The social sciences are critical to furthering our understanding of health policy and systems around the world. Political science, anthropology, sociology, economics, among other disciplines, provide a range of concepts that allow us to look at our research in a new light – offering new methodologies (process tracing from political science or extended engagement and observation from anthropology) and analytic tools (political economy analyses). These disciplines are increasingly being interwoven into health policy and systems research, facilitating the development of new lines of inquiry, and enabling us to deepen our understanding and analysis of inequity in health outcomes and access to health services. Researchers are also amplifying the call to apply more varied social science theory to health policy and systems (see Van Belle et al 2017 and Daniels et al 2017), and are also organizing collaboration in this space through the SHAPES (Social science approaches for research and engagement in health policy & systems) thematic working group of Health Systems Global.
The application of social sciences to health policy and systems is growing, but still in a somewhat nascent stage. Further, there appears to be a perceived overuse of certain theories or the under-utilization of others (theoretical understandings of power for example). These are valid points, but perhaps there are some additional questions that we need to ask. Beyond calling for social science research, we must also consider why the social sciences have not been perhaps sufficiently integrated into HPSR. At a recent symposium on global health policy and the role of power, Sara Bennett raised an important point – why exactly don’t we have more social science in health policy and systems research? What are some systemic and structural reasons that explain this disconnect? As crucial as the social sciences are to health policy and systems research, the underlying causes are critically important to understand and address. In my view, the disconnect seems to emerge from a series of interconnected issues – the nature of our training in public health, the accessibility of much social science theory, and the ways in which we build networks.
First, many people engaged in health policy and systems have been trained primarily in public health. Globally, public health training programs have evolved to adopt a somewhat formulaic approach – structured around biostatistics and epidemiology and oriented towards programs and applied research. Factor in the short length of time for these programs and the lack of cross-disciplinary teaching, and there simply isn’t the space or ability to adequately teach key social science concepts. Students therefore don’t have the opportunity to pursue training in a particular discipline, or have the breathing room to determine what their interests actually might be.
Second, accessing social science theory in the ‘real world’ is not easy. Exploring these resources often requires good access to a library and an online database, major challenges in most low- and middle-income countries, particularly for those working outside of academic institutions. Engaging with this literature also requires an extended period to sift through materials in attempt to figure out the right kind of social science theory or approach to apply. Such time is often built into doctoral research, but quite rare for other types of researchers facing fast deadlines or competing projects. Social science theory can sometimes feel opaque, and at least in my case, requires a long hard stare before comprehension kicks in. Since self-teaching is often necessary in our field, the combination of dense material and time limitations is a possible barrier.
Third and finally, there is the issue of disparate professional networks and obligations. Despite considerable progress on this front, academics are often incentivized to speak to and write for their ‘people’ (with of course many notable exceptions), limiting opportunities for cross-network learning. The broader health policy and systems research community particularly benefits from such cross-disciplinary fora, providing more exposure to new methods, concepts and theories. At a recent international studies conference, a theme that emerged in a global health session was the limited opportunities for social scientists to cross boundaries and present their work in trans-disciplinary fora. There are certainly many more cross-disciplinary fora now than in years past, particularly with international conferences, but such opportunities could be more widespread, certainly in LMIC settings.
These three barriers listed here can be addressed, but will require a concerted and coordinated effort, particularly from academics. The SHAPES community has recently been discussing possibilities of expanding the reach of the social sciences, for example, through accessible learning resources. Gagnon and a group of political scientists recently published an excellent commentary suggesting avenues for collaboration between their discipline and public health. Other ideas include expanding joint offerings in public health schools between public health and social sciences (more common for example in economics than in political science), and introducing more online courses for those already in the workforce. Finally, a more challenging endeavor will be to bridge divisions, real or artificial, between those squarely in their social science disciplines, and those in the health policy and systems research realm. Taking these steps could allow us to address those structural issues that underpin the lack of social sciences in health policy and systems, and enable us to ask different questions, and go deeper in our analysis and thinking.