Questions bout sexual and gender identity are in the news at the moment. The NHS in England has announced that patients will be routinely asked their sexual identity so services can be better tailored. The Office of National Statistics has caused a storm of controversy over proposals to change the way the census asks about gender and sex in 2021 to make it more trans-inclusive.
This might seem an odd gambit to open a blog post about a seminar on knowledge exchange, but it is appropriate because this directly links to knowledge I, as a researcher, want to transfer into policy and practice in Scotland. Basically, I want housing and homelessness organisations to routinely collect data on the sexual and gender identity of service user and tenants.
In the research project I discussed at SKAPE in November (published Open Access in Evidence and Policy) we found that researchers have many motivations for wanting to impact policy, and also varying backgrounds, experience and knowledge to do so. This, surprisingly, is not something considered in detail in the literature to-date. In particular, three key themes stood out in the data that acted as barriers, or enabled researchers, to effectively translate research findings into policy-making: their biographies; their disciplinary background and institutional pressures.
How do these three categories apply to myself and my desire to get the findings of my own research into policy? Considering my biography, I am a gay man myself, and I have always been committed to progressing issues of social justice in my research, inspired by my family background and the work of my doctoral supervisors on urban regeneration.
This then links to my disciplinary background – I am an applied policy researcher and have been in an academic environment where doing activities to influence public policy is valued since my first academic job. This compares to other disciplines – in our research the arts and humanities – where such activities may not be common and so there is no shared understanding of how to do them. It also contrasts with the experiences of some participants in our research who had their activities in trying to influence policy-making or service delivery actively dismissed by their institutions as inappropriate activities for an academic to be doing.
Finally, institutional pressures have affected my decision-making. As impact is valued in the REF, in fact it is to be valued even more, it is work I will be positively assessed for. Further, I am fortunate enough to have a period of research sabbatical at the moment, which means the work of organising meetings, writing policy-briefings, and contacting organisations can be fitted into a hectic schedule without the pressures of teaching or administrative duties.
For many academics these reflections might seem banal – it’s just the sort of everyday things you notice when you’re working with colleagues, or in reflecting on your experiences. However, coproducing our research with a civil servant involved in policy-making, meant that it was these factors that were highlighted as being key to understanding why some academic research, and researchers, found their routes into affecting policy-making much easier than others.
In our work following the research, a key focus has been on helping academics better reflect on their own behaviour – to see themselves as a policy-maker might see them. So how has such reflection helped me in my own attempts to influence the delivery of housing and homelessness services?
Primarily, I have strategically hidden the theoretical logic that has led me to my policy recommendation and that supports my argument. In analysing the data from my research organisations were reticent to ask service users their sexual or gender identity for fear of causing offence. This view, expressed by heterosexuals, presumes that being LGBT+ is something that people should be ashamed of, and people should be expected to volunteer when it is relevant, rather than something an organisation should seek to know about their service users. I interpret this as implicitly homophobic. This insight comes from queer theory and its insights into how heteronormativity is replicated by the everyday behaviours of heterosexuals. Thinking of how I might be viewed making such an argument, I am actively downplaying this theoretical argument in my engagement with policy-makers so I don’t come across as an activist scholar who uses long words and jargon, such as “heteronormativity”.
Rather, I am reframing the argument as one that should matter in delivering services. I use my data to highlight that many LGBT+ have negative experiences – such as harassment and violence – that should be tackled by service providers. Therefore, service providers should be routinely asking people their sexual and gender identity so they identify problems, and also that service users will be more comfortable in volunteering such information in future.
Whether academic research should seek to change policy-making, or should be measured for doing so, remain as key debates across most academic disciplines. However, our research suggests that if academics want to do this, then honest reflection on their own behaviour will make the sort of communication and ongoing relationships that can mean that academic research can make policy better.
This blog post is based on a talk at the SKAPE lunchtime seminar on July 5th 2017.
Taina Meriluoto, University of Jyväskylä, Finland, firstname.lastname@example.org
In early 2010’s, I was employed in a Finnish Civil Society Organisation working within the social welfare sector. I was in charge of a project whose objective was to ‘bring the organisation back to its roots’ – to remind a deeply professionalized organisation about the value of volunteers and members, and more profoundly, introduce ‘a participatory approach’ in the organisation’s core activities. As a means to engage the organisations’ beneficiaries – and perhaps more importantly, to influence our colleagues’ way of working – we introduced the notion of ‘experts-by-experience’ into the organisation’s vocabulary.
For four years onwards, I was deep into developing expertise-by-experience in this organisation. I met truly amazing survivors, whose point of view definitely deserved to be included and heard. However, at the same time, I grew increasingly concerned. The idea of expertise-by-experience was introduced by us, the organisation’s practitioners. It stemmed both from our commitment to the inclusive values of civil society, but also from what we thought our funder was expecting of us. As one of my later interviewees put it, she ‘didn’t want to become an expert-by-experience, she was rather made into one’. This was decidedly not a bottom-up initiative. It was not about the people ‘fighting to get their voices heard’. Instead, it was about us wanting to show that we listen.
In addition, quite a few of my colleagues expressed a strong urge to contain and limit either the issues the experts-by-experience would be allowed to discuss, or the scope of who should be allowed to act as an expert-by-experience. When I discussed the idea with one colleague, she acclaimed in slight horror: ‘But [if we were to listen to everyone] then there’s no telling what kind of ideas they might have!’ Participation and inclusion appeared scary, and the response was to set up standards, guidelines, rules and recommendations that made the ‘wild and uncontrollable’ participation manageable.
Finally, it was the notion of expertise that baffled me. Why do we need to call these people experts to be able to listen to them? As it later turned out, I was definitely not the only one perplexed by the concept. As I then began finding out, the aspect of ‘making experts’ was a very crucial tool in the initiatives as they constructed their participants as subjects.
In large part as a result of this bafflement, I have since studied expertise-by-experience in the Finnish social welfare sector as a PhD research project. I have interviewed both experts-by-experience, practitioners and policymakers, and analysed policy documents that provided the impetus for developing expertise-by-experience within the Finnish social welfare. I have focused most of all on the governmental aspect of ‘making experts’: What characterizes the subjectivities created through crafting ‘experts-by-experience’? What kind of participation and ‘way of being’ is encouraged and made feasible? Through which practices the participants are constructed as experts? And finally, how do the participants respond to and engage with their subjectivization? This blog post summarizes some of my key findings. But first, a brief note on context and background.
The peculiarities of Finnish experts-by-experience
In the Finnish context, the term expert-by-experience is used to refer to people with prior social problems, who have been invited to act as ‘experts’ in CSO’s and public sector organisations. The term was introduced in the Finnish context by mental health organisations, following the introduction of a strong participatory emphasis on the Finnish social policy outlines (see, e.g. National Development Programme for Social Welfare and Health Care (Kaste) http://stm.fi/en/kaste-progamme). Now, it is a hugely popular concept, and an approach that is largely developed in projects – both in the public and the third sector.
