Policy & Impact in Medical History & Humanities

Last week I was invited to be a panellist on a roundtable discussion about ‘impact’ in medical history and humanities (MHH), organised by the Wellcome Trust at the Society for the Social History of Medicine conference at QMUL. The Trust are currently attempting to develop a framework for understanding and assessing impact in MHH, which is consistent with RCUK’s formulation and the requirements of the upcoming REF, but which is also broad enough and sensitive enough to the different kinds of ‘impact’ research in MHH can have, from academic impact to social, cultural, clinical, policy impact and public engagement.

The Trust are reluctant to resort to tick-box metrics, and are more interested in how research is disseminated beyond traditional boundaries and academic resources, particularly into the public sphere. The main concern of the imposition of the ‘impact agenda’ into academia has been, I think, that it is seen as another part of the grant application form to be filled in, as an afterthought, in order to secure funding. But as Prof. Mark Jackson suggested, impact need not be seen as an additional burden to be feared or dreaded: many of the activities of MHH researchers fall under the notion of ‘impact’, but the challenge is to identify and somehow quantify the relationship between research and this somewhat nebulous idea.

Aside from representing early career researchers (ECRs) in the field, I was also asked to provide a brief insight into how ‘impact’ could be construed in the relationship between academic MHH research and policy-making. This was on account of my experience at POST last year, which I have previously blogged about here. It is often said friction exists between policy-makers and academics: the former want quick answers to problems and to press forward certain policy initiatives, whilst the latter are inherently disinclined to provide concrete answers to complex conceptual, historical or social questions, and understandably resent the implication that their research should be influenced by a political agenda. During the discussion, the historian Prof. Virginia Berridge mentioned the problems of academic research being distorted to fit a particular agenda, and the frustrations that ensued. This mismatch presents significant obstacles for academic ‘impact’ to reach policy, even though it may be sorely needed (especially, I would argue, in health).

Bioethics is arguably the most prominent area of health-related humanities discourse in public policy, particularly on issues around the beginning and end of life but conceptual and historical research also has a role to play, even in a world where the main criterion for policy is that it be ‘evidence-based’.

For example, the philosophically messy notion of wellbeing is currently high on the policy agenda, but while the government press ahead with trying to measure it there is a striking absence of engagement with its complex political and psychological history. The focus on patient choice in the NHS is partly driven by an increasing individual ‘responsibilisation’ for health, which raises questions about what we mean by health and illness and where the boundaries of medical practice lie. The ageing of the workforce and the population will not only present challenges to health and social care, but can also be understood against a backdrop of historically changing patterns of work, generationally shifting attitudes towards older age and: these are all really critical and current topics that can be and have been addressed in MHH research.

The direct impact of academic research in policy debates is usually, and rightly, the domain of senior academics, who are sought after by policy makers to serve on commissions, committees and consultations on account of their credibility and authority as experts. But the more I thought about my potential contribution to the roundtable discussion, the more I realised there could be an interesting connection between the plight of the ECR attempting to consolidate and further their academic credentials, the perennial question of how to get policy-makers and academics engaged in mutually beneficial conversations, and the problem of defining or measuring impact in MHH.

I think we should be careful not to define impact too narrowly, or presume it is a unidirectional process from research to policy, and only occurring at a high level. This would be to overlook the reciprocal impact that exposure to a policy environment may have on academics themselves, and to this extent I think it is worth considering researchers earlier in their careers and the influences on the way they conduct, frame and disseminate their research.

This is where my own experience comes in. As I’ve discussed before, last year I undertook the first 3-month Wellcome fellowship in MHH at POST. This involved researching and writing a 4 page briefing note for Parliamentarians on a topic of current policy interest, in my case, the ageing workforce. During my time I learned a great deal about the policy process, the kinds of relations that exist between policy advisors, government departments and academics. I learned how it was possible to compress a huge array of evidence, expertise and often wildly conflicting opinion and present it to Parliamentarians as an accessiblenarrative. Interestingly, it was the interviews with historians on the social history of retirement that provided some much-needed context for the final report.

This immersion into a busy policy advisory environment had 2 lasting impacts on my own academic practice and interests that I think are relevant to the discussion on impact and policy.

Firstly, I became much more aware of the political and policy relevance of my research, even if not directly addressing the issues being debated and certainly not providing concrete policy options. Much of my work focuses on the language and classification of mental disorder, and a large part involves somewhat abstract theorising and argument. But some of the notions I grapple with in day-to-day research crop up in public discussions on health, for example the apparent inadequacy of the government’s work capability assessment for conceptualising the disabling nature of mental health problems. The notion of ‘recovery’ is now central to mental health policy but poses interesting conceptual problems for established models of mental disorder and its treatment that translate into huge practical and ethical challenges for health services (I am looking forward to reading the newly published OUP collection on recovery, mentioned here).

