Engaging Antiracist and Decolonial Praxis to Advance Equity in Oregon Public Health Surveillance Practices
Health Affairs (2024)
Ryan J. Petteway, Daniel F. Lopez-Cevallos, Mira Mohsini, Andres Lopez, Roberta Suzette Hunte, Tim Holbert, and Kusuma Madamala
Abstract
Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle it. Here, we outline a critique of standard surveillance systems and practice, drawing from the social epidemiology, critical theory, and decolonial theory literatures to illuminate matters of power germane to epistemic and procedural justice in the surveillance of communities of color. We then summarize how community partners, academics, and state health department data scientists collaborated to reimagine survey practices in Oregon, engaging public health critical race praxis and decolonial theory to reorient toward antiracist surveillance systems. We close with a brief discussion of implications for practice and areas for continued consideration and reflection.
“The standard BRFSS telephone interview is, effectively, the poster child of testimonial quieting. These surveys have limited ability to produce anything other than narratives of risk and vulnerability because their existence and use is premised on an epistemology of deficits, damage, and needs anchored in logics of White supremacy and settler colonialism. They were not conceived, nor are they designed or implemented, with matters of epistemic justice or antiracism in mind; they are, in effect, the quintessential “master’s tool.””
“Addressing the consequences of structural racism necessitates addressing the structurally racist, settler-colonial logics that have guided public health surveillance systems and data practices to date. These are not matters of a separate discourse; they are fundamental to any serious conversation in which racism has been declared a public health crisis. There is no future in which public health becomes antiracist without dismantling the racism and settler colonialism latent within its public health surveillance systems and data practices”