Despite its popularity, the term remains ambiguous and is used to signify a variety of people and activities. Most commonly, the experts-by-experience act as
Overall, the projects developing expertise-by-experience have three broad objectives:
As the savvy reader might have guessed, the plethora of activities and reasons given to expertise-by-experience have resulted in quite a few controversies regarding who should be allowed to act as an expert-by-experience, and what purposes their expertise are supposed to serve. Were the experts-by-experience to serve as experts of their lives, social welfare services, rehabilitation, the effects of a particular policy or was their role as an intermediary translator between the beneficiaries, social welfare practitioners and policy-makers? What was the nature of the knowledge they were supposed to contribute? Was it personal or representative? Should the experts-by-experience be interviewed and trained, or act purely based on ‘their raw experiences’? And finally, who gets to define knowledge and expertise in this context, when the expertise concerns the people themselves?
The purpose of my research is not to provide answers to these questions, but instead explore why these questions emerged as relevant in the first place, and how different answers to these questions might help us understand the different processes of self-making that take place in the projects developing expertise-by-experience. I plan to explore these issues through the following four arguments.
Experts of themselves
1: In order to be accepted as an expert of services or a policy, the experts-by-experience need to first become ‘an expert of themselves’
In an article in Critical Policy Studies, I explored the process of ‘becoming an expert on oneself’. I discovered that the projects entail several practices of ’working on oneself’ that are geared towards creating a specific relationship between oneself and one’s experiences. I suggested that in order to be accepted as an expert-by-experience, one needs to be able to turn oneself into something one ‘knows’ rather than ‘is’ — and to draw the definitions of knowledge from the dominant system of thought.
This finding is a crucial stepping stone for further inquiries, as it illustrates the significance and role that the definitions of ‘knowledge’ and ‘expertise’ hold in this context. As the participants’ subject-construction is influenced by the projects’ definitions of the appropriate process and form of ‘knowing oneself’, and the experts-by-experience are expected to participate as experts of themselves, the definitions of credible knowledge can be translated into conditions the participants have to meet to be allowed to participate. ‘Knowing yourself’ becomes a prerequisite for participation, and the definitions of that knowledge provide powerful governmental devices to steer the participants’ way of being.
2: ’Knowing oneself’ equals neutral and constructive behaviour
In many of the projects I investigated, knowledge and expertise were defined as being ‘distanced’, neutral and objective. As the ability to ‘assume a more general outlook’ and ‘not to have any emotional outbursts’. This was done, primarily, by labelling the ability to express one’s experiences neutrally and constructively as ’a sign of empowerment and rehabilitation’. The following interview transcript illustrates:
TM: What does it mean that the past has been dealt with? E17: [sighs] Well, I think that dealing with your past means that you are able to talk about it without big emotional reactions, I mean that you don’t burst into tears or feel very angry or bitter, but you are able to talk about your experiences in a calm and neutral manner. I mean that your emotions are no longer uncontrollable. And that you have constructed your story into a whole where you already understand the connections between the facts.
These pre-requirements of neutrality and objectivity were, above all, measures to contain and control the experts’-by-experience participation. By equating ‘knowing oneself’ with the ability to talk in a neutral and objective manner, the projects’ practitioners retained control over deciding who, and what kinds of input would be accepted and recognised. Furthermore, they preserved the ability to legitimately exclude unwanted and awkward inputs, and to steer the participants towards a way of being that was convenient for them.
3: Framing participation as co-production makes knowledge, instead of an opinion, a legitimate content of political participation
Framing participation as ‘co-production’ made the rather strict and technocratic definitions of knowledge feasible within the projects’ context. If the experts’-by-experience participation is justified because of the contributions it produces – instead of, for example, their right to be heard –definitions of ’valuable knowledge’ become perfectly logical tools to be used to delineate ’valuable participants’, as the following two practitioners illustrate:
P8: Experts-by-experience don’t act in a therapeutic environment and the listeners don’t need to receive any emotional outbursts but the facts as they are. P9: Yeah, for example when talking about service development, if you have very bitter experiences, it’s very good if you have been able to form them into constructive criticism. Then you don’t cause any resistance in the professional’s part.
4: Instead of contesting ‘experience-based action’, the participants’ critique attempts to redefine expertise
The participants experience the disconnect between the projects’ promise of inviting their ‘raw’ experiences, and the need to transform them into neutral knowledge’ as attempts to narrow and limit their possibilities for action. As one workshop participant put it, this can lead to a situation, where the experts-by-experience fulfil the role of ‘trained monkeys’ – they are physically present to show that ‘the participatory duty’ was met, but no contribution is welcome from their part, as the following group discussant explains
G4: I quit the customer board myself. I felt that the possibilities of truly having an impact were pretty non-existent. I mean, they say that you can disagree with the professionals, but you have to remain within a certain frame. So, in effect, you can slightly disagree, but if you disagree a lot, it is a wrong opinion to have.
The experts-by-experience are however not, by any means, mere sitting ducks. They, along with some practitioners, engaged strongly in questioning the demands of neutral and collaborative way of being expected from them. Intriguingly, they did not discard the notion of expertise in so doing, but instead took up the initiatives’ promise of treating them as ‘truth-tellers’. In various ways, the participants attempted to reclaim the right to define the meaning of expertise and knowledge in the projects’ context. For them, expertise-by-experience was the gateway to a political debate on knowledge and expertise in a social welfare context – something that the policymakers seem to have been largely unequipped and unwilling to engage in.
Why journalists should engage with their readers: a view from Slovakia
What happens when journalists join in the discussion in the often-frightening comments section below their articles? That’s one of the questions I sought to answer in my book, Discussing the News: the uneasy alliance of participatory journalists and the critical public, published earlier this year as part of the Palgrave Studies in Science, Knowledge & Policy that SKAPE edits.
In traditional newspaper culture, journalists do not often engage with their readers. So, as a researcher I jumped at the chance of witnessing an attempt to foster a more conversational relationship between journalists and the public at the newly-founded Slovak daily, Denník N
The newspaper is based in the Slovakian capital Bratislava. It was set up by the senior editors of Slovakia’s second-most read daily, SME, who walked out in protest in September 2014 when a financial group suspected of political influence and corruption acquired a 50% stake in the newspaper.
Half the newsroom followed them into a new venture, which was initially only online. In January 2015, they launched a print edition five days a week.
Participation and editorial independence
As an antidote to the rise of media oligarchs in Central Europe Denník N relies on a subscription-based business model. It views this approach as a condition for editorial independence and sees it as a promising strategy in Slovakia, where internet penetration rate is of 85% and the press is free
In this country of over 5 million people, readers are above-average news consumers. According to a 2015 poll conducted for my research, about 72% of respondents were active participants in news dissemination, both via social networks and on newspaper websites. What’s more, according to the 2016 Digital News Report, Slovakia is the leading EU nation for commenting on news websites.
By building a strong relationship with its audience, Denník N sought to offset the chronic dependence of media organisations on institutional or private shareholders with potentially conflicting interests. Participation was a natural extension of this philosophy as it encourages readers to subscribe and make the media more independent.
The newspaper encouraged its journalists not just to read the comments on their articles but to respond to them. And, to varying degrees, they did.
Journalists reply on journalism
In analysing these exchanges and talking to journalists, I discovered that there were certain comment types that journalists significantly over- or under-selected for reply.
They had a strong preference for comments about journalism. Readers commenting on editorial choices – mistakes, headlines, accusations of bias – rather than on the theme of an article were more likely to get a response.
The journalists’ responses drew on a stable repertoire of argumentative forms. Basically, when they engaged – beyond simple acknowledgements and thanks – they resorted either to process or to authority arguments. These, as Andrew Abbott describes in his book The System of Professions, are strategies of professional legitimisation.
