Epidemic Illusions: On the Coloniality of Global Public Health

by Eugene T. Richardson, Paul Farmer (Foreword)

A physician-anthropologist explores how public health practices--from epidemiological modeling to outbreak containment--help perpetuate global inequities.In Epidemic Illusions, Eugene Richardson, a physician and an anthropologist, contends that public health practices--from epidemiological modeling and outbreak containment to Big Data and causal inference--play an essential role in perpetuating a range of global inequities. Drawing on postcolonial theory, medical anthropology, and critical science studies, Richardson demonstrates the ways in which the flagship discipline of epidemiology has been shaped by the colonial, racist, and patriarchal system that had its inception in 1492. Deploying a range of rhetorical tools and drawing on his clinical work in a variety of epidemics, including Ebola in West Africa and the Democratic Republic of Congo, leishmania in the Sudan, HIV/TB in southern Africa, diphtheria in Bangladesh, and SARS-CoV-2 in the United States, Richardson concludes that the biggest epidemic we currently face is an epidemic of illusions—one that is propagated by the coloniality of knowledge production.

Genres: Nonfiction, Medicine, Health, Science, Anthropology, History, Health Care

208 pages, Kindle Edition

First published January 1, 2020

About the author

Eugene Richardson is a physician and ecological anthropologist based at Harvard Medical School. His overall focus is on biosocial approaches to epidemic disease prevention, containment, and treatment as well as the health effects of climate change.

Reviews

[Seiji Yamada · Rating 5 out of 5]

With this thin volume (143 pages, with 46 pages of notes), Eugene Richardson takes to task the discipline of epidemiology, and with it, public health. Utilizing the West Africa Ebola epidemic of 2013-2016 as his canvas, Richardson paints a picture that highlights the racism that undergirds the conventional medical and public health perspectives. When the people of the region have been subjected to centuries of slavery, colonial subjugation, and wealth extraction - why would they not be suspicious of public health measures that strive to contain the epidemic but offer little in the way of treatment? When caregivers fall ill for attending to their loved ones, particularly after they die – why are they blamed for their “backward” beliefs?

The parallels to the COVID-19 catastrophe in the U.S. are obvious. It is structural racism that relegates minorities to crowded, multigenerational housing and essential work with no paid sick leave. Structural violence leads to infection and death. This year, everybody has learned a little epidemiology: we all now know about epidemic curves and R0. But also, during this year, we have gained a better understanding of white supremacy - which we had trouble seeing before because it is the water that we fish swim in. Black Lives Matter has helped the scales fall from our eyes. Epidemic Illusions serves that function for epidemiology. It shows us how global public health is itself fraught with white supremacy and colonial assumptions. It is a book for our times.

[Brad · Rating 5 out of 5]

I absolutely devoured this book. Richardson's antiracist message on the coloniality of epidemiology really resonated with me. This gave me great context for the decolonization movement that's currently gaining ground in the field of global health. I feel better-informed after reading Epidemic Illusions and am eager to bring these ideas into my work. While Richardson's 'carnivalized' approach to writing may not be for everyone, I personally enjoyed the style of the book. I highly recommend it to anyone interested in public health, decolonizing humanitarian aid, and/or antiracist literature.

[Allie · Rating 5 out of 5]

One of the best

[Degenerate Chemist · Rating 5 out of 5]

"Epidemic Illusions" is how our global health systems are an extension of colonialism and a tool for spreading neoliberalism. The focus of the analysis is on the West African Ebola pandemic in 2013-2016.

Richardson is an excellent author, well versed in the writings of Nkrumah and Fanon. His redescriptions are invaluable in helping the reader understand what was happening in West Africa. In short, the sick often went untreated despite there being effective treatments available. Containment prioritized over healing. The health organizations were more interested in collecting data than caring for the sick. Ebola superspreader events were allowed to continue in the name of corporate wealth.

If this sounds familiar, it should. What we allow to happen to the vulnerable will eventually come to bite us in the ass.

This book was a hard read, but it is absolutely essential reading.

