People don’t want to exchange views, discovers Laura Potts

‘It’s all good data’, my colleague Sarah Nettleton would reassuringly remind us, after another frustrating episode in our research project Divided We Stand: bridging differential understanding of environmental risk.(1)

True enough: as social science, the project yielded some fascinating insights into how and why people were reluctant to talk and listen to each other;(2) but I am left with a nagging disillusionment about the process, and its implications for the ‘new social contract’ between science and society.

Hearing different viewpoints

The explicit aim of the project was to bring together different viewpoints on the role of exposure to environmental hazards in the incidence of breast cancer, by providing opportunities for all the participants to hear each others’ arguments and evidence.

We involved a range of communities of interest: women with personal experience of breast cancer, lay health activists, environmental campaigners, specialist breast cancer nurses, oncologists, public health practitioners, epidemiologists, biologists and toxicologists. We were also keen to establish more equitable participatory processes for science and policy-making, and to examine the relationship between professional and lay knowledge. As well as using traditional qualitative research methods – interviews, focus groups, participant observation – we organized three hearings: one in a city, one in a rural market town, and one in an area with concern about a recent cluster of cases. And, finally, a national hearing in Westminster, supported by the chair of the All Party Parliamentary Party Group on cancer.

How hard can that be? Surely, just business as usual for experienced social researchers? But the stumbling blocks we encountered were far greater and more intractable than we anticipated.

Unwilling participants

Getting people to take part at all was the first problem. A cancer epidemiologist told me we were ‘barking up the wrong tree’. An oncologist argued there was no point his coming to a local hearing because ‘the advance of our scientific understanding in these areas is unlikely to be facilitated by dialogue’. A Department of Health spokesperson claimed that the primary prevention of breast cancer wasn’t on their agenda.

There were a few sticky moments in the process of the hearings too: at the national hearing, the director of an environmental NGO refused to sit next to the CEO of a UK public health body. Places round the table were allocated alphabetically, but still she insisted on moving to another position.

What was going on? Professionalism demands boundaries for both discipline and identity, through vocabularies and practices. It seemed to be very hard for some to overcome those learned behaviours, and old habits of stereotyping and mutual suspicion of The Other die hard.

All sorts of evidence

The contemporary ‘tyranny of the evidence base’ overlooks the existence of different sorts of evidence, and of different sorts of people’s concerns. Arguably, we get a more complete picture of the multi-factorial jigsaw of breast cancer causation if we are more inclusive; a recent Demos report(3) asserts the value of all sorts of expertise. In the US, the community-based research initiative supported by National Institute for Environmental Health Sciences is taking just such an approach, but our experience in the UK suggests it may be decades before that might be adopted here.

Common ground

In a posthumous review, John Higgins(4) wrote of Edward Said’s commitment to finding ‘common ground’ as ‘a fundamental moral and political principle’: ‘identifying and occupying such common ground are not easy tasks because they are activities that can involve a questioning rather than a fortifying of self, and usually mean giving up the sense of security that comes with the absolute denigration of your opponent’.

Our hearings were organized on the basis of the best advice we could find, from business, deliberative democracy and human communication – and years of experience as social researchers. They demanded, as Higgins suggests, considerable ‘intellectual effort’, and while we were not, perhaps, blessed as Said was, with ‘uncommon talent…charm and personality’, we were welcoming, informative, reliable and committed.

Next move

It’s time to move on. A colleague and I have a new project under funding review. We want to bring together the genetic researchers and the environmental researchers looking at causes of breast cancer, to learn from each others’ work and begin to shape policies for primary prevention.

The questions framing this dialogue will come from a broadly based steering group, and will attempt to establish a common language for understanding what contributes to the continuing rise in incidence of the disease. I’m optimistic that the lessons learned from Divided We Stand will help us establish some common ground this time.

References

1. Divided We Stand, bridging differential understanding of environmental risk, as part of the Economic and Social Research Council’s Science in Society programme
2. See ESRC website for more information about the project
3. Jack Stilgoe, Alan Irwin and Kevin Jones: The Received Wisdom: opening up expert advice
4. Higgins, J., 2004. Times Higher Education Supplement, 9-7-2004

Laura Potts is Reader in Public Health and the Environment at York St John University