Paper short abstract:

Health policy ethnography requires conceptual and analytical preparation to inform ‘fruitful ways of looking’. This paper presents an interpretive framework to instil direction and purpose through the concepts of what policy makers ‘do, know, use and make’, and to impart meaning to routine practices

Paper long abstract:

Ethnographic study of health policy makers and their institutional setting raise important questions about the appropriateness of the traditional anthropological toolkit to this non-traditional endeavour. This paper will present an outline of the interpretive framework I used in my 2018-19 doctoral fieldwork in an Australian Indigenous health policy department, and how it helped harness my ethnographic sensibilities to understand this setting as socio-cultural domain. With participant observation as overarching method, this framework provided me with direction and purpose, or ‘fruitful way of looking’ to structure data collection and the sense making that follows. I applied concepts from experienced ethnographers (Agar, Spradley, Atkinson) as a lens for observing 'what policy maker do', 'what they know' and 'what they make and use'.

I discuss how this framework assisted me to focus on the human experience and cultural behaviour (such as what happens in meetings), attend to cultural knowledge and expertise (such as executing work tasks), and to make sense of cultural artefacts (such as bureaucratic documents). Also, how this framework provided me a way to conceptually integrate social encounters and interpersonal interactions into my observations, to seek meaning in these, and emphasise how this policy world is experienced from within. Lastly, a rationale to focus on the practices of everyday life and the routines and rituals of policy making gave me justification to join meetings, to learn what happens during these structured conversations, and to take note of the content and flow of written information and documents that arise from these events.

Paper short abstract:

Ethnographies of policies in the NHS in England illustrate how multi-site ethnography expands and deepens an understanding of contemporary governance and supports dialogical policy processes that generate more creative, acceptable and effective policies

Paper long abstract:

Contemporary forms of government work through expert knowledge and activities. In the healthcare field, national policy makers, policy documents, academics, think tanks, management knowledge, regional managers, managerial strategies, educational practices, training materials, and healthcare professionals are brought together to shape the conduct of citizens. Multi-site ethnography, that ‘follows’ policy through space and across time, can capture the diversity of actors, practices and arenas of governing. By observing actual behaviour, anthropologists can show how heterogenous material effects are produced as policies interact with situated agency and local traditions all along the policy chain. Multi-site ethnography of reforms in the English NHS has illuminated key features of contemporary governance: how decisions are hidden in the spaces ‘in between’ and ‘out of reach’; the enrolment of doctors in governing; and the way that management consultants and think tanks circulate policy models that homogenise organisational form. At the same time, ethnographic attention to instances of resistance shows the influence of alternative foundations for action, such as forms of belonging. Anthropology’s slow burn expands and deepens our understanding of contemporary governance and supports dialogical policy processes that generate more creative, acceptable, and effective policy.

Paper short abstract:

What happens when the ambiguity of health policy engenders a politics of interpretation at local levels? How do we navigate such ambiguity? This paper addresses these questions by critiquing the contested place of ‘religion’ in debates surrounding the teaching of sexuality education in the UK.

Paper long abstract:

This paper is concerned with how the ambiguity of health policy engenders a politics of interpretation among intended beneficiaries, which anthropologists are tasked with navigating in methods, analysis and ethical positioning. It does so by taking the case of sexuality education, which is viewed by UNICEF as a cornerstone of promoting sexual wellbeing in adolescence and across the lifecourse.

In the UK, statutory guidance around the teaching of Relationships & Sex Education (RSE), including LGBT content, has provoked claims of ‘religious opposition’ among parents, activists and educators. Statutory guidance itself demonstrates how health policy engenders the potential for conflict with the category of religion, by noting that ‘the religious background of all pupils must be taken into account when planning teaching.’ The paper draws on interviews conducted with educators, activists, parents and youths from Orthodox Jewish and Muslim neighbourhoods, as well as observing debates in public fora, to illustrate how interpretations of health policy provoke conflicting ways of framing and deploying ‘religion’ vis-à-vis RSE and LGBT content.

Conducting ethnographic research and interviews on a comparative and multi-local level basis illustrates how the category of ‘religious opposition’ is itself situated. Whereas parents, activists and educators in Orthodox Jewish and Muslim neighbourhoods tended to view RSE and LGBT content as a challenge to ‘religious’ rights and freedoms, adolescents viewed comprehensive and inclusive curricula as a right in itself. Anthropological methods reveal how health policy produces, maintains and reinforces a discourse of ‘opposition’ that is best understood as a politics of interpretation.

Paper short abstract:

Covid-19 has made vivid the importance of social infrastructures to health policy. We propose that ethnographic methods that take the borough as the focus of study, with attention to neighbourhood, street and virtual spaces, are best suited to examine these infrastructures and propose interventions.

Paper long abstract:

Public health and other policy responses to the Covid-19 pandemic have extended the ongoing securitisation of state and communities. Beyond a narrow legal sense, a broader ‘state of exception’ has emerged as the implementation of such policies converge with – and galvanise – new forms of mutuality and reflections on social relationality. Such a state, this paper suggests, lends itself to reconfigurations and, necessarily, reconceptualisations of ‘community’. In this moment of reflection and the remaking of social relations, the paper illustrates how ethnographic methods provide the tools required to render visible and make vivid the layered and multidimensional interactions of ‘social infrastructures’ (Bear et al. 2021) at the interface of kinship networks, diverse communities and VCS groups, local government and the state. Second, the paper argues for the merits of placing Local Authority districts (‘the borough’) at the centre of ethnographic investigations. This level and scale of analysis is required in order to reveal the fragile relational networks that crosscut (in)formal care relations, as well as their articulation with broader state policies that inform localised political and socio-economic histories and realities. Third, the paper suggests that an ethnographic focus on the borough requires and enables, rather than forecloses, close-up examinations of the neighbourhood, street and virtual spaces, which can provide nuance to recent discussions about place and spatial relations. Fourth, a collaborative ethnographic approach can provide discrete, stand-alone studies of particular boroughs while opening up possibilities for comparison and the ‘scaling up’ of analysis for broader policy recommendations and interventions.