Category Archives: easst review

News from the Council

Dear members of EASST

Warm greetings to you all. We would like to update you on the latest developments regarding EASST. At our Council meeting in June we discussed several issues of great importance.

First of all, we are working towards holding a physical conference in 2022. We have decided that this will take place in Madrid. We are currently negotiating with a potential venue and setting up a local conference committee to be expertly chaired by Vincenzo Pavone.

Previously, we have run our conferences in a university setting. However, that will not be possible in 2022. Our conference has outgrown the capacity of most European universities. And many universities find themselves unable to commit to holding a conference next year given that we do not exactly know how the pandemic will develop.

Nevertheless, Council has decided to take a leap of faith and trust that we can have a physical conference next year. In particular, we really, really miss the face-to-face interaction and fun of our past conferences. However, the fact that we are opting for a professional venue means that organizing costs will increase. Our registration fees will therefore be higher compared to the Lancaster venue (20-30%). We regret this, but can see no other way to proceed. Once we have an overview of the entire budget we will consider support measures to keep the event as inclusive as possible. We hope that you, our community, will accept this and join us in making the Madrid conference next year a huge success.

Secondly, Council members had a good initial discussion about our responsibility as a scholarly community to support open science and the creation of FAIR (findable, accessible, interoperable and reusable) data around our scholarly activities – for instance our conference and publication work. We will not be able to lift this agenda singlehandedly, but we will try to collaborate with other actors who share in our beliefs about the importance of open availability of our (meta)data and publications (rather than having ownership reside with big publishing companies that are not working according to the same principles). We have formed a working group that will work with this theme and suggest ways forward.

We also discussed forming a group that will review our EASST awards (Amsterdamska, Freeman & Ziman awards) and the process by which these are decided. We would like to hear from you, our community, about this. What is it that you believe we should award as a community and how you think we should celebrate our scholarly achievements? If you have views, comments and questions regarding this, please send an email to Maja using majho(at)dtu.dk.

Finally, we discussed how to proceed with identifying a conference venue for what we hope will be a joint conference with 4S in 2024 (they seem as keen as we are). We also discussed how to manage our EASST fund for extra-conference activities, our prize committees and our own budget and admin.

We hope you all have/had a very happy Summer and a well-deserved holiday break.
On behalf of EASST Council,

Ulrike Felt and Maja Horst
President and President elect of EASST

Genomics in Context

The joys of research and writing – of pursuing a line of inquiry, finding an exciting vignette – can too often turn to frustration. However pleased you are with that carefully crafted couple of paragraphs, they just have to be removed. They really do not advance the argument enough to stay in, given the word count and the additional suggestions of the reviewers. As a result, it gets cut, and maybe lives on dormant in a document located somewhere in a labyrinthine file system.

So, when historian of biology Michel Morange suggested as a spin-off of the European Research Council funded ‘TRANSGENE: Medical translation in the history of modern genomics’ project that we develop a web resource showcasing our research, I immediately grasped its potential. Such a resource could make use of the research and writing that does not make it into a paper. It could allow us to develop these elements, or other research findings that cannot achieve full bloom in the cramped confines of a peer-reviewed article. It could also provide us with the platform to summarise our research for non-specialist audiences. I felt this was needed, as public resources specifically on genomics that are deeply informed by humanities and social science scholarship tend to be scattered, when present at all.

The idea was born for ‘Genomics in Context’. A successful application for a Beltane Public Engagement Fellowship gave me the room and impetus to explore this idea. I discussed it with colleagues with experience in public engagement, other academics teaching genomics to undergraduates, and professional writers. The website – www.genomicsincontext.com – includes articles of three to five-thousand words, with an accompanying blog for shorter pieces. The intention ultimately is to use blog posts as seeds for longer articles. For now, it serves as a valued venue to allow selected students on courses here in the Science, Technology and Innovation Studies subject group to develop high quality assignments into public posts, with my guidance as editor.

For the articles, upon advice I have shaped a review process that provides a rigour to ensure high-quality outcomes worthy of inclusion on a CV, while making it as painless and constructive for contributors as possible. A small group of researchers here at the University of Edinburgh have participated, attending review meetings at which we discussed draft articles, with the author present if they wished to be. An assigned lead reviewer was tasked with collating and synthesising the views discussed in the meeting, and producing a report for the author to aid them in their revising ahead of publication. Since the outbreak of the pandemic, I have been less able to secure new writers and the review process has necessarily become more virtual and distant. Soon, I hope to be able to be out there securing commitments and holding review meetings similar to the pre-pandemic model.

