Richard Freeman

Epistemological Bricolage: How Practitioners Make Sense of Learning:

How do policy makers come to know what they know? How do they think of learning? And how does that inform what they do? In this qualitative, empirical study, public health officials variously display scientific, institutional, and more socially situated epistemological strategies or rationalities. In turn, the study reveals that a key element of what they do is “piecing together,” assembling and literally making sense of different bits of information and experience, often creating something new from what they have acquired secondhand. It shows how much policy making is knowledge work, and how learning might be thought of as a process of epistemological bricolage.

The Work the Document Does: Research, Policy, and Equity in Health

At the center of the politics of health equity, in many countries and circumstances, stands a signal report of research. This article is concerned with what might be described as the architecture of such documents, including how they are produced and organized and the relationships they demonstrate with others that parallel, precede, and succeed them. The article examines how scientific and political authority is established and comments on the evidence of cross-national learning that these documents reveal. It discusses differences in how the problem of health equity is constructed in different countries and how research findings are converted into policy recommendations. It begins to trace a process of implementation by noting how these documents are referred to and written about. The argument is that the politics of health equity are expressed or realized in the documents and reports, which are its principal vehicle. This is not to claim that there is no world beyond the text or that the world somehow is a text, but that to fully understand that world we must understand the text and the work it does.

Reverb: Policy Making in Wave Form

When we think of policy as mobile, what is it we think is moving? Asking after the mobility of policy is important not least for the ontological questions it raises: what is policy such that it moves? Ordinarily, we might think of policy as existing in time and space while, given certain conditions, some policies move from one time and/or space to another. This paper, by contrast, begins by describing policy as resulting from movement, setting out a model or heuristic which takes its mobility as prior to its existence. For policy is made in communicative interaction, both oral (in meetings) and textual (in documents). We might think of it in wave form, which helps to explain both its mobility and its mutability. The paper illustrates this conception in a study of WHO activity in respect of mental health in Europe, exploring aspects of translation—understood as the generation of messages in interaction—and of iteration, as those messages are reformulated and repeated in different contexts. The policy concept reverberates, and it is in this way that collective sense is consolidated and reproduced.

Health Care Systems and the Problem of Classification

Abstract Classification is integral to comparison. The aim of this paper is to reflect on the nature, purpose and limits of classification in comparative health policy. We begin by describing the role of classification in comparative research design, discussing Webers concept of the “ideal type” and drawing on the sociology of scientific knowledge to reflect on classification as an essentially social and uncertain process. In the sections which follow, we present an outline history of the classification of health systems, identifying a “normal science” of comparative studies of health policy and exploring a number of theoretical, conceptual and methodological issues which arise from it.

learning by meeting

Abstract It has become something of a truism that organisational and political environments are internationalised, and that policy making is informed at least in part by increased understanding of what takes place in parallel domains and jurisdictions. Leaders and policy makers learn about, from and with their counterparts elsewhere. By the same token, the international meeting, workshop or seminar has become a more prominent part of professional, organisational and political routines. This paper asks simply: what do we learn by meeting? While both learning and meeting can be readily dismissed as operations of a crude construction of power, the paper is interested in what might remain. It is notable, for example, that international encounters are often highly valued by participants, albeit in ways they find difficult to express. What do participants experience in meeting, and what do they know differently as a result? Drawing on seminal work by Margeret Mead and others, and using ethnographic and documentary methods, the paper describes processes of introduction, presentation, recognition, confusion, socialisation, communication and reporting. Conceived as a microstudy of purportedly macrolevel activity, it is meant both as an exercise in analytic interpretation and as a resource for participants and practitioners.

Recursive politics : Prevention, modernity and social systems

The aim of this paper is to connect the recent interest in prevention to recent developments in social theory. It begins by recovering some of preventions essential features from the realm of common sense, showing that what is taken to be the common sense of prevention is emblematic of modernity. For prevention is built on scientific understandings of cause and effect and the possibility of prediction; on a capacity for controlled intervention by government in social life; on a universal value base; on the authority of professional expertise; on rational, calculating, individual social subjects. As this order develops and changes, many of its constituent elements begin to be threatened by social processes which it has itself set in train. Prevention is affected by (and implicated in) these changes, too. But far from being eclipsed by them it becomes more prominent. Drawing on systems theory, the paper argues that prevention meets the essential purpose of boundary maintenance by which the functioning of social systems is sustained. For reasons both external and internal to welfare agencies, including an increased burden of social risk and increasing organisational complexity, this need to mark and maintain system boundaries is ever more pressing. At the same time, at least part of the problem of the fragility of boundaries is attributable to attempts to maintain them. It is for this reason that preventive policy making can be described as recursive, or self-propelling. Copyright

The health care state in the information age

The computerization of the medical record has important implications for the governance of health care, and the importance of health care means that changes wrought there are indicative of changes in government as a whole. This paper draws on work in public policy, medical sociology and studies of science and technology, as well as on cross–national empirical research in Britain and France. It describes the recent development of information policy in health care as an exercise in state–building, realized specifically in the governance of the health professions. The paper concludes with a discussion of what is both new and not so new in the form and extent of state power which emerges.

Prevention and Government: Health Policy Making in the United Kingdom and Germany

The gap between rhetoric and reality in health policy making for disease prevention services is well recognized. I do not try once more to close the gap, but rather argue that the rhetoric of prevention is politically significant. Beginning with an account of prevailing explanations of prevention in policy making, I explore the idea that prevention has a pervasive legitimacy in health politics. This affords opportunities for instrumental policy making by government. To this end, I concentrate on the relationship between disease prevention and health care delivery, discussing in detail the association between prevention and health care reform. My arguments are based on case studies of policy making in Germany and the United Kingdom. I discuss implications for understanding the core interests of government, physicians, and users with respect to prevention in health policy making. The concluding section offers comparative commentary on the role of disease prevention in health sector restructuring.

Care, policy, knowledge: translating between worlds

It is the achievement of this collection to challenge our everyday distinction between care and policy. In these ethnographic accounts, we learn how something we might call ‘care-policy’ is achieved in practice, ‘on the ground’. This brief postscript draws attention to the corollary world of the office, the way care-policy is constructed in the committee room and the debating chamber, in the offices and corridors of its administration. The author notes how the work of the office is likewise constituted in practice, in interaction between people and between people and things. It is suggested that care-policy in the field and in the office is predicated on different ways of knowing which reflect a specific tension between case and category. The studies presented here are made at the point of intersection of discrepant worlds/knowledges: some seem to expose and emphasise those discrepancies, but others point to ways in which, in practice, they might be resolved. In carrying out inspections, in assembling and articulating generic experiences of injustice, some actors seem to do care and policy together, piecing together knowledges of different kinds, translating between worlds.

For a (self-)critical comparison

This article reflects on the design and organization of cross-national comparative research in social and public policy, based in our own experience of leading and taking part in projects of this kind. We acknowledge recent criticism of comparison conceived as the measurement of similarity and difference between discrete national units, and note the political as well as methodological difficulties such work entails. We describe our attempts to overcome them, calling for both (1) a critical theory of comparison and (2) a critical practice of comparison. We outline ways of working based on the collective interrogation of case studies, and conclude by formalizing an approach to comparison conceived not as cross-national experiment but as international encounter.