Experiential Knowledge, Public Health Evidence, and Health Inequality by Erica Borgstrom

Jennie Popay (Lancaster University) recently gave a talk on what experiential knowledge can contribute to a public health in relation to understanding health inequalities. Her premise is that understanding how people make sense and live their lives should be an integral part of public health research. Valuing experiential knowledge as evidence enables researchers to reframe their questions. This will provide the potential for context-appropriate solutions and the ability to shift the moral tones of current public health discourses.

The first part of her talk outlined how experiential knowledge can be considered as evidence. Popay reflected on philosophical literatures that describe knowledge as being about practical wisdom that can explain the contingencies of everyday life. She noted that how people make sense of and present their experiences is often very systematic and fits within the logic of their lives, even if it does not match the logic of (positivists) researchers. She stressed the need to trust that people are skilled interpreters and translators of their experience. With this definition, it is unsurprising that social scientists are more readily willing to accept knowledge as evidence as they typically use stories as data and their roles are to “excavate the stories of the everyday”.

The relationship between experiential knowledge and evidence within public health is an unequal one. There is a hierarchy of evidence, it was argued, that privileges quantifiable data (especially if collected in certain ways). For many of the SAHN members in the room, this dominance is often a lived experience that comes across in our engagements with health policy and in the research projects we work on. A useful way of framing the issue as she presented it was not to think about the validity of experiences, but in the purpose that these experiences have in helping us to understand the issues at hand.

In order to illustrate her case, Popay looked at several case studies where qualitative methods, social theory, and/or public engagement were used to understand health inequalities. For example, she drew on Hilary Graham’s research that describes smoking behaviour as an example of coping within their life contexts and asserting a positive social identity. Rather than negatively moralising such behaviours, as public health research and policy can do through an emphasis on individual responsibility, exploring experiential accounts helps to connect the actions with the material and social contexts in which it is being done through which positions of moral worth and control can be reframed.

Her talk is reflects a growing interest in experiential knowledge as evidence. Social scientists working within medical fields are uniquely placed to collect and make sense of these forms of knowledge as evidence. Popay suggested thinking of innovative ways in which this can be done, such as doing public sociology, to make use of lay understandings early on in research projects. Many of the non-social scientists in the audience may have left the seminar unconvinced about the role and ability of experiential knowledge to make sense of contemporary public health problems. For those of us with whom her talk resonated, the challenge is for us to reflect on the ways in which we engage with and represent people’s experiences and at what point we incorporate their views into research design and analysis.

-Erica Borgstrom, anthropologists based at the Institute of Public Health, University of Cambridge. Follow on Twitter @EricaBorgstrom

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