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Interconnected health-environmental challenges:
Between the implosion of the
modernist evidence regime and the
emergence of alterna
ti
ve evidence prac
ti
ces?
Guido Caniglia and Federica Russo
@GuidoCaniglia |@federicarusso
2
Sustainability and public health challenges
3
Sustainability and public health challenges
Wicked problems
4
5
Sustainability and public health challenges
Wicked problems
Evidence // Actors // Action
6
Sustainability and public health challenges
Wicked problems
Evidence // Actors // Action
7
What are these failures telling us?
Are there alternatives? How can we
better understand what is
happening?
Sustainability and public health challenges
Wicked problems
Evidence // Actors // Action
8
?
?
ALTERNATIVE
EVIDENCE
PRACTICES
9
?
?
ALTERNATIVE
EVIDENCE
PRACTICES
10
?
?
ALTERNATIVE
EVIDENCE
PRACTICES
11
?
?
ALTERNATIVE
EVIDENCE
PRACTICES
12
?
?
ALTERNATIVE
EVIDENCE
PRACTICES
13
?
?
Part 1
ALTERNATIVE
EVIDENCE
PRACTICES
14
?
?
Part 1
Part 2
ALTERNATIVE
EVIDENCE
PRACTICES
15
?
?
Part 1
Part 2
Part 3
ALTERNATIVE
EVIDENCE
PRACTICES
16
?
?
Part 1
Part 2
Part 3
ALTERNATIVE
EVIDENCE
PRACTICES
?
Evidence Action
Actors
?
Evidence
Action
Actors
?
?
18
ALTERNATIVE
EVIDENCE
PRACTICES
Part 1
19
?
?
• Paradigms (Kuhn)
• Thought styles (Fleck)
• Episteme (Foucault)
• Assumptions (evidence, action, actors)
• Historical, embedded, changing
20
?
?
• Paradigms (Kuhn)
• Thought styles (Fleck)
• Episteme (Foucault)
• Assumptions (evidence, action, actors)
• Historical, embedded, changing
The ‘modernist evidence regimes’
21
Evidence-based medicine: The RCT paradigm
Eco-modernism: the technology-centered paradigm
The ‘modernist evidence regimes’
Modernist evidence regime
(A) Epistemological
assumptions
Certainty and predictability
Knowledge first, then action (Linear connection:
best knowledge leads to best action)
(B) Metaphysical
assumptions
Controllability (deterministic causal processes)
We can control courses of action and their
consequences.
(C) Axiological
assumptions
Neutrality and objectivity
Knowledge does not carry values, but actions do.
Evidence Action
Actors
23
?
?
Part 1
Part 2
Part 3
ALTERNATIVE
EVIDENCE
PRACTICES
24
Participatory research on interconnected health-environmental challenges
25
Evidence
Action
Actors
Participatory research on interconnected health-environmental challenges
26
Evidence
Action
Actors
Participatory research on interconnected health-environmental challenges
• … generates evidence of or knowledge about mixed mechanisms (How)
• Includes bio-social-political-cultural-demographic-historical-technical-…
factors (in complex mixed mechanisms)
• … generates evidence and knowledge for decisions and actions (Who)
• Involves multiple stakeholders and actors (individual, institutions)
Knowledge:
● … not a thing possess, but embedded in personal, interpersonal and social processes
(within and without the world of science).
● … not separate from action, but tightly entangled and embedded in decisions-making,
deliberation and action processes.
Evidence:
● … not a place holder in the probabilistic relation of hypotheses, theories, data
● … not that generated by the ‘top methods’ of evidence hierarchies
• WHO: Actors-orientation through power and
learning
• Actors involved (researchers and citizens/
patients) as active epistemic agent
• Mutual learning and collaboration (the
processes)
• HOW: Action-orientation in context
• Mixed mechanisms: Their organisation
and structure helps design participatory
interventions
• Context: As background conditions/
supporting factors, integral part of the
reasoning leading to decisions and actions
Modernist evidence regime Participatory evidence practices
Epistemological
assumptions
Certainty and predictability Uncertainty and unpredictability
Knowledge first, then action (Linear
connection: best knowledge leads
to best action)
Knowledge and action are intrinsically
interconnected. (One implies the
other)
Metaphysical
assumptions
Controllability (deterministic causal
processes)
Complex causality, emergence, and
co-evolution
We can control courses of action
and their consequences.
