Amplifying the voices of young care leavers

This post by Lucy Jamieson and Wiedaad Slemming considers how an international co-production project helped to empower a group of young care leavers epistemically and politically.

The voices of young care leavers are routinely discounted, ignored or excluded from conversations that directly affect their lives. Their knowledge, insights and expertise about navigating complex systems are rarely centred in policy, practice or research.  Led by Prof Mandi MacDonald (Queen’s University Belfast) and Lucy Jamieson (Children’s Institute, University of Cape Town), the Amplifying the Voices of Young Care Leavers project built an international learning community between care-experienced youth, researchers and practitioners in Northern Ireland (VOYPIC) and South Africa (Mamelani Projects). 

Through online discussions, international exchanges in Cape Town and Belfast, and participatory filmmaking, young people shared their experiences, identified priorities for leaving care research and developed advocacy messages alongside researchers and service providers to change policy and practice.

Despite living more than 10,000 kilometres apart, participants found striking similarities in their experiences. Conversations repeatedly returned to the importance of relationships, belonging, identity and being listened to. Young people spoke about the challenges of securing stable housing, employment opportunities, financial support and mental health struggles before and after leaving care. They also highlighted a less visible need: the desire to feel seen, heard and supported over time rather than only during moments of crisis.

What made this project particularly significant was its commitment to recognising young people as knowledge producers. Participatory filmmaking enabled care leavers to tell their own stories rather than having them interpreted by others. The resulting documentary, United & Unique: Separated by Geography, Connected by Community, foregrounds perspectives that are often marginalised and challenges stereotypical narratives about young people with care experience.

From an epistemic justice perspective, one of the most powerful messages to emerge was that young people are experts on their own lives. The project demonstrated that when care-experienced youth are given meaningful opportunities to participate, they generate valuable insights into what works, what does not, and what change is needed. As participants reflected, leaving care is not a single event but an ongoing process requiring sustained support and strong relationships.

The project's impact continues beyond the documentary. In South Africa, the findings are supporting advocacy for stronger policy commitments and funding for aftercare services beyond the age of 18. In Northern Ireland, the project is helping to highlight gaps between policy commitments and implementation. More broadly, it has created a platform where care-experienced young people can influence public understanding and policy conversations.

For those of us concerned with epistemic injustice, the lesson is clear: meaningful change begins when young people are not only invited to speak but are recognised as credible knowers whose lived experience is vital to shaping the systems that affect them.

The young people have produced a report to accompany the film, which you can download: McCallin_et_al_25_United_Unique_youth_report.pdf

Watch the film:

About the authors

Lucy Jamieson and Prof Wiedaad Slemming, from the Children’s Institute, University of Cape Town visited the University of Bristol to foster a partnership with the Centre for Childhoods and Social Justice.  When planning international research with children, considerations of decolonisation and epistemic justice assume particular significance. 

Epistemic justice asks who is doing the research, with whom, about what, through what means, to what ends, in whose interests and requires reflection on power imbalances to ensure genuine and equitable partnership across cultures and generations.  

International partnerships between the Global North and the Global South are especially challenging due to inequities in resources to produce knowledge, recognition of expertise, and the platforms to have that knowledge heard. Lucy presented on participatory methods used in two international research projects including the co-production of the documentary United and Unique.

Whose knowledge counts? Learning from epistemic injustice in global health

This post, by Michael Bresalier, reports and reflects on a recent, interdisciplinary workshop about epistemic injustice in global health.

Global health aspires to reduce inequality—but its structures can also reproduce the very inequities it seeks to solve. This paradox sat at the heart of a recent EPIC roundtable on Learning from epistemic injustice in global health. Organised and convened by Michael Bresalier, the roundtable brought together a health systems researcher, a legal scholar, a consultant physician in HIV/Sexual Health, a doctoral researcher in mental health, and a philosopher to tackle this paradox. Seye Abimbola, Himani Bhakuni, Rageshri Dhairyawan, Ian James Kidd and Linda Maqutu shared their insights on how knowledge and power shape global health, how these forces determine whose voices are heard and ignored, and ways to address epistemic injustice in healthcare systems.

Defining key terms:  ‘epistemic injustice’ and ‘global health’

To start, panellists were asked to define the two key terms under discussion. They broadly agreed that epistemic injustice involves harms done to people in their capacity as knowers. Kidd explained that people have fundamental “epistemic needs” – to understand, interpret and share knowledge – and injustice occurs when these needs are blocked by prejudice, bias, or structural exclusion. Bhakuni extended this to global health, describing systematic forms of epistemic harm that affect entire populations, particularly through credibility deficits (where local expertise is dismissed) and interpretive marginalisation (where communities lack the resources to define their own experiences). Dhairyawan characterised epistemic injustice as one of the ways in which healthcare can dehumanise individuals and groups. There was broad agreement that these injustices are not incidental but deeply embedded in healthcare systems.

