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Tag: epistemology

  • The crisis in scientific publishing: from AI fraud to epistemic justice

    The crisis in scientific publishing: from AI fraud to epistemic justice

    There is a crisis in scientific publishing. Science is haunted. In early 2024, one major publisher retracted hundreds of scientific papers. Most were not the work of hurried researchers, but of ghosts—digital phantoms generated by artificial intelligence. Featuring nonsensical diagrams and fabricated data, they had sailed through the gates of peer review.

    This spectre of AI-driven fraud is not only a new technological threat. It is also a symptom of a pre-existing disease. For years, organized networks have profited from inserting fake papers into the scholarly record. It seems that scientific publishing’s peer review process, intended to seek truth, cannot even tell the real from the fake.

    These failures are not just academic embarrassments. In fields like global health, where knowledge means the difference between life and death, we can no longer afford to ignore them. Indeed, the crisis in scientific journals is not, at its heart, a crisis in publishing. It is a crisis of knowledge—of what we value, who we trust, and how we come to know. That makes it a crisis of education.

    Crisis in scientific publishing: The knowledge we ignore

    Consider what Toby Green has called the “dark side of the moon.” He is referring to the vast body of knowledge produced by established experts in international organizations. Volumes of high-quality reports and analyses come from organizations large and small. They contain immense expertise. Often, not only do they qualify as science. They may be more likely to shape policy and practice than most academic outputs. Yet this “grey literature” is rarely incorporated into the scholarly record. This is why Green is actively implementing projects to find, collect, and index such materials.

    If the formal knowledge of some of the world’s leading experts is being left in the dark, what hope is there for the practical wisdom of a frontline nurse?

    In the rigid hierarchy of evidence that governs global health, a randomized controlled trial sits at the pinnacle. At the very bottom, dismissed as mere “anecdotes,” lies the lived experience of practitioners. A nurse in a rural clinic who discovers a better way to dress a wound in a humid environment has generated life-saving knowledge that could be useful elsewhere. A community health worker who develops a sophisticated method for building trust with vaccine-hesitant parents has solved a problem in context. Yet, in our current culture, their insights are not data. Their experience is not evidence.

    To dismiss such knowledge is an act of willful ignorance. Science, at its best, is a process of disciplined curiosity. Its fundamental purpose is to reduce ignorance and expand our understanding of the world. To willfully ignore entire categories of human experience and expertise is therefore a betrayal of the scientific ethos itself. It is an active choice to remain in the dark.

    Crisis in scientific publishing: the architecture of exclusion

    This devaluation of practical knowledge is not an accident. It is a feature of a system designed to exclude. The modern ideal of science began with a radically open mission. As the scholar John Willinsky has meticulously documented in his history of Western European science, the creation of scientific journals in the 17th century was intended to create a public commons of knowledge, accelerating progress for the benefit of humanity. The principle was one of access. How was this mission corrupted?

    The architecture of modern science was built on a colonial foundation. Its violence was not only physical but also scientific and intellectual. Frantz Fanon, the Martinican psychiatrist who became a theorist of decolonization in the crucible of Algeria’s war of independence, described colonization’s deepest work as the effort to “empty the mind of the colonized.” This is a systematic process of convincing people that our own histories, cultures, and ways of knowing are worthless.

    Generations later, the Māori scholar Linda Tuhiwai Smith detailed how this was put into practice. She showed that Western research methodologies themselves were often not neutral tools of discovery but instruments of empire. The acts of observing, classifying, extracting, and analyzing were used to control populations and invalidate their knowledge systems, replacing them with a single, supposedly universal, European model of truth.

    This worldview pretends to be a neutral, “view from nowhere,” a concept also critiqued powerfully by the white American feminist philosopher Donna Haraway. She argued that all knowledge is situated—shaped by the position and perspective of the knower. You see the landscape differently from the mountain top than you do from the valley. A complete map requires both perspectives.

    Echoing this, her philosophical and geographical sister Sandra Harding argued that by excluding the perspectives of marginalized people, dominant science becomes “weakly objective.” It is blind to its own biases and assumptions.

    Crisis in scientific publishing: Fear of knowledge

    A common and deeply felt fear among scientists is that embracing diverse forms of knowledge will lead to a dangerous relativism, where objective truth dissolves and “anything goes.”

    Harding’s work shows this fear to be misplaced. She argues that the “view from nowhere” provides not a stronger, but a more brittle and fragile grasp of the truth. A truly “strong objectivity,” she contended, is achieved by intentionally seeking out multiple, situated perspectives. This does not mean that all views are equally valid. It means that by examining a problem from many standpoints, we can triangulate a more robust and reliable understanding of reality. We can identify the biases and blind spots inherent in any single view, including our own.

    This process is the antidote to the willful ignorance mentioned earlier. It strengthens our grasp of objective truth by making it more complete and more honest.

    Can change be paved by good intentions?

    Today, the need for a change in research culture is widely acknowledged. The world’s largest research funders publish reports calling for more diversity and inclusion. Yet we observe paralysis rather than progress. The individuals who sit on the decision-making committees of such institutions will almost certainly not fund a project with a primary investigator whose work is not validated by the existing system of prestigious but exclusive journals. Elite global scholars leading the vital movement to “decolonize global health” first established their legitimacy by adhering to conventional norms, then began using the master’s tools to have their critiques of the system heard. Such contradictions illustrate how deeply the exclusionary norms are embedded.

    Since top-down change is caught in such contradictions, a meaningful path forward may be to change the culture of science from the ground up. The core challenge is to correct for epistemic injustice: the wrong done to someone in their capacity as a knower. This injustice takes several insidious forms.

    The most obvious is testimonial injustice. Imagine the scene. A senior male doctor from a famous university presents a finding and is met with nods of assent. His words carry the weight of evidence. A young female nurse from a rural clinic presents the exact same finding based on her direct experience. Her knowledge is dismissed as a “story” or an “anecdote.” She is not heard because of who she is. Her credibility is unjustly discounted.

    Even deeper is hermeneutical injustice. This is the wrong of not even having the shared language to make your experience understood by the dominant culture. The community health worker who builds trust with hesitant parents may have a brilliant system, but if they cannot articulate it in the formal jargon of “implementation science,” their knowledge remains invisible. They are wronged not because they are disbelieved. They are wronged because the system lacks the concepts to even recognize their wisdom as knowledge in the first place.

    Projects like Toby Green’s grey literature repository or initiatives like Rogue Scholar, pioneered by Martin Fenner, that assign a permanent Digital Object Identifier (DOI) to science that was not previously in the scholarly record, are practical interventions. But this not a technological problem. It is an educational one. Changing a culture that perpetuates these injustices is the primary work. Within this larger project, new tools can serve as tactics of resistance. As such, they can be used to support acts of epistemic defiance, for example by creating a formal, citable record of knowledge that exists outside the traditional gates. Yet they remain tools, not the solution.

    The science of knowing

    You cannot fix a broken culture by patching its systems. You must change its DNA. The crisis haunting science is not ultimately about publishing, fraud, or peer review. It is a crisis of education—not of schooling, but of how we come to know. If physics is the science of matter, education is the science of all sciences. It provides the architecture of assumptions and values that shapes how every other field discovers and validates truth.

