Comment: This entry was prompted by two recent articles on health policy that offer the WPR approach as one of their adopted methodologies (Baum et al., 2018; Windle et al., 2018). The articles also juxtapose WPR with critical realism, the latter (Windle et al.) most explicitly. I wish to reflect on the implications of this juxtaposition.

In Baum et al. (2018) the authors ask “What’s the Problem Represented to be?” of their selected documents in order to identify “what the authors of the document consider to be the problem/issue that needs to be addressed” (p. 6, Table 1, column 3). This adaptation of WPR does not follow the recommended analytic strategy of starting analyses from proposed solutions and focusing attention on the implicit problem representations within them (Bacchi 2009). Instead it uses WPR to identify rhetorical commitments to SDH/HE [Social Determinants of Health/Health Equity] and proceeds to assess these commitments using a “critical realist evaluation approach” (Baum et al. 2018: 8; see Danermark et al. 2002; Pawson 2003). The policy statements are to be assessed against “adopted frameworks for understanding optimal policy action on SDH/HE in Australia” (p. 5). While this research design does not create the opportunity to probe deep-seated epistemological and ontological assumptions within the policy documents – as per a WPR analysis – attention to policy “silences” and to how “problem conceptions” may have “delimited the objectives and strategies in ways which are favourable or unfavourable to action on SDH/HE”, indicates some resonance with WPR thinking.

The Windle et al. (2018) contribution uses WPR to probe differing stakeholder conceptions of equity, specifically in relation to the implications of PHFs’ [private health funds] involvement in PHC [primary health care]. This use of WPR to explore the understandings of policy advocates and policy makers is a fairly common adaptation of the approach, though not in line with the specific WPR goal of interrogating problem representations within policies and policy proposals (Bacchi 2015 Bacchi The Turn to Problematization). The authors note that they applied “two theoretical perspectives; realism and Carol Bacchi’s (2009) constructionist approach”. Usefully, for the purposes of this entry, they state:

“We recognise that the underlying ontologies of these two approaches have been regarded as incompatible (e.g. Guba & Lincoln 1994). However, in keeping with Cairney’s (2013) discussion of options for multitheoretical approaches to public policy research, we did not seek to synthesise these two approaches but to apply them separately to illuminate different aspects of the policy environment in a complementary way. (Windle et al. 2018: 4)”

As stated, to achieve this multitheoretical analysis, Windle et al. (2018) ignore the “underlying ontologies” of the WPR and realism. Can this be done? Is there a cost? How does this discussion fit with earlier entries in the Research Hub on “criticality” (Dec. 3, 2018; Dec. 17, 2018) and “ontological politics” (Dec. 10, 2017)

In line with the first entry on “criticality” (Dec. 3, 2018) I would like to suggest the usefulness of pursuing this topic by asking about the political implications of contrasting theoretical stances. To what extent is it possible, or desirable, to adopt, or claim to adopt, the kind of “multitheoretical approach” advanced in these studies?

Returning to Annemarie Mol’s (2002: 155) argument that research methods are forms of political intervention rather than ways to access “truth”, and in line with a “performativity” perspective on “reality” (Bacchi and Goodwin 2016: 30), it is useful to think of research practices as creating realities. To quote John Law (2004: 143), “method is not, and could never be, innocent or purely technical” because it “unavoidably produces not only truths and non-truths, realities and non-realities, presences and absences, but also arrangements with political implications”. The task then becomes reflecting on the specific realities and “arrangements” our research practices create.

Now I acknowledge that this task is not one likely to engage critical realists who postulate a reality existing “independently of social actors”, while accepting that the interpretations of those actors can influence that reality (Gilson 2012: 35-36). Still, I think it worthwhile to consider if such a position itself has political effects that require consideration. For example, elsewhere, Malin Rönnblom and I (2011; RonnblomBacchiBudapest copy), alongside Law (2004) and Rowse (2009), reflect on the political fallout accompanying the assumed fixity of “nation-states” in much political science analysis. Law points out that, by deploying concepts such as “nation-state” unproblematically, analysts actually install them as “real”. Hence, they participate in creating a reality of nation-states, reinforcing contemporary geopolitical arrangements.

This issue of the status assigned conceptual categories arises in commentaries on Kevin Stenson’s (2008) “realist governmentality”. Wendy Larner (2008: 23) points out what gets lost in Stenson’s references to  “white flight”, the “knowledge economy” and “social capital” as “self-evident descriptors of the terrain being analysed” in his study of “community safety” in the UK Thames Valley region:

“These terms bundle together a set of presuppositions about the nature of the region, the causes of the problems to be solved, and the capacities of the subjects involved. They need to be denaturalized, made specific, and their governmental implications revealed.” (Warner 2008: 23)

Put too briefly, in treating these “entities” as “real”, the politics involved in their formation disappears from the analysis.

Elsewhere I (2016; Bacchi Problematizations Health Policy) have reflected on the political implications of other key critical realist premises. Specifically I make the case that the primacy accorded “mechanisms” that work through the “behaviours” of social actors can serve to promote a focus on individual responsibility for health outcomes, exacerbating the “lifestyle drift” that concerns so many health policy analysts (Bacchi 2016: 6).

