Klepac and colleagues‘ scoping review of climate change, malaria and neglected tropical diseases: what about the epistemic significance of health worker knowledge?
The scoping review by Klepac et al. provides a comprehensive overview of codified academic knowledge about the complex interplay between climate change and a wide range of infectious diseases, including malaria and 20 neglected tropical diseases (NTDs).
The review synthesized findings from 511 papers published between 2010 and 2023, revealing that the vast majority of studies focused on malaria, dengue, chikungunya, and leishmaniasis, while other NTDs were relatively understudied.
The geographical distribution of studies also varied, with malaria studies concentrated in Africa, Brazil, China, and India, and dengue and chikungunya studies more prevalent in Australia, China, India, Europe, and the USA.
One of the most striking findings of the review is the potential for climate change to have profound and varied effects on the distribution and transmission of malaria and NTDs, with impacts likely to vary by disease, location, and time.
However, the authors also highlight the uncertainty surrounding the overall global impact due to the complexity of the interactions and the limitations of current predictive models.
This underscores the need for more comprehensive, collaborative, and standardized modeling efforts to better understand the direct and indirect effects of climate change on these diseases.
Another significant insight from the review is the relative lack of attention given to climate change mitigation and adaptation strategies in the existing literature.
Only 34% of the included papers considered mitigation strategies, and a mere 5% addressed adaptation strategies.
Could we imagine future mapping to recognize the value of new mechanisms for and actors of knowledge production that do not meet the conventional criteria for what currently counts as valid knowledge?
What might be the return on going at least one step further beyond questioning our own underlying assumptions about ‘how science is done’ to actually supporting and investing in innovative indigenous- and community-led, co-created initiatives?
This gap highlights the urgent need for more research on how to effectively reduce the impact of climate change on malaria and NTDs, particularly in areas with the highest disease burdens and the populations most vulnerable to the impacts of climate change.
While the review emphasizes the need for more research to fill these evidence gaps, this begs the question of the resources and time required to fill them.
This is where there is likely to be value in the experiential data from health workers on the frontlines to provide insights into the mechanisms of climate change impacts on health and effective response strategies.
The upcoming Teach to Reach 10 event (background | registration) , a massive open peer learning platform that brings together health professionals from around the world to network and learn from each other’s experiences, offers a unique opportunity to engage thousands of health workers in a dialogue that can deepen our understanding of how climate change is affecting the health of local communities.
Experiential data has been, historically, dismissed as ‘anecdotal’ evidence at best.
The value and significance of what you know because you are there every day, serving the health of your community, has been ignored.
The expertise and knowledge of frontline health workers are often overlooked or undervalued in global health decision-making processes, despite their critical role in delivering health services and their deep understanding of local contexts and challenges.
Yes, the importance of incorporating the insights and experiences of health workers in the global health discourse cannot be overstated.
As Abimbola and Pai (2020) argue, the decolonization of global health requires a shift towards valuing and amplifying the voices of those who have been historically marginalized and excluded from the dominant narratives.
This concept, known as epistemic justice, recognizes that knowledge is not solely the domain of academic experts but is also held by those with lived experiences and practical expertise (Fricker, 2007).
Epistemic injustice, as defined by Fricker (2007), occurs when an individual is wronged in their capacity as a knower, either through testimonial injustice (when a speaker’s credibility is undervalued due to prejudice) or hermeneutical injustice (when there is a gap in collective understanding that disadvantages certain groups).
In the context of global health, epistemic injustice often manifests in the marginalization of knowledge held by communities and health workers in low- and middle-income countries, as well as the dominance of Western biomedical paradigms over local ways of knowing (Bhakuni & Abimbola, 2021).
By engaging health workers from around the world in peer learning and knowledge sharing, Teach to Reach can help to challenge the epistemic injustice that has long plagued global health research and practice.
By providing a platform for health workers to share their experiences and insights, Teach to Reach – alongside many other initiatives focused on listening to and learning from communities – can contribute to ensuring that the fight against malaria and NTDs in the face of climate change is informed not only by rigorous scientific evidence but also by the practical wisdom of those on the ground.
That is only if global partners are willing to challenge their own assumptions, and take the time to listen and learn.
Moreover, the decolonization of global health requires a shift towards more equitable and inclusive forms of knowledge production and dissemination.
This involves challenging the historical legacies of colonialism and racism that have shaped the global health field, as well as the power imbalances that continue to privilege certain forms of knowledge over others (Büyüm et al., 2020).
By fostering a dialogue between health workers and global partners, Teach to Reach can help to bridge the gap between research and practice, ensuring that the latest scientific findings are effectively translated into actionable strategies that are grounded in local realities and responsive to the needs of those most affected by climate change and infectious diseases.
The value of experiential data from health workers in filling evidence gaps and informing effective response strategies cannot be understated.
As the Klepac review highlights, there is a paucity of research on the impacts of climate change on many NTDs and the effectiveness of mitigation and adaptation strategies.
While more rigorous scientific studies are undoubtedly needed, waiting years or decades for this evidence to accumulate before taking action is not a viable option given the urgency of the climate crisis and its devastating impacts on health.
Health workers’ firsthand observations and experiences can provide valuable insights into the complex mechanisms through which climate change is affecting the distribution and transmission of malaria and NTDs, as well as the effectiveness of different intervention strategies in real-world settings.
This type of contextual knowledge is essential for developing locally tailored solutions that account for the unique social, cultural, and environmental factors that shape disease dynamics in different communities.
Furthermore, engaging health workers as active partners in research and decision-making processes can help to ensure that the solutions developed are not only scientifically sound but also feasible, acceptable, and sustainable in practice.
The involvement of frontline health workers in the co-creation of knowledge and interventions can lead to more effective, equitable, and context-specific solutions that are responsive to the needs and priorities of local communities.
