Donald A. Schön The new scholarship requires a new epistemology

Knowing-in-action: Bridging the theory-practice divide in global health

Global health

The gap between theoretical knowledge and practical implementation remains one of the most persistent challenges in global health. This divide manifests in multiple ways: research that fails to address practitioners’ urgent needs, innovations from the field that never inform formal evidence systems, and capacity building approaches that cannot meet the massive scale of learning required. Donald Schön’s seminal 1995 analysis of the “dilemma of rigor or relevance” in professional practice offers crucial insights for “knowing-in-action“. It can help us understand why transforming global health requires new ways of knowing – a new epistemology. Schön’s analysis: The dilemma of rigor or relevance Schön begins by examining how knowledge becomes institutionalized through education. Using elementary school mathematics as an example, he describes how knowledge is broken into discrete units (“math facts”), organized into progressive modules, assembled into curricula, and measured through standardized tests. This systematization shapes not just content but the entire …

Critical evidence gaps in the Lancet Countdown on health and climate change

Critical evidence gaps in the Lancet Countdown on health and climate change

Global health

The 2024 report of the Lancet Countdown on health and climate change “reveals the health threats of climate change have reached record-breaking levels” and provides “the most up-to-date assessment of the links between health and climate change”. Yet its treatment of experiential knowledge – particularly the direct observations and understanding developed by frontline health workers and communities – reveals both progress and persistent gaps in how major global health assessments value different forms of knowing. The fundamental tension appears right at the start. The report notes a significant challenge: “A global scarcity of internationally standardised data hinders the capacity to optimally monitor the observed health impacts of climate change and evaluate the health-protective effect of implemented interventions.” This framing privileges standardized, quantifiable data over other forms of knowledge. Yet paradoxically, the report recognizes that “health workers are already intimate witnesses to the impacts of climate change on the health of …

Strengthening primary health care in a changing climate

Strengthening primary health care in a changing climate

and Global health

A new article by Andy Haines, Elizabeth Wambui Kimani-Murage, and Anya Gopfert, “Strengthening primary health care in a changing climate,” outlines how climate change is already impacting health systems worldwide, with primary health care (PHC) workers bearing the immediate burden of response. Haines and colleagues make a compelling case for strengthening primary health care (PHC) as a cornerstone of climate-resilient health systems. First, they note that approximately 90% of essential universal health coverage interventions are delivered through PHC settings, making these facilities and workers the backbone of healthcare delivery. This is particularly significant because PHC systems address many of the health outcomes most affected by climate change, including non-communicable diseases, childhood undernutrition, and common infectious diseases like malaria, diarrheal diseases, and respiratory infections. Furthermore, PHC workers are often the first responders to extreme weather events such as floods, droughts, and heatwaves. They must manage both the immediate health impacts and …

Anecdote or lived experience reimagining knowledge for climate-resilient health systems

Anecdote or lived experience: reimagining knowledge for climate-resilient health systems

Global health

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 …

Saci in Defunking Grunter-small

Defunking Grunter

Thinking aloud, Writing

Part 1: The Journey Begins Suspended in the swirling galaxies beyond our own, the celestial stage of the Cat’s Eye Nebula shimmered. The nebula was a kaleidoscope of iridescent gases, dazzling cosmic dust, and radiant energy, an ideal sanctuary for the Astral Scholars. Their gathering place, the Obsidian Forum, was a levitating, jet-black platform, as if carved from a fragment of the universe itself. It was etched with constellations, celestial bodies, and navigational lines of ancient wormholes–an atlas of the universe under their feet. The youngest among them, Saci, was a fledgling star, her eyes twinkling with raw curiosity and a deep yearning for acceptance. A cloud of unresolved excitement perpetually surrounded her, compelling yet subtle, a characteristic trait of many passionate seekers before her. One day, during a session of interstellar navigation training, her enthusiasm came to the fore. Saci hurriedly approached the Grand Orrery, a celestial model showcasing real-time …

Pyramide d'abricot à La bague de Kenza (Paris)

Bite-sized update: higher education in fragile contexts, discovery without analytics, and the epistemology of learning culture

Thinking aloud, Travel

As much as I wish this blog could document my reflections as I read, research, speak, and listen… it cannot. Knowledge is a process, not a product, in this VUCA world we live in. I know that I am doing too much, too fast, to be ale to process everything. Accepting this is part and parcel of navigating the knowledge landscape. So here is an incomplete round-up with some schematic thoughts about where I’m headed. Higher education in fragile contexts as a wicked problem: Most ed tech conferences I’ve attended are mostly male, and tend to focus on the education of those least-in-need. Inzone’s workshop on education in fragile contexts was at the other end of that spectrum, with a diverse team of scholars and practitioners coming together to tackle wicked learning problems such as how to ensure access to education for Syrian refugees in Turkey (access), what to do when refugee camp conditions are such …