemology of
health sciences and medicine. The ways in which health and
social policies are set, as well as the way research agendas are
framed, are not value-free. Representation is essential in defin-
ing research agendas, in prioritizing research topics and in the
policy-making processes. If there is no inclusion, racial minor-
ity groups and those on the bottom layer of the social structure
will suffer and health disparitie s wi l l persist.
Critically examining the racist practices of the past and pre-
sent is essential to pave the path to an improvement of future
practices. Change is needed in teaching and learning processes,
and higher education can be central to social transformation.
Understanding its central place in society, higher education
needs to examine teaching, learning, and researching practices.
Higher education needs to practically implement the idea of
empowerment in its teaching learning processes—as Freire
(1970) reaffirms, “to learn is to construct, to reconstruct and
critically observe the word and the world.”
In the past, excellence has been defined according to Euro-
centric perspectives: the mind set is that there is only one way
of knowing the world, and implying that the Euro-centric way
is that way. Such mindsets reinforce the notion that Europe is
the world’s center; the rest of the world lies in the periphery.
Sadly, this became the ideological “reasoning” for racism, sla-
very, colonialism, neocolonialism, and imperialism. Higher
education can help to redefine the concept of excellence that
centers on all diverse knowledge and experiences. To prevent
health disparity different types of knowledge, experience and
ways of knowing should be centered and education should pro-
vide students with a wider scope of understanding the world
and facilitate conditions for students to define their needs and
aspiration.
This paper has raised five major issues. The first issue is that
racism is a social construct that is intended, consciously or
unconsciously, to subordinate individuals and groups of people
based solely on skin color, cultural background or geographical
origin. Race emerged as a social construct useful not only for
classifying humans, but also for justifying the exploitation of
so-called inferior groups. The conceptualization of race has
been largely shaped by cultural, economic, and political con-
siderations, and has served important ideological functions in
society. It is conceivable that racism articulated the relations
between slaves and slaveholders, and serfs and feudal lords,
(Goldberg, 1999) defining a specific social-economic status that
had impact on the social well-being of people.
The second issue raised is that racism affects health because
it affects the social determinant conditions. Disparities in health
between different racial groups is mainly determined by so-
370

B. DUGASSA
cio-economic factors rather than by biological differences.
These disparities can be effectively tackled by appropriate so-
cial reform. The third point is that racist epistemologies priori-
tize the kinds of issues that are to be studied, defining them in
accordance with the kinds of effects that necessarily follow.
Racist epistemology affects how research agendas are set.
Though knowledge is not value-free political power is even
more important in the policy-making process. Knowing this can
lead us to the point where the idea of equity can only be
achieved if there is representation of racial minorities in con-
ducting research and in the policy-making process. Researchers
acquire the knowledge tool to conduct research from higher
education. It seems clear to me that higher education is at the
center, and that it can be vital in helping to create social change.
Last, physiologically human beings strive for quality of life
and this motivating factor can be used as a tool to measure the
absence or presence of racism and equity within our society.
Academia is the site of political struggles for socio-economic-
political transformation: it is one of the locations where ideo-
logical contests take place, including the anti-racist struggle. To
effect social transformation and prevent health disparities,
higher education must be accessible to racial minorities, and
excellence should be redefined and the standpoint of racial
minority groups should be taken into consideration. Research
goals must be defined within the perspective of the marginal-
ized people rather than from the perspective of profitability.
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