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HEALTHANDTHEEPISTEMOLOGIESOFTHESOUTH

BySusanadeNoronha,MariaPaulaMenesesandJoãoArriscadoNunesCentreforSocialStudies(CES)|UniversityofCoimbra-Portugal

“Ourtimeisnotatimeofstronganswers.Itisatimeofstrongquestionsand of weak answers.” (Santos 2007) Science in general, and socialsciencesinparticular,cannotyetgiveastronganswertoongoingdebatesand struggles over health and well-being! Why? When we speak ofemancipatoryapproaches tohealth,where fromdowespeak?Andwhoare we speaking to (Meneses 2004)? Do we hear, see, understand andacknowledgewhoeverandwhateverhasbeensilencedordemolishedbyviolent and monolithic Eurocentric worldviews, by the prevalenthegemonic monoculture of knowledge? Considering the potentiallyunendingdiversity of epistemic, healthcare andmedical systems,why iswestern science, alongwith its biologically-centeredunderstandings andfragmented and exclusionary visions of reality, still regarded as theultimatesourceofvalidationofknowledgesandpractices,understandingsandactionsinmattersofhealthandillness?The notion of health as a separate domain of human life and activityshould be put under scrutiny, since it is not shared by allontologies/epistemologies existing in the world. As several authorsunderline, in various languages and contexts, words and conceptionscorresponding to Western hegemonic notions of health, illness anddisease do not find a direct translation (Meneses 2007). What we callhealthmaybeexpressedas ‘good life’,but itwillnotbethoughtofasadomain with a privileged relation to biology and subject to specializedhuman intervention which can be separated from other aspects of life(Nunes2012).

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Inmostof theworld,conceptionsofdisturbance,disordersorafflictionsaffectingthelifeofpeopleareaneverydayconcern,beingdescribedandunderstood through different vocabularies, related to differentcosmogonies.Healingasa response todisturbances isaculturalprocesspresentineverysociety,butitis,generally,stronglyconnectedtoarangeof forces, processes and entities which are not separable into organic,psychic or social, natural or human-made. The ways of dividing andclassifying theworldmaybequitediverseacross societies, communitiesand collectives. The naturalistic worldview of modern, Eurocentricbiomedicinehasbeen introduced intomostsocietiesof theglobalSouthas oneof the key instruments usedbymodern colonialism, producing atrail of disqualification, suppression, invisibilization or appropriation ofother knowledges and practices, and sometimes even the physicaleliminationofthosewhoheldthoseexperiences(LockandNguyen2010).In the global South, biomedicine and the conception of health as aseparatedomainofknowledge,practicesandinstitutionswereassociatedwith tropical medicine, and, nowadays, subsumed under the broaderumbrellaofglobalhealth.The diversity of ‘idioms of distress’ (Nichter 1981), vocabularies andexpressionsof suffering, even if theydonot exhaustwhat is at stake inaddressing conceptions and experiences of life and death, violence andsuffering, disease and cure, provides a convenient entry point forengagingwithnon-Eurocentricunderstandingsofwhat countsashealth,illnessanddiseaseandforpursuingthedynamicsofemergingecologiesofknowledgesandpracticesassociatedwithcareandcure(Santos2018c).The “Epistemologies of the South” (Santos 2018, 2018b) are a politicaland epistemological proposal aimed at facilitating and promoting thepossibility of Ecologies of Knowledge(s) as alternativemodes of thinkingand acting against the dominant monoculture of knowledge (Santos2007). The South is not (or not just) a geographical space or place. TheSouth is a metaphor for all the experiences, forms of knowledge andagencyemergingfrombodies,communities,placesandrealitiessilenced,ignored, excluded or suppressed from the epistemic core of the North.Capitalism,colonialismandpatriarchy,withtheirappendicularextensions,ethnocentrism, racism, sexism, classism, ageism, heterosexism, amongother isms that have shapedWestern epistemology and its boundaries,have produced an immense waste of experience and of knowledgethrough abyssal and non-abyssal exclusions, affecting ethnic, cultural,linguistic,politicalandreligiousminorities,indigenous/nativepopulations,

