Let's make 2018 the year of wisdom-based policy and practice

11 January 2018

Professor Jennie Popay considers the role of experiential knowledge in policy and practice decision-making.

On New Year’s Eve, like many folk, I found myself musing over the ‘waning’ year and the one to come: over the things I would like to see happen and those I fear will.

What I would dearly like to see happen in 2018, is for the ‘experiential knowledge’ acquired by people bearing the brunt of social injustice and inequalities - what Aristotle called ‘practical wisdom’ – to be privileged in policy and practice decision-making above the codified ‘knowledge’ provided by research evidence and professional ‘experts’.

Before the experts and evidence producers protest - the scientists, lawyers, economists, engineers, et al, I should be clear.  Obviously, research evidence and professional expertise must have a place, but their knowledge should not (as it typically does) dominate public policymaking and professional practice. Through a systematic process whereby experience is checked against life events, circumstances and history, lay people acquire an ‘expert’ body of knowledge; different from, but equal to, that of professionals and to knowledge generated by research. History has shown us the consequences of continuing to ignore this experiential expertise can be profound.

Things were much simpler in the 19th century. Then, knowledge was counter-posed with ignorance not with ‘research evidence’ as it is today. Plato’s view of knowledge as a “true belief” justified on the basis of “familiarity with someone or something acquired through experience, observation or education” was widely accepted. The rub, of course, was that then, as now, some people’s experiential knowledge counted far more than others!  

The emerging ‘sciences’ of the 19th century were closely linked to social reform movements. For example, public health and epidemiology – the study of disease - developed in the face of major health problems thrown up by urbanisation and industrialisation and began with a strong emphasis on the need for clean water, sewage systems, decent housing, and education. However, the link between public health and social reform was transformed by the rise of bacteriology and the focus on the control of specific diseases such as tuberculosis, diphtheria and syphilis. Public health became medicalised, concerned with changing individual behaviour and lifestyles. It excluded the voices and experience of the people who inhabited the “ruinous and filthy districts” where the bacteria of interest were festering. The failure to see potential relevance in the ‘experiential knowledge’ of lower socio-economic groups was evident across the emerging sciences and the newly-developing professions and continues to this day.

In 1994, Gareth Williams, Professor of Sociology and Director of the Cardiff Institute of Society, Health and Wellbeing at Cardiff University, and I argued that no matter how sophisticated or illuminating it is, experiential knowledge people acquired as a result of living lives shaped by social and economic injustice posed little, if any, direct challenge to the powerful… then, as now, it was typically excluded from the worlds of science and politics.

But this is not always the case. There are important examples of the experiential knowledge of oppressed groups developing into organised protests against the ‘misuse’ of more ‘powerful’ knowledges. Around the world, local communities and trade unions have highlighted the relationship between their health problems and exposure to poor working conditions, to toxic waste, to damp and/or structurally unsafe housing, to industrial pollution and high traffic densities.

Too often, however, this experiential knowledge continues to be construed as interesting but misguided. It is contested and/or ignored by professional and/or scientific opinion. And this is despite the fact that history and in some cases ‘high-quality’ research has subsequently shown that such experiential knowledge can be accurate.

In the case of the 1988 Camelford incident[1]  in England, where aluminium sulphate was accidentally tipped into a local water supply, two ‘expert’ reports concluded that the physical problems reported by local people were not the result of exposure to the chemical, but associated with “all the worry and concern” and that “the psychological harm could last a long time for some people”. This view was subsequently shown to be wrong by academic research, published in the Lancet, that supported the residents’ claims that exposure to the chemical in the drinking water had caused lasting damage to their health.

Similarly, when parents in Scotland complained to public health practitioners that respiratory illnesses in their children were linked to damp in their homes they were told the cause was their smoking behaviour.   Again, subsequent research showed that the view of professionals was misguided: highlighting instead a dose-response relationship between the prevalence of respiratory illness in children and exposure to damp in the home – the worse the damp the more illness children experienced. And even when experiential knowledge isn’t discounted, the ‘methodological difficulties’ of proving the relationship of concern may be used as an excuse for inaction. For example, at a public meeting called to discuss urban pollution and childhood asthma in the Docklands area of London in the early 1990s, the local Director of Public Health warned that it would be difficult and costly to prove the effects of pollution on health. A quarter of a century later, as London tries to reduce pollution, professional experts are arguing about the reliability of the much-quoted figures of 40,000 people across the UK and 9,500 in London dying prematurely each year from particulate pollution and nitrogen dioxide[2]. Meanwhile, the ‘experiential knowledge’ of those most exposed is absent from the debate.

The Grenfell tragedy has demonstrated again, on an unprecedented scale in Britain, the profound consequences of continuing to neglect the experiential knowledge acquired by people bearing the brunt of unjust social and economic systems locally, nationally and globally. Residents of the tower block formed the Grenfell Action Group in 2010 to raise their concerns about the health and safety risks associated with the poor quality renovation of their homes – concerns which were systematically ignored by the local authority and the government. Not surprisingly, there is considerable distrust of the formal enquiry chaired by Sir Martin Moore-Bick.  He has broadened the remit from narrowly technical concerns to include broader issues of communication and management but, as a recent Guardian editorial noted, “in the stark clash of cultures between the dry academic approach of the judges and lawyers, and the survivors and bereaved families’ entirely human need to bear witness, to feel ownership of the investigation, the human must prevail”. The survivors understandably want their voices to be heard by the panel of assessors and their experience to make a difference not just for them but for others. They want to shift the balance, however modestly, towards greater social justice.

But appointing a community engagement expert to the enquiry panel and ensuring diversity in membership will not be sufficient to privilege the experiential knowledge of Grenfell residents. Their knowledge is not only a source of equal but different ‘evidence’ that the enquiry panel must hear – it is also a framework for interpreting and assessing the different sources of ‘evidence’ the enquiry will consider.  This means that their knowledge must have an equal role in determining which problems need to be addressed by the panel, how these problems and their causes are defined, which solutions are possible and what success or failure should look like in the future. For this to happen the Grenfell residents must have a continued presence in all the enquiry panel discussions – only in this way will their vital experiential knowledge be genuinely privileged. Maybe 2018 is the year Aristotle’s practical wisdom will prevail?

Professor Jennie Popay

Jennie Popay has been Professor of Sociology and Public Health in the Division of Health Research since January 2002. She is currently director of the Centre for Health Inequalities and co-director of the Liverpool and Lancaster Universities Collaboration for Public Health Research (LiLaC) one of eight academic members of the NIHR School for Public Health Research (SPHR). She is also Director of Engagement and Public Health Lead for the NIHR Collaboration for Leadership in Applied Health Research and Care for the NW Coast – a collaboration between 36 partners including universities, local authorities and NHS organisations. She was the inaugural Chair of People's Health Trust.

 

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