    A new philosophy of education is needed, one that includes these three principles:

    1. It must recognize that the most durable knowledge comes from praxis—the cycle of acting in the world and reflecting on the consequences.
    2. It must be built on collaborative intelligence, understanding that the most difficult problems can only be solved by weaving together many perspectives.
    3. It must pursue strong objectivity, not by erasing human perspective, but by intentionally seeking it out to create a more complete and honest picture of reality.

    To change science, we must change how scientists are taught to see the world. We must educate for humility, for critical self-awareness, and for the ability to listen. This is the work of creating a science that is not haunted by its failures but is directly contributes to a more just and truthful account of our world.

    References

    1. Boghossian, P., 2007. Fear of knowledge: Against relativism and constructivism. Clarendon Press.
    2. Couch, L., 2021. Wellcome Diversity, equity and inclusion strategy [WWW Document]. Wellcome. URL https://wellcome.org/what-we-do/diversity-and-inclusion/strategy (accessed 11.8.22).
    3. Fanon, F. (1963). The wretched of the earth. Grove Press.
    4. Fenner, M., 2023. The Rogue Scholar: An Archive for Scholarly blogs. Upstream. https://doi.org/10.54900/bj4g7p2-2f0fn9b
    5. Gitau, E., Khisa, A., Vicente-Crespo, M., Sengor, D., Otoigo, L., Ndong, C., Simiyu, A., 2023. African Research Culture – Opinion Research. African Population and Health Research Center, Nairobi, Kenya. https://aphrc.org/project/african-research-culture-opinion-research/
    6. Green, T., 2022. Wait! What? There’s stuff missing from the scholarly record? Med Writ 31, 44–48. https://doi.org/10.56012/ajel9043
    7. Haraway, D. (1988). Situated knowledges: The science question in feminism and the privilege of partial perspective. Feminist Studies, 14(3), 575–599. https://doi.org/10.2307/3178066
    8. Harding, S. (1991). Whose science? Whose knowledge? Thinking from women’s lives. Cornell University Press.
    9. Smith, L. T. (2012). Decolonizing methodologies: Research and indigenous peoples (2nd ed.). Zed Books.
    10. The Social Investment Consultancy, The Better Org, Cole, N., Cole, L., 2022. Evaluation of Wellcome Anti-Racism Programme Final Evaluation Report – Public. Wellcome, London. https://cms.wellcome.org/sites/default/files/2022-08/Evaluation-of-Wellcome-Anti-Racism-Programme-Final-Evaluation-Report-2022.pdf
    11. Wellcome Trust, 2020. What researchers think about the culture they work in. Wellcome, London. https://wellcome.org/reports/what-researchers-think-about-research-culture
    12. Willinsky, J., 2006. The access principle: The case for open access to research and scholarship. MIT press Cambridge, MA.

    Image: The Geneva Learning Foundation Collection © 2025

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  • HPV vaccination: New learning and leadership to bridge the gap between planning and implementation

    HPV vaccination: New learning and leadership to bridge the gap between planning and implementation

    This article is based on my presentation about HPV vaccination at the 2nd National Conference on Adult Immunization and Allied Medicine of the Indian Society for Adult Immunization (ISAI), Science City, Kolkata, on 15 February 2025.

    The HPV vaccination implementation challenge

    The global landscape of HPV vaccination and cervical cancer prevention reveals a mix of progress and persistent challenges. While 144 countries have introduced HPV vaccines nationally and vaccination has shown remarkable efficacy in reducing cervical cancer incidence, significant disparities persist, particularly in low- and middle-income countries.

    Evidence suggests that challenges in implementing and sustaining HPV vaccination programs in developing countries are significantly influenced by gaps between planning at national level and execution at local levels. Multiple studies confirm this disconnect as a primary barrier to effective HPV vaccination programmes.

    Traditional approaches to knowledge development in global health often rely on expert committee models characterized by hierarchical knowledge flows, formal meeting processes, and bounded timelines. While these approaches offer strengths like high academic rigor and systematic review, they frequently miss frontline insights, develop slowly, and produce static outputs that may be difficult to translate effectively into action.

    How the peer learning network alternative can support HPV vaccination

    At The Geneva Learning Foundation (TGLF), we have developed a complementary model—one that values the collective intelligence of frontline health workers and creates structured opportunities for their insights to inform policy and practice. This peer learning network model features:

    • Large, diverse networks with multi-directional knowledge flow
    • Open participation and flexible engagement
    • Direct field experience and implementation insights
    • Iterative development through experience sharing
    • Continuous refinement and living knowledge

    This approach captures practical knowledge, enables rapid learning cycles, preserves context, and brings together multiple perspectives in a dynamic process that continuously updates as new information emerges.

    HPV vaccination: the peer learning cycle in action

    To address HPV vaccination challenges, we implemented a structured five-stage cycle that connected frontline experiences with policy decisions:

    1. Experience collection at scale: In June 2023, we engaged over 16,000 health professionals to share their HPV vaccination experiences through our Teach to Reach programme. This stage focused specifically on capturing frontline implementation challenges and solutions across diverse contexts.
    2. Synthesis and analysis: TGLF’s Insights Unit identified key themes, success patterns, and common challenges while highlighting local innovations and practical solutions that emerged from the field.
    3. Knowledge deepening: In October 2023, we conducted a second round of experience sharing that built upon earlier discussions at Teach to Reach. This stage featured more in-depth case studies and implementation stories, providing additional contexts and approaches to vaccination challenges.
    4. National-level review: In January 2024, we facilitated a consultation with national EPI (Expanded Programme on Immunization) planners from 31 countries. This created direct connections between field experience and national strategy, validating and enriching the collected insights.
    5. Knowledge mobilization: Finally, we synthesized the insights into practical guidance, ready for sharing back to frontline workers, and established a foundation for continued learning cycles.

    This process uniquely values the practical wisdom that emerges from implementation experience. Rather than assuming solutions flow from the top down, we recognize that those doing the work often develop the most effective approaches to complex challenges.

    Teach to Reach: Building a learning community for HPV vaccination

    Our Teach to Reach programme serves as the hub for this peer learning approach. Since its inception, the community has grown steadily since January 2021 to reach over 24,000 members by December 2024. The participants reflect remarkable diversity.

