Epidemiology and (neo-)colonialism

Reflecting on the complex and important issues raised in the paper by Luis Aviles in this issue of the journal,1 I would like to discuss an example of how a recent shift in the epidemiological approaches used by researchers at an international agency may both mirror the underlying assumptions and reinforce the practice of neocolonialism. As experienced by many low income countries today, “neocolonialism” refers to the replacement of colonial powers' direct political and military control with indirect economic control by multilateral international lending agencies, bilateral donors (often including the former colonisers), and private, corporate investors from affluent countries. Underlying this new order are the basic free market assumptions that aggregate economic growth is the ultimate measure of societal development, and that optimal growth can only be attained when market forces are unimpeded by policies designed to redistribute wealth.

What is the relevance of these political and economic issues to epidemiology? For centuries, strong links between health and socioeconomic status/position (SES) have been demonstrated across diverse settings and health measures. Given that evidence, and the widening disparities in wealth occurring in countries of all income levels, many have argued for routine reporting and analysis of health information disaggregated by markers of SES.2-6 This perspective supports ongoing monitoring of social inequalities in health (SIH) within countries, that is, health disparities between subnational population groups defined by social factors such as poverty/wealth. With the goal of providing data needed to …