The Pathogenic Episteme: Addressing Public Health Underdevelopment in Africa

Background: Health and disease are socially constructed phenomena, shaped by the interplay of knowledge and power that determines the distribution of social determinants of health. The underdevelopment of public health in Africa is rooted in both historical and contemporary injustices. Racist policies, founded on beliefs in racial and cultural superiority, established frameworks of moral inclusion and exclusion that designated African people as “outsiders” and subjected them to exploitation. Achieving the core mission of public health requires a critical examination of the pathogenic effects of the racist episteme that informed the theories and practices enabling subjugation. Objectives: Existing research on Africa’s experience under slavery and colonialism has primarily focused on themes of exploitation, assimilation, and power. Analyses within public health have largely examined factors such as military mobility and the transmission of infectious diseases. However, the influence of foundational knowledge systems has received limited attention. This study investigates the impact of racist epistemologies on public health in Africa by employing the framework of upstream thinking. Methods: The “upstream” metaphor is utilized to analyze and understand the complex landscape of public health issues in Africa, drawing connections between historical and contemporary contexts. By examining the racist episteme as the foundational source of numerous public health challenges, this approach demonstrates how entrenched racism functions as a root cause, shaping public health outcomes across the continent. Findings: A racist episteme shapes policy decisions that exploit African populations, thereby exacerbating poverty, food insecurity, and water scarcity, and generating pathogenic social conditions. Eliminating the pervasive and harmful racist episteme and promoting Afrocentric knowledge production represent significant steps toward empowering populations across Africa.