There are also grounds, I suggest, for linking endorsements of methodological pluralism to critical realist premises. Specifically, critical realists assert a separate “real world” that can only be “known” through partial perspectives. As Margaret Archer et al. (2018) explain:

“Ontological realism is committed to the relatively autonomous existence of social reality…; however, our knowledge about that reality is always historically, socially, and culturally situated.”

As a result, says Archer et al. (2018), “methodological pluralism” is deemed to be a “necessity”.

It follows, I suggest, that endorsements of methodological pluralism are “not innocent, or purely technical” (see Law above), regardless of how benign they may sound. In this instance methodological pluralism forms part and parcel of a critical realist paradigm.

All of this highlights the importance of being clear about the ontological, epistemological and political commitments that accompany our research choices rather than simply using them in a “pick and mix” fashion (Whittle and Spicer 2008: 620). This argument does not imply opposition to the use of several theoretical perspectives (Scott 1991: 116); rather, it encourages careful reflection on the “unexamined ways of thinking” (Foucault 1994: 456) that inform our methodological choices.  To this end I recommend that we ask of our research methods, “What’s the Problem Represented to be?” (see Primdahl et al. 2018).

References

Archer, M., Decoteau, C., Gorski, P., Little, D., Porpora, D., Rutzou, T., Smith, C., Steinmetz, G. and Vandenberghe, F. 2018. What is Critical Realism?  Perspectives  38(2): 4-9. Available at: http://www.asatheory.org/current-newsletter-online/what-is-critical-realism Accessed on 12 December 2018.

 Bacchi, C. 2009. Analysing Policy: What’s the Problem Represented to be?Frenchs Forest: Pearson Education.

Bacchi, C. 2015. The Turn to Problematization: Political Implications of Contrasting Interpretive and Poststructural Adaptations. Open Journal of Political Science   5: 1-12.

Bacchi, C. 2016. Problematizations in Health Policy: Questioning How “Problems” are Constituted in Policies.  Sage Open, April-June: 1-16.

Bacchi, C. and Goodwin, S. 2016. Poststructural Policy Analysis: A Guide to Practice. NY: Palgrave Macmillan.

 Baum F, Delany- Crowe T, Fisher M, et al. Qualitative protocol for understanding the contribution of Australian policy in the urban planning, justice, energy and environment sectors to promoting health and health equity. BMJ Open2018;8:e025358. doi:10.1136/ bmjopen-2018-025358

Cairney, P. 2013. Standing on the shoulders of giants: how do we combine the insights of multiple theories in public policy studies? Policy Studies Journal, 41: 1–21.

Danermark, B., Ekstrom, M. and Jakobsen, L. 2002. Explaining Society: critical realism in the social sciences.London: Routledge.

Foucault, M. 1994 [1981]. So is it important to think? In J.D. Faubion, (Ed.), Power: Essential works of Foucault 1954–1984, vol. 3, Hurley, R. and others (trans.). London: Penguin.

Gilson, L. (Ed.). 2012. Health policy and systems research: A methodology reader. Geneva, Switzerland: World Health Organization.

Guba, E.G. and Lincoln, Y.S. 1994. Competing paradigms in qualitative research. In N.K. Denzin and Y.S. Lincoln, (eds) Handbook of Qualitative Research, Thousand Oaks, CA, Sage Publications, pp. 105–7.

Larner, W. 2008. Comments on Kevin Stenson’s “Governing the Local: Sovereignty, Social Governance and Community Safety”, Social Work & Society   6(1): 21-25.

Law, John 2004. After Method: Mess in social science research. New York: Routledge.

Mol, A. 2002. The Body Multiple: Ontology in medical practice.Durham and London: Duke University Press.

Pawson, R. 2013. The Science of Evaluation: A Realist Manifesto.Thousand Oaks, CA: Sage.

Primdahl, N. L., Reid, A. & Simovska, V. 2018. Shades of criticality in health and wellbeing education, Journal of Curriculum Studies,DOI: 10.1080/00220272.2018.1513568

Rowse, Tim 2009. The Ontological Politics of “Closing the Gaps”. Journal of Cultural Economy 2(1 & 2) March/July: 33-48.

Scott, J. W. 1991. The Evidence of Experience. Critical Inquiry  17(4): 773-797.

Stenson, K. (2008). Governing the Local: Sovereignty, Social Governance and Community Safety.  Social Work & Society  6(1): 1-14.

Whittle, A. & Spicer, A. 2008. Is Actor Network Theory Critique? Organization Studies  29(4): 611-629.

Windle, A., Fisher, M., Freeman, T., Baum, F., Javanparast, S., Kay, A., and Kidd, M. 2018. Increased private health fund involvement in Australia’s primary health care: Implications for health equity.Australian Journal of Social Issues, 2018: p. 1-17; DOI: 10.1002/ajs4.45