Charting a path forward toward integrating macrolevel phenomena, marginalization, and health equity principles in...

Dissemination and implementation (D&I) science is ascendant within public health in the United States, but D&I scientists have long voiced concern at their field's capacity to fulfill two essential and intertwined public health responsibilities: analyzing and intervening in macrosocial determinants and achieving health equity. To help break this impasse, we explore D&I's theoretical roots by critically reviewing three historical eras, eras that D&I's origin story has identified as foundational to D&I's development: 1890-1903: Tarde's Laws of Imitation. 1920-1960: Rural Sociology. 1960-1980: Knowledge Utilization Research. Our racism-conscious disciplinary self-critique reveals that, as elsewhere in public health, D&I became ascendant in part by developing an "epistemology of ignorance" that has acted in service to racial capitalism - that is, D&I has developed a structured way of (not) knowing that systematically suppresses evidence about racial capitalism and its consequences. Each of D&I's foundational eras was characterized by marked transitions in racial capitalism, in which macrosocial phenomena produced novel forms of marginalization that in turn engendered mass resistance (e.g., industrialization and imperialism; farming crises). In response, D&I's forebears crafted explanatory frameworks (e.g., Diffusion of Innovation) that obscured these transformational macrosocial phenomena, reinforced the marginalizations that they produced, and diverted attention toward atomistic individual-level phenomena. These frameworks have helped foster an epistemology of ignorance within D&I about macrosocial phenomena, marginalization, and health inequities that persists to this day. We propose that D&I has an opportunity to forge another era now in which it partners with critical social scientists, practitioners, activists, and people with lived experience to bring macrosocial phenomena, marginalization, and health inequities more firmly into its orbit. We close with principles to guide the development of this era that are rooted in learnings from D&I's history and Public Health Critical Race Praxis.