[Evan · Rating 5 out of 5]

Dr. Richardson, “a white upper-middle-class male settler-colonist privilege-exerciser” (his words not mine) has chosen to use his access, privilege, and expertise - not to continue the predatory accumulation of capital be it political, academic, or monetary - but instead, with self-awareness typically exercised by those outside white America, to dismantle the inherent and often unquestioned moral, political, and economic values and choices masquerading as the “one” truth in epidemiology. Epidemic Illusions contains lessons to be applied in any field where inequality is epidemic.
- Evan Whitfield, Olympian, Lawyer, Sports Equity Activist, VP of Equity - Chicago Fire FC

[Denisse Descamps · Rating 5 out of 5]

I really enjoyed this book, particularly as someone who has been struggling with how global health epidemiology, and many other branches of public health, perpetuate neocolonialist structures and imperialism, and how to further navigate these concepts as an Epidemiology student. Although I wish the book was written in simpler language because I believe it is not a book only epidemiologists or public health professionals should read (and it was quite dense at times), I think it is an incredibly powerful book that should shape the way we practice public health.

[Matthew Loftus · Rating 3 out of 5]

A very weird book, written by someone who is clearly brilliant but perhaps always trying to be a little too clever. I don't know; maybe it would be eye-opening for someone who works in global health who has never thought of any of the things the author discusses. For me, I knew from the start that I more or less agreed with his basic premise and so nodded along with the weirdness.

[William Reynolds · Rating 5 out of 5]

Incredibly concise and well written. With stories which add real grounding to the stats and facts. Adore the anti-Western structure employed here, just think it does dip a bit too much into inaccessible academic language. However must read if you’re interested in decolonisation in a health context.

[jaya · Rating 5 out of 5]

just looked this guy up .. did NOT expect him to look like that
anyway i love it i think it's very illuminating and i appreciate his nonconformist way of writing this

[Megan Lee · Rating 4 out of 5]

Dear Jillian and Joaquin,,,,


To be so real this was a TOUGH read. I just think I might’ve been a bit too dumb for this one, but from what I DID grasp it was really good, and he brought up really good points on how structurally we keep colonialism alive in public health and how detrimental it can be to the countries we’re aiming to “help”. But again too many words beyond my vocabulary🥴🥴🥴

On to the next before the coffee gets cold!!😋☕️

Cheers,
Megan

[Rebecca (Jones) Antwi · Rating 5 out of 5]

Picked this up as prep for a class in the fall, but feel this should be required reading for anyone in public health. Excellent read

[Ally Perrin · Rating 4 out of 5]

Without a historically deep inquiry, one that “successfully” parameterizes (i.e., turns into variables for computational modeling purposes) political-economic forces, unwitting social scientists serve as “mechanisms of normalization [dispositifs de normalisation]” for core neoliberalii tenets under the guise of disinterested objectivity (and with the goal of accruing academic capital). Another way of saying this is that they serve as the organic intellectuals of neocolonialism. For future infectious disease outbreaks, a radical reframing of computational epidemiology—and other such “monocultures of the mind” for that matter—is in order, one that transcends the blinkered logic of protected affluence and global health coloniality (Equation 1) to find ways of parameterizing the effects of the Maafa, exploitative colonialism, purposeful underdevelopment, structural adjustment, resource extraction, illicit financial flows, and gender violence, inter alia.

[Soniya · Rating 5 out of 5]

A short, but dense book that questions the "neutrality" of public health science, epidemiology and knowledge construction using the 2013 - 2016 Ebola crisis in West Africa as a prime example. I had the privilege of listening to Dr. Richardson speak about his work and I cannot recommend this book enough. As someone who is passionate about decolonisation and unlearning coloniality, this book has provided me with greater understanding, but also tools on how to navigate the field of colonial global health.

[Dinithi · Rating 5 out of 5]

I read this book as part of my interdisciplinary PhD investigating disease ecology in a village near national park in Uganda. I am hoping to blend molecular/bioinformatic methods of studying disease emergence with social methods as a way of not only producing better results but also of committing to my faith in epistemic justice. I am sure this book will be tattered and dog-eared by the time I complete my research!

[Kate · Rating 5 out of 5]

Short but dense read—and well worth it. Implicates the field of epidemiology and global health practitioners (including WHO and the Gates Foundation) in (often unintentionally) reinforcing coloniality and attendant violence in the Global South. Thanks to Richardson I will certainly think twice before using or accepting the usage of the term ‘superspreader’ in the future.

