Paper long abstract:

'Solidarity' is widely considered a founding principles for collective arrangements for the delivery of medical care in Europe. Yet the centrality of solidarity is often of a rhetorical nature, used to defend arguments in favor of and against both increased privatization and managerial approaches to health care, and the emergence of personalized medicine. Very few analysts seriously address the question what 'solidarity' means in practice; how it is situated in infrastructures and practices for health care delivery and gets configured through the distribution of concrete medical interventions.

In this paper, I link questions of 'solidarity in practice' to the conceptual framework of bio-constitutionalism. This framework seeks to understand the joint configuration of understandings of what life is and prescriptions for how to live it - individually and collectively. In the particular context of European health care delivery, it opens avenues for seeing how situated notions of solidarity, institutional mechanisms for health care delivery and genetic diagnostic categories in medicine are jointly defined. 'Solidarities', then, are culturally pre- and reconfigured practices that shape how the delivery of medical innovations ought to contribute to the collective good.

I develop this argument through a comparative study of the distribution of genetic technologies in three European countries. With specific examples, I argue that different applications and understandings of genetics in medicine as well as different institutional mechanisms for delivery of care co-produce distinct formations of solidarity in the Germany, the Netherlands, and the United Kingdom.

Paper long abstract:

Insurance is an economic technology which creates security through elaborate actuarial calculations, the pooling of resources and the spreading of risk. Because insurance always involves the sharing of responsibility, solidarity is inherent to this technology. However, the Finnish case of health care insurance for children shows that insurance solidarities can go in many directions, and they can even be mutually exclusive. In Finland, all children are covered by social insurance and are entitled to free public health service. Yet, many families want to supplement this service: some 40% of children under 7 years are insured privately, despite the extra cost of some 350€ per year per child. In addition to an increased sense of security, families are willing to pay for the convenience of use; private health centres are more flexible service providers for parents with demanding work schedules. Many fear, however, that the strengthening of the private health care sector threatens to weaken both the legitimacy of, and the service given by, the public sector. The analysis of this issue shows that the way in which the insurance tool is assembled affects whether insurance creates solidarity with the population at large, or rather, with the workplace, for example. The question examined in this paper is: how can forms of solidarity not only be produced but also dismantled by the use of the insurance tool? The data studied are interviews with families and with the representatives of insurance companies and public administration.

Paper long abstract:

Insurance has played a crucial role in performing solidarity, framed in the epistemology of 19th century statistics and its sociology of 'the norm', enabling the development of 'insurance society'. The statistical possibilities to calculate the risk for disease, unemployment and death made threats more visible, calculable and mutually shareable, resulting in an ex post solidarity.

The welfare state's solidarity - the stabilized result of these epistemological possibilities - is, however, not the only possible one. Today, the rapid development of predictive modelling and its widespread use of genomic algorithms and data-mining techniques have begun to challenge both the epistemology of statistics and the idea of solidarity that informed the insurance society.

In the last thirty years, internet databanks and the growing capacity to store data changed thoroughly the way insurers have to cope with data. 'Big data' demands a new epistemology: the 'norm' has to be replaced by the 'profile', the bell curve around the average has to be replaced by a data-structure in which there are only singularities in relation to other data.

In this paper we will demonstrate how an STS approach is particularly useful to study an insurance epistemology put to practice and challenged by the proliferation of 'big data' and predictive modelling. We will also explore whether solidarity as we have known it can persist in light of the emergence of an epistemology of 'big data' and predictive modelling.

Paper long abstract:

The move towards personalized healthcare that is being promoted as a panacea to public health challenges is often perceived by critics as contributing to an erosion of solidarity. Powerful warnings are sounded about the extent to which increased "personalization", "participation" and "activation" mask a devolution of responsibilities onto the shoulders of citizens, and will lead to new forms of fragmented individualism. In this context self-tracking for health, the use of wearable sensors and mobile applications to collect and monitor personal biometric data, is perceived as an exemplary "counter-solidarizing" practice, that encourages individuals to take on a pro-active, responsible attitude towards their health.