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immigrants, refugees and undocumented people, the poor and the sick,disabledindividuals,women,children,theelderly,LGBTQandnonbinarypersons,justtonameafew(Santos2007b).Procedures like the sociology of absences and the sociology ofemergences (Santos 2003) are central to the kind of “rearguard”intellectualworkthatliesattheheartoftheEpistemologiesoftheSouthas a call for an alternative thinking of alternatives (Santos 2018).Acknowledging that a completely levelled or horizontal dialogue cannotever take place within modern academia between science and otherformsof knowledge, how can scientists, including social scientists, bringother bodies, experiences, ontologies and epistemologies intoconversation, learningfromandwiththem?Morethanaskingquestions,wehavetoactually listenandlearnfromanactiveengagementwiththestruggles against abyssal and non-abyssal exclusions, for cognitive andsocial justice and for human dignity and respect for life in all its forms,whatever the idiom of these struggles. The strong answers are beingcreatedinandbystruggleswhichareinextricablyepistemicandpolitical,foughtbysubjectswithaface,aname,astory,andavoicethatexpressesexperienceandlivedknowledge.Hence, theEpistemologiesof theSoutharepremisedonacollaborative,co-constructedandco-authoredwayofworld-knowingandworld-making,embracing hybrid, experimental and creative methodologies, doingsciencewithandforthecommunity,focusedonitsurgencies,needsandclaims. Inmattersof health and illness, theEpistemologiesof the Southaim to acknowledge the different experiences of disease and illness, ofsufferingand care,of crisis and cure. Theseexperiencesare inscribed inflesh, bodies and lives, patients, survivors, caregivers, families andcommunities, but also doctors, caretakers, healers, researchers andactivists, their stories, expressions, forms of resistance and creativeagency, their concepts and representations ofwellbeing, health, healingand treatment, their different medical and healthcare systems, acrossculturesandsocieties.Thesediverseandalternativevoices,practicesandforms of knowledge, emerging from the geographic, geopolitical andepistemicSouth,canenable“Us”torethinkhealth,illnessandresistance,towardsawideranddiverseconceptionofwellbeing,adignifiedlifeandaprudentproductionofknowledge(Santos2018).

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Embodied and lay knowledge, oral narratives and artistic expressions,therapeuticactivismandcitizens’collectivemovementsandinterventions,amongseveralothersourcesofexperience,information,experimentation,andagency, can challengeWestern science, a knowledgeamongothers,to learn from the diversity of the World in a non-extractive dialogue,creatingacommonbutdiverseontologicalandepistemologicallandscape,lessfragmentedbutgrowinglyplural(Noronha2019;Nunes2006;Santosetal2004).Scientificliteraturehasalreadydemonstratedhowindividualsandcommunitiesfeel,thinkandactinaneclecticway,applying,accordingto their circumstances and needs, a vast array of different forms ofknowledge,putting themtouse in theirday today lives (Lambek1993),improvingtheirpresentandfuture.TheEpistemologiesoftheSouthareacommitment to encourage an internally pluralistic science to seek thissamecapacity,workingforthecommongood,learningfromthismultipleand growing abundance, sharing outcomes, reducing exclusions,rememberingthatallhumanlivesmatter.TheEpistemologiesoftheSouththusseektoopenupnewspacesfortherecognitionof thisdiversityofknowledges,practicesandexperiences,oftheirco-presenceandencounters,ofthestrugglesforcognitiveandsocialjustice that find in the current struggles for access to health care in itsmultiple forms, for the recognition of the diversity of conceptions ofhealth andof knowledges andpractices of care and for the right to theprotectionofmodesoflifeandtheecologiestheyareinextricablefrom.02/08/2019References:Lambek,M. (1993), “KnowledgeandHubris”, inKnowledgeandPractice inMayotte:

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