We can navigate but not stir emergent
change processes
Axiological
assumptions
Neutrality and objectivity Situated and embedded
Knowledge does not carry values,
but actions do.
Knowledge and actions carry values
and normativity
Evidence
Action
Actors
Evidence Action
Actors
28
?
?
Part 1
Part 2
Part 3
ALTERNATIVE
EVIDENCE
PRACTICES
What to do in order to capture what is happening ?
“Diverse voices for equity, diversity, and
inclusion in the scientific process and
to increase quality and effectiveness of
scientific knowledge”
What should happen? A new epistemology?
“Diverse voices for equity, diversity, and
inclusion in the scientific process and
to increase quality and effectiveness of
scientific knowledge”
A new epistemology?
• Diverse voices
• Inter- and trans-disciplinarity as a way of increasing diversity of voices
• Participation
• Equity, diversity, inclusion
• The value-promoting character of methods and of interventions
• Need to learn from perspectives and knowledge of multiple actors
• Scientific knowledge
• Evidence as clues for action
• Clues to describe and intervene on mixed mechanisms
“Diverse voices for equity, diversity, and
inclusion in the scientific process and
to increase quality and effectiveness of
scientific knowledge”
A new epistemology?
• Diverse voices
• Inter- and trans-disciplinarity as a way of increasing diversity of voices
• Participation
• Equity, diversity, inclusion
• The value-promoting character of methods and of interventions
• Need to learn from perspectives and knowledge of multiple actors
• Scientific knowledge
• Evidence as clues for action
• Clues to describe and intervene on mixed mechanisms
33
Science has the responsibility to change in order to
(contribute to) avoid(ing) this snowball of failures!
There are no easy fixes, but it will be essential to diversify
voices and perspective in the science process by embracing
and amplifying equity, diversity, and inclusion strategies to
overcome historically entrenched injustice of in the science
system (e.g., ableism, colonialism, racism, transphobia)
Thanks!
Guido Caniglia and Federica Russo
@GuidoCaniglia |@federicarusso
Extra material
35
Gradiational
• Critically evaluate the criteria used to assess the strength of different
kinds of clues as evidence for action
• Evidence is not categorical, as responding to yes or no, but rather a
matter of degree
• think about how we determine what makes some clues, stronger or weaker,
better or worse, than others, not in absolute terms, but depending on the
problem addressed and on the relevant features of the mixed-mechanisms in
which research takes place
36
Quasi-holism
• As multiple perspectives and methods provide different clues for
action within complex mixed mechanisms, develop integrative ways to
deal with them
• a middle ground between atomism (focusing on one claim or one
situation at the time in isolation) and holism (where the full
complexity of a situation is kept into consideration)
• “The evidence relevant to a claim is usually complex and ramifying;
but not everything is important to everything” (Haack 2014, 15).
37
Personal
• Consider that personal motivations and interests as well as the
positionality of different actors influence what evidence is generated
or how existing evidence is used
• Evidence justification is personal as it depends on the quality of the
evidence that leads them to have a certain belief, to believe in
something
• This aspect of evidence resonates with scholarship that emphasizes the
situatedness of any type of knowledge
38
Experiential
• Look for clues not only in forms of explicit knowledge, but also in tacit, embedded
and embodied forms of knowledge
• Experiential evidence consists of perceptual events, which are often tacit and not
expressed in propositional language
• Individuals’ and groups’ experiences (of seeing, hearing, tasting, and
remembering) play a role in influencing or even in determining what one believes
to be true
• Considering tacit and experience-based knowledge can improve our ability to
generate evidence that is more appropriate to the complexity of the issues at
hand, rather than pretending that not considering them makes research more
objective
39
Crosswords vs triangulation
Full triangulation: different studies point to the same result
Instead, thinking in terms of crossword about interventions and decision implies understanding:
● How different pieces of evidence belong to the same puzzle
○ E.g., how the biology of the virus interacts with and within social environments (epistemic)
○ The implications for this knowledge for how certain sectors of the populations might deal with it (action-oriented)
● How different pieces of evidence provide clues which can direct towards further investigation
○ E.g., why certain ethnic groups are more vulnerable (epistemic)
