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Neocolonialism and epidemiology

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    The International Conference on Health Research for Development celebrated last year in Bangkok provided the stimulus for a special issue of the BMJ related to global health and the governance of global health research was discussed. Several papers emphasised the need to turn round the inequitable nature of health research. The effect on health research of the interests and conditions posed by the international funding bodies was considered also as an important concern.

    There is a general agreement on the need in producing high quality research that tackles the major health problems of developing countries. However, matters related to the theories that drive the research and how these theories and methodological approaches affects health policy making are not frequently considered.

    The JECH has published papers and debates on epidemiological theories. In this issue we welcome an especially important debate: the way in which institutions devoted to international development create a discourse that influences the conduct of epidemiological studies is examined. A paper by Luis A Avilés has been an occasion to trigger off the debate. Four invited commentaries approach the topic in a greatly diverse way.

    The paper by Avilés is a case study based upon theEpidemiological Profile, a document sponsored by the United States Agency for International Development (USAID). According to Avilés, the USAID report illustrates how epidemiological assessments are imbued with theoretical assumptions shaped by the institutional setting under which the research is conducted thus resulting in a neocolonial practice of epidemiology. Charles Poole, using the same documents discusses the points raised by Avilés and poses some interesting and difficult questions. Mauricio L Barreto, Naomar de Almeida-Filho and Jaime Breilh highlight the contribution of Avilés' paper as a reference regarding the misuse of epidemiology in the context of international politics. They also point out a relevant aspect of Avilés' paper. According to them the paper fails to build a North-South partnership omitting the intellectual efforts of Latin American scholars. Paula A Braveman, provides an excellent example showing how a recent shift in the epidemiological approaches used by researchers at an international agency may both reflect the underlying assumptions and reinforce the practice of neocolonialism. She also claims for more rigorous scrutiny and open debate on the assumptions that underlie the epidemiological analysis. Finally, Tim Lang, after describing the present world situation as neo-mediaeval, demands our compromise in providing an evidence base for just and equitable public policy and practice.

    Clearly this debate is not finished with these contributions, the international epidemiological community needs an open space for further discussions in this topic. The JECH will be receptive in the future to contributions adding perspectives to the questions posed in this issue: is epidemiology a colonial biased science?