In the screenshot here, a reporter thanks a reader for spotting a typo before explaining that the report was published “two minutes after the President’s official statement arrived”. This reference to the time pressure that online newspapers work under when dealing with breaking news highlights that they sometimes sacrifice orthographic precision for speed.
This is what’s called a process argument, in that the author provides an insight into the conditions of production of an article. The logic is that if people have a better understanding of a process they might be more understanding of the results.
The second type of justification is the authority argument. In commenting on their own pieces, journalists would, wherever possible, efface their own voice and defer to other, more credible authorities. They might quote in greater depth one of the sources of their article, link to an official report, scientific article or statistical database, or cite a public opinion poll in order to back up the facts or interpretations outlined in the piece.
In both process and authority arguments, Slovak journalists used the discussion as an accountability instrument, acting almost in the manner of readers’ editors or ombudsmen.
Occasionally, they took a different track. Some writers crossed the line of neutrality and distance that journalists usually keep, and digressed from facts to interpretations. They took up or threw down polemical gauntlets and got into arguments.
The three who did so most frequently had different backgrounds and beats: one was a commentator writing mostly on economic issues; another was a young reporter on the foreign news desk, covering controversial topics such as gay rights and the refugee crisis; and the third was a correspondent writing long-form reportage and interviews.
When faced with criticism, some bluntly told commenters that they were wrong, or ridiculed their assertion by calling it “laughable”. Doing this risks inflaming the discussion, but they sensed this kind of reply was in keeping with the spirit of online discussions: animated verbal conflict is acceptable there.
The same goes in many well-established media genres: heated debates, as television and radio reporters have long known, make for very good viewing and listening.
Denník N’s “polemicising” journalists took on a distinct “discursive identity” in their comments, a style they would never indulge as newspaper reporters (unless they were writing opinion pieces). In other words, they recognised the characteristics of a genre and adapted their own discourse accordingly.
Just as I’m using a genre-specific form of writing in this article (which differs from the style of my book, though it’s still based on or derived from it), I witnessed astute journalists at Denník N treating discussions as a distinct genre, one that is only now emerging. It challenges them to learn to talk credibly in poorly scripted situations, ones that journalism school doesn’t really touch.
As journalists must now juggle several digital channels of communication – both to retain relevance with an online audience (for marketing purposes) and to explore new forms of dialogue between information-producers and information-consumers (from a democratic perspective) – this is an increasingly important skill.
Not commenters: contributors
According to French philosopher Joëlle Zask, participation is contributory if each participant in a situation retains the possibility of making and claiming a difference through their intervention. The contributor is thus valued for his or her singularity.
So here’s a modest proposal: let’s call a person who discusses the news a “contributor”, instead of using less dignified terms such as commenter or user.
The term is a useful boundary object; it allows journalists and their increasingly critical publics to meet on neutral ground without equalising their status.
By encouraging journalists to consider their “below-the-line” critics as contributors, we can challenge them to think of their own published texts as provisional accounts, always open to outside additions, clarifications, objections and corrections.
But by asking journalists to think of themselves as contributors when they engage with a critical online audience in comments or on social media, we give them a sort of professional shield. They can more easily value the time they spend in the dialogue, while still treating it as different from and subsidiary to their main role as writer, safe in the knowledge that they are not tacitly endorsing the claim that we are all journalists now
And if we agree that these contributors – both readers and journalists – can constructively exchange, clicking on the comment button becomes a much less frightening experience.
* An earlier version of this piece was published in The Conversation on 8th June 2017: https://theconversation.com/why-journalists-should-engage-with-their-readers-a-view-from-slovakia-78114
This article was originally published on Sociology Lens on 12 April 2017
Author: Dr Ingrid Young, CSO-Chancellor’s Fellow, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh
On 10 April 2017, the Scottish Medicines Consortium (SMC) announced that PrEP (pre-exposure prophylaxis) – the use of HIV treatment in people who are HIV-negative to prevent HIV – would soon be available on the NHS. This is a landmark decision for the use of HIV treatment as prevention in the UK, making Scotland the first – and currently only – country to provide PrEP through the NHS.
PrEP policy pathways
The Scottish pathway to this policy decision has been very different to that of England. Third sector and health policy organisations, community activists, clinicians and researchers came together in both countries to collate evidence about PrEP’s effectiveness and show how it might address a public health need for additional HIV prevention tools.
However, concerns around cost, judgements around ‘lifestyle’, and debate about responsibility for prevention contributed to a long and protracted debate and delay in England. This resulted in ongoing community campaigns (e.g. #united4prep) and legal actions demanding PrEP, and finally the promise of a new PrEP trial to enable access to PrEP in England, although little detail is currently available [http://prepster.info/2017/02/know-new-england-prep-trial/]
In contrast, and learning from the experiences of colleagues in England, the Scottish process appeared to be less hindered by bureaucratic decisions and negative public debates with expert working group and community consultation reports feeding directly into the decision [http://www.hivscotland.com/our-work/prep-in-scotland/ ] While policy processes and outcomes differed between the two countries, the language of cost-effectiveness, the framing of responsibility and the mobilisation of scientific knowledge within and by coalitions of activists have been critical in both of these stories.
Treatment as prevention – a lifestyle choice or an essential treatment?
PrEP has continually captured headlines – and imaginations – in the UK. Yet at the same time that clinical evidence for PrEP was released, international clinical trials found that HIV treatment in people living with HIV could also prevent its transmission. Unlike the very public debates of PrEP, HIV treatment as prevention in people living with HIV has moved forward as a policy decision with little fanfare. The most recent BHIVA Treatment Guidelines [http://www.bhiva.org/documents/Guidelines/Treatment/2016/treatment-guidelines-2016-interim-update.pdf ] now recommend that HIV treatment be offered to all people living with HIV for the prevention of onward transmission. The difference with this and PrEP, it seems, is that treatment as prevention is not seen as a lifestyle choice, but as an essential treatment for people living with an illness.
One of the more interesting developments to emerge during this interim PrEP policy period has not only been growing activism demanding NHS provision of PrEP, but how coalitions of community and clinical actors have circumvented the formal health system to fill the gap. The creation of a website (Iwantprepnow.co.uk) to access generic PrEP for personal use has not only been embraced by NHS clinicians in the absence of state provision, but led to the provision of clinical support for the use of these otherwise privately acquired drugs ( i-Base 2016, Portman 2016). In the context of a public-funded health system that needs to make both public health and budgetary choices, what are the implications of private acquisition of what some have called ‘essential prevention drugs’? While this do-it-yourself PrEP option is available to those in the know, who have sufficient income to pay for these drugs and who can navigate complicated regulations to import pharmaceuticals for private use, who does this leave behind?
Biomedicalisation, inequalities and implementation
The uneven implementation of this ‘new’ HIV science speaks to the ways in which the processes of biomedicalisation implicit in HIV treatment as prevention are not homogenous. As colleagues and I highlighted in our 2016 article in anticipation of the implementation of HIV treatment as prevention[http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12372/epdf], understandings of cost and cost-effectiveness, ongoing stigma around ‘lifestyle choices’ or public health needs, and debates around responsibility for prevention continue to be woven through current policy processes and decisions.