    This diversity of contexts and experiences creates a rich environment for learning. The programme demonstrates significant impact on participants’ professional capabilities—compared to global baselines, Teach to Reach participants show:

    • 45% stronger worldview change
    • 41% greater impact on professional practice
    • 49% higher professional influence

    7 insights about HPV vaccination from peer learning at Teach to Reach

    Through this process, we uncovered several important implementation insights:

    1. Importance of connecting field experience to policy

    • Each stage deepened understanding of implementation challenges
    • We observed progression from tactical to strategic considerations
    • Growing recognition of systemic factors emerged
    • Evolution from individual to institutional solutions became apparent
    • Value of structured knowledge sharing across levels was demonstrated

    2. Implementation learning

    • Success requires multi-stakeholder engagement
    • Sustained communication proves more effective than one-time campaigns
    • School systems provide critical implementation platforms
    • Community leadership is essential for acceptance
    • Integration with other services increases efficiency
    • Local adaptation is key to successful implementation

    3. Unexpected implementation findings

    • Tribal communities often showed less vaccine hesitancy than urban areas
    • Teachers emerged as more influential than health workers in some contexts
    • Personal stories proved more persuasive than statistical evidence
    • Integration with COVID-19 vaccination improved HPV acceptance
    • Social media played both positive and negative roles
    • School-based programs sometimes reached out-of-school children

    4. Counter-intuitive success factors

    • Less formal settings often produced better results
    • Simple communication strategies outperformed complex ones
    • Male community leaders became strong vaccination advocates
    • Religious institutions provided unexpected support
    • Health worker vaccination of own children became powerful tool
    • Community dialogue proved more effective than expert presentations

    5. Unexpected challenges

    • Urban areas sometimes showed more resistance than rural areas
    • Education level did not correlate with vaccine acceptance
    • Health workers themselves sometimes showed hesitancy
    • Traditional media was less influential than anticipated
    • Formal authority figures were not always the most effective advocates
    • Technical knowledge proved less important than communication skills

    6. Examples of novel solutions

    • Using cancer survivors as advocates
    • WhatsApp groups for community health workers
    • School children as messengers to families
    • Integration with existing women’s groups
    • Leveraging religious texts and teachings
    • Community theater and storytelling approaches

    System-level surprises

    • Success was often independent of resource levels
    • Informal networks proved more important than formal ones
    • Bottom-up strategies were more effective than top-down approaches
    • Social factors were more influential than technical ones
    • Local adaptation was more important than standardization
    • Peer influence was more powerful than expert authority

    In some cases, these findings challenge many conventional assumptions about HPV vaccination programmes. In all cases, they highlight the importance of local knowledge, social factors, and adaptation over standardized approaches based solely on technical expertise.

    The power of health worker collective intelligence

    Our approach demonstrates the value of health worker collective intelligence in improving performance:

    • High-quality data and situational intelligence from our network of 60,000+ health workers provides rapid insights
    • Field observations on changing disease patterns and resistance can be quickly collected
    • Climate change impacts can be tracked through frontline reports
    • The TGLF Insights Unit packages this intelligence into knowledge to inform practice and policy

    This represents a fundamental shift from assuming expert committees have all the answers to recognizing the distributed expertise that exists throughout health systems.

    Continuous learning: The key to improvement

    In fact, previous TGLF research has demonstrated that continuous learning is often the “Achilles’ heel” in immunization programs. Common issues include:

    1. Relative lack of learning opportunities
    2. Limited ability to experiment and take risks
    3. Low tolerance for failure
    4. Focus on task completion at the expense of building capacity for future performance
    5. Lack of encouragement for learning tied to tangible organizational incentives

    In 2020 and 2022, we conducted large-scale measurements of learning culture of more than 10,000 immunization professionals in low- and middle-income countries. The data showed that ‘learning culture’ (a measure of the capacity for change) correlated more strongly with perceived programme performance than individual motivation did. This challenges the common assumption that poor motivation is the root cause of poor performance.

    These findings help zero in on six ways to strengthen continuous learning to drive HPV vaccination:

    1. Motivate health workers to believe strongly in the importance of what they do
    2. Give them practice dealing with difficult situations they might face
    3. Build mental resilience for facing obstacles
    4. Prompt them to enlist coworkers for support
    5. Help them engage their bosses to provide guidance, support, and resources
    6. Help them identify and overcome workplace obstacles

    Impact and benefits of peer learning

    This approach delivers multiple benefits:

    • Frontline workers gain broader perspective
    • National planners access grounded insights
    • Practical solutions spread more quickly
    • Policy decisions are informed by field experience
    • Continuous improvement cycle gets established

    Key success factors include:

    • Scale that enables diverse input collection
    • Structure that supports quality knowledge creation
    • Regular rhythm that maintains engagement
    • Multiple levels of review that ensure relevance
    • Clear pathways from insight to action

    How can we interpret these findings?

    This model generates implementation-focused evidence that complements rather than competes with traditional epidemiological data. 

    The findings emerge from a structured methodology that includes initial experience collection at scale, synthesis and analysis, knowledge deepening through case studies, national-level review by EPI planners from 31 countries, and systematic knowledge mobilization. This approach provides rigor and scale that elevate these observations beyond mere anecdotes.

    For epidemiologists who become uncomfortable when evidence is not purely quantitative, it is important to understand that structured peer learning fills a critical gap in implementation science by capturing what quantitative studies often miss: the contextual factors and practical adaptations that determine programme success or failure in real-world settings.

    When implementers report across different contexts that tribal communities show less vaccine hesitancy than urban areas, or that teachers emerge as more influential than health workers in specific settings, these patterns represent valuable implementation intelligence.

    Such insights also help explain why interventions that appear effective in controlled studies often fail to deliver similar results when implemented at scale.

    In fact, these findings address precisely what quantitative studies struggle to capture: why education level does not reliably predict vaccine acceptance; why some resource-constrained settings outperform better-resourced ones; how informal networks frequently prove more effective than formal structures; and which communication approaches actually drive behavior change in specific populations.

    For programme planners, this knowledge bridges the gap between general guidance (“engage community leaders”) and actionable specifics (“male community leaders became particularly effective advocates when engaged through these specific approaches”). 

    Accelerating HPV vaccination progress

    To make significant progress on HPV vaccination as part of the Immunization Agenda 2030’s Strategic Priority 4 (life-course and integration), we encourage global health stakeholders to:

    1. Rethink how we learn
    2. Question how we engage with families and communities
    3. Focus on trust

    By combining expert knowledge with the practical wisdom of thousands of implementers, we can develop more effective strategies for HPV vaccination that bridge the gap between planning and execution.

    This peer learning network approach does not replace expertise—it enhances and grounds it in the realities of implementation.

    It recognizes that the frontline health worker in a remote village may hold insights just as valuable as those of a technical expert in a capital city.

    By creating structures that enable these insights to emerge and connect, we can accelerate progress on HPV vaccination and other public health challenges.

    Acknowledgements

    I wish to thank ISAI’s Dr Saurabh Kole and his colleagues for their kind invitation. I also wish to recognize and appreciate Charlotte Mbuh and Ian Jones for their invaluable contributions to the Foundation’s work on HPV vaccination, and Dr Satabdi Mitra for her tireless leadership and boundless commitment. Last but not least, I wish to thank the thousands of health workers who contributed their experiences before, during, and after successive Teach to Reach peer learning events. What little I know comes from their collective intelligence, action, and wisdom.

    References

    Dorji, T. et al. (2021) ‘Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis’, EClinicalMedicine, 34, p. 100836. Available at: https://doi.org/10.1016/j.eclinm.2021.100836.

    Faye, W. et al. (2023) IA2030 Case study 18. Wasnam Faye. Vaccine angels – Give us the opportunity and we can perform miracles. The Geneva Learning Foundation. Immunization Agenda 2030 Case study 18. Available at: https://doi.org/10.5281/ZENODO.7785244.

