• Ethics- Medical

In social systems or spaces, distance between the centre and the periphery breeds epistemic injustice. There are growing accounts of epistemic injustice in health-related fields, as in the article by Pratt and de Vries.1 The title of the article asks: ‘Where is knowledge from the global South?’ Like me, you may answer by saying: ‘Knowledge from the global South is in the global South’. That answer says a lot about how we right epistemic injustice done to actors in the global South or the periphery, including in health ethics. Pratt and de Vries identified four sets of actors (individuals, institutions, journals and funders) responsible for righting epistemic injustice. For three of the four sets of actors, they recognised the need for—or the possibility of—symmetry between global North and global South. Except journals. They did not seriously consider that journals are either present in or could belong to the global South; to the periphery.

Platforms for knowledge exchange, circulation, cultivation and curation—such as journals, conferences, publishers, blogs, archives, seminars, books and the media, social or traditional—are neither physically nor epistemically neutral. They are situated. The BBC cannot do for Nigeria or Australia what it does for Britain; neither can the BMJ. Many of us take our position at the centre or periphery as neutral, natural, necessary or permanent. But the African American writer Toni Morrison proved the opposite with her career: ‘I stood at the border, stood at the edge and claimed it as central. l claimed it as central, and let the rest of the world move over to where I was.’2 Although physically in the USA, Toni Morrison was writing from the epistemic global South. The periphery must claim centrality by itself or have centrality claimed on its behalf. It would take a two-sided transformation in which: one, we provincialise global North platforms; and two, we centralise global South platforms. Epistemic justice requires a pluriversal, polycentric world without a dominant epistemic centre.

It is far more important to strengthen and build global South knowledge platforms than it is to include global South voices on global North platforms. I will make my case from two perspectives:

First, in relation to gaze; that is, the power of your audience or interlocutors to shape your writing, knowledge production, or research.3 The primary function of knowledge platforms is connection.4 Your audience matters enormously if you are going to connect your system or space to more of itself so that it can learn from and about itself.4 With such connection in social systems or spaces, there is greater use of local knowledge, stronger accountability relations, collective sensemaking, development and honing of situated interpretive tools, and social production. As argued by Toni Morrison, ‘Black music… is as splendid and complicated and wonderful as it is because its audience was within; its primary audience. …It has become universal, worldwide… because it wasn’t tampered with, and editorialised, within the community.’2 To focus primarily on a global North audience and interlocutors is to weaken or sever connections. The conversation people of the global South want to have among themselves is different from the one they may want to have with the global North.

Second, in relation to pose; that is, whom you are writing, producing knowledge or conducting research as—your standpoint.3 Toni Morrison knew that the periphery or ‘being a black woman writer’, ‘is not a shallow place but a rich place to write from. It does not limit my imagination; it expands it. It’s richer than being a white male writer because I know more and I’ve experienced more.’5 The periphery is rich in part because knowers at the periphery are grounded in the ways of the periphery, must learn the ways of the centre, while also continuously making sense of the dissonance. Holders and sense makers of health ethics knowledge in the global South know more and have experienced more for being at the periphery. Platforms on which such knowers engage among themselves are sites that global North knowers should visit regularly to learn, with occasional contributions therefrom to global North platforms. Toni Morrison also connected her epistemic global South position to the physical global South position when she said: ‘The people who helped me most arrive at that kind of language [of the periphery] were African writers… Those writers who could assume the centrality of their race because they were African, and they didn’t explain anything to white people.’6 African literature flourished in the 1960s and the decades after in part because of a platform that was nurtured by Africans to publish African writers primarily for African audiences: the African Writers Series,7 edited for a decade by the Nigerian writer Chinua Achebe whose novel Things Fall Apart was described by Toni Morrison as being ‘more important to me than anything only because there was a language, there was a posture, there were the parameters, I could step in now, and I didn’t have to be consumed by or concerned by the white gaze’.6

Table 1 shows how one’s pose and one’s gaze have specific implications for testimonial and hermeneutical injustice.8 The examples in table 1 indicate the ameliorative potential of strong global South platforms for knowledge exchange, circulation, cultivation and curation. In their article, Pratt and de Vries included an important list of actions to right epistemic injustice.1 To this list, I will include efforts to strengthen and build global South platforms for knowledge exchange, circulation, cultivation and curation—by the same set of knowledge actors they had identified—individuals, institutions, journals (and other knowledge platforms) and funders.

It is easy for those of us who have managed to imagine ourselves into the centre of the world to think that the periphery can only exist in relation to us; in relation to the centre. It is easy for us to think that the periphery cannot exist on its own terms. If a tree falls in the forest and there’s no one there to see it, did it actually fall? Or, in our case, if people know things at the periphery and their knowledge is not available on platforms that belong to the centre—or their knowledge is not intelligible to people at the centre—do they actually know things?

We mustn’t give in to the notion that the global South must come to the global North’s table to be seen as knowers. When we raise concerns about ‘missing’ voices or ‘less heard’ voices in scholarship, we must remember to ask: missing from where; less heard by whom? The voices are present and are well heard in some spaces—global South spaces or supposedly peripheral spaces; the kind of spaces that Toni Morrison described as ‘where the soil was’, ‘where the fertility was’, and ‘this place that was so precious to me’.2 We must strengthen and build platforms that allow knowledge to thrive in those spaces. In a pluriversal, polycentric world, those spaces and their knowledge platforms would also be central in our imgination. Without prompt, they would become where we go to seek and find ‘knowledge from the global South’. Our ability to hear global South voices from where we stand, or include global South knowledge on our platforms, is of secondary importance. We shouldn’t be surprised that global North platforms significantly under-represent global South knowers.

We distance ourselves from the periphery—by virtue of our central location, physical or epistemic—and we wonder or even ask: why can’t we access knowledge from the periphery? It is a colonial conceit. To strengthen or build global South knowledge platforms is to repair what colonialism destroyed. It is reparative. The periphery—physical or epistemic—owes the centre, any centre, nothing. To expect that knowers at the periphery must play on the centre’s court—and that if they are not playing on the centre’s court, then they are not in the game of knowledge—is the kind of expectation that breeds epistemic injustice.