Keywords

1 Epistemic Trespassing for Better Public Health Policy

An archaeologist wouldn’t dare to proffer suggestions to the work of a brain surgeon in theatre. A theoretical astrophysicist would be ridiculed if they were to engage in the design of pharmaceutical clinical trials. Similarly, an immunologist would hesitate to venture an opinion on the structural engineering calculations of skyscrapers or suspension bridges. Cross-disciplinary transgressions have been deemed ‘epistemic trespassing’. Ballantyne (2019) identified that ‘Epistemic trespassers judge matters outside their field of expertise. Trespassing is ubiquitous in this age of interdisciplinary research and recognizing this will require us to be more intellectually modest’ (p. 367). In the case of the potentially life-threatening ontological challenges, epistemic trespassing is clearly dangerous. But in more fuzzily defined domains like public health and public policy, such encroaching moves sometimes seem to have become ‘rights of way’. The public discourse around the COVID-19 pandemic has brought the challenges at the interface (or overlap) between health and public policy into never-before-seen sharp focus.

For the public, opinions, beliefs, advocacy, and assessments of the appropriateness of dimensions of the public policy process are also more easily shared with the world than ever before through the proliferation of individualized and social media. In the past, one needed significant capital, political clout, and entrepreneurial skill to start and maintain an influential media outlet (hence the term ‘press baron’). The twenty-first century has seen the emergence of ‘influencers’ on microblogs (e.g. Twitter and Instagram) and micro-syndication (e.g. Substack and Paper.li). Together with the creation and availability of mass accessible databases (some of which are more validated and credible than others, with Our World In Data and GapMinder setting gold standards for accountability and transparency) the world has turned into a place where billions of people believe epistemic trespassing is a civic duty. Of course, our new social media environment has also allowed another form of such trespassing—the rapid spread of misinformation and disinformation with sometimes tragic consequences.

In academe, there is also an entire debate to be had about the legitimacy of scholarly disciplines and professional boundaries. The hermetic nature of some forms of knowledge has, indeed, rightfully been challenged. These challenges have led to an attempt at the democratization of knowledge and the recognition that some forms of knowledge have been granted privileged status in knowledge hierarches (Bhattacharya et al., 2020; Gehlert et al., 2010). An Indigenous knowledge systems discourse appropriately argues that the decolonization of the scholarly enterprise is needed. Also, it makes sense, at least analytically, to understand complex systems of public policymaking for public health as exactly that: systems with distinctive components, performances, outcomes, and impacts. Political deliberation is one part of the systems machine, scholarly interrogation another, as is community activism. For some, this calls for use of systems theory (Knai et al., 2018); for others, it means critical population health research (Labonte et al., 2005).

Notwithstanding these challenges, we are strong proponents of epistemic trespassing of all kinds if it is in support of broader shared goals and more than an attempt to argue the merits of one worldview over another or engage in critique for its own sake. More precisely, this book is an attempt to demonstrate what can be gained by political science for public health. Thus, in the introduction to this book, we outlined our ambitions:

  • To show how political science perspectives (broadly defined) can inform public health research and practice;

  • To demonstrate how much political science can gain from a deeper engagement with public health; and

  • To advance the interconnection of public health and political science as scholarly disciplines with a particular view of addressing the apparently irreconcilable ideas between health scientists and policy students about the role of evidence (generation and dissemination) in policy (development and implementation).

We suggested that exploring and exploiting the interfaces and overlaps between the two fields would yield new, and potentially better, insights for public health policymaking. We took the advice from critical colleagues given in conference sessions and workshops, and heeded the call to proactively develop reciprocal epistemic incursions between the public health community and the policy process interested political science community (Bekker et al., 2018).

In this wrap-up of our collection, we will therefore reflect on two issues:

  • Did we meet our own aspirations, and

  • Did the contributors convincingly demonstrate the added value of applying notions from each field to the other?