    Gonçalves, I.M.B. et al. (2020) ‘HPV Vaccination in Young Girls from Developing Countries: What Are the Barriers for Its Implementation? A Systematic Review’, Health, 12(06), pp. 671–693. Available at: https://doi.org/10.4236/health.2020.126050.

    Jones, I. et al. (2024) Making connections at Teach to Reach 8 (IA2030 Listening and Learning Report 6). Available at: https://doi.org/10.5281/ZENODO.8398550.

    Jones, I. et al. (2022) IA2030 Case Study 7. Motivation, learning culture and programme performance. The Geneva Learning Foundation. Available at: https://doi.org/10.5281/ZENODO.7004304.

    Kutz, J.-M. et al. (2023) ‘Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review’, BMC Public Health, 23(1), p. 974. Available at: https://doi.org/10.1186/s12889-023-15842-1.

    Moore, K. et al. (2022) Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers. The Geneva Learning Foundation. Available at: https://doi.org/10.5281/ZENODO.6965355.

    Umbelino-Walker, I. et al. (2024) ‘Towards a sustainable model for a digital learning network in support of the Immunization Agenda 2030 –a mixed methods study with a transdisciplinary component’, PLOS Global Public Health. Edited by M. Pentecost, 4(12), p. e0003855. Available at: https://doi.org/10.1371/journal.pgph.0003855.

    Watkins, K.E. et al. (2022) ‘Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention’, BMC Health Services Research, 22(1), p. 736. Available at: https://doi.org/10.1186/s12913-022-08138-4.

    Wigle, J., Coast, E. and Watson-Jones, D. (2013) ‘Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects’, Vaccine, 31(37), pp. 3811–3817. Available at: https://doi.org/10.1016/j.vaccine.2013.06.016.

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

    Knowing-in-action: Bridging the theory-practice divide in 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.

    Listen to this article below. Subscribe to The Geneva Learning Foundation’s podcast for more audio content.

    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 organization of time, space, and institutional arrangements.

    From this foundation, Schön introduces his central metaphor of two contrasting landscapes in professional practice that prevent “knowing-in-action”. As he describes it:

    “In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.”

    The cruel irony, Schön observes, lies in the relative importance of these terrains: “The problems of the high ground tend to be relatively unimportant to individuals or to society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.”

    This creates what Schön calls the “dilemma of rigor or relevance” – practitioners must choose between remaining on the high ground where they can maintain technical rigor or descending into the swamp where they must rely on experience, intuition, and what he terms “muddling through.”

    The historical roots of the divide

    Schön traces this dilemma to the epistemology embedded in modern research universities. Drawing on Edward Shils’s historical analysis, he describes how American scholars returning from Germany after the Civil War brought back “the German idea of the university as a place in which to do research that contributes to fundamental knowledge, preferably through science.”

    This was, as Schön notes, “a very strange idea in 1870,” running counter to the prevailing British model of universities as sanctuaries for liberal arts or finishing schools for gentlemen. The new model first took root at Johns Hopkins University, whose president embraced the “bizarre notion that professors should be recruited, promoted, and granted tenure on the basis of their contributions to fundamental knowledge.”

    This shift created what Schön terms the “Veblenian bargain” (named after Thorstein Veblen), establishing a separation between:

    • Research universities focused on “true scholarship” and fundamental knowledge
    • Professional schools dedicated to practical training

    Knowing-in-action in global health: From fragmentation to integration

    The historical division between theory and practice that Schön identified continues to shape global health in profound and often problematic ways. This manifests in three interconnected challenges that demand our urgent attention: the knowledge-practice gap, the scale challenge, and the complexity challenge. Yet emerging approaches suggest potential paths forward, particularly through structured peer learning networks that could help bridge Schön’s “high ground” and “swamp.”

    Three fundamental challenges

    Challenge #1: The knowing-in-action divide

    The separation between research institutions and field practice creates not just an academic concern but a practical crisis in healthcare delivery. Consider the response to COVID-19: while research institutions rapidly generated new knowledge about the virus, frontline health workers struggled to translate this into practical approaches for their specific contexts. Their hard-won insights about what worked in different settings rarely made it back into formal evidence systems, epitomizing the one-way flow of knowledge that impoverishes both research and practice.

    This pattern repeats across global health. Research agendas, shaped by academic incentives and funding priorities, often fail to address practitioners’ most pressing challenges. A community health worker in rural Bangladesh facing complex challenges around vaccine hesitancy may struggle to find relevant guidance – while global experts are convinced that they already have all the answers. Meanwhile, local solutions to building vaccine confidence remain uncaptured by formal knowledge systems.

    The rise of implementation science attempts to bridge this divide, yet often remains subordinate to “pure” research in academic hierarchies. This reflects Schön’s observation about the privileging of high ground problems over swampy ones, even when the latter hold greater practical significance.

    Challenge #2: The scale imperative

    Traditional approaches to professional education face fundamental limitations in meeting the massive need for health worker capacity building. The World Health Organization projects a shortfall of 10 million health workers by 2030, mostly in low- and middle-income countries. Conventional training approaches that rely on cascading knowledge through workshops and formal courses can reach only a fraction of those who need support.

    More fundamentally, these knowledge transmission models prove inadequate for addressing complex local realities. A standardized curriculum developed by experts, no matter how well-designed, cannot anticipate the diverse challenges health workers face across different contexts. When a district immunization manager in Nigeria must adapt vaccination strategies for nomadic populations during a drought, they need more than pre-packaged knowledge – they need ways to learn from others who are facing similar challenges.

    Resource constraints further limit the reach of conventional approaches. The cost of traditional training programmes, both in money and time away from service delivery, makes it impossible to scale them to meet the need. Yet the human cost of this capacity gap, measured in preventable illness and death, demands urgent solutions.

    Challenge #3: The complexity conundrum

    Contemporary global health faces challenges that fundamentally resist standardized technical solutions. Climate change exemplifies this complexity, creating cascading effects on health systems and communities that cannot be addressed through linear interventions. When rising temperatures alter disease patterns while simultaneously disrupting cold chains for vaccine delivery, no single technical fix suffices.

    Similarly, emerging and re-emerging infectious diseases demand responses that cross traditional boundaries between animal and human health, environmental factors, and social determinants. Health workforce development must grapple with complex systemic issues around motivation, retention, and capacity building. The COVID-19 pandemic demonstrated how traditional approaches to health system strengthening often prove inadequate in the face of complex adaptive challenges.

    Emerging solutions: A new paradigm for learning and practice

    Recent innovations suggest promising approaches to bridging these divides through structured peer learning networks. Digital platforms enable health workers to share experiences and solutions across geographical boundaries, creating new possibilities for scaled learning that maintains local relevance.

    Solution #1: The power of structured peer learning

    Experience from digital learning networks demonstrates how structured peer interaction can enable more efficient and effective knowledge sharing than traditional top-down approaches. When health workers can directly connect with peers facing similar challenges, they not only share solutions but collectively generate new knowledge through their interactions.

    These networks provide mechanisms for validating practical knowledge through peer review processes that complement traditional academic validation. A successful intervention developed by a rural clinic in Thailand can be critically examined by peers, adapted for different contexts, and rapidly disseminated across the network. This creates a more dynamic and responsive knowledge ecosystem than traditional publication cycles allow.

