Qualitative and quantitative approaches to health impact assessment: An analysis of the political and philosophical milieu of the multi-method approach

Abstract

Health Impact Assessment (HIA) is a relatively new, but increasingly important, contributor to both local and national decision-making processes. Adopting a multi-method approach, it incorporates qualitative and quantitative analyses to determine the various health impacts of policies and projects. HIA thus reflects recent developments in sociological theory, which have promoted qualitative techniques and challenged the dominance of quantitative methods. HIA embodies a particular renegotiation of the qualitative/quantitative opposition; each individual HIA represents an empirical instance of this renegotiation. As such, HIA can be conceptualized as a kind of ‘political space’, in which the opposition in question is structured by various social forces and plays out in concrete ways. Moreover, and notwithstanding the supposed methodological rapprochement, an analysis of a number of HIAs claims to expose a continuing, but perhaps unsurprising, privilege in favour of quantitative methods. In the first place, the paper contends that closer examination reveals this privileging to be unjustified, both empirically and theoretically, and alternative methodological and epistemological configurations are suggested accordingly. Specific gestures are made in this respect toward the work of Martin Heidegger and Jacques Derrida. In particular, the paper argues for a broad hermeneutic approach that both encompasses and situates the methodological tensions HIA stages. Second, attention is drawn to the fact that various and particular sociopolitical conditions maintain the characteristic architecture of the opposition. The political importance of HIA across a series of key issues is underscored in support of a more radical interpretation. For once situated within its wider cultural context, HIA ceases to resemble some straightforwardly neutral technology for health protection and delivery. If, instead, one reads it as an indicative micropolitical phenomenon, then one can begin to interrogate this simple policy tool in more complex ways. HIA both reveals, and is implicated in, a more fundamental and diffuse process that is presently resisting, undermining and regenerating traditional power distributions within the administration of health and beyond. The paper implicitly argues that HIA can only be properly understood within this context and, equally, allows one a certain analytical access to this context.

Keywords:

• Health impact assessment
• qualitative and quantitative research methodology
• politics of health
• Heidegger
• Derrida
• multi- and mixed-method research

Notes

Notes

1. The United Nations Economic Commission for Europe Protocol on Strategic Environmental Assessment was adopted by 36 countries at the 5th Ministerial Conference ‘Environment for Europe’ (Kiev, Ukraine, 21–23 May 2003). In Article 1 alone, the phrase ‘environmental, including health’ is used four times (UNHCE, 2003).

2. For instance, health status of a geographical area (Scottish Needs Assessment Programme, 1999); areas of deprivation (Garfield & Santana, 1997; Winters, 1998); crime statistics (Winters & Scott-Samuel, 1997).

3. We lack the space to explore each of these assertions in detail and refer readers to the texts in question in order that they may reach their own conclusions. By way of example, we will take one instance. In Broomfield, everything from the project itself, to the structure of the assessment, to the form of question used in consultation has been predetermined by researchers and professionals. There is seemingly no attempt to elicit unfiltered community views or to encourage grass-roots participation. The project and its assessment are being ‘served up’ to the community by the experts. In one telling sentence Broomfield states that ‘[a]ll sections of the community need to ‘buy into’ the redevelopment’ (1998, p. 5). We fundamentally disagree. The community needs to be empowered to participate in the production of its own development, not required retrospectively to engage with a pre-designed package. Here the consultative process (that is itself dictated and dominated by professionals and academics) is simply used to justify an intervention; we suggest that consultation give way to participation.

4. Moreover, the emergence of HIA with its specific methodologies, etc., ought to be viewed in conjunction with a number of coincident social phenomena. The validity of expert knowledge is not only an issue in relation to health (Williams & Popay, 1994, p. 65), but also in relation to the environment (Wynne, 1996), food safety (BSE, GMO) and the entire techno-scientific project more generally (Beck, 1992, 1995). In terms of health alone, the process of questioning first opens, and is then further animated by, the particularly contemporary possibility of professional disrepute: the Bristol Royal Infirmary Inquiry 1998 to 2001 (Dyer, 2001); the Shipman Inquiry 2000 (Baker, Jones, & Goldblatt, 2003). One must wonder whether such inquiries would even have been conceivable 30 years previously and, if not, what such profound social changes signify.

5. It remains to test the limits and limitations of this participative approach, and with this the newly ascendant values of transparency and equity may also find certain limits. For the present purposes, however, such considerations remain marginal, although not entirely incidental.

6. For a health related discussion of this critique see Pope & Mays (1995), Pope & Mays (1999).

7. Munro, Chambers, and Marwaha, (2001) report that 23% of those attending their practice had not been included or were unsure whether or not they had been included in the 2001 census. These were typically ‘those least fluent in English, and those with mental health problems’.

8. As we have already indicated, others are more cautious in respect of the epistemological question (cf. Bryman 1992, pp. 59, 64, and Popay et al., 1995, p. 390).

9. Etymologically, the term theory is derived from the Greek θεωρεîν, ‘to see’.