Policy-oriented studies in british medical and health geography since the 1980s

Abstract

Human geography's contributions in policy arenas have long been discussed within the discipline. Although policy (re) turn debates emerged after the late 1990s, the author suggests it is important to examine not only the current situation of policy-oriented geographical studies, but also their long-term development and evolution. In this paper, the author traces and analyzes policy-oriented studies in British medical and health geography since the 1980s, when quantitative and policy science approaches came to be severely criticized and various alternative approaches developed in British geography. Since the 1980s, the dominant research in these areas were, first, studies seeking fundamental explanations and primarily depending on political economic/Marxist approaches, and second, studies strongly influenced by humanistic geographies and various social theories, including the so-called cultural turn movement, with focuses on differences and particularities. These developments shifted medical and health geographers' attention toward factors affecting individual health, from medical affairs to non-medical (environmental, psychological, social, etc.) ones. Qualitative methods (such as in-depth interviews and discourse analyses) also came to be eagerly introduced into these areas. In their policy-oriented research, researchers using a political economic/Marxist approach tried to "explain" the fundamental mechanism behind why health disparities emerged, leading to the introduction of certain policies. Cultural and social approaches aimed at "understanding" the more nuanced meanings of policies and their effects. On the other hand, policy "evaluation" and "design" studies were largely discarded. In contrast, some related disciplines developed such studies, and a few medical and health geographers claimed to tackle them. Especially important, we feel, are quasi-experimental and quasi-market approaches. The former approach's purpose is to gain evidence for effective policy intervention, exploiting naturally emerging situations. The latter seeks the effective use of market mechanisms by minimizing its faults. Thus far, these approaches have not been accepted enthusiastically. If we hope to seek contributions to policy evaluations and development and improve the public's health through policy interventions, we should not only develop policy evaluation and design studies, but also constructively promote the supplementary and integrative use of various approaches such as qualitative and quantitative, political-economic and cultural-social, policy science, etc.