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What does experiential knowledge contribute to public health evidence to reduce health inequalities?

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BRADFORD HILL SEMINAR

This talk will be introduced by Dr Louise Lafortune, Scientific Co-ordinator, SPHR (Cambridge.

‘The people are excluded from forming judgements on various matters on the ground that expert knowledge is required, and that of course the people cannot possess.... The debunking of the expert is an important stage in the history of democratic communities because democracy involves the assertion of the common against the special interests’ (Aneurin Bevan, quoted in Smith, 1993:178).

Whatever else ‘health’ is, it is also a ‘moral imperative’ deeply embedded in unequal power relationships. And although the context has changed profoundly it was ever thus. From traditional tribal societies to contemporary African States struggling to control Ebola in an unequal global economy; from Galenian notions of disharmony and disequilibrium to the (Post) modern ‘western’ world obsessed with individual lifestyles and the regulation and disciplining of the self, becoming ill has always been a sign of moral failure and a source of blame: and is therefore inherently associated with moral meanings and judgements.’ What worth then has knowledge based on experience or ‘the wisdom of experience’ as E P Thomson called it?

Research on health and health inequalities is dominated by an epistemology rooted in naturalism, positivism and quantification. Ironically, in this numerical world, individuals dominate but as accumulations of vulnerabilities or resiliences and/or sets of freely chosen behaviours, with the ‘wisdom’ acquired through ‘everyday’ experiences typically neglected or devalued. An alternative perspective sees individuals and communities as ‘knowing subjects’ constructing meanings and judgements about health that are logical in the context of their lives: able and willing to account for their actions. For people living in difficult socio-economic circumstances, experiential knowledge serves to (re)-establish moral worth in the context of enduring inequalities in health and in access to the resources needed to maintain and promote health.

In this context no single definition or associated quantitative measure of health – no matter how dynamic – will suffice. Instead of current approaches to evidence accumulation and utilisation, dominated by scientific and professional rationalities, public health to engage multiple lay, scientific and professional perspectives in deliberative processes that, whilst uncomfortable, and often conflictual, could provide the beginnings of a collective verstehende theorising, creating ‘new knowledge spaces’ for the development of shared understandings of health problems and potential solutions. a more civic epistemology.

This talk is part of the Bradford Hill seminars at the Cambridge Institute of Public Health series.

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