With Scotland’s PrEP decision and the continued uneven access to PrEP across the UK, we need to consider how factors such as geography, ethnicity, gender, sexuality and money continue to play important roles in how scientific developments are translated in health and health policy. Given the increasing role of pharmaceuticals for prevention (Greene 2016, Lancet 2017), as well as the growing provision of pharmaceuticals outside of the formal, state-funded health system, we will need to be particularly attentive to ongoing implementation of HIV treatment as prevention. While many activists are celebrating a well-earned policy decision, this is by far the end of the story.
Ingrid Young is a Chancellor’s Fellow at the University of Edinburgh. She is currently funded by the Scottish Chief Scientist Office. This blog draws on Ingrid’s ongoing work in the translation of HIV treatment as prevention. Ingrid was a member of the Scottish Short Life Working Group who recommended the implementation of PrEP in Scotland.
Greene J, Condreau F, & Watkins ES (eds) (2016) Therapeutic Revolutions: Pharmaceuticals and Social Change in the 20th Century Chicago: University of Chicago Press.
i-Base (2016) UK Guide to PrEP i-Base collaborative publication (2nd edition) London.
Lancet editorial (2017) Polypills: an essential medicine for cardiovascular disease Lancet 389 (10073): 984.
Portman, M. Pre-exposure Prophylaxis: making history Sexually Transmitted Infections 2017: 93;7.
In recent years, research impact has emerged to become a part of the everyday life of UK academics. The underlying logic of the impact agenda, as reflected in policy documents, is that excellent research would lead to societal benefits (see for example RCUK). But how do these policy expectations fit with the realities of knowledge exchange and impact work? This question is at the heart of my upcoming SKAPE presentation, in which I will offer some early findings emerging from my PhD project, which studies academics involved in knowledge exchange organisations.
The emergence of research impact
Many academics came across research impact when it was introduced as an element of RCUK research funding under the heading of “Pathways to impact”, or as the impact case study component of the Research Excellence Framework. However, these changes can be understood as part of a longer-term ‘impact’ focused policy project that can be traced back to at least the 1993 White Paper “Realising Our Potential. A Strategy for Science, Engineering and Technology”. This document introduced an ambitious project of a cultural change:
“The aim is to achieve a key cultural change: better communication, interaction and mutual understanding between the scientific community, industry and Government Departments.” (Cabinet Office, 1993, p. 5).
This idea was further developed in multiple documents that followed, including “Realising our potential”, the Lambert Review of Business-University Collaboration and the 2004-2014 Science and Innovation Investment Framework). A key development was the 2006 Warry Report, which pointed to the gap between ‘excellent science’ and ‘insufficient’ implementation of science in policy and economy. The Warry Report proposed that, in order to fill this gap, ‘impact’ should be introduced as a criterion of research funding allocation. This new funding paradigm has opened up a route to the inclusion of impact as both a desired outcome of scientific activity and a measurement criterion for research funding in both strands of the UK’s government funded research system – the Funding Councils and the Research Councils. RCUK’s “Pathways to impact” (introduced in 2009) were designed to encourage researchers to think about the potential of their proposed research for achieving impact (and allowed reviewers to assess these proposals). REF impact case studies, introduced in 2014, were designed to assess impacts that had already been achieved. The definition of research impact is consistent across these two systems and highlights excellent research as a basis of research impact: the RCUK’s definition of it being: “The demonstrable contribution that excellent research makes to society and the economy”; and the REF definition being “All kinds of social, economic and cultural benefits and impacts beyond academia, arising from excellent research, that have occurred during the period”.
The emergence of the research impact agenda has led to multiple investments by UK research councils in related mechanisms, including in knowledge exchange organisations, with the aim of increasing the impact of research on behalf of individual researchers or research groups. In my presentation, I will explore how people employed in these kinds of positions experience and understand research impact and how these understandings translate into strategies oriented towards achieving research impact. To illustrate this, I will explore two ways in which their experiences deviate from the assumptions behind the impact agenda: 1) in terms of misalignment of impact and academic excellence, and 2) in terms of impact being a concrete, measurable phenomenon.
The misalignment of excellence and relevance
Contrary to documents discussed in the preceding section that present research impact and excellent research as causally connected, many of the interviewees saw the achievement of research excellence and of impact as two separate processes. Data show that academics working in impact-oriented organisations perceived themselves as operating within contradictory and competing logics: that of official declarations of the importance of impact, and that of practical accountability and performance measurement in terms of high-impact journals. In their work the contextualisation and localisation of the impact activities was contradicted by the universality and generalisability of what is conceived of as “excellent research”.
Interestingly, data show that academics operating within impact roles do not find the cultural differences between academia and policy as challenging as meeting the contradictory expectations of the universities and funders. So how do academics deal with this double-accountability? One way identified in the data is the creation of social spaces for people with similar views, goals and value systems. The perception of their organisation as a space separate from the university creates an opportunity for the academics to alleviate the tension stemming from contradictory expectations of being simultaneously socially involved and academically distant. Within these spaces, the career risks and responsibility for meeting performance indicators are dispersed among multiple members. As a result, the interviewees view their organisations as standing at the forefront of cultural change in academia.
The making of impact
“Research impact” has emerged as a tangible policy concept, reflecting an activity that can be planned, executed (as in the “Pathways to impact”), measured and reported (for example through REF impact case studies). This idea could be contrasted with the experiences of academics in impact roles who perceive research impact to be the result of complex social processes and structures that cannot always be measured. In my presentation I will focus on two of the processes and structures: 1) sense-making process of the translational role of the organisation and understanding of what impact is, as well as how this understanding came to be; and 2) the wider structural and organisational context in which the organisation is operating, including the university setting, policy structures that the organisation is aiming to influence, and funding structures. These processes and institutional arrangements affect the different strategies that organisations and people in those organisations adopt to influence policy and consequently the types of impact sought (and achieved) by these organisations. Particularly interesting here, in terms of the architecture of the impact agenda, is the relationship between the way the organisation is set up and the potential breadth of the resulting impact. These differences are illuminated by a comparison between the studied organisations. The first one, created in close collaboration with partners, was operating in a reactive mode, responding to policy needs. This approach increased the chances of more direct instrumental impacts. A contrary approach could be identified in the second organisation. Here the participants perceived their work as initiated by research, rather than policy questions. Thus their approach would not yield measurable policy outcomes but rather a broader illumination and enrichment of the policy debate.
In the concluding segment of my presentation, I will reflect on the perception of these organisations as facilitators of a cultural change in academia. By creating spaces where narratives and ideas about research impact are created, knowledge exchange organisations offer an alternative to impact agenda policy accounts of academic engagement.
A recent report by the CCC (the Committee on Climate Change) made its low-key way to Parliament (‘The compatibility of UK onshore petroleum with meeting the UK’s carbon budgets’). In it a key message: shale gas exploitation, commonly known as ‘fracking’, if it is carried out on a significant scale, will be incompatible with the UK’s climate change targets. To be clear, this means for instance that both the UK carbon budgets, and the 2050 commitment to reducing emissions by at least 80% would be compromised. This will happen, the report states, unless three fundamental conditions are met: strictly limiting emissions in the phases of development, production and decommissioning of wells; keeping gas consumption within the limits defined by the budgets; and fitting emissions from shale gas production into the existing carbon budgets.
