Health care through the `lens of risk' and the categorisation of health risks – An editorial

Abstract

This editorial will introduce a four issue series of Risk, Health & Society special editions, Health Care Through the `Lens of Risk'. The editorial will argue that risk-thinking offers a particular approach to contingency, its culturally universal precursor. Contingency arises from the perception that one of two or more alternative outcomes might occur, or might have occurred. It addresses the infinity of possibility, and is properly located in minds rather than the material world in which singular events simply happen. The lens of risk renders contingency as the probability of a specified adverse event occurring within a particular time period. But each of the elements included in this definition can be reframed interpretively: events as categories; adversity as negative valuing; probabilities as uncertain expectations; and time periods as time frames. The editorial will outline this analysis, introduce the special issue series and briefly review the original research papers included in this first special issue which focuses on risk categorisation.

Keywords:

• risk thinking
• interpretive approaches to risk
• the natural attitude to risk
• risk social science
• risk categorisation

Notes

1. The interview in this special issue with Nick Pidgeon, one of the main social science contributors to the Royal Society (1992) Risk report, provides an interesting historical context relating to the heated debate which arose within the Royal Society at that time about the objectivity of risks.

2. The traditional interpretive approach to health and other risks provides a surprisingly powerful analytical tool, which can withstand postmodern critiques of social scientific claims to privileged access, because it confronts the natural attitude to risk. The latter may appear dated, as is the Royal Society (1992) Risk report. But the interpretive approach continues to offer illuminative insights into everyday attitudes towards risks. Anyone who manages a particular risk has to treat it as `real' in order to avoid being paralysed by Hamlet-like doubts.

3. The risk ‘superpower’ can be located in a family of terms (Skolbekken 1995) which convey different attitudes towards contingencies framed as risks. Selection of ‘danger’ conveys the speaker's view that a risk ought to be avoided, whilst ‘vulnerability’ points up intrinsic weaknesses of a person or other entity. ‘Uncertainty’ invites delay until further evidence is obtained. Such lexical choices are driven pragmatically rather than by inherent differences between types of contingency (Heyman et al. 2010, pp. 25–29).

4. For a gripping exposé see ‘Big Bucks, Big Pharma: Marketing Disease and Pushing Drugs’ at http://www.youtube.com/watch?v=lKP_ISD3rvQ. According to US advertisements, ‘restless leg syndrome’ seriously damages the life quality of 1 in 10 Americans, but can be cured by taking the appropriate drug. Such cringe-making but sinister examples illustrate in extremis the interpretive socio-political processes which can lie concealed in the identification of an ‘adverse event’.

5. As these examples illustrate, the four identified elements of risk thinking are interrelated, so that, for example, altering the time frame within which a risk is considered or the inclusivity of a risk category will change its probability of occurrence.

6. As noted by Nick Pidgeon, whose views are presented in this issue, a fissure has developed between risk researchers concerned primarily with system safety who publish in journals such as Risk Analysis and Risk Research and risk social scientists whose papers are printed in journals such as Sociology of Health and Illness and Health, Risk & Society. The latter, including the present authors, have focussed on interpretive issues for over two decades, but have had relatively little impact on government, public services or industry.

7. Although multiple contingencies or a continuous range may be envisaged, decision-making often requires binary decisional choices, e.g. about whether to follow screening with a diagnostic test or not, which force probability ranges into ‘high’ and ‘low’ risk categories, often processed further into the presence versus absence of a risk.

8. Most physicists believe that multiple possibilities can ‘exist’ at the quantum level, with measurable effects, but this troubling belief does not impact directly on the cookbook world of risk analysis.

9. Because every event is different, history can only appear to repeat itself after occurrences have been categorised and thereby rendered ‘the same’.