The resource is intended to be a long-term project, with articles and blog posts steadily added, and additional resources for further exploration included and contextualised. I have plans to add some video content, and also to include an ‘ontology’, an information resource modelled on ontologies in the natural sciences, in which entities – such as individuals, institutions and projects – and the relations between them, can be accessed by users. This would be useful as a reference, as well as a research tool for discerning connections and patterns across genomic research.

Feedback, suggestions for content (including new kinds of content) and submissions of draft blog posts and articles are always welcome. Please fill out the contact form on the website to do this.

 

Staying with the troubles of infrastructuring stsing: between assemblage and “Verein”

How could it take four years? When the first general assembly of stsing will take place on 10 September 2021, four years will have passed since the first ideas of (re)organising STS in Germany emerged over two cappuccinos and an Americano. Covid-19 is a good excuse, as is German bureaucracy. But they are not the only reasons. Once, when one of us first told him about STS, a math professor and research-collaborator exclaimed “you seem to complexify things; isn’t science about making problems simple and easy to solve”? He had gotten a good sense of STS.

The STS community in Germany does not make it easy for itself to create an association. As is often the case in STS, we seem not just to want to provide innovative results; we also want to intervene into the mode of producing results. In Germany, a part of the STS community wants to organise itself differently from how academic societies traditionally organise. It wants more of a dynamic platform that empowers young scholars and less of a society safeguarded by established colleagues. It desires more facilitation of new ideas and less emphasis on tradition. It urges for more decentralized and unpredictable activities and less ceremonial events. It seeks to embrace linguistic cosmopolitanism while also supporting local forms of communication. It wishes to be inclusive while also having norms about how (not) to treat each other. It aspires for co-laboration with non-academics, while sticking to high intellectual standards. It is critical of scholastic conventions but insists on engaging with the socio-material constraints of universities as workplaces.

Plans

In view of these ambitious intentions the device chosen for infrastructuring the community may seem hopelessly antiquated: the “Verein” organisational form. This German association entails among others a statute, clearly defined (non-)members, general assemblies with fixed agendas, and a board. The task at hand was to mobilise these rigid structures for our visions of fluid, caring, and co-laborative processes. We (obviously many more than the authors of this text) studied how activist organisations had solved this problem before us, and agreed on the observation that the flexibility and care we sought to nurture would flourish best in smaller autonomous groups. We envisioned independent workgroups to be the core organs of the associations: project groups sharing research on particular topics, event groups planning conferences or workshops, interest groups discussing STS teaching, peer-support groups helping each other with research applications and publications, etc.

However, such a decentralized structure is likely at risk of fragmentation, and thus integrative devices had to be invented. Four devices were conceived that should provide this:

  1. a shared communication platform, which would allow all members a window into what happened in the other workgroups, and also ease access for newcomers,
  2. a reporting system which would require of workgroups to regularly sum up and inform about their activities,
  3. an organ that would collect the workgroups’ reports and communicate them back to the community and to external observers, and
  4. informal regional groups in which members across the specialised workgroups would meet and mingle.

Members of the workgroups would be likely to come from all over the country (and probably from abroad as well), and maybe even primarily meet online. This could make it difficult for newcomers to join and it could easily end up formalising interaction, which was thought to likely obstruct creativity, and indeed care. The regional groups should enable members to meet up across the workgroup and to exchange their activities, experiences and ideas more informally than through reporting.

Each of the four devices turned out to be controversial. Very much so the question of the collectors workgroup reports. These were originally thought of a foresters or caretakers who should consider themselves as servants of the workgroups rather than their editors or regulators. The formal organ that was available for this task in the “Verein” organisational form was the board. Voices critiqued naming the board “foresters” or “caretakers”, as this would conceal the power granted to them. What a dilemma! How do you redefine, and disempower a formally powerful organ, when renaming it at the same time conceals its power? How strong or how weak is the performativity of a name? The question will have to be answered in another context, since we reacted to the critique by refraining from renaming the board.

Situated action

This infrastructure was a “Kopfgeburt” (head birth) that still is in the process of being turned into real bodies, relations and events. On 27 October 2020 ten people gathered in the central Berlin part Tiergarten to found the association; with distance and outside to avoid Sars-Cov2 contagion. A board of seven people was elected, and the work of turning the conceived infrastructure into lived reality began. A seemingly endless number of trivial formal decisions were to be made, which in the interaction among STS scholars all become political: from the question of which data to collect on the membership form to how to store membership data securely, which lawyer to choose for the registering of the association, whether and in what form to add an anti-discrimination statement in the statute, how to address workgroups in order to perform the desired role of the board, how to secure that not only men are working on the technical infrastructure, etc., etc.