Not everything that’s caught my eye has been followed up but this keen awareness of the relevance and significance of my field to the policy sphere has, I think, fostered more creative and engaging avenues of research than I would otherwise have pursued.

Secondly, being in a policy environment enabled me to meet an extremely broad range of very interesting people. This is especially important for ECRs who are in the process of formulating research interests and expertise, and, increasingly importantly, cultivating networks of contacts, possible collaborators and potential future users of their research. In forming such connections one can begin to understand what kinds of questions policy makers are asking. The development of these connections may not themselves constitute impact, but they are vitally important in determining whether and how research gets taken on board and used in policy-making, and are thus key to enabling impact to resonate beyond academia. 

There was much interesting debate and discussion at the roundtable. It was reassuring to see there was an awareness that for many ECRs, institutional and funding infrastructure is going to be essential if they are to engage in research activities that have demonstrable impact, and that these activities are valued and valid. The Wellcome Trust (and other research funders) are supporting these activities with secondments such as the POST fellowship, but it is understandable that for most ECRs publishing journal articles and monographs take absolute priority, as these are what will ensure academic progression is possible.

Yet it seems to me that there is a growing appetite for conversation and influence beyond the academy. MHH is, I think, uniquely placed its potential to thrive from such engagement, given the nature of its subject matter. As such, it may have an easier time demonstrating impact than some other areas of humanities, if researchers are able and willing to seek out new audiences for their research early on in the process.

From the perspective of someone with an interest in the relation between research and policy, my contention is that impact goes both ways. Particularly for those at the early stages of academic careers, openness to the potential use their knowledge and skills have for important issues in policy is, I think, something that falls under the umbrella of impact, although it cannot directly be measured in terms of research output. Equally, the cultivation of networks of relationships may create the conditions of possibility for future impact of research, and it would be a mistake to underestimate the value of working to build such networks by neglecting them in metrics of impact.

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About Natalie Banner

Wellcome Research Fellow
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3 Responses to Policy & Impact in Medical History & Humanities

  1. This is a wonderful post. I have some strong views on the significance of the health humanities and the history of medicine/public health on public policy, but I also have to acknowledge my bias here (being a lawyer with public policy experience and having done a postdoc on the same).

    In part, I think about the history of the studia humanitatis here. Ignoring for the moment some of the obvious race, class, and gender structures at work, the medieval and Renaissance humanists who helped create the educational program of the humanities were profoundly interested in policy and impacting the daily lives of the places and communities in which they worked. It is no coincidence that so many of them had some kind of legal training insofar as expertise in canon and emerging common law equipped a young patrician or even in some circumstances a commoner with key tools that could be used to influence policy, diplomacy, and statecraft. Indeed, for many of the humanists, such shaping was indeed the point, to use erudition in the service of virtue and virtuous sovereignty.

    I have argued that the humanists were therefore in a critical sense early translational researchers, and that we current humanities scholars do them a disservice if we neglect their lesson and avoid efforts to engage in policy.

    But I should acknowledge that I’ve had vigorous disagreements on this with many people, and again, my own personal background and training undoubtedly colors my perspective here. Anyway, great post!

    • Natalie Banner says:

      Thanks very much for your comment! It’s interesting to hear about the historical relation between humanities research, law and public policy: I hadn’t realised they were so intertwined. We tend to think that any attempt to bring the humanities closer to policy and public affairs runs the risk of instrumentalising the value of academic research, and that this is a relatively new phenomenon in the age of ‘impact’, research funding and so on. Perhaps (aptly enough!) greater awareness of the history of humanities study would provide some context for this debate, and enable both ‘sides’ to recognise the potential for crossover to some extent?

  2. I certainly agree some historical context in terms of the roots of the studia humanitatis would help here. But I also agree that instrumentalism is a worry, and I visit this concern all the time in my own work, given my efforts to link history and public health policy. My own strategies for dealing with this very real concern center on effort to avoid reducing the use of history and/or the humanities to the ends of policy.

    That is, history is worth studying for its own sake. It has intrinsic value, and even if it told us absolutely nothing about our current and future states of affairs, it would still be of immense value. But this fact does not preclude the great capacity of history to illuminate much of importance for present and future issues of public policy, and I think it does a disservice to the incredible reach and scope of the field to artificially limit it as such. Given the incredible work done by so many historians of medicine & public health to show the potential an historical approach has for illuminating policy — see especially the History & Policy Group — I do my best to tread down the path already laid by giants.

    This observation goes for much of the health humanities, I tend to think. These tools are of great use for thinking about current policies, and changing them for the better, as the humanists would have urged — but they are not valuable simply because of this capacity. Or so I think!

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