    Solution #2: Network effects and collective intelligence

    The potential of practitioner networks extends beyond simple knowledge sharing. When properly structured, these networks create possibilities for:

    1. Rapid adaptation to emerging challenges through real-time sharing of experiences
    2. Collective problem-solving that draws on diverse perspectives and contexts
    3. Systematic capture and analysis of field innovations
    4. Development of context-specific solutions that build on shared learning

    Most importantly, these networks can help bridge Schön’s high ground and swamp by creating dialogue between different forms of knowledge and practice. They provide spaces where academic research can inform field practice while simultaneously allowing field insights to shape research agendas.

    Four principles toward knowing-in-action for global health

    Drawing on Schön’s call for a “new epistemology,” we can identify four principles for transforming how we know what we know in global health:

    Principle #1: Valuing multiple forms of knowledge

    The complexity of contemporary health challenges demands recognition of multiple valid forms of knowledge. The practical wisdom developed by a community health worker through years of service deserves attention alongside randomized controlled trials. This requires challenging existing hierarchies of evidence while maintaining rigorous standards for validating knowledge claims.

    Principle #2: Enabling knowledge creation from practice

    Health workers must be supported as knowledge producers, not just knowledge consumers. This means creating structures for systematically capturing and validating field insights, building evidence from implementation experience, and enabling continuous learning from practice. Digital platforms can provide scaffolding for this knowledge creation while ensuring quality through peer review processes.

    Principle #3: Scaling through networked learning

    Traditional scaling approaches that rely on standardization and top-down dissemination must be complemented by networked learning to create and amplify knowing-in-action. This means building systems that can:

    1. Connect practitioners across contexts and boundaries
    2. Enable peer validation of knowledge
    3. Support rapid dissemination of innovations
    4. Build collective intelligence through structured interaction

    Principle #4: Embracing complexity

    Rather than seeking to reduce complexity through standardization, health systems must build capacity for working effectively within complex adaptive systems. This means supporting adaptive learning, enabling context-specific solutions, and building capacity for systems thinking at all levels.

    The challenges facing global health today demand new ways of creating, validating, and sharing knowledge. By embracing approaches that bridge Schön’s high ground and swamp, we may find paths toward health systems that are both more rigorous and more relevant to the communities they serve.

    Looking forward

    Schön’s analysis helps explain why traditional approaches to global health knowledge and learning often fall short. More importantly, it points toward solutions that could help bridge the theory-practice divide to support knowing-in-action:

    1. New digital platforms that enable peer learning at scale
    2. Networks that connect practitioners across contexts
    3. Approaches that validate practical knowledge
    4. Systems that support rapid learning and adaptation

    Schön’s insights remain remarkably relevant to contemporary global health challenges. His call for a new epistemology that can bridge theory and practice speaks directly to our current needs. By embracing new approaches to learning and knowledge creation that honor both rigor and relevance, we may find ways to address the complex challenges that lie ahead.

    The key lies not in choosing between high ground and swamp, but in building new kinds of bridges between them – bridges that can support the massive scale of learning needed while maintaining the local relevance essential for impact. Recent innovations in peer learning networks and digital platforms suggest this bridging may be increasingly possible, offering hope for more effective global health practice in an increasingly complex world.

    The challenge now is to develop and implement these bridging approaches at the scale needed to support global health workers worldwide. This will require new ways of thinking about knowledge, learning, and practice – ways that honor both the rigor of research and the wisdom of experience. The future of global health may depend on our success in this endeavor.

    Listen to the AI podcast deep dive about this article

    Reference

    Schön, Donald A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34. https://doi.org/10.1080/00091383.1995.10544673

    Image: The Geneva Learning Foundation Collection © 2024

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

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

    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 the communities they serve, possessing valuable knowledge that should inform both science and policy.”

    This recognition of frontline experience as a valid source of knowledge is significant, even if not fully integrated into the report’s methodology.

    Health workers’ experiences are not merely anecdotal but represent a crucial form of evidence gathering and early warning that conventional research methods cannot match.

    When a nurse in Bangladesh notices changing patterns of heat-related illness in specific neighborhoods, or when a community health worker in Kenya observes shifts in disease transmission seasons, they are detecting signals that might take epidemiological studies decades to formally document.

    Can we afford to wait?

    As the report acknowledges that we face “record-breaking threats to their wellbeing, health, and survival from the rapidly changing climate,” why wait for traditional longitudinal studies to validate what health workers are already seeing?

    Explore the value of health workers’ experiential knowledge: 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

    Their observations, if their significance and value were fully recognized, could provide vital early insights into emerging health threats and guide rapid, life-saving adaptations.

    This is especially critical given the report’s call to alarm that climate change impacts are “increasingly claiming lives and livelihoods worldwide” and that “delays in climate change mitigation and adaptation have intensified these impacts.”

    The humanitarian imperative to act quickly makes health workers’ experiential knowledge not just valuable but essential – they are the canaries in the coal mine of our climate crisis, and their insights could help bridge critical evidence gaps while more traditional research catches up.

    The report’s most thoughtful engagement with alternative forms of knowledge comes in its treatment of Indigenous knowledge systems.

    A panel titled “Indigenous knowledge for a healthy future” explicitly acknowledges that “Indigenous peoples maintain deep connections with the natural environment that are important for the social, livelihood, cultural, and spiritual practices that underpin their health and wellbeing.”

    More importantly, it recognizes that “Indigenous knowledge has been shown to be the key to protect Indigenous health in times of health emergencies when official health systems and governments are unable to provide assistance to Indigenous communities.”

    However, the report also acknowledges that “Indigenous medicine and worldviews are rarely considered within health care or health risk preparedness and response.”

    This gap between recognizing the value of Indigenous knowledge and actually incorporating it into health systems and policies reflects a broader challenge.

    A crucial observation comes in the report’s data discussion: available data are “rarely disaggregated by relevant groups (eg, gender, age, indigeneity, ethnicity, and socioeconomic level)” and “Indigenous knowledge is often overlooked, and Indigenous populations are seldom taken into consideration in the production and reporting of evidence and data.”

    This gap in representation means that crucial experiential knowledge is systematically excluded from our understanding of climate change’s health impacts.

    Perhaps most tellingly, while the report calls for “improved data” to evaluate progress on international commitments, it focuses primarily on standardized quantitative metrics rather than developing new frameworks that could better integrate experiential knowledge.

    This reveals an underlying epistemological bias – while experiential knowledge is acknowledged as valuable, the report’s methodology remains firmly grounded in traditional scientific approaches.

    Looking forward, truly leveraging experiential knowledge in understanding climate change’s health impacts will require more than just acknowledgment.

    It will require developing new methodological frameworks that can systematically incorporate and validate different forms of knowing, while ensuring that frontline voices – whether from health workers, Indigenous communities, or other groups with direct experience – are centered rather than marginalized in our understanding of this global crisis.

    For the Lancet Countdown to fully live up to its mission of tracking progress on health and climate change, future reports will need to more fundamentally rethink how they recognize, validate, and incorporate experiential knowledge.

    The seeds of this transformation are present in the 2024 report.