Defining global health proved more difficult. Rather than settling on a single definition, panellists agreed that global health is a set of relationships structured by inequality. Abimbola offered a resonant framing of global health as a “meeting of unequals,” a relationship structured by disparities in power, resources, and authority—especially epistemic power—that shape how health problems are defined and addressed across the globe. This imbalance determines everything from which problems are prioritised to how research is conducted—and whose knowledge is seen as legitimate.

Others reinforced this relational view. Bhakuni stressed that the “global doesn’t exist without the local,” pointing out that similar power asymmetries recur at multiple scales – from international partnerships to doctor-patient interactions. Maqutu similarly pointed to “unequal epistemic authority” not only between the Global North and South but also within healthcare systems. Taken together, global health emerged as both an aspirational project of reducing health inequities and a field structured by persistent asymmetries in what knowledge is produced, valued and applied.

Colonialism and epistemic injustice

A particularly nuanced discussion focused on the relationship between colonialism and epistemic injustice. Panellists agreed that colonial histories are deeply entangled with global health but resisted reducing all epistemic injustice to colonialism alone. Abimbola described the relationship as a “Venn diagram”: overlapping but not identical. Colonialism is one important driver of epistemic injustice, he suggested, but epistemic harms can also arise from other forms of exclusion and hierarchy. At the same time, colonial legacies continue to shape whose knowledge is recognised in global health. Maqutu illustrated this through the marginalisation of Indigenous knowledge systems, such as African traditional medicine, which are often excluded in mental health provision even when they are central to patients’ health beliefs and lives.

The roundtable stressed that while global health remains historically entangled with colonising forms of power, not all epistemic injustice in global health is colonial in origin. Overextending this connection risks collapsing complex problems into a single historical frame. Instead, analyses of unjust knowledge systems in global health require multifactorial perspectives.

These complex dynamics become especially visible in practice. In a discussion of the challenges in justifying funding for a small study of intimate partner violence among HIV-positive women, Dhairyawan described how both patients and healthcare workers can experience dismissal or silencing, sometimes leading to “testimonial smothering.” Abimbola highlighted how global metrics or standards—often set by organisations like the WHO—can distort local realities when imposed without context, forcing countries to “understand themselves” through external frameworks while ignoring local health realities. Across these cases, epistemic injustice appears as a structural feature of how knowledge is produced, validated, and applied.

From inclusion to transformation

When it came to solutions, panellists agreed that responses to epistemic injustice must be context-sensitive, dialogical, and attentive to power. But individual-level changes—such as encouraging clinicians or researchers to listen more—are not enough. While individual virtues such as empathy are important, they are insufficient on their own. Structural change is essential.

Bhakuni proposed reframing epistemic harms as violations of dignity and rights, requiring institutional accountability. Maqutu argued for epistemic decolonisation: not just including marginalised voices but transforming the standards by which knowledge is judged. Abimbola cautioned that even well-meaning efforts at inclusion can fail if underlying power structures remain unchanged.

Kidd added an important caveat for those using the epistemic injustice as a universal framework. Dominant understandings of epistemic injustice often reflect moral and political frameworks rooted in Global North traditions. Scholars in the Global South have challenged this apparent universality, emphasising the need for broader, more context-sensitive interpretations. In this view, epistemic injustice should be understood not as a single fixed concept, but as a wide class of epistemic wrongs—arising from prejudice, bias, and exclusion—shaped by long, complex historical and social processes, including but not limited to colonialism.

The roundtable closed with a powerful insight. Epistemic and material harms are deeply intertwined in healthcare. Ignoring people’s knowledge not only marginalises them—it can also undermine trust, worsen health outcomes, and deepen inequalities.

While global is committed to justice and equality, it often operates through unequal knowledge systems. If it is to live up to its promise of equity, global health must come to terms with this paradox. This means grappling not only with disparities in resources, but with inequalities in knowledge itself—asking, at every level, not just what works, but whose knowledge counts.

Watch the workshop in its entirety here: https://www.youtube.com/watch?v=ITsCjkTwijk

Further reading

Seye Abimbola (2024), The Foreign Gaze: Essays on Global Health (open access), Marseille: IRD Editions.

Himani Bhakuni and Seye Abimbola (2021), “Epistemic injustice in academic global health,” The Lancet: Global Health.

Himani Bhakuni (2023), “Epistemic repair in global health: a human rights approach towards epistemic justice,” BMJ Global Health.

Rageshri Dhairyawan (2024), Unheard: The Medical Practice of Silencing, Trapeze: London.

Linda Maqutu (2025), “Challenging Philosophical Instincts and Embracing Complexity: A Commentary on Elizabeth Barnes’s Health Problems,” Philosophical Psychology.

Author bio

Michael Bresalier is Senior Lecturer in the History of Medicine at Swansea University and Special Investigator on EPIC, for which he leads a case study on the history of ’selective’ tuberculosis vaccination in Britain, 1965-2005.