Setting aside all the other social and political challenges that fracking poses, this report and the conditions it sets for meeting climate change targets raises interesting questions about the nature, role and impact of targets in climate change policy. Here are a few: what is the value of targets as a policy tool, and – in particular – in framing and constructing climate policy in the UK, Europe, and internationally? What are the most useful mechanisms for monitoring performance against these targets? What are the most effective means for ensuring compliance with targets, and how is non-compliance to be detected?
These questions were the focus of an ESRC funded project on ‘The Politics of Monitoring’ (ES/K005170/1 and an associated JPI award “IPCC AR5 in Europe”) and addressed by a panel of experts, policymakers and members of NGOs at a meeting held late last year in conjunction with IPPR (Institute for Public Policy Research). Our analysis below includes the views of that panel in arriving at fresh views on targets, climate change and policy making.
For about two decades the world of UK public policy has been dominated by the discipline and language of targets. The setting of quantitative objectives in a wide range of areas (from education, to hospital waiting-lists, to immigration and to policing) has become a familiar part of attempts to make public services more responsive, more controllable and more focused on ‘delivery’. This approach was famously enshrined in the Public Service Agreements (PSAs) that were a leading feature of New Labour endeavours in the public sector and in the Prime Minister’s Delivery Unit. Professional and academic commentators have drawn attention to the extent to which targets were ‘gamed’ – honoured in formal terms but subverted in practice.
An initial issue is the extent to which the use of targets in the climate area is linked to this policy approach. Other environmental policy arenas have a long and independent history of using numerical targets as a management/negotiating tool. For example, the measures to deal with acid rain and similar issues taken under the UN Convention on Long Range Transboundary Air Pollution (CLRTAP) have been specified in terms of percentage reductions for over thirty years. It appears likely that such natural scientific entities – and particularly entities that exist at supra-national scales – are simply susceptible to being governed through numerical targets. It is unclear how much new public management had an impact on these areas or whether these policy ambitions were, so to speak, fortuitously cast in a target-setting mode from the outset.
Emissions targets instil a degree of clarity in policy-setting. Providing targets do not change too frequently, and providing the main actors have confidence in the durability of the targets, there can be widespread ‘buy-in’ to targets for managerial and organisational reasons (as well as because people believe in the validity of the targets themselves).
This prompts a related question about how accurate or precise the measures and targets are. Because with CLRTAP and greenhouse gases (GHGs) we are dealing with technical and scientific entities, it is easy for policy-makers and the public to presume that targets are objective and open to being reliably measured. But the GHG figures are based on complicated accountancy procedures for estimating and tracking the amounts of carbon emitted. CO2 emissions are not measured so much as accounted for. And in the case of other GHG emissions, as with nitrous oxide and methane, it is harder to know whether the figures have the robust objectivity that one would like to ascribe to them; the same applies to measurements of land-use change and forestry impacts.
For management purposes, targets are supposed to be about disciplining performance and holding people accountable. But, as respondents in our study made clear, targets may also have a strong political or signalling logic (Boswell et al, 2015). The UK targets for CO2 and general greenhouse-gas emissions before the Climate Change Act were not particularly ambitious “stretch” targets. It seems to have been assumed that these targets would have been rather readily achieved; they might indeed have been achieved even without becoming targets of official policy at all. However, the targets did function to signal the UK’s commitment to this issue, and allowed it to take a lead role in international fora as a country that was manifestly ‘doing the right thing’ about climate change.
The specific language of budgets in climate change policy
For the UK, the Committee on Climate Change tracks the latest emissions data and identifies underlying progress towards targets set in the carbon budgets and more broadly. Measuring and monitoring of greenhouse-gas emissions is governed by international agreements, and the CCC’s work is based on these data. But the CCC’s role is broader than the collation and publicising of such data since its aim is to interpret this information for the UK context, to look forward and locate areas where targets could be missed, and to identify key actors (whether in policy or industry) who need to be involved in the attainment of future targets.
Although there are clearly still some uncertainties around specific emissions data (energy data are believed to be robust while those from agriculture and land use still need further research and development), the CCC focuses on trends. If data collection processes are consistent and the figures are heading in the right direction, one can feel confident about trends in performance even if the figures are not known with great accuracy.
Worldwide, the dominant framing of targets relating to climate change has clearly been centred on emissions targets. But, with the passing of the Climate Change Act and the growing role of the CCC in open discussion of carbon budgets, future budgets have emerged as a different kind of target. In the IPCC’s AR5 the idea of a global-level carbon budget (or ‘carbon space’) came to be highlighted by the IPCC for the first time. This re-framing of the issue (asking who should be able to use which slice of the carbon budget and when) was not particularly newsworthy in the UK because of its familiarity. But in Norway, for example, it became an important new expression of the policy issue: should the Norwegian government really be exporting its oil and gas and thus using any of the world’s carbon space at all? The effectiveness of the language of carbon budgets raises questions about the consequences of constructing targets in different registers.
Compliance with targets
After the UNFCCC Paris Agreement at the close of 2015, climate policy is faced with a new approach to targets in the world of nationally devised targets (known as INDCs). In the run up to the Paris COP, the pressure was on governments to make commitments that were not embarrassingly meagre. Post-Paris, the challenge is to hold to the targets countries have set themselves and then join in international efforts to ‘ratchet down’ from those commitments. But there are still questions over how those commitments were arrived at and how accurate a guide to future emissions they can be expected to offer. Currently, the major concerns are over the adequacy of the INDCs (since between them they offer global emissions reductions that fall significantly short of the target believed to be linked to two-degrees warming) and over the questions of how compliance will be monitored and overseen.
Compliance is clearly pivotal, though in many areas the detection of non-compliance with regard to emissions, or through deforestation and land-use changes, or through building new power stations is relatively straightforward using observational and technical means. In many respects the upcoming key issues are to do with the political and policy responses to non-compliance. Countries may wish to invoke security concerns in relation to data about their energy sectors or emissions. And in the extreme the only sanctions available, aside from the court of international opinion, would be trade sanctions or the sanction of the UN Security Council. Though the Paris Agreement processes focused on a ‘ratchet’ relating to emissions, there was also a need for a ratcheting up of transparency over environmental data.
From the above, one message can be retained when reading and making sense of the CCC report on shale gas and carbon budgets: the difficulties in meeting the three tests set for fracking by the CCC are formidable. But does this mean that the language of targets has ruled out shale gas exploitation? We would not go that far.
Academics working in the UK are being increasingly encouraged and incentivized to seek research impact beyond the academy and the consequences of these changes have caused alarm for some. In a new article in the Journal of Social Policy, we outline a range of concerns that have been raised in publications to date, across disciplines, and then present an interview based case study of 52 academics working on health inequalities during the decade in which the UK’s current research impact architecture has evolved. We assess these concerns in the context of impact-related guidance from research funders and REF2014 panels. Our findings highlight a range of problems with the current approach to measuring, assessing and rewarding research impact. In this blog, we briefly summarise each key concerns that we identified, before making some tentative suggestions as to how existing knowledge about research and policy might be used to inform changes to the current research impact system to address each of these concerns. This is by no means a polished list – the intention is merely to start a conversation about how we might make better use of existing empirical and theoretical knowledge to inform attempts to monitor and reward research impact.