○ And how to create conditions and opportunities so that those groups can be protected or protect themselves
(action-oriented)
● These considerations, both the epistemic and the action-oriented ones, need to be co-developed
● For better understanding of a phenomenon
● For better policy design
● For empowering citizens and patients
40
Joint work with N. Hulvej-Rod, M. Hulvej-Rod, K. Stronks
41

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The implosion of medical evidence: emerging approaches for diverse practices at the intersection of health and environmental challenges

  • 1. Interconnected health-environmental challenges: Between the implosion of the modernist evidence regime and the emergence of alterna ti ve evidence prac ti ces? Guido Caniglia and Federica Russo @GuidoCaniglia |@federicarusso
  • 2. 2
  • 3. Sustainability and public health challenges 3
  • 4. Sustainability and public health challenges Wicked problems 4
  • 5. 5 Sustainability and public health challenges Wicked problems Evidence // Actors // Action
  • 6. 6 Sustainability and public health challenges Wicked problems Evidence // Actors // Action
  • 7. 7 What are these failures telling us? Are there alternatives? How can we better understand what is happening? Sustainability and public health challenges Wicked problems Evidence // Actors // Action
  • 15. 15 ? ? Part 1 Part 2 Part 3 ALTERNATIVE EVIDENCE PRACTICES
  • 16. 16 ? ? Part 1 Part 2 Part 3 ALTERNATIVE EVIDENCE PRACTICES ?
  • 19. 19 ? ? • Paradigms (Kuhn) • Thought styles (Fleck) • Episteme (Foucault) • Assumptions (evidence, action, actors) • Historical, embedded, changing
  • 20. 20 ? ? • Paradigms (Kuhn) • Thought styles (Fleck) • Episteme (Foucault) • Assumptions (evidence, action, actors) • Historical, embedded, changing The ‘modernist evidence regimes’
  • 21. 21 Evidence-based medicine: The RCT paradigm Eco-modernism: the technology-centered paradigm The ‘modernist evidence regimes’
  • 22. Modernist evidence regime (A) Epistemological assumptions Certainty and predictability Knowledge first, then action (Linear connection: best knowledge leads to best action) (B) Metaphysical assumptions Controllability (deterministic causal processes) We can control courses of action and their consequences. (C) Axiological assumptions Neutrality and objectivity Knowledge does not carry values, but actions do. Evidence Action Actors
  • 23. 23 ? ? Part 1 Part 2 Part 3 ALTERNATIVE EVIDENCE PRACTICES
  • 24. 24 Participatory research on interconnected health-environmental challenges
  • 25. 25 Evidence Action Actors Participatory research on interconnected health-environmental challenges
  • 26. 26 Evidence Action Actors Participatory research on interconnected health-environmental challenges • … generates evidence of or knowledge about mixed mechanisms (How) • Includes bio-social-political-cultural-demographic-historical-technical-… factors (in complex mixed mechanisms) • … generates evidence and knowledge for decisions and actions (Who) • Involves multiple stakeholders and actors (individual, institutions) Knowledge: ● … not a thing possess, but embedded in personal, interpersonal and social processes (within and without the world of science). ● … not separate from action, but tightly entangled and embedded in decisions-making, deliberation and action processes. Evidence: ● … not a place holder in the probabilistic relation of hypotheses, theories, data ● … not that generated by the ‘top methods’ of evidence hierarchies • WHO: Actors-orientation through power and learning • Actors involved (researchers and citizens/ patients) as active epistemic agent • Mutual learning and collaboration (the processes) • HOW: Action-orientation in context • Mixed mechanisms: Their organisation and structure helps design participatory interventions • Context: As background conditions/ supporting factors, integral part of the reasoning leading to decisions and actions
  • 27. Modernist evidence regime Participatory evidence practices Epistemological assumptions Certainty and predictability Uncertainty and unpredictability Knowledge first, then action (Linear connection: best knowledge leads to best action) Knowledge and action are intrinsically interconnected. (One implies the other) Metaphysical assumptions Controllability (deterministic causal processes) Complex causality, emergence, and co-evolution We can control courses of action and their consequences. We can navigate but not stir emergent change processes Axiological assumptions Neutrality and objectivity Situated and embedded Knowledge does not carry values, but actions do. Knowledge and actions carry values and normativity Evidence Action Actors Evidence Action Actors
  • 28. 28 ? ? Part 1 Part 2 Part 3 ALTERNATIVE EVIDENCE PRACTICES
  • 29. What to do in order to capture what is happening ?
