University of Victoria

Connecting Health Policy, Health Knowledge, and Health Practice I

Sociologists of knowledge and medicine have challenged the assumption that medical science and medical knowledge are “outside of culture” and free from social structural influences. In this vein, this session seeks papers exploring the interconnections between health knowledge, health practice and health policy. For example, papers may explore how the creation of medical knowledge is influenced by health policy. Others may investigate how health provision practices are constrained or determined by health policies and how these relate to health knowledge. Or, presenters may examine the gaps between medical research, medical practice, and medical policy. Submissions focusing on either: an empirical problem, a theoretical problem, or, a methodological problem related to health knowledge, practice and policy are equally welcome.

Chair: Diane Field, University of Calgary

Session Organizer: Kate Hickey, University of Calgary, hickey.k8@gmail.com

Preventing Tragedy: Constructions of risk and responsibility in government documents about alcohol consumption during pregnancy

Rebecca Godderis, Wilfrid Laurier University , rgodderis@wlu.ca , Zipparah Stephenson, Brock University, zipparah.stephenson@gmail.com

Using critical discourse analysis, our presentation will explore the connection (or lack thereof) between medical research and government-supported policy and practice in the case of alcohol consumption during pregnancy. The most recent consensus clinical practice guidelines released in Canada, and endorsed by the federal government, continue to advocate abstinence from alcohol. The authors of the guidelines also suggest periodic universal screening for all pregnant women and for all women of child-bearing age to monitor alcohol consumption (Carson et al., 2010). The primary aim of such policy is to reduce (and potentially eliminate) the incidence of fetal alcohol syndrome (FAS); yet there remains a lack of scientific evidence that points to the detrimental effects of alcohol on the fetus especially at low to moderate levels of consumption (Lowe and Lee, 2010). Without evidence of this causal connection, the promotion of abstention as the best way to address the ‘problem of FAS’ becomes highly problematic. Such analyses do not integrate any discussion of the complex ways that social, political and economic factors affect the incidence of FAS. Instead, instances of FAS become positioned as an individual responsibility that is gendered by definition. This critical discourse analysis contributes to the relatively limited body of feminist literature that has examined constructions of risk and responsbility in government endorsed policies regarding alcohol consumption during pregnancy.

Carson, G., L. Vitale Cox, J. Crane, P. Croteau, L. Graves, S. Kluka, G. Koren, M. Martel, D. Midmer, I. Nulman, N. Poole, V. Senikas, and R. Wood. 2010. Alcohol use and pregnancy consensus clinical guidelines. Journal of Obstetrics and Gynaecology in Canada Supplement 3: S1-S33.

Lowe, P. K., and E. J. Lee. 2010. Advocating alcohol abstinence to pregnant women: Some observations about British policy. Health, Risk & Society 12: 301-311.

Tuesday June 4, 2013 08:45 AM - 10:15 AM Building: Elliott Building, Room: E-060

The problem of evidence: Breast cancer, overdiagnosis, and threats from the ‘outside’ of medicine

Ariane Hanemaayer, University of Alberta, ahanemaa@ualberta.ca

My paper argues that evidence-base medicine (EBM), the dominant model of medical training and practice, lacks the methods to assess the processes by which medical research is producing evidence and guidelines for clinical practice. Evidence-based clinical judgments rely on the best possible medical evidence in order to improve patient care (e.g. Sackett et al 2000). Recent controversy surrounding the use of mammography stirs up questions concerning evidence of breast cancer and the basis for medical interventions (e.g. Weeks 2012). In medicine, overdiagnosis occurs when a patient has been diagnosed with an illness that will never cause symptoms or death (Welch 2011). Sociologists, however, might understand the overdiagnosis of breast cancer as a result of the medicalization of breast abnormalities. This paper engages with the case of breast cancer to examine the influences from ‘outside’ of medicine that structure the production of ‘evidence’ upon which medical practitioners are basing their judgments. I move beyond the medicalization thesis, and argue that medicine is increasingly dominated by pharmaceutical funding agencies and the consumer-oriented cultural currents that influence the production of evidence. These influences are changing the nature of medical practice, the production of practice guidelines, and the delivery of medical care.

Tuesday June 4, 2013 08:45 AM - 10:15 AM Building: Elliott Building, Room: E-060

Looking for evidence of evidence-based policy-making: Policy-makers’ descriptions of their work

Catherine van Mossel, University of Victoria, cvanmossel@islandnet.com

This presentation examines how the oft-lauded “evidence-based policy-making” works in a health policy-making setting claiming this approach guides its work. Responding to literature extolling its virtues, which includes removing politics and ideology from policy-making and relying upon the "truth" only science can produce, are well-established critiques that counter these assertions and problematise their assumptions. However, there is little research that explicates how policy workers engage with/in the discourse of “evidence based” in their daily practices. This research delves into these practices, specifically as they relate to managing the increasing “burden” of chronic disease, revealing contradictions between: the (perceived) valuing of evidence, scientific method and rigour, and the stories of daily practice; what policy workers say they are doing and their descriptions of that work; and the practices of different workers.

Either frankly or sotto voce, many policy workers scorn a fundamental assumption of evidence-based policy-making: that policy-making should – and even can - be apolitical. Using a Foucauldian understanding of discourse to understand “subtle workings of power in complex policy processes” (Sharp and Richardson 2001 198), I intend to show how policy workers enact the all-too political work of evidence-based policy-making.

Tuesday June 4, 2013 08:45 AM - 10:15 AM Building: Elliott Building, Room: E-060