Abstract
Health inequalities research has shown a growing interest in participatory ways of working. However, the theoretical ideas underpinning mainstream approaches to participation remain underexplored. This article contributes to theorising participatory practice for the kind of egalitarian politics to which many of those focused on reducing health inequalities are committed. First, we argue that the ambitions of participatory practice should be concentrated on ‘overcoming alienation’, rather than ‘attaining freedom from power’. An over-emphasis on negative freedom may help to explain a worrying confluence between participatory democracy and neo-liberal marketization agendas – we look instead to traditions of participatory practice that emphasize positive freedom and capacities for collaboration. Second, we discuss some such perspectives though consideration of critical pedagogy, but highlighting the role of materialised relations of authority, spaces, objects and encounters. Third, we explore the relationship between objectivity and alienation, arguing that participatory politics, against alienation, can look to reclaim objectivity for participatory, lively, practice. We then seek to show that participatory practice can play a role in creating common knowledge and culture, and in fostering a sense of public ownership over objective knowledge and institutions concerned with health. We conclude by asking what this looks like in practice, drawing some ‘rules of thumb’ for participatory practice in health inequalities research from existing inspiring examples.
Highlights
Placing the Public in Health Inequalities ResearchFrustration and concern about the persistence of health inequalities in the United Kingdom (Mackenbach, 2011; Bambra et al, 2012) have stimulated efforts by researchers to increase public awareness of, and engagement with, research in this area, efforts that are being facilitated by the UK’s evolving ‘research impact’ agenda (Greenhalgh, 2014)
Such an assumption belies the small number of in-depth, qualitative studies of public understandings of health inequalities, which demonstrate that many of the communities most negatively affected by health inequalities already have a good understanding of the factors and processes that contribute to their communities poor health To quote George (1976, p. 289), those living in poverty already ‘know what is wrong with their lives’
We argue here that what health inequalities research requires instead are forms of participatory practice that are oriented around overcoming alienation
Summary
Frustration and concern about the persistence of health inequalities in the United Kingdom (Mackenbach, 2011; Bambra et al, 2012) have stimulated efforts by researchers to increase public awareness of, and engagement with, research in this area, efforts that are being facilitated by the UK’s evolving ‘research impact’ agenda (Greenhalgh, 2014). Potential consequences, of this kind of public engagement is not always adequately reflected upon. In many cases, it seems, such efforts rest on an elitist model of knowledge production, in which scholars come to know the world in ways that others cannot and work to translate their findings into more accessible formats for other, less scholarly folk. The issue, is what we, collectively, might do about this With this in mind, we argue here that what health inequalities research requires instead are forms of participatory practice that are oriented around overcoming alienation. As Marent et al (2012, p. 190) have argued, research on participation and health has been dominated by a focus on methods and models of participation, with little effort to systematically connect these approaches to social theory
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