Edited volumes, particularly in fuzzy fields like political science and public health, tend to run a risk of being eclectic collections of unique perspectives, a cabinet of curiosities. We claim a degree of coherence that would allow for a programmatic follow-up towards the further evolution of a public health political science where interests intersect.

2 Does Public Health Political Science Add Value?

First, across the chapters in this book, we have witnessed a significant consistency around the quintessential engine room of the field: the realm where facts and evidence production meet with politics and policies. Whether we explored the more conceptual and theoretical underpinnings of the emergent field in Part I; the empirical contributions in Part II describing knowledge production, the processing and percolation of evidence, and mechanisms that move policies through society and interest groups; or Part III where authors acknowledge the complexities and wicked nature of taking into account other players’ role in determining health outcomes (and threats), the lessons are that agents in the public health field with particular policy agendas cannot assume a simple mechanical model. Time and again, the authors of the different chapters describe how successful actors and institutions in the public health policy arena achieve better outcomes through the ability to scan dynamics in institutional arrangements and jurisdictional responsibilities, coupled with an astute processing of (assumed) ‘facts’ in the policy game. Different theories of the policy process privilege particular roles for policy actors: policy entrepreneurs, coalition builders, equilibrium maintainers and watchguards, policy learning drivers, boundary spanners, street-level bureaucrats, or evidence synthesizers. Yet at their core, each of these actors does the same thing: they flexibly map, monitor, and adapt (e.g. by interfacing mental maps of different networks and identifying the critical pressure points) (de Leeuw et al., 2018).

For seasoned policy officers in large policy bureaucracies, this observation will not come as much of a surprise. But what our volume adds is that the authors have pointed out several highly applicable heuristics to guide and make sense of this quintessential dynamic. By moving beyond the tendency towards theoretical monomania, we witness the significant added value of a flexible identification and adaptation of (sometimes combinations of) theoretical models of the policy process. Many of our authors freely borrow from neighbouring disciplines, most notably sociology, as discussed in Chapter 3 (Greer, 2022), and philosophy (see, for example, Chapter 11 [Cairney et al., 2022]), to augment what political science has to offer to make sense of complex public health realities. This, we feel, creates an invitation and opportunity to budding public health political scientists to identify and pragmatically apply theoretical notions that resonate best with their contexts and provide support to the public health enterprise and not merely make public health a case study among many.

Second, we think that the chapters that explicitly deal with the multi-level complexities of the public health (promotion) effort are nothing but a forceful invitation to the political science community. Here is a field that needs analyses of the policy process and the political forces beyond simplistic stakeholder maps. The empirical chapters show how, for instance, local governments, e-cigarette debates, active (public) transport policies, and population-level vaccination development and deployment programmes are delightfully messy. They are worthy of systematic and ongoing inquiry. The empirical chapters also provide some indication of how to manage the tensions between public health policy that reflects the best available scientific evidence but also policy choices that reflect public concerns. An overview is provided in Chapter 13 by Cassola and colleagues. Hawkins and Oliver in Chapter 9 focus on parliamentary committees, and Smith and her colleagues in Chapter 7 focus on experiments with citizen juries. But many public policy gems remain in the locker, and methodologically, there are magnificent opportunities to understand the present and project the future from a political science analysis of the past.

Public health, in this collection, benefits demonstrably from a political science perspective. There are also clearly great opportunities for the political science community to grow by both analysing public health policy challenges (and not just pandemic-related) and benefitting from the rich data and methodical sophistication of public health research (see, for example, Hoffman et al., 2019; Topp et al., 2021). And we have compiled a collection of arguments that consistently show the importance, and efficacy, of flexible multi-level responses of scholars and practitioners at the nexus between our realms.