    Doing so is both necessary to improve science and consistent with The Lancet Countdown’s commitment to “operate an open and iterative process of indicator improvement, welcoming proposals for new indicators… from the world’s most vulnerable countries”.

    References

    1. Romanello, M., et al., 2024. 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
    2. 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
    3. 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
    4. Sadki, R., 2025. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
    5. Sadki, R., 2025. Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries. https://doi.org/10.59350/redasadki.21339
    6. Sadki, R., 2024. Knowing-in-action: Bridging the theory-practice divide in global health. https://doi.org/10.59350/4evj5-vm802
    7. Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
    8. Sadki, R., 2024. World Health Summit: to rebuild trust in global health, invest in health workers as community leaders. https://doi.org/10.59350/343na-80712
    9. Sadki, R., 2024. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
    10. Sanchez, J.J. et al. (2025) ‘The climate crisis and human health: identifying grand challenges through participatory research’, The Lancet Global Health, p. S2214109X25000038. Available at: https://doi.org/10.1016/S2214-109X(25)00003-8.

    Image: The Geneva Learning Foundation Collection © 2024

  • Strengthening primary health care in a changing climate

    Strengthening primary health care in a changing climate

    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 the longer-term consequences of these events.

    This comprehensive view of PHC’s role in climate resilience represents a significant shift from viewing primary care merely as a service delivery mechanism to recognizing it as a crucial component of climate adaptation and health system strengthening.

    The authors argue that investing in PHC is not only essential for addressing immediate health needs but also for building long-term resilience to climate-related health threats.

    In examining workforce issues, Haines et al. specifically emphasize that “building the capacity of the PHC and public health workforce in emergency preparedness and response to climate-induced risks is crucial for enhancing the resilience of health systems.”

    They argue that “the health-care workforce, including multidisciplinary PHC teams, should be provided with training and education on the impacts of climate change on health and the implications for health-care delivery.”

    The article specifies that this training should focus on three key areas: “strengthening integrated disease surveillance and response systems,” “diagnosis and management of changing disease patterns (eg, outbreaks of vector-borne diseases in new locations),” and “interpretation and use of available climate, weather, and health data to support planning and management of adaptation and mitigation interventions.”

    They mention resources like those proposed by the “WONCA Global Family Doctor Planetary Health Working Party” as instructive for such training.

    Although the article emphasizes the role of PHC workers as being “often on the front line of responses to extreme events such as floods, droughts, and heatwaves,” it does not discuss mechanisms for capturing or leveraging their experiential knowledge.

    This is what they know because they are there every day.

    Recommendations follow a traditional institutional approach: strengthen health information systems, build workforce capacity, develop integrated service delivery models, increase funding, and enhance governance.

    While these recommendations are well-founded, they primarily envision a top-down flow of knowledge and resources, with health workers positioned as recipients of training and implementers of policies.

    The epistemological framework underlying their recommendations reflects what educational theorists would recognize as a transmission model of learning, where knowledge is conceived as flowing primarily from experts to practitioners in a hierarchical manner.

    This approach, while valuable for disseminating standardized protocols and evidence-based practices, implicitly positions health workers as passive recipients rather than active knowledge creators and agents of climate-health resilience.

    Such a framework potentially undervalues the situated knowledge and practical wisdom (what Aristotle called phronesis) that practitioners develop through direct experience with climate-health challenges in their communities.

    It also overlooks the potential for what complexity theorists describe as emergent learning – where new knowledge and practices arise from the dynamic interactions between practitioners facing similar challenges in different contexts.

    Our research has documented how health workers are already responding to climate-related health challenges.

    For example, observations from more than 1,200 health workers in 68 countries reveal a rich tapestry of local knowledge and insights that often go unrecognized in formal academic and policy discussions

    Health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.

    Where Haines sees health workers primarily as implementers of climate-resilient healthcare strategies, we view them as leaders and innovators in climate adaptation.

    However, these perspectives need not be mutually exclusive.

    TGLF’s model offers a bridge between formal institutional approaches and ground-level experiential knowledge.

    New peer learning platforms like Teach to Reach enable rapid sharing of solutions across geographical and institutional boundaries.

    This platform enables health workers to be both learners and teachers, sharing successful adaptations while learning from colleagues facing similar challenges in different contexts.

    Such participatory approaches also help local knowledge inform global understanding – if global research institutions and funders are willing to listen and learn.

    When TGLF gathered observations about climate change impacts on health, we received detailed accounts of everything from disease transmission to healthcare access.

    A health worker from Cameroon described how flooding from Mount Cameroon led to deaths in their community.

    Another from Kenya shared how changing agricultural patterns forced them to develop new strategies for ensuring safe food access.

    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

    These granular insights complement the broader statistical evidence presented in academic literature, providing crucial context for how climate changes manifest in specific communities.

    TGLF’s model demonstrates how digital technologies can democratize knowledge sharing to strengthen scientific evidence and drive locally-led action.

    This creates a dynamic knowledge ecosystem that can respond more quickly to emerging challenges than traditional top-down approaches.

    Importantly, this model addresses a key gap in Haines’ recommendations: the need for rapid, scalable knowledge sharing among frontline workers.

    While formal research and policy development necessarily take time, climate impacts are already affecting communities.

    TGLF’s approach enables immediate peer learning while building an evidence base for longer-term policy development.

    The model also addresses the issue of trust.

    Health workers, as trusted community members, play a crucial role in helping communities make sense of and navigate the changes they are facing.

    Their understanding of local contexts and constraints are critical to develop strategies that can actually be implemented.

    By combining institutional support with health worker-led local action, we can strengthen health systems to be both technically robust and locally responsive.

    Our experience at the Geneva Learning Foundation suggests that new learning and leadership are needed to bridge these approaches, enabling the rapid sharing of both formal and experiential knowledge while building the collective capacity needed to survive the impacts of climate change on our health.

    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

    Image: The Geneva Learning Foundation Collection © 2024

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

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

    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.

  • Defunking Grunter

    Defunking Grunter

    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 cosmic patterns and wormhole trajectories.

    “Look, Sumé,” she called, her finger tracing the holographic routes swirling around the Orrery. “The quantum oscillations of the Thule wormhole – they’re anomalous, aren’t they? Do you think they might cause instability?”

    Sumé, a gentle smile on his face, looked at the eager apprentice. “Saci,” he said, his voice as calm as a placid cosmic sea, “those oscillations are part of the natural rhythm of this Nebula. What makes you interpret them as signs of instability?”

    She looked back at him, her eyes sparkling with conviction. “Because, aren’t these patterns identical to the Arcturian Singularity that collapsed last millennium? I’ve read about it in the chronicles.”

    Sumé chuckled softly, “Your diligence is commendable, Saci. But remember, not every rhythm plays the same tune. Sometimes, young star, the cosmos dances just for the sake of it.”

    As Sumé’s words trailed off, the other Astral Scholars watched from the corners, a twinkle of amusement and anticipation in their eyes. This was just the beginning of a long and winding journey.

    Little did they know, it would prove transformative for them all.

