I'm now nearly two years into the Wellcome Trust Fellowship. The lull in posting since starting in May 2022 is a reflection of how long it has taken me to get to grips with the project, and to figure out what I can contribute through the work. In the next three posts, I will share the learning I've had so far, and provide an update on the direction of travel of the research.
As a reminder, the project title is “Framing inequalities through causal stories: a cross-case comparison and critical reflection”. The idea for the study came out of three central reflections:
The health system is not alone in being tasked to address socially patterned outcomes that reflect underlying social and economic inequality – similar patterns exist across many public sector areas.
Groups advocating for action on 'health inequalities' are presumably also not alone in having to constantly challenge or push back against narrow explanations for inequalities (e.g., those that focus on individual characteristics and behaviour over wider social factors).
Prominent concepts and ideas designed to counter narrow explanations for 'health inequalities' have had mixed success in influencing health policy and practice; as such, it may prove fruitful to learn from the experiences and the framing debates around inequalities from across other sectors.
Getting started
The sectors I'm looking at are early childhood education and care, youth justice, and housing. Since starting the project, I have been reading extensively to get my bearings in each of the three areas and focusing in particular on literature that says something about how inequalities have been framed in each. I have complemented this activity with wider reading around the theory and method of analysing problems and stories, and their role in shaping what actions get taken across policy and practice. There has been much trial and error in these early stages. On numerous occasions I felt that I had 'nailed down' how I would pull out information from pertinent texts, only to be completely dissatisfied with the end result!
I realised over time that the issues stemmed from a fundamental tension in the design of the research. While I thought I was on the hunt for literature that offered up competing causal explanations for the same agreed upon problem (i.e., inequalities in specific outcomes), what I was finding was literature that questioned, in a much more fundamental way, what should be considered 'the problem' or indeed 'problematic'.
The remainder of this post is dedicated to sharing the insights that helped me to make sense of this tension and how they are shaping the project.
Learning 1: 'Conditions that hurt people need not become problems'
Early on in my reading, I found myself in a part of the academic literature that I had never encountered before - the sociology of social problems. There was much to enjoy here (along with many a rabbit hole to fall into), but it was the writing of Murray Edelman that I found most compelling. Edelman's 1987 article entitled "The construction of social problems as buttresses of inequalities" served to shatter my naïve optimism about how and why certain problems find themselves to the fore of political agendas. Edelman's argument is that many harmful conditions or behaviours are never considered 'problems' by political actors, and so it is essential to question why some kinds of problems are consistently favoured by governments over others. His own sense is that:
Problems come into discourse and therefore into existence as reinforcements of ideologies, not simply because they are there or because they are important for well-being. They signify who is virtuous and useful and who is dangerous or inadequate, which actions will be rewarded and which penalized. [1]
Learning 2: Policy problems have 'effects'
A closely related point is that policy problems do more than simply point to the existence of an issue; they have important (and often political) consequences or 'effects'. In Carol Bacchi's popular analytic approach 'What's the problem represented to be?', a dedicated step in the process is to critically interrogate such 'effects'. A typical example is illustrated in the quote above whereby people who are implicated in the policy 'problem', and who are also the targets of policy actions, come to be understood in particular ways (e.g., as lacking the 'right' morals or values). The central point that Bacchi makes is that there are real people living the effects of how we come to think about policy problems, and it is essential that we are alive to these effects and especially any harms that arise, unintended or otherwise [2].
Learning 3: All causal accounts are not created equally
I designed the fellowship around the idea of 'causal' or 'diagnostic' stories because they are recognised as central to how problems get framed in policy and practice [3]. However, there were three things that I had failed to fully appreciate at the outset of the study:
There often isn't consensus about what needs 'diagnosing'. Modern science and statistics tend to offer up inequalities metrics as the starting point for causal explanations (e.g., life expectancy). But such metrics convert human hardship and suffering into anonymous numbers and graphs, and can feel far removed from the immediate and practical struggles of every day life in deeply unequal societies [4].
There is also a more fundamental question of whose knowledge, or what kinds of knowledge, are deemed valuable and relevant in identifying the 'problems' of the day, and in crafting diagnostic stories about what is going on, and what needs to change.
Finally, causal stories are not mirror images of action stories. 'Knowing' the causes of a 'problem' is an altogether different task to realising social and political change, which itself requires a different set of intellectual tools, resources, and commitments.
Learning 4: Need to consider the 'roots' of our thinking
In light of the reflections presented above, I had to ask myself - what was the source of these oversights? And where did the taken-for-granted assumptions that I had designed into the research come from?
These questions led me to the writing of scholars like Vanessa Andreotti [5] and Tania Murray Li [6], who helped me to appreciate how contemporary efforts to 'problem-solve' or 'improve' societies are underpinned by very particular ways of thinking about the world. Within this model, messy realities are converted (most often by 'experts') into 'technical problems', the discrete causes of which can be isolated using scientific methods, which in turn can be 'fixed' through properly implemented ('expert' designed) intervention. While this model can work well for many issues, it is perhaps less well equipped to generate stories about how to realise a fairer society. Rather than interrogating competing causal stories that have emerged from the same 'root thinking', a more pressing task for the fellowship then seems to be about exploring alternative approaches that open up space for thinking and working differently. I'll explain more about my modest attempt at doing this in the following posts.
[Note: This is the first post in a set of three]
Acknowledgements
Thankfully, I am not muddling through this project alone! Please have a look at this page which gives more information and due credit to the advisory group whose experience and reflections are also shaping the work.
References
[1] Edelman, M. (1987). The construction of social problems as buttresses of inequalities. U. Miami L. Rev., 42, 7.
[2] Bacchi, C. (2000). Policy as discourse: What does it mean? Where does it get us?. Discourse: studies in the cultural politics of education, 21(1), 45-57.
[3] Stone, D. A. (1989). Causal stories and the formation of policy agendas. Political science quarterly, 104(2), 281-300.
[4] de Sousa Santos, B. (2018). The end of the cognitive empire: The coming of age of epistemologies of the South. Duke University Press.
[5] de Oliveira, V. M. (2021). Hospicing modernity: Facing humanity's wrongs and the implications for social activism. North Atlantic Books.
[6] Li, T. M. (2007). The will to improve: Governmentality, development, and the practice of politics. duke university Press.