This is the time to return to epistemic trespassing. Despite the abundant promise of a fruitful evolution of a public health political science that we have documented consistently in this collection, the world is filled with well-meaning self-anointed ‘expert’ epistemic transgressors. Submissions to public policy inquiries also highlight a baffling arrogance from sectors and actors that are peripheral to the public health effort in formulating what proper policy ought to do. For instance, the approach used by Pogrmilovic et al. (2019) demonstrates that much of the physical activity policy analyses wholly ignore the body of knowledge that both public health and political science could bring to advance the field. Nevertheless, perhaps because it is a systematic review (see Chapter 5 [Oliver, 2022]), this review has been elevated to a global gold standard in physical activity policy research (Whiting et al., 2021). Such studies often do not amount to more than loose-sand collections of factoids (Greenhalgh et al., 2014). They do not elevate our level of understanding public health policymaking. They fail to add sophistication to the applicability and efficaciousness (let alone transfer and learning) of policy development in public health. In contrast, in this book, we have tried to assemble authors who have come from different disciplines but have all grappled with how institutional design can help to make sense of some of the public health trends that we’ve seen before and during the COVID-19 pandemic (and will see again), e.g. why predictions regarding pandemic preparedness didn’t pan out; why rules and plans that were in place weren’t followed; why critical public health institutions were unable to perform as intended, the apparent disregard for the International Health Regulations, etc.

3 A Development Agenda

We believe we have achieved our aspirations. The value at the interface between public health and political science is clear. The authors in this collection describe the intricacies of providing a political science perspective on how evidence moves through complex systems to shape public health policies. Yet several additional challenges remain. As Lenin famously asked, ‘What is to be done?’ (Lenin, 1952).

First, the global network of colleagues at this disciplinary interface is growing but remains dispersed, both spatially and conceptually. There is a need for some sort of ‘home’. There is also a need to systematically incorporate the fact that public health policymaking in low- and middle-income countries is often quite different from what is described in this collection. Similarly, most of what is presented in this volume assumes democracy as usual. In authoritarian regimes and in countries where populism is on the rise, the challenges of public health policymaking are distinct and very real (Falkenbach & Greer, 2021).

Second, more cross-disciplinary teaching, training, research, and publishing in public health and political science are required (Abuelezam, 2020; Asgary, 2018; Bekker et al., 2018; de Leeuw et al., 2014; Fafard & Cassola, 2020; Greer et al., 2018). At the teaching and training level, this would require more joint programmes, integrated courses, and faculty cross-appointments that would increase exposure to each other’s tools and help to develop a common theoretical, conceptual, and methodological language. On the research side, achieving this goal would require more focused interdisciplinary funding for public health political science. Such funding could bridge the rigid disciplinary application and review criteria that typically channel work into one field or another. In the realm of publishing, creating more venues for public health political science would involve an effort on the part of journal editors to solicit and support the publishing of more interdisciplinary work, including special issues jointly convened by experts in both disciplines and by relaxing strict criteria for article formats and word lengths that may reduce the possibility for in-depth, interdisciplinary work.

Third, public health can benefit from the insights of the full range of sub-disciplines in political science (Gagnon et al., 2017, pp. 496–497). This collection emphasizes the insights of policy scholars and students of comparative politics. But there is a great deal of insightful work being done in international relations (see, for example, Davies & Wenham, 2020); various parts of political theory (see, for example, Weinstock, 2011); studies of local government (see, for example, O’Neill et al., 2019); not to mention various forms of political economy (see, for example, Stuckler & Basu, 2013). Moreover, the authors of the various chapters are from democracies in a relatively small number of high-income countries. But public health can also benefit enormously from the burgeoning political science research from researchers based in or from countries of the Global South (Bonnet et al., 2021; Lavis et al., 2012; Parkhurst et al., 2021; Ridde & Dagenais, 2017).

Finally, and perhaps most importantly, we need to follow the advice by our collaborators Cairney and Oliver (Oliver & Cairney, 2019) and leave the ivory towers of academe (whether political science or public health) and more proactively engage with policymaking efforts. This can take many forms. For some, it will be expert advice to governments; for others, it will be working closely with community organizations; and for still others, it will be media commentary. In all cases, if we are to not simply make a point but actually make a difference, drawing on the insights of both public health and political science is not just desirable, it is essential.