    Part 2: Cosmic symphony

    In the grand theater of the cosmos, the Obsidian Forum remained a tranquil sanctuary nestled in the heart of the Cat’s Eye Nebula. The Astral Scholars, guardians of cosmic wisdom, convened here, each bringing their unique light to the stellar discourse. Amidst them, Saci, a fledgling star, was on a path of self-transformation.

    It was Sumé, Saci’s mentor, who first perceived the subtle shift in the cosmic tide. Sumé, the guiding luminary appreciated for his wisdom and empathy, felt the ripples between Saci and the Astral Scholars. Sensing the need for a gentle intervention, he decided to foster a bridge of understanding between them.

    Beneath the timeless gaze of the cosmos, Sumé approached Saci, his voice as soothing as a cosmic lullaby. “Saci,” he began, his words imbued with an age-old wisdom, “A journey towards knowledge often walks hand in hand with humility. It’s about engaging in a dance of giving and receiving, a cycle as old as the cosmos itself.”

    Saci listened, her fiery spirit quieted by the softness of Sumé’s words. Part of her perceived his counsel as a reflection on her demeanor. The protective shell of her self-awareness hardened, a comet fortifying itself against the cosmic wind.

    “I appreciate your guidance, Sumé,” Saci responded, her voice vibrating with a controlled energy. “But do I really need to dismiss my very own thoughts? After all, isn’t the cosmos itself a cacophony of countless stars, each shining in its unique way?”

    The celestial silence that followed was palpable, a quiet pause before the eruption of a supernova. Sumé regarded Saci, her resolute spirit flickering like the pulsating rhythm of a quasar.

    “Indeed, Saci,” Sumé replied gently, his gaze unblinking. “The cosmos is a symphony, each star adding its own note. But remember, the harmony is born from listening as much as from contributing. Only then does the cosmic dance truly take shape.”

    His words echoed in the Obsidian Forum, a quiet place that embodied understanding and unity. Yet, Saci remained cocooned in her protective shell, her fledgling light dancing between self-doubt and self-affirmation. This spirited exchange between Sumé and Saci marked a key turning point, revealing a complex tapestry of cosmic interplay. It was an age-old dance of wisdom and perception, a dance that had only just begun.

    Part 3: The Dance of Realization

    In the expansive theater of the cosmos, the Obsidian Forum was alight with anticipation. The Astral Scholars convened once more, their collective wisdom creating a celestial symphony. At the heart of this cosmic orchestra, Saci stood, her spirit dancing on the precipice of understanding.

    A cosmic day dawned when Saci once again took the floor. Her voice, now more tempered but still vibrant, filled the forum, “I’ve been thinking, revisiting my understanding of TGLF and Movement. Perhaps I’ve been viewing them through a narrow cosmic lens, my own.”

    Sumé observed her, a quiet sense of anticipation glinting in his eyes. “That’s a brave admission, Saci,” he commented, his voice as serene as the cosmic sea, “It’s only through recognizing our constraints that we learn to perceive the boundless.”

    This time, Saci didn’t bristle at the mentor’s words. Instead, she took a moment, absorbing his wisdom. There was no sharp retort, no defiant glare. Just a simple nod, signifying her acceptance and understanding.

    The days passed like comets streaking across the cosmic sky, each bringing with it a new opportunity for Saci to learn and grow. She began to approach the Astral Scholars, engaging them in thoughtful conversations, exchanging ideas and exploring possibilities. The once ruffled cosmic energy was now smoothing into a harmonious flow.

    “I’ve come to understand that the cosmic dance isn’t merely about contributing one’s rhythm but adapting to the music already playing,” Saci said one day, her voice echoing the newfound realization.

    Sumé smiled, his eyes reflecting the pulsating lights of the Nebula. “And that, Saci, is the beauty of our cosmic symphony. It’s about playing our notes while also tuning in to the melody of the universe.”

    Saci’s journey was far from complete, but she was learning. She was learning to question her understanding, to seek wisdom, and to adapt. Her fiery spirit had not dimmed; instead, it was glowing with a newfound brilliance, illuminating her path towards becoming a true Astral Scholar.

    As the cosmic twilight descended, Sumé watched Saci. Her transformation was reminiscent of a celestial event, where a collapsing star forms a beautiful Nebula. It was a challenging process, as boundless as the galaxies themselves, but the outcome was worth the struggle.

    Sumé knew that Saci’s journey was just beginning. There were galaxies of knowledge to explore, infinite cosmic mysteries to unravel. But for now, he was content. For now, Saci was dancing with the cosmos, and the cosmos was dancing back.

    With her enthusiasm mildly tempered but not extinguished, Saci ventured further into the Astral Scholar’s realm of knowledge. She found herself engrossed in the study of the Trans-Galactic Light Flux (TGLF), a phenomenon as mesmerizing as it was complex. Her observations led her to draw parallels between it and Movement, an elevated state of consciousness understood and practiced by the Astral Scholars.

    One evening, as the cosmic choir of distant stars filled the Obsidian Forum, she approached Sumé. “I believe I’ve found something significant, Sumé,” she said, a gleam of excitement in her eyes.

    Sumé turned to her, his face illuminated by the myriad colors of the Cat’s Eye Nebula. “Go on, Saci. What discovery awaits us tonight?”

    “I’ve been studying TGLF,” she started, her hands involuntarily weaving through the air as if molding her thoughts into tangible forms. “And I think… I think it’s a form of energy transport, you know? And there’s a parallel with Movement, an exchange of energy at a higher level of consciousness. They’re intertwined.”

    There was a pregnant pause as Sumé absorbed her words. Then he replied, “An interesting perspective, Saci. Your innovative thinking keeps us on our toes. But remember, TGLF and Movement, though they might seem related, function on different planes. One is the heartbeat of the cosmos, while the other is the song of our souls.”

    Later, Saci presented her ideas to the conclave. Her voice was firm, her gaze unwavering. She spoke with conviction, her words leaving ripples in the energy matrix of the Forum. Some Astral Scholars responded with applause, others with probing questions, and a few with skeptical silence.

    As Saci navigated the nuances of cosmic academia, she began feeling the weight of differences in her viewpoints. She noticed her perspectives sometimes overlooked the tradition of ‘stellar contribution’, a fundamental part of the Astral Scholar’s social contract. It was like missing a star from a constellation, leading to incomplete celestial narratives.

    “Saci,” Sumé began in a gentle tone, after one heated debate had dissolved into cosmic silence, “Your theories are like comets, bright and fascinating. But remember, each celestial body, each star and planet, contributes to the cosmic dance. This, too, is a part of our learning, our growth.”

    Listening to Sumé’s words, Saci felt a twinge of isolation but also a spark of curiosity. The day’s lesson had been a tumultuous ride through cosmic wisdom, but she realized that her journey was only just beginning. The Astral Scholars watched her retreating figure, their eyes gleaming with unspoken thoughts. The journey was far from over, and there was still much to learn for everyone.

    Throughout the cosmic days and celestial nights, Saci dove deeper into the intricacies of the cosmos. She brought forth radical theories and challenged age-old interpretations, her voice echoing throughout the Obsidian Forum. Her bright mind shone like a supernova, illuminating previously uncharted corners of cosmic understanding.

