Review of Epidemic Illusions: On the Coloniality of Global Public Health. Eugene Richardson, Cambridge, MA: MIT Press, 2020, 232 pp.

Reviewed Book

Epidemic Illusions: On the Coloniality of Global Public Health. Eugene Richardson, Cambridge, MA: MIT Press, 2020, 232 pp.

Epidemic Illusions: On the Coloniality of Global Public Health. Eugene Richardson, Cambridge, MA: MIT Press, 2020, 232 pp.

Cover of Epidemic Illusions (2020)

Andrew Wooyoung Kim

University of California, Berkeley

Eugene Richardson’s Epidemic Illusions: On the Coloniality of Global Public Health unveils the conservative politics of modern public health science and epidemic management and their insidious perpetuation of global health inequities. Using a collection of ethnographic evidence, semiotic analysis, and literary techniques, Richardson argues that public health institutions in the Global North undermine their own ambitions to advance health equity through various means that, instead, preserve their own “protected affluence” and amplify disease transmission in the Global South. Despite the physician–anthropologist’s extensive work with numerous infectious disease epidemics, he notes that the most striking epidemic contributing to health inequalities is “an epidemic of illusions—an epidemic propagated by the coloniality of knowledge production” (p. 5).

Richardson collates perspectives on critical and postcolonial theory, decolonial thought, semiotics, and critical medical anthropology to ground and execute his conceptual apparatus that is “coloniality,” which he defines as “the racial, political economic, social, epistemological, linguistic, and gendered hierarchical orders imposed by European colonialism that transcended ‘decolonization’ and continue to oppress in accordance with the needs of pan-capital accumulation” (p. 3). Throughout the text, Richardson illuminates how the coloniality of global public health science functions through the logics and authority of epidemiological knowledge production as well as the symbolic violence (re)produced by representations of disease inequality from major global health actors. These include public health programs at elite universities (e.g., Harvard School of Public Health), NGOs (e.g., Partners in Health), and multilateral institutions like the World Health Organization, all of which are sites of analysis (and past employers) for the author.

While Richardson sets out to uncover the colonially driven epistemic violence of global health practice, his larger intention is to “struggle against those forms of power where he is both instrument and object” (Deleuze and Foucault 1972 in Richardson, p. 13) and to develop his own episteme of the “Havenot-istemic,” or “subjugated ways of interpreting phenomena that do not become hegemonic, owing to the social position of their creators and their often-destabilizing ramification for global elites” (p. 7). This perspective of “border gnosis” is poignantly reflected throughout many aspects of the book (or, as he describes it, his “pseudomonograph”), such as the use of ironist and carnivalesque literary styles and “redescriptions” instead of chapters. These redescriptions include a mix of ethnographic analysis, “flash fiction” and allegories, and critique of epidemiological case studies to illuminate the illusions of global health science. Readers will likely find this approach unconventional and at times confusing or nonsensical, but this unorthodox form is Richardson’s attempt to disrupt the traditional epistemological techniques of social science research and colonial knowledge production that may make way for new academic interventions and a more mindful and critical scientific practice.

Throughout several of his redescriptions, Richardson walks us through multiple concrete examples of epidemiological practice that highlight how “tangible sources of exploitation disappear behind the facades of objective rationality” (p. 46). The deconstruction of the logic, assumptions, and mechanisms of epidemiological analysis and the process of empirical inference in studying disease epidemics (such as rates of Ebola virus transmission, HIV/AIDS morbidity, and mortality rates) is one of the strengths of this book. For instance, Richardson criticizes a highly regarded gold-standard method and subdiscipline in epidemiology—causal inference—which allows researchers to make causal conclusions using quantitative data based on key assumptions, study designs, and statistical techniques. Richardson shows how “causal” pathways conceptualized by epidemiologists to understand mechanisms resulting in disease transmission typically omit variables related to historical or structural determinants, eliding the illicit financial flows, architected underdevelopment, and exploitative systems of oppression that contribute to poor individual health and broader disease dynamics (Redescription 6).

He contrasts this quantitative and behavioralist inquiry with ethnographic interview data that highlight counterdiscourses raised among his interlocutors that directly accuse corrupt governments, foreign corporations, and colonial legacies for exacerbating viral disease transmission (Redescription 7). The author also describes how such alternative perceptions of disease and prevention are then relegated to false beliefs and interpreted as conspiracy theories. Consequently, as argued by Richardson, conservative ideologies of health inequities and ahistorical empirical analyses “render invisible the social machinery of oppression” (p. 87), silence local perspectives that conflict with biomedical worldviews of disease, and further global health inequities by hiding behind the veil of scientific objectivity.

This pseudomonograph is not without weaknesses. The first set of limitations comes from the author’s tendency to generalize. While Richardson draws on case studies and ethnographic analysis from his work in Sierra Leone, the Democratic Republic of the Congo, and South Africa (to varying degrees), he frequently generalizes his arguments to the entirety of the Global South, which seems antithetical to the medical anthropological and decolonial perspectives he applies. Additionally, the empirical data Richardson present from these sites, his past experiences as a practitioner, and the limited engagement with existing theories and literature on the coloniality of global health and science did not always support the scale of his arguments, which tend to generalize across entire academic disciplines or epidemic containment practices.

The second set of limitations comes from the text’s experimental approach. While Richardson’s intentions for using alternative literary and writing styles are mindful and commendable, the purposes of some of the more experimental redescriptions and their contribution to the broader arguments of the text were not always clear. Additionally, the ironist presentation of some of his key examples was intriguing but puzzling at times, and I fear that readers may misinterpret Richardson’s ironic claims as literal fact. Finally, while criticisms of epidemiology are needed, some of Richardson’s sweeping criticisms erase the important work of critical epidemiologists and social scientists integrating anti-and decolonial perspectives into their practice.

In sum, Epidemic Illusions presents an important critique on the coloniality of global health science and amplifies the call for greater reflexivity in the world of epidemiology, global public health, and positivist social sciences. Undergraduate students, public health trainees, and global health professionals will benefit greatly from this pithy and punchy book. As the worlds of anthropology, global health, and other disciplines contend with the resurgence of calls for decolonization, scholars and practitioners can draw inspiration and create tangible next steps from Richardson’s words.