Background & Glossary

• Knowledge, what we know and believe to be true, is derived from a variety of sources – education, experience, instinct or intuition, and experimentation. Historically, the scientific community has placed greater value on experimental knowledge, elevating not only the information it provides, but also the methods by which it is obtained. This thinking has created a scientific knowledge system that is insulated and limited. In recent years, deep politicization of science combined with a public reckoning with racism in the United States (and in science) has spurred a reevaluation of what constitutes knowledge. Despite growing attention to research focused on racial and Indigenous equity, structural racism and settler colonialism are embedded in how the current research ecosystem operates - from how research is done, to who gets tenure and how it is incentivized and achieved, from who and what research is funded, to the type of research that is published and cited. 
• In recognition of the importance of a more holistic basis of knowledge, constructed from multiple sources and approaches, the Robert Wood Johnson Foundation (RWJF) is working to transform the “Health Science Knowledge System” to shift the paradigm around how knowledge is created, valued, and distributed. The aim of this effort is not to eliminate or exclude the scientific method, but to expand on it, recognizing that it is one of many valuable ways of knowing and generating knowledge for a broader understanding of what is needed to advance racial and Indigenous health equity. Scientific knowledge has been - and continues to be - incredibly valuable for understanding health and wellbeing in communities. But other forms of knowledge generation, including lived experience, community knowledge, and Indigenous Ways of Knowing, are equally important for understanding the conditions that shape health and identifying solutions to improve it. These forms of knowledge should be equally valued and used to inform action to advance health equity. For instance, quantitative research is often privileged as the gold standard for determining what constitutes rigorous science, but we recognize that this is flawed. Communities should not have to wait for a scientific study to validate what they already know through lived experience before their experiences and priorities elicit action.

The Ways of Knowing initiative, co-developed by two Robert Wood Johnson Foundation programs, Evidence for Action (E4A) and Partners for Advancing Health Equity (P4HE), in close collaboration with expert co-organizers, is an ongoing effort to leverage collective wisdom and action to transform the HSKS. This transformation aims to uplift the knowledge, expertise, and power of people and communities who have been continuously oppressed and marginalized, and advance health equity research along a continuum towards health justice. 

The Ways of Knowing initiative is also an effort to redefine rigor in the health sciences, moving from a narrow methodological hierarchy that heavily favors causal inference designs to a broader definition that accounts for both how the research is conducted (and assess the methods based on their ability to answer the research question) and whether the research has an impact, noting that impact is not confined to policy reform but rather relates to whether it results in some benefit to the community.

Non-profit organizations play a vital role in transforming the HSKS because they often serve as the bridge between communities and research institutions, including academia, funders, and journals. Typically rooted in the communities they serve, non-profit organizations are uniquely positioned to translate community priorities to institutional partners while also helping communities navigate and engage in the research process. In doing so, they can serve as trusted connectors and holders of accountability, ensuring that research remains responsive to community priorities and that institutions are accountable to the people they aim to serve. While not traditionally categorized as gatekeepers within the HSKS, non-profits do wield power and have an important role to play in knowledge generation, translation, and implementation, especially community-based organizations that are grounded in their local communities, for example. This Action Agenda encourages non-profits to recognize and embrace this power by using their position to push boundaries, advocate for more equitable partnerships, and help build the capacity of community members to meaningfully participate in and lead research.

We recognize that non-profits are diverse. They vary in size (from small community-based organizations to large, national think tanks), mission, and resources, and their experience engaging in research ranges from extensive to limited. Some have dedicated research infrastructure and longstanding partnerships, while others are just beginning to build this capacity. The recommendations in this Action Agenda are intended primarily for non-profits that are engaged in research partnerships with other institutions. Consequently, not every priority action can be accommodated by all non-profits.

The Health Science Knowledge System (HSKS) is defined as a system of knowledge generation, currently heavily influenced by institutional gatekeepers or decision-makers of scientific knowledge—academic and other research institutions, journals, scientific review boards, research funders, and other entities (e.g., the government)—that make decisions about what constitutes scientific knowledge, what we produce, collect, and share. For this reason, this Action Agenda specifically focuses on decision-makers in positions of power or influence within the current HSKS, who we can collectively hold accountable to make changes in the processes, policies, and procedures of their institutions to support a more holistic HSKS (e.g., academic administrators, journal editors, and research funders).

In this Action Agenda, beyond the HSKS decision-makers, the Ways of Knowing ecosystem represents the players within the HSKS who share values related to advancing health equity and justice. Within this ecosystem are health equity scholars, grassroots researchers, non-profit organizations, members of communities most impacted by injustices, and others with a vested interest in using research as a tool for advancing health equity. These players have diverse lived experiences and represent diversity across positions of power and privilege within the HSKS and beyond. As our ecosystem continues to expand and welcomes new voices and perspectives, we anticipate that this work, including the shared language we use to describe it, will evolve to better honor the dignity and representation of our growing collective.