Miro Board from Board meeting

Parallel to the board busy infrastructing stsing, another group is working on the inaugural conference, which due to the SARS-Cov2 pandemic had to be postponed and hopefully will take place on 20-21 May 2022 in Paderborn, with and exciting experimental programme. Yet other people have taken contact to the German Research Foundation to initiate a discussion of how STS research applications are best handled in a highly disciplinary funding landscape. Some scholars gather to develop a concept of how to ensure stsing engagements to be anti-discriminative. Other colleagues organise the technical infrastructure and the online elections for the next board, etc.

STS beyond stsing

While stsing is currently quite occupied with its own internal infrastructuring, its founding has also had effects on the larger landscape of STS in Germany. The Gesellschaft für Wissenschafts- und Technikforschung (GWTF) has existed since the EASST conference in Bielefeld in 1987, just as many other organisations and networks exist that are concerned with technology assessment, politics of technology, philosophy of science and philosophy of technology, the needs of young STS scholars, etc. Due to the abundance and well-established scholarly organisations in Germany dealing with science and technology, voices arose inquiring if what we need is really yet another association? This led to intense debates, but the shared wish to embrace diversity and abundance of STS in Germany has resulted in an initiative to bring all these heterogeneous networks and organisations together, many of whom had prior not been aware of each other’s existence. Both in 2019 and in 2020 meetings were organised for all the STS groups in Germany, and at the moment a group is organising a larger joint conference in the autumn of 2022 for all the German STS networks.

Nicely troubling

Writing this short report, we realize that a lot has happened over the past four years. Much has unfolded in smaller groups, such as the board convening online every other week. With the view to the upcoming first general assembly on 10 September, we expect stsing activities to be more publicly visible and engaging. The first general assembly will have public online keynotes and take place as a distributed event in smaller local “hubs” all over the country. We are looking forward to seeing STS colleagues gathering locally while sharing this collective event. It is exciting to be part of organising a community that does not shy away from neither complexity nor trouble and where there always seems to be someone, who has yet a better idea, or who point to yet another problematic implication of the latest decision. We feel confident that by cultivating response-ability to these many voices, stsing will indeed keep mobilising the German STS community in a lively, productive and nicely troubling way.

Anyone is warmly invited to join the infrastructuring endeavour; the discussions, complications, transformations, and indeed the celebrations that make stsing happen. Membership is open to all. It starts here: https://stsing.org/

Stsing.org webpage

The Cosmology of stsing

Every society needs a cosmology to explain itself to itself. Where do we come from? What are we all about? Where are we going? Without such a foundational narrative, socioecological cohesion cannot be achieved, purpose cannot be agreed upon, decisions cannot be made.

“Doing STS in and through Germany” – or stsing for short – is not really a people in an anthropological sense, nor is it a society in a sociological or institutional sense. More an emergent community of practice, perhaps. Yet, communities of practice also need a cosmology. So, here is one version of a founding myth: It is the 4th of October 2017, early afternoon. Picture a grey overcast coldish day in Berlin. Typical autumn weather. In a small bustling café on Friedrichstraße, three still young(ish) scholars from three different German universities huddle in a quiet corner around a small table drinking cappuccinos and an Americano. I’d like to think the scene and the mood were conspirative, but, realistically, no-one in the café that day could have cared less about what the three were concocting in their corner. The three are seriously overworked and mainly glad to share a coffee with long-time friends before heading back to work. All three of them consider themselves scholars in/of/with science and technology studies and over the years have had their conversations about the state of this weird inter-discipline worldwide and in the German academic landscape that is still so strongly shaped by disciplines – for better or worse.

That autumn afternoon, the conversation once more turns to STS in Germany. The three agree that a lot has been happening lately: new posts, new centres and new people; mainly in places where you wouldn’t expect it, rarely connected to the established landscape of philosophy, sociology and history of science. Interesting. What seems to be missing, though, is a sense of shared ownership of STS, is an institutional base, and are possibilities to get together as STSers, and to systematically contribute our expertise to society, and learn from societal actors. It’s not too bad in Berlin, because there is always already lots of everything in Berlin so you find your people, have coffee and engage in exciting discussions. Yet in many other cities and at many other universities, many STS-minded scholars – especially early career scholars – are sitting in disciplined departments and struggle to find interlocutors for those matters of concern that exceed the established thought styles that surround them.