Adopting a practice-based approach, in which community and solidarity are taken to be the result of practices, rather than pre-existing them, can help orient our attention to new enactments of solidarity in unexpected places. Indeed, if self-tracking can seem highly individualistic and narcissistic, for many practitioners a crucial aspect of self-tracking is the opportunity to share their data with others, online in patient groups or offline at "Quantified Self" meet-ups. And while self-benefit is surely an important incentive for sharing, an undeniable dimension is also a willingness to assist others with similar health experiences, often at a cost.

This paper explores some of the limits and possibilities of these new enactments of solidarity. Is the move from "n=me" to "n=we" elitist and segregating nonetheless, or does it allow for increased inclusion? And can it be harnessed for contributing to clinically useful information beyond the limits of the community of practitioners?

Paper long abstract:

For the marketing of functional food, scientific evidence is an operator regulating access to the market. Legally, no medical properties can be ascribed to food, such as curing or preventing disease. Food can only be statistically related to 'health' or 'the reduction of disease risk', which both lie ahead in time and are not immediately observable. Therefore, scientific evidence alone is insufficient in order to market functional foods. This paper unfolds cases where scientific evidence is echoing moral imperatives, standing on the fragile edge which delineate medicine from values. For instance, the morality of these industrial foods lies in the relationship that humans must develop with these foods, based on trust and cooperation. Functional foods will only realize their promise if humans put their faith in them and cooperate by consuming specific products and adopting healthy lifestyles. They can be understood as "matter of concern" (Latour 2004).

In this paper, we analyse recent advertisements of cholesterol-lowering margarine. This issue will allow us to ask more encompassing questions about specific forms of cooperation that are required by objects generated by a 'speculative economy of the promise' (Stengers, 2013). We intend to tell the story of how the involved actors revolving around functional foods cross lines between medicine and morals, humour and irony. This distinction matters when it comes to the politics of solidarity, as we intend to show.

Paper long abstract:

The practice of "incident reporting" is commonly recognized as an effective mean to reduce the vulnerability of "at risk" socio-technical systems (e.g. nuclear plants, large industrial facilities or hospitals), as it allows the concerned community to learn from past incidents. Indeed, it is assumed that collective resilience will be upgraded via the use of institutionalized Incident Reporting System (IRS), enabling the organization to improve the quality of the actions and reactions in case of deviation from normality, or to prevent such deviation. Yet, inductive analysis of what happens with those IRS in practice are not numerous. In this paper, we address this gap and display the results of semi-structured interviews conducted in a nuclear facility. During those interviews, participants were also requested to produce a mind map of the IRS they are concerned with. As a result, we show that safety is a matter of solidarities that are situated in specific contexts. To that regard, incident reporting is a practice of decomposition and recomposition of trusts and thus of solidarities. Reporting incidents consists in putting solidarity on trial, as the collective safety was threatened. We show that such open trial is often avoided because questioning solidarities is not always desirable in order to allow the group to continue functioning. Overall, we argue that informal reporting behaviors can also contribute to upgrade collective resilience without implying to put solidarities on trial.

Paper long abstract:

Through a multi method triangulation, it was intended to identify all those aspects that are confirmed, complemented or discovered, when results on the same object of study are analyzed. The focus was on the regularities, or behavior consistencies, which could be taken as patters for enhancing solidarities from research teams. Even when emphasis was placed on externalism of science, dimensions taken for the analysis were: epistemic, psychological, sociological, historical, economic and political. Since it was a longitudinal study, transituationality played a main role for the identification of patterns. Following Sharpe and Hawkins (1992), efforts were directed, not to a causal explanation, but towards a descriptive probabilistic explanation in terms of the whole series of environmental conditions shown through time. Results revealed epistemic dimension as the leading one for the enacting of solidarities. Several patterns display interesting information about what could be named natural solidarity and about solidarity when scientific policy becomes stronger to rule the behavior of the scientists. These are exploratory data, gathered from the behavior of scientists dedicated to psychological research in México, where Psychology, as an empiric science, started by the 60's. Even when this study can be taken as an exploratory case study research, interesting inferences have emerged, which could be researched within different epistemic communities or sociotechnical sites.