    Yet, it was not without consequence. Her relentless drive to validate her theories sometimes made her miss out on the gentle wisdom carried by the cosmic winds. Her interactions started drifting towards a series of inquiries and statements that leaned more towards validation rather than mutual understanding.

    One such day, during a meeting under the veil of a cosmic aurora, Saci brought forth a new framework about the behavior of Quantum Strings. “Isn’t it plausible,” she argued passionately, “that the Quantum Strings in the Sumé Belt oscillate at a higher frequency due to the influence of TGLF?”

    The Forum fell silent, each Scholar processing her theory. After a moment, Cygnus, the oldest among them, replied, “Saci, your enthusiasm is a beacon of hope for all of us. Your thirst for knowledge, undeniable. But have you considered the universal harmony in your hypothesis, the subtle rhythm of the cosmos? And the ‘stellar contribution’ that each celestial body brings to this cosmic ballet?”

    Saci met his gaze, her heart pounding with the intensity of a pulsar. “I… I have,” she said, “but the strings’ behavior is so compelling, it’s hard to ignore.”

    Cygnus responded with a soft smile, “Indeed, it is. Yet, the cosmos is a grand orchestra, my dear. Not a single note out of place, not a single beat without purpose.”

    That night, as the cosmic choir hushed and the Obsidian Forum basked under the soft glow of the Cat’s Eye Nebula, Saci found herself wrestling with a whirlwind of thoughts. Her conviction wavered, her theories began to seem flawed. Yet, she was adamant about standing her ground. The Astral Scholars watched her from the corner of their eyes, seeing a reflection of their own past in her passionate defiance. They realized that their newest member was beginning a transformative journey that was as much hers as it was theirs. It was only the beginning.

    Beneath the brilliant display of the Cat’s Eye Nebula, Saci’s fervor continued to permeate the Obsidian Forum. She was a force, a cosmic storm that stirred the otherwise tranquil conclave. She was bold and innovative, pushing boundaries and invoking intense debates. Yet, underneath her confident exterior, the Astral Scholars observed subtle signs of a silent battle.

    One cosmic twilight, Sumé found Saci gazing at the holographic star maps, her face bathed in a soft celestial glow. “Saci, your presence reminds me of a fledgling supernova, ready to explode and scatter your elements across the cosmos,” he said, his voice barely a whisper.

    Saci turned towards Sumé, her mentor and her guiding star. “And what if the cosmos rejects my elements, Sumé?” she asked, her voice shaking, revealing a side she had often masked with her indomitable spirit.

    Sumé took a moment to answer, his gaze soft. “The cosmos doesn’t reject, Saci. It transforms. Your elements, your ideas, they add to the cosmic soup. They cause reactions, start a chain of events that lead to new creations. This is the essence of ‘stellar contribution.’ Embrace the differences, the debates, and the questions.”

    As Saci absorbed Sumé’s words, a realization dawned upon her. Her perception of acceptance had been rooted in agreement, while the cosmos and the Astral Scholars thrived on divergence, debates, and transformation.

    While her confidence seemed unscathed, the Astral Scholars couldn’t miss the shadow of self-doubt that had subtly started to creep in. Sumé, the gentle mentor, understood this was a crucial turning point in Saci’s journey. He knew she was ready to embark on an introspective journey to revisit her beliefs, question her understanding, and transform her approach. As Sumé and the Astral Scholars looked on, Saci stood at the precipice of a great learning curve. This was her initiation into a deeper understanding of cosmic knowledge, a step towards becoming a true Astral Scholar.

    And so, under the incandescent gaze of the Cat’s Eye Nebula, the first chapter of Saci’s journey among the Astral Scholars came to a close. It was a chapter of discovery, of challenging conventions, and of understanding the intricate dance of cosmic forces. But, most importantly, it was about the recognition of her own growth areas and the willingness to address them.

    As the cosmic twilight gave way to the shimmering space-time fabric, the Obsidian Forum began to shimmer with the echoes of Saci’s thoughts. Her realization about her journey sparked a metamorphosis in her approach, a change as significant as the birth of a star.

    Sumé and the Astral Scholars watched Saci’s retreating figure against the cosmic backdrop. They saw the uncertainty in her eyes, the self-doubt that threatened to overshadow her bright spirit. But they also saw a glimmer of hope, the promise of a new dawn, the beginning of a deeper understanding.

    Yes, Saci had made mistakes. Yes, her ideas had stirred the cosmic pot. And yes, she had a long path ahead of her, a path fraught with learning and challenges. But she was just at the beginning of this path, and every path has its own wisdom to offer.

    And so, as the Nebula watched silently, Saci left the Obsidian Forum, her mind full of thoughts, her heart filled with resolve. The first chapter of her journey had come to a close, but the story was far from over. In the grand cosmic dance, Saci was still finding her steps, still learning the rhythm, and the Astral Scholars were right beside her, guiding, watching, and learning alongside.

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

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

    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 that the committed Jesuit educators who staff the education program burn out after a few days or months, how to adapt courses to learners who lack resources or basic skills (quality), and  how to teach 21st century knowledge skills (spanning the range from keyboard typing to critical thinking) in such contexts. Workshop organizer, InZone director, educator, and interpreter (that’s a lot of hats) Barbara Moser-Mercer is doing an amazing job of building meaningful connections and collaboration with other teams from universities and international organizations. This is what a 21st century learning network should look like.

    What use is discovery without analytics? Wednesday evening, I’ll be one of a jury of twelve for Semantico’s thought leadership dinner in London, which the digital publishing company describes as “as a way of bringing together leading influencers from the scholarly publishing ecosystem to debate a relevant topic over fine wine and food.” Sounds tasty. I read this as the question of epistemology: how do we know what we know about how people discover knowledge (packaged in containers like publications)? Are the analytics you get from publishing (number of downloads, time spent engaging with content) sufficient when education-based approaches can reveal so much more about what people do with our content?

    Learning culture as strategy: The more time I spend with organizations and teams investigating their learning culture, the more it feels like a methodology that starts with diagnosis (measuring learning culture using Karen Watkins’s and Victoria Marsick’s DLOQ instrument) and then deepens individual and team understanding of the learning practices that foster continuous learning and connections with others. Asking questions about how we learn (beyond formal training) makes it obvious how little we reflect on experience. The lesson learned is what we tend to keep, rather than the journey that got us there. Without reflection, this is the Achilles’s heel of learning by doing. Epistemology again. The payoff when you figure this out is that actioning learning culture drives knowledge performance.

    Knowledge performance: What is the relationship between individual creativity and an organization’s ability to learn? “We should just test people’s IQ and hire only the most intelligent ones,” is probably one of the silliest statements I’ve heard in the recent past blurted out by one of the smartest people (and dear friend) that I know. Leave aside the fiery debates about the biases of IQ measurements. Just consider that an organization’s ability to learn (no, organizations do not have brains but organizations that do not adapt and change, die) walls in your ability as an individual to exercise and productively apply your creativity, serendipity, and invention. In other words, no matter how smart you are, if your organization has low knowledge performance, you may come up with the most brilliant idea, but it is unlikely to translate into practice.

    Photo: Algerian patisserie from La bague de Kenza (Paris), a personal favorite.