A health worker in rural Kenya notices that malaria cases are appearing earlier in the season than usual.
A nurse in Bangladesh observes that certain neighborhoods are experiencing more heat-related illnesses despite similar temperatures.
These observations often remain trapped in the realm of “anecdotal evidence.”
The dominant epistemological framework in public health traditionally dismisses such knowledge as unreliable, subjective, and of limited scientific value.
This dismissal stems from a deeply-rooted global health paradigm that privileges quantitative data, randomized controlled trials, and statistical significance over the nuanced, contextual understanding that emerges from direct experience.
The phrase “it’s just anecdotal” has become a subtle but powerful way of delegitimizing knowledge that does not conform to established scientific methodologies.
Yet this epistemological stance creates a significant blind spot in our understanding of how climate change affects health at the community level.
Climate change manifests in complex, locally specific ways that often elude traditional epidemiological surveillance systems.
The health worker who notices shifting disease patterns or the community nurse who identifies vulnerable populations possesses what philosopher Donald Schön termed “knowing-in-action” – a form of knowledge that emerges from sustained engagement with complex, dynamic situations.
Experiential knowledge often precedes formal scientific understanding, particularly in the context of climate change where impacts are emerging and evolving rapidly.
Health workers’ observations are not mere anecdotes but rather early warning signals of climate-health relationships that would take years to document through traditional research methods.
Why would we build early warning systems that ignore the significance or value of health worker observations and insights?
Is the risk of error greater than the risk of inaction?
In late 2023, more than 1 million people were displaced by flooding from intense rainfall in parts of Somalia, Kenya, and Ethiopia, attributed to a combination of climate change and the Indian Ocean Dipole, a natural climate phenomenon.
Are there signals that health workers might be attuned to, alongside weather systems to measure them?
The challenge, then, is not to replace scientific methodologies but to develop new epistemological frameworks that can integrate different forms of knowing.
This requires recognizing that knowledge exists on a spectrum rather than in hierarchical tiers.
Experiential knowledge, systematic observation, statistical analysis, and randomized controlled trials each offer different and complementary insights into complex climate-health relationships.
A new epistemological framework would recognize that the health worker who notices changing disease patterns is engaging in what anthropologist James Scott calls “mētis” – a form of practical knowledge that comes from intimate familiarity with local conditions.
Is this knowledge necessarily less valuable than statistical data or no data?
It is different and often provides crucial context that helps interpret quantitative findings.
Let us imagine how this integration might work in practice.
In the Philippines, a climate-health surveillance system could combine traditional epidemiological data with structured documentation of health workers’ observations.
Health workers would use a mobile app to share unusual patterns or emerging concerns with each other.
This could then be analyzed alongside conventional surveillance data.
Such an approach could identify climate-health relationships that are not visible through standard surveillance alone.
Health workers can also form “knowledge circles” in which they regularly meet to share observations and insights about climate-related health impacts.
These observations can then be systematically documented and analyzed, creating a bridge between experiential knowledge and formal evidence bases.
When patterns emerge across multiple knowledge circles, they trigger more formal investigation.
This shift requires rethinking how we validate knowledge.
Instead of asking whether an observation is “merely anecdotal,” we might ask: What does this observation tell us about local conditions? How does it complement our quantitative data? What patterns emerge when we more systematically collect and analyze experiential knowledge?
The implications of this epistemological shift extend beyond climate change.
By recognizing the value of experiential knowledge, health systems will become more adaptive and responsive to emerging challenges.
Health workers, feeling their knowledge is valued, become more engaged in systematic observation and documentation.
Communities, seeing their experiences reflected in health system responses, develop greater trust in health institutions.
However, this shift faces significant challenges.
Academic institutions, funding bodies, and policy makers often remain wedded to traditional hierarchies of evidence.
Publishing systems privilege certain types of knowledge over others.
Career advancement often depends on producing conventional scientific evidence rather than integrating different forms of knowing.
Overcoming these challenges requires institutional change.
Medical and public health education needs to incorporate training in recognizing and documenting experiential knowledge.
Research methodologies need to expand to include systematic ways of collecting and analyzing practical knowledge.
Funding mechanisms need to support projects that bridge different epistemological approaches.
The climate crisis demands this evolution in how we think about knowledge.
As health systems face unprecedented challenges, we cannot afford to ignore any source of understanding about how climate change affects human health.
The health worker’s observation, the community’s experience, and the statistician’s analysis all have crucial roles to play in building climate-resilient health systems.
This is not about replacing scientific rigor but about expanding our understanding of what constitutes valid knowledge.
By creating frameworks that can integrate different forms of knowing, we strengthen our ability to respond effectively to the complex challenges posed by climate change.
The future of climate-resilient health systems depends not just on what we know, but on how we think about knowing itself.
References
Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7
Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.10204660
Jones, I., Mbuh, C., Sadki, R., Steed, I., 2024. Climate change and health: Health workers on climate, community, and the urgent need for action. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.11194918
Romanello, M., et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet 404, 1847–1896. https://doi.org/10.1016/S0140-6736(24)01822-1
Schön, D.A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34.
Scott, J.C., 2020. Seeing like a state: how certain schemes to improve the human condition have failed. ed, Yale agrarian studies. Yale University Press, New Haven, CT London.