  • 30. “Diverse voices for equity, diversity, and inclusion in the scientific process and to increase quality and effectiveness of scientific knowledge” What should happen? A new epistemology?
  • 31. “Diverse voices for equity, diversity, and inclusion in the scientific process and to increase quality and effectiveness of scientific knowledge” A new epistemology? • Diverse voices • Inter- and trans-disciplinarity as a way of increasing diversity of voices • Participation • Equity, diversity, inclusion • The value-promoting character of methods and of interventions • Need to learn from perspectives and knowledge of multiple actors • Scientific knowledge • Evidence as clues for action • Clues to describe and intervene on mixed mechanisms
  • 32. “Diverse voices for equity, diversity, and inclusion in the scientific process and to increase quality and effectiveness of scientific knowledge” A new epistemology? • Diverse voices • Inter- and trans-disciplinarity as a way of increasing diversity of voices • Participation • Equity, diversity, inclusion • The value-promoting character of methods and of interventions • Need to learn from perspectives and knowledge of multiple actors • Scientific knowledge • Evidence as clues for action • Clues to describe and intervene on mixed mechanisms
  • 33. 33 Science has the responsibility to change in order to (contribute to) avoid(ing) this snowball of failures! There are no easy fixes, but it will be essential to diversify voices and perspective in the science process by embracing and amplifying equity, diversity, and inclusion strategies to overcome historically entrenched injustice of in the science system (e.g., ableism, colonialism, racism, transphobia)
  • 34. Thanks! Guido Caniglia and Federica Russo @GuidoCaniglia |@federicarusso
  • 36. Gradiational • Critically evaluate the criteria used to assess the strength of different kinds of clues as evidence for action • Evidence is not categorical, as responding to yes or no, but rather a matter of degree • think about how we determine what makes some clues, stronger or weaker, better or worse, than others, not in absolute terms, but depending on the problem addressed and on the relevant features of the mixed-mechanisms in which research takes place 36
  • 37. Quasi-holism • As multiple perspectives and methods provide different clues for action within complex mixed mechanisms, develop integrative ways to deal with them • a middle ground between atomism (focusing on one claim or one situation at the time in isolation) and holism (where the full complexity of a situation is kept into consideration) • “The evidence relevant to a claim is usually complex and ramifying; but not everything is important to everything” (Haack 2014, 15). 37
  • 38. Personal • Consider that personal motivations and interests as well as the positionality of different actors influence what evidence is generated or how existing evidence is used • Evidence justification is personal as it depends on the quality of the evidence that leads them to have a certain belief, to believe in something • This aspect of evidence resonates with scholarship that emphasizes the situatedness of any type of knowledge 38
  • 39. Experiential • Look for clues not only in forms of explicit knowledge, but also in tacit, embedded and embodied forms of knowledge • Experiential evidence consists of perceptual events, which are often tacit and not expressed in propositional language • Individuals’ and groups’ experiences (of seeing, hearing, tasting, and remembering) play a role in influencing or even in determining what one believes to be true • Considering tacit and experience-based knowledge can improve our ability to generate evidence that is more appropriate to the complexity of the issues at hand, rather than pretending that not considering them makes research more objective 39
  • 40. Crosswords vs triangulation Full triangulation: different studies point to the same result Instead, thinking in terms of crossword about interventions and decision implies understanding: ● How different pieces of evidence belong to the same puzzle ○ E.g., how the biology of the virus interacts with and within social environments (epistemic) ○ The implications for this knowledge for how certain sectors of the populations might deal with it (action-oriented) ● How different pieces of evidence provide clues which can direct towards further investigation ○ E.g., why certain ethnic groups are more vulnerable (epistemic) ○ And how to create conditions and opportunities so that those groups can be protected or protect themselves (action-oriented) ● These considerations, both the epistemic and the action-oriented ones, need to be co-developed ● For better understanding of a phenomenon ● For better policy design ● For empowering citizens and patients 40
  • 41. Joint work with N. Hulvej-Rod, M. Hulvej-Rod, K. Stronks 41