[Courtney · Rating 4 out of 5]

Read this for a paper I'm writing about neo-colonialism within global public health. I liked the ironic and playful style of this; I thought it was very unique. However it was extremely dense, which makes sense given the academic audience. But it's an important message and I wish that there was a simpler version to make it more accessible.

[Natalie Paul · Rating 5 out of 5]

Very thought-provoking. It truly challenged most of the assumptions I have been taught in my training as a nurse practitioner around public health. I think there are many parallels in the colonialism in how the UN and WHO mismanaged the Ebola outbreak in west Africa and how COVID-19 is being treated. It’s like the dehumanization is spreading to include everyone outside the ruling elite.

[Nai Kalema · Rating 5 out of 5]

An amazing read for all social scientists!

I highly recommend this book for people interested in health equity and decolonizing knowledge production. I think this book is an excellent read.

[Syakirah ◡̈]

Picked up this book just for fun because I like reading books that are light (fiction) and heavy (non-fiction) at the same time. Though I only fully understand like 12% of it, I somehow enjoy the book. Made me interested to pick up books related to this topic!

[Aurea Cunanan · Rating 4 out of 5]

Prompt and straightforward book. A good book to read in conjunction with other books - for example, the Paul Farmer book has on Ebola or Kwame Nkrumah. I thought it was a good read, I would like to see if there's a second volume in the midst of the COVID epidemic as it just brushes it.

[Tessa Adzemovic · Rating 5 out of 5]

This book was described to me as wild, interesting, and stimulating, it is certainly those three and more. I’m re-starting just as I finished.

[Zoe Hughes · Rating 5 out of 5]

One of my all-time favourite books.

[Nehemiah Olson · Rating 5 out of 5]

One of the most creative and subversive books I’ve ever read. Incredible writing that pulls you in, makes you think, and gives one joy.

[Olivia · Rating 5 out of 5]

dank

[Nate Foster · Rating 3 out of 5]

Interesting critical work on how global public health science isn’t the objective practice it claims to be, and that global public health outside of the West should correctly be understood within a framework of historical and ongoing exploitation, towards the interests of what Richardson calls “protected affluence.” Western health science is described as a system of knowledge production that institutionally establishes a series of supposedly objective truths about public health, “an institution which reproduces the conditions of the social order.”

I don’t know how to feel about the critical/postcolonial theory this book is grounded in. I do think it’s important to map out the power relations and social forces that inform people’s understandings, but the ensuing critique ends up coming off as way too absolute and relativistic. All of this talk about subverting universal knowledge frameworks and yet it feels like “coloniality” is being claimed as this universally enlightening idea. Definitely interested in learning more.

Also the constant emphasis on critical language and “redescription” in the book was tough to get through at times. Sometimes it worked well (like his research article showing how African women at risk for HIV would see the greatest reduction in incidence by changing their race), sometimes it did way too much (fictional Kwame Nkrumah using ze/zir pronouns to describe decolonization in an altered version of Plato’s cave allegory).

Still learned a lot of good stuff from this book, and it was entertaining to say the least.

[David Martin · Rating 2 out of 5]

Eugene Richardson offers a critique of global public health and epidemiology.
I share his concern about the pervasive coloniality in current global public health, and there were parts of this book that inspired further reflection.
However, I ultimately just didn’t enjoy what came out of his „carnivalization“ and his so-called „ironist“ approach. Moreover, I found the introduction was in need of significant editing; I found it unorganized and just a bit too much trying to sound clever.
From what I learned about Richardson from the book, I respect his commitment to lived solidarity and his passionate call for global health equity. His goal of unveiling coloniality in our science and praxis is an important one, and I appreciate his efforts to bring this to light. However, I’m just not convinced this book is the most successful in achieving that aim, and I personally found it quite unappealing.

[Eileen Wood · Rating 4 out of 5]

I want to read this because I read a review on Twitter.

[Nai K. · Rating 5 out of 5]

Highly recommended read!

[Zaid · Rating 3 out of 5]

Brilliant message. Disappointing delivery.

[David Roach · Rating 5 out of 5]

Great take on the global health community and a must-read for researchers in the field. It is humorous but also touches on important truths that we should all grapple with.