Short Abstract

‘Problems’ do not exist independently of our knowledge of them, but instead take shape through our efforts to study and evaluate them. This poster presents findings from a qualitative study that used visual metaphor to explore the implications of this epistemic insight for evaluation practice.

Description

Despite significant research, intervention, and evaluation to inform policy and practice responses to health inequalities, improvements have been slow to follow, with some metrics even suggesting that health inequalities are widening. While the reasons for this are multiple and complex, there is increasing recognition that the ways in which inequalities get framed for action might be contributing to the challenge.

Scholarly insights from fields such as the sociology of social problems, and from novel Foucauldian-inspired approaches to policy and discourse analysis, have demonstrated the importance of attending to the forces that put shape on complex problems in policy and practice, and how they can open up or close down the scope of possibility for action.

Inspired by these insights and their practical application in the fields of health, early childhood, and youth justice, I created a resource of visual metaphors that is designed to assist practitioners in undertaking this form of critical analysis, and to reflect on how dominant approaches to evaluation may inadvertently lead to inequalities being framed in narrow and limiting ways. I undertook extensive engagement and data collection with people working to implement and evaluate action on inequalities across the health system in England to explore their perspectives on the role and value of this kind of creative resource in their work.

On the whole, health system actors were positive about the visual resource and appreciated the ways in which it distilled down complex and often abstract or theoretical ideas into a digestible narrative with supporting imagery in the form of visual metaphors. They offered constructive critique on aspects of the resource that could be further developed and clarified. However, they also expressed a degree of pessimism about the extent to which institutions can be reshaped and felt additional tools and resources would be required to help operationalise the insights presented. While the booklet does offer a useful tool for collective reflection and dialogue, more prescriptive guidance on the ‘how’ of realising deep institutional change to engage with and value alternative approaches to evaluation is needed.