First, before we summarise the key concerns, it is worth noting that academics involved in health inequalities research (or at least the ones we interviewed) tend to be keen to influence policy. Reflecting this, most of the academics we spoke to were broadly supportive of the idea that research impact should be encouraged and rewarded (things may feel very different for academics working on less overtly policy-orientated issues). Despite this, most of the academics we interviewed had concerns about the current research impact reward system and here we summarise six of the most common.
Problem 1: Research impact agenda might encourage and reward what Ben Baumberg Geiger describes as ‘bad’ impact. This fear included the possibility that REF structures encourage researchers to seek impact for (potentially misleading) single studies, rather than seeking to promote wider bodies of research. The ESRC’s guidance states that “you can’t have impact without excellence” but many interviewees felt that this not only possible but, in many ways, actively incentivized by the current system.
How might existing science and policy knowledge help here? Science studies authors such as Knorr Cetina clearly demonstrate that academics work hard to develop grant applications that have the greatest chance of success and that, as a consequence, grant applications reflect academics’ perceptions of what funders are looking for. If major sources of academic funding (from the higher education councils, through REF, and UK research councils) are all stressing the importance of research impact, then we can expect that many academics will commit themselves to undertaking this kind of work, regardless of how appropriate they may feel it is for specific studies. It is therefore crucial to both think more carefully about what kinds of research impact we want to encourage and to make space for researchers to apply for funding for projects that are not impact orientated. Both REF and the UK research councils currently tend to reward impact for single studies or small groups of researchers within single institutions. If we want to encourage researchers to work to improve the use of collective bodies of research, stretching beyond their institution, then clear incentive and reward systems are needed to encourage this kind of outward-facing, synthesising work.
Problem 2: Some of our interviewees recounted instances where their work had been reinterpreted, and sometimes completely misinterpreted, by research users in troubling (sometimes ethically problematic) ways. Currently, neither REF nor UK research councils do much to acknowledge the fact that impact may not always be desirable.
How might existing science and policy knowledge help here?: Researchers across disciplines but particularly those involving humans and animals in their research have spent a lot of time developing guidelines on conducting ethical research. But undertaking research ethically does not guarantee that the results of that research will be used ethically. Now that research impact is being so explicitly incentivised in the UK, we need to be building on the foundations of research ethics guidance to develop ethical dimension to reward systems for research impact (for both potential research funders and REF2020 case studies).
Problem 3: Even researchers supportive of the aims of the current research impact agenda expressed concerns about whether its current architecture captures impact in a meaningful way. Many described the disconnect between their knowledge of the complex ways in which evidence influences policy, and the experience of ‘playing the game’ of depicting much more straightforward impact: one interviewee wryly stated that one achievement of the impact agenda has been to make “people lie more convincingly on grant applications”. It is often the most far-reaching kinds of research impacts that are most difficult to demonstrably track (whereas it is the less ambitious forms of impact that more easily enable a clear audit trail). Or it may be, as Christina Boswell has demonstrated for immigration policies, that research is used by policymakers more for ‘symbolic’ than ‘instrumental’ reasons (i.e. rather than informing policymakers assessments of the optimal policy route, research is used to lend authority to decisions or to signal a ‘capacity to make sound decisions’).
How might existing science and policy knowledge help here? The point here is that both research on policymaking and science studies suggest these kinds of behaviours are rationale and unlikely to change. Hence, it may be necessary to broaden the criteria for demonstrating impact for research, especially where research has contributed to substantial social or policy changes over longer periods of time. Indeed, it’s possible to conceive of a system that would enable a broader, more encompassing set of criteria for demonstrating impact that was deemed particularly significant/large-scale, whereas narrower/lower level impact would require much more specific supporting evidence (as we suggest in Figure 1 in our article).
Problem 4: Several researchers with ongoing policy connections suggested that policymakers who are already struggling with information overload may not welcome increasing numbers of academics making ever-more efforts to send research outputs their way or to involve them in research design.
How might existing science and policy knowledge help here? Looking at current guidance on research impact, the system currently seems to be predicated on the idea that improving the use of research in policy means increasing the flow of research into policy. Empirically informed theories of the policymaking process, from Lindblom’s concept of ‘muddling through’ to Kingdon’s ‘policy streams’ model, paint a picture in which decision-makers face a daily barrage of information, with advocates and lobbyists working to pull their focus in different directions. This suggests that academic incentive structure ought to focus more on improve the use of research in policy, which may actually mean reducing the flow of research outputs into policy but improving their quality or accessibility. As noted above, one way of doing this might involve doing more to incentivise academics to synthesise existing bodies of research for policy, advocacy and public audiences. It also suggests that a lot more could be done to incorporate the realities of policymaking processes into research impact guidance and tools.
Problem 5: Several interviewees, particularly those who were at an earlier career stage, suggested that impact reward systems may be unintentionally reifying traditional academic elites. It is, after all, a lot easier to achieve research impact if you are already a senior academic with a strong reputation in policy circles – it’s even easier to do this if you went to school with, or are otherwise personally connected to (e.g. as friends/neighbours/family) senior policy folk (see for example Ball; Ball & Exley). Further issues arise when we consider that the timing of key opportunities for ‘impact’ can be particularly difficult for academics with caring responsibilities (evening and weekend networking opportunities, for example). There are also basic workload issues that are likely to be more constraining for those with caring roles (several interviewees reflected that they did not feel the demands of achieving impact had been matched by commensurate reductions in other workloads). Since we know that women take on a disproportionate amount of caring work, then this is a gender issue.
How might existing science and policy knowledge help here? Research on policymaking processes in UK suggest that older, white men continue to dominate structures. Surveys of higher education suggests the situation is similarly imbalanced for chair level academic posts. If our interviewees are correct, then the research impact agenda is reinforcing this, much as Les Back argues, with the impact agenda encouraging ‘an arrogant, self-crediting, boastful and narrow’ form of academic work that positions ‘big research stars’ as ‘impact super heroes’. This suggests, at the very least, that REF impact case studies ought to be subject to some form of equality assessment (as research outputs are). It also underlines the importance of taking impact related work into account in workload allocation models. It may also be worth considering additional support for achieving, and/or a lower threshold for demonstrating, research impact for earlier career academics and those with substantial caring roles.
Problem 6: around a third of our interviewees discussed the challenges of maintaining critical, intellectual independence while trying to align one’s research ever more closely with policymakers’ concerns. The ‘fudge’ which several of our interviewees described resorting to, involved phrasing policy recommendations in strategically vague ways, softening perceived criticism and (as one put it) “bend[ing] with the wind in order to get research cited”.
How might existing science and policy knowledge help here? Research on both academic and policy work has highlighted the value of critical and blue skies academic work and few seem to be actively suggesting that it is desirable to restrict this kind of work. Yet, a research funding system that rewards demonstrable research impact clearly squeezes the opportunities for this kind of work when it is competing against proposals for empirical research offering research impact potential. Potential ways of redressing this might protecting/increasing research calls/funding that are specifically for critical and blue skies research, removing the time limits for impact case studies in REF2020, and rewarding efforts for knowledge exchange and public engagement with academic work that could not (for economic, political or practical reasons) be expected to have impact in terms of achieving demonstrable policy or social change.
