Indigenous epidemiology in Canada: Epistemic struggle towards evidence, authority, and governance.

OBJECTIVES: Indigenous epidemiology has emerged as a critical intervention to address health inequities and the exclusion of Indigenous Peoples from population health research. While advances in Indigenous data sovereignty and community-led surveillance have strengthened ethical accountability, less attention has been given to the epistemic conditions that shape how Indigenous knowledge systems are evaluated, constrained, and authorized within epidemiological research. This article examines how routine methodological, governance, and interpretive practices constrain Indigenous epistemologies in public health research and introduces the Theory of Epistemic Containment. METHODS: The analysis draws on a longitudinal, reflexive, meta-methodological study of institutional texts produced over 15 years (2011-2026), including peer-review reports, grant-adjudication feedback, research ethics correspondence, editorial decisions, and committee and governance deliberations. The study treats methodological negotiations as empirical evidence of how scientific authority is produced and contested. RESULTS: The findings reveal recurring patterns of epistemic containment, including differential standards of methodological scrutiny, the relegation of Indigenous governance to ethical or contextual domains, the separation of Indigenous governance from epistemic authority, and asymmetrical authorization of causal claims and policy relevance. Quantitative epidemiological methods are routinely treated as neutral and self-authorizing, whereas Indigenous methodologies and governance systems are subjected to heightened justification, limitation, and restraint. CONCLUSION: This article advances the Theory of Epistemic Containment as a framework for understanding epistemic racism in Indigenous epidemiology. It argues that transforming population health research requires moving beyond methodological inclusion towards methodological accountability, recognizing Indigenous governance as an epistemically authoritative foundation for knowledge production, public health decision-making, and Indigenous self-determination.