We expect that most of the concerns raised here will be familiar to colleagues who have come across contributions on this issue from Greenhalgh & Farly, Pain et al, Back, or simply from discussions with colleagues in the offices, staff rooms and corridors of the UK’s universities. Our goal in writing this is to encourage, in the hiatus between REFs, colleagues to begin making clearer suggestions for more constructive approaches to encouraging and rewarding research impact. The current architecture is not a ‘done deal’: researchers who care about the relationships between research and policy, perhaps especially those whose research careers are based on studying the construction of research and policy such as those connected to SKAPE, must try to improve how we recognize and reward research in the ‘real world’.
Authors : Hilary Cornish and Graham Spinardi
The recent discussion in parliament, which passed the motion to replace Britain’s Trident nuclear deterrent submarines, was a rare occasion where a defence procurement decision hit the headlines. The MoD’s current estimate for four new submarines is £31bn, with a planned contingency of £10bn, a figure that has already grown from the previous £25bn estimate. However, whether the new submarines can be delivered within this budget, and crucially within the planned schedule, is difficult to predict given the realities of major defence procurement projects, as evidenced by the problems with procurement of the astute class submarine. More generally the past record of the MoD in delivering to targets set for procurement by Public Service Agreements (PSAs) highlights the difficulties faced in achieving cost and schedule targets.
Meeting the targets
The PSAs introduced under the Blair government in 1998 were intended to increase the accountability of the government in delivering public services, drawing on the new public management trend to set targets that were SMART – Specific, Measurable, Attainable, Realistic, Timely. In the case of the MoD these PSAs included targets for defence procurement. Whilst they varied a little during the lifetime of the PSAs they focused on ‘big ticket’ projects and set targets for three areas of performance – cost increases, in-service dates, and meeting customer requirements. They aimed to ensure the MoD was delivering the necessary equipment, on time and to budget. Reporting against the PSA’s was generally favourable. Customer requirements were always on target, never less than 97% met. Until 2001, schedule and cost requirements were also reported as either ‘met’ or ‘on course’. Slippage of In-Service Dates showed the most variation: the target wasn’t met in either 2002/03 or 2004/05, but was back on course in 2005/06 and 2006/07. For costs, the picture was also good, either meeting the target or ‘on course’ until 2003/04, where slippage was reported, and 2004/05, where the target was ‘partly met’. In the period 2005 to 2007 cost targets were not only met, but exceeded. However, in 2007/08 that trend changed, and the In-Service Date target and cost increase target were both missed by a substantial margin. Nonetheless, the overall assessment in 2007/08 was that the targets have been ‘partly met’, considering also that 100% of customer requirements had been met.
The “Black Hole”
Despite this rosy picture of how performance was reported as compared to the PSA targets, in 2009 the MoD’s own figures showed schedule overruns of around 80% or about five years, and cost overruns of around 40% or about £300 million. This led the Public Accounts Committee to report in 2010 that the MoD defence procurement programme was unaffordable, with ‘commitments exceeding forecast budgets over a ten year period by £36 billion’. The apparently disastrous state of defence procurement was effectively portrayed as an overall failure of the Labour government to control spending. The new coalition government made much use of rhetoric that emphasised the ‘black hole’ in the defence budget. What had only recently appeared to be successful management of defence procurement, as evidenced by apparently favourable PSA performance indicators, was now revealed to be the opposite. What could explain this?
One explanation is that defence procurement faces many intractable problems. The ‘big ticket’ items require state-of-the-art performance, often resting on the incremental improvement of existing technology. They are lengthy projects, with responsibility for delivery shifting as people change posts regularly. Over-optimism is encouraged at the early planning stages, as once contracts have reached certain thresholds, cancellation is unlikely. Furthermore, a culture of resistance to external oversight and scrutiny was highlighted by our interviewees.
Balancing the books for defence in the short term often meant delaying projects or ‘shifting them to the right’, resulting in longer term cost increases. Alternatively, reducing numbers of items reduces short term and long term costs, but increases the relative overall cost per unit. Taken together, these factors make for a complex environment for defence, with multiple actors – from Service Personnel, civil servants, defence industry and scientists – each having different incentives within the system.
Juking the stats?
The difficulty of defence procurement explains why cost and schedule overruns happen, but it does not explain why reporting of performance against the PSA targets appeared to miss the growing problem during the 2000s. In the award winning TV series The Wire, which deals with drugs, politics and much else in Baltimore, the local police cope with political demands for crime reduction by ‘juking the stats’. By reclassifying serious crimes as less serious ones the police are able to claim to have met targets to reduce crime, satisfying the demands of local politicians. “Juking the stats … Making robberies into larcenies. Making rapes disappear. You juke the stats, and majors become colonels.” Could the same be said of UK defence procurement? Does the apparent achievement of most of the PSA targets during the 1997-2008 raise the question of whether the Ministry of Defence was also juking the stats?
We have no evidence to support any suggestion that this was done deliberately, but what is clear is that the whole PSA process was seen as a peripheral activity within the MoD rather than something that was central in driving procurement reform. The MoD likely reported accurately on their performance against the PSA targets, but perhaps the real question is, what did those targets actually measure? In most cases the performance reported is based on predictions about on-going projects, and is thus prone to the over-optimism that was at the heart of the problem with UK defence procurement. Meeting annual targets or goals shows only a small piece of the picture, and can obscure or incentivise decisions with long term implications, potentially on someone else’s watch. The PSAs themselves had little traction for many working in defence procurement that we interviewed, who were largely sceptical of their impact. One described them as “an exercise in bureaucracy”. Rather than shed light on MoD performance for the general public, those looking for a deeper understanding of procurement need to look at a wider range of performance measures.
These issues with defence procurement hang over Parliament’s vote to pass the motion to renew Britain’s Trident replacement programme. Andrew Rosindell MP asked the Secretary of State for Defence “what steps his Department has taken to ensure that the actual cost of replacing Trident does not exceed the current estimated cost?” The answer from the new minister for procurement was fairly circumspect, highlighting recent reforms and commitments. It is to be hoped that these reforms prove more effective than the target-led approach of the PSAs. The complexity of delivering large projects on time and in budget will no doubt be played out in the renewal of Trident over the next decades.
This article draws on research carried out for the ESRC project The Politics of Monitoring.
Drawing on a detailed case study of Scotland’s National Health Service, Publics and Their Health Systems: Rethinking Participation is a novel contribution to the growing academic engagement with the institutionalisation of public participation as a routine feature of governance. Author Ellen Stewart offers a ‘citizen’s-eye view’ of the Scottish health system, challenging dominant policy narratives by exploring diverse forms of public participation around one system. Helen Pallett praises this rich empirical account, which will be vital for future theorising of public participation and for scholarly interventions into broader systems.
Publics and Their Health Systems: Rethinking Participation. Ellen Stewart. Palgrave Macmillan. 2016.
Once viewed as a radical challenge to mainstream politics, public participation has in many contexts become a routine feature of governance. Over the last two decades, public participation processes have become institutionalised in the domains of development, planning, science policy-making, scientific research, healthcare and more. In Publics and Their Health Systems: Rethinking Participation, Ellen Stewart joins a growing community of scholars from different academic fields in recognising that it is now often difficult to find instances of policy- or decision-making where no public participation has taken place. She seeks to engage critically with the ways in which this institutionalisation of participation is transforming governance.
Stewart’s approach to this challenge is a novel one. Rather than focusing on individual instances of participation around her chosen topic of healthcare in Scotland – as is the conventional approach in the participation literature – she explores multiple forms of participation in and around the Scottish health system. In doing this, she offers not only what she refers to as a ‘citizen’s-eye view’ of the Scottish health system – challenging the framing of dominant policy and academic narratives – but also describes a system of participation which shapes who gets to participate, how they participate and what issues they can participate about.
Various accounts of deliberative systems, systems of practice and constitutional relations shaping participation have been advanced in recent years, but Stewart’s book is the first monograph to map such a diversity of different forms of participation around one system. The book is organised around five contrasting modes of participation in the health system, and Stewart draws on her own empirical work to shed light on the differences between these modes of participation and their relationships to each other and to the Scottish health system. Stewart considers participation through lay membership of committees concerned with health governance, one-off events or outreach work – ‘the quintessential terrain of participation’ (55) – the inclusion of elected representatives on Health Boards, protests against hospital closures and the simultaneously mundane and subversive engagement of everyday users of Scotland’s NHS.
This detailed account demonstrates how these different forms of participation are produced alongside different visions of, or roles for, the public. For example, Stewart describes how lay committee members are carefully selected for their particular skills and experience. They are then expected to adopt the standard procedures of these governing bodies just like the other members. In contrast, protesters against hospital closures took a much more active and explicitly political role, though they were often presented by policy-makers and academics as being dangerously partisan and irrational, undermining the legitimacy of their participation in the system. While everyday service users are often assumed to be passive recipients of healthcare services, Stewart’s interviews with a group of young people show the very active but often unacknowledged ways in which they participated in their own treatment: for example, by gaming appointment booking procedures or negotiating their own diagnoses. These roles stray from the demographically representative public or the ‘ordinary’ unknowledgeable public that is usually assumed in policy and academic accounts of health service participation.
Though the definition of the issues at stake in participation processes is not at the centre of Stewart’s argument, her examples illustrate how divergent definitions of the health issues under discussion and the health system being participated in are produced through these different practices. For example, Stewart found that the practice of committee work was characterised by a focus on the procedures and governance of healthcare, often foreclosing discussions of controversial issues. Even the experiments in including elected representatives on Health Boards were unable to alter these tacit practices, with representatives who had campaigned on specific political issues such as disability rights or hospital closures either resigning their positions or adopting conventional bureaucratic practices. In the case of outreach events around healthcare, Stewart offers a brilliantly worked through example of how the narrow framing and interpretation of a particular outreach event worked to reinforce existing policy logics around the topic of pregnancy support, even where participants had contributed a wide range of different perspectives.
The most important contribution of Stewart’s combination of carefully contextualised descriptions and wide-ranging comparisons is perhaps the significant challenge it offers to conventional assumptions about participation in both policy and academic work. She shows that accounts of participation which only consider the temporary participation processes created through outreach work, and even those which also consider citizen involvement in health committees, give only a very partial picture of participation in the Scottish health system. To only consider these ‘invited’ forms of participation ignores the multiple other ways in which citizens participate, the different roles they inhabit and the different views of the health system and health issues that they articulate.
Stewart’s account also begins to hint at the connections and overflows between these different kinds of participation: for example, where governance committees are involved in outreach work or encounter protesters, where the issues considered too controversial to discuss in committees overspill into broader public debate or where marginalised groups who refuse to participate in committees or outreach processes still participate in shaping the health system and their own health care in quietly subversive ways.
This book is an excellent illustration of the value of mapping a particular system, quickly uncovering both its diversity and exclusions. As Stewart acknowledges, there is more to be done to explore and problematise this system in order to systematically identify instances and forms of participation, and to consider how they interact with and shape the Scottish health system. Stewart argues in her conclusion that her account shows the important role played by academics themselves in inscribing and shaping participation around health, demonstrating the scope for future work exploring citizens’ participation in the health system through their involvement in research projects. There are also multiple forms of everyday participation and engagement with health and the health system which could be explored in this way.
This monograph demonstrates the value of the recent turn to whole systems or institutional studies of public participation. Rich empirical accounts such as this one will be vital to further theorising and attempts to intervene in these broader systems.
Helen Pallett is a lecturer in the human geography of the environment in the School of Environmental Sciences at the University of East Anglia. Her research is concerned with the intersections between science policy processes and practices of democracy. Her past research includes in-depth ethnographic work into institutionalised practices of public engagement in UK science policy, and she is currently working on a UK Energy Research Centre-funded project which involves mapping diverse forms of public participation around the UK energy system and carrying out new participation experiments. Helen tweets at @HelenPallett and you can find out more about her research here.
Note: This review gives the views of the author, and not the position of the LSE Review of Books blog, or of the London School of Economics.
The global management of emerging and reemerging infectious diseases present a complex governance issue. The most recent Public Health Emergency of International Concern (PHEIC), the incidence of cases of microcephaly associated with the Zika virus, demonstrates the high level of scientific uncertainty associated with infectious disease risks. When the World Health Organization (WHO) declared the PHEIC in February, the issue was surrounded by a high degree of uncertainty: for example, around the mode of transmission (and the possibility of sexual transmission), the association between microcephaly and Zika infection, and the likelihood of a Zika-infected pregnant woman carrying a child with microcephaly.
Such uncertainties are integral to the experience of infectious disease. The riskiest threats are those which are transmissible, novel and/or under-evidenced; diseases which may also have the highest potential to spread globally amongst an immunologically naïve population.
The 2009/10 H1N1 Pandemic, the WHO’s first PHEIC declaration under the revised International Health Regulations, provides a useful lens through which to investigate the relationship between uncertainty and policymaking around contemporary risks. Here, the novel infectious agent of the influenza H1N1/A virus spread swiftly across the globe, but the perceived lack of severity of the disease lead to widespread criticism of the WHO’s management.
In understanding the WHO’s position in calling a PHEIC and declaring a Pandemic, the issue of scientific uncertainty is key. As illustrated by co-productionist conceptions of risk, knowledge around a new risk is always in itself uncertain (due to the number of variables and contingencies involved), and often highly politicised. Risky phenomenon such as H1N1 are novel, complex, variable and by definition ill-understood. Although it is assumed that infectious diseases are stable and knowable phenomena, initial investigation cannot produce solid and complete evidence. What is achieved instead are probabilistic models, which are essentially untestable and tentative.
The initial knowledge surrounding the newly spreading disease is limited (based upon partial and preliminary epidemiological evidence) and abstract (based on modelling and necessarily incomplete data). However, once a risk has entered the social and political consciousness it necessitates action. The institution in charge of responding to the risk needs to be seen to act swiftly. Simultaneously, interpretations of the empirical data are unstable because of the multiple contingent variables, and complex network of actors, involved.
Risk managing institutions – the WHO in this case – must be seen to act despite (or even because of) the uncertainty surrounding the disease. In the case of H1N1, as events unfolded, it became clear that the disease was relatively mild. The WHO was criticized for the apparent mismatch between the global response and the severity of the pandemic. Yet this lack of severity could not be forecast during the early, uncertain, emergence of disease threat.
In dealing with the threat of infectious disease, policies attempt to produce preparedness for often unpredictable events. The diversity of diseases declared a PHEIC – H1N1, the resurgence of poliovirus, Ebola, and microcephaly associated with the Zika virus – are a demonstration of the variation in potential global threats and the flexibility needed by policy frameworks. Acting at the early and most unstable emergence of a threat, risk-managing institutions are placed in a precarious position of negotiating action around potentially severe events bound by uncertain knowledge.