Is this not the right time, the three surmise trying to ignore the hissing of the coffee machine, to set up some sort of society for STS scholars in Germany? The idea sits on the table like a joke or at least matter out of place. Yet, the ideas flourish: A platform for societal actors meeting up with STS scholars, discuss current issues, learn from each other and share their expertise, create connections across disciplines and across the boundaries of academia. Make STS a visible actor in German academia society. They have emptied their coffee. How would that work? No tenure, no future, no idea where to even start. Then there is the intellectual issue: Is the spirit of STS not diametrically opposed to the idea of a ‘society’ – board meetings, rules of procedure, membership fees…? And then there is the institutional issue: Germany already has a Society for the Study of Science and Technology, the GWTF, with its small but beautiful annual meetings of largely sociologists of science and technology.

In all its absurdity, the idea still seems right. Maybe ‘society’ is not the right framing. Maybe it needs something more rhizomatic, something more platform-like. Not in the start-up economy, exploitative sense, but in the sense of providing a platform to early career scholars to network, to develop collective formats of learning, to generate new ideas. Also: Representation is an issue. STS is institutionally weak and underrepresented in the core funding agencies. For a moment, there is a sense of something exciting coming together. Diffuse yet and too big to grasp. But time is up and the three need to return to work. Two things are agreed: It is worth a try. They need help.

A few months later, help has arrived: Tanja Bogusz, Endre Dányi, Jörg Niewöhner, Martin Reinhart, Martina Schlünder, Estrid Sørensen and Tahani Nadim gather in Berlin to prepare a lunchtime meeting at the EASST conference in Lancaster in 2018 of what has now received the working title: STS Germany. The purpose is clear: Get a sense of numbers and interest for STS in Germany. Bring the existing organisational forms together. Listen. Network. Plan. A rough sketch for the meeting is quickly drawn up, Estrid is elected frontwoman for the day, post-its and white boards are organised. Ready to go.

What if we have STS Germany and no-one shows up? Preparing the room that day in amazingly sunny and warm Lancaster on the university campus, there is doubt in the air. So much STS, so many brilliant sessions: Who were we to think that STS needs another grouping in Europe? Then its lunchtime and they come: More than 110 people cram into the room listening to Estrid’s kick off, to representatives from GWTF, the Science & Democracy Network run in Germany by MCTS in Munich, and INSIST – the young scholars network organised out of Bielefeld. Who would have thought? The group is heterogeneous, dominated by early career scholars, and it is enthusiastic. All sorts of things are suggested but agreement is reached on the following:

  • None of the existing networks represent a significant majority of the people who attend the meeting.
  • The majority of people who speak articulate the need for exchange, cooperation and support within this emerging community.
  • The relationship of a potential new body with existing networks needs to be clarified. In any case, anything new needs to respect and work together with existing forms.
  • Most people favour a decentralised, rhizomatic structure (network) strongly building on and caring for early career scholars from MA/Sc students to senior research associates.
  • The network ought to support knowledge, mentoring and exchange on the inside, function as a port of call for people abroad, over time represent STS in Germany to the outside world, and improve STS’s standing with funders.
  • The network should facilitate online collaborative support, for instance through an online platform/database (projects, people, degrees, syllabi …), foster possibilities to link and exchange, organise meetings and prepare joint grant applications.
  • Modes of co(l)laboration among academic STS scholars and experts developing, governing, administrating and using science and technology should be developed.
  • An annual meeting and smaller workshops (e.g. around methods) seemed desirable. Perhaps a new journal?

 

2019 stsing Workshop in Kassel
2019 stsing Workshop in Kassel

What a frenzy. The meeting is over quickly and the crowd disperses into further sessions. What remains is a newsletter to sign up for and a strong sense of enthusiasm and possibility. Not much to go on, but it is enough for people to start meeting in the following weeks and months in groups to specify tasks in organisation, communication, infrastructure and administration. A follow-up meeting in Kassel begins to emerge with a much more specific agenda focused on how this can actually be done: when, by whom and in what way so as to respect the interests of everyone involved. The momentum carries.

 

There is a foundational myth for you. As if STS could ever handle a singular cosmology.

 

‘Studying Up’ on Fukushima

Nuclear disasters do not end – they fade away. Radioactive isotopes decay to stable ones. Clean-up efforts progress. Evacuees return to their homes, or settle into new lives, as legal challenges meander from one court to the next. Yet this process takes decades and finds itself outpaced by the half-life of political attention. The Fukushima Daiichi disaster is no exception to this trend. I began to work on this topic as an undergraduate, conducting my dissertation fieldwork in the summer of 2012, when Japan’s anti-nuclear protests were reaching their height. Two-hundred thousand protestors would flood the streets of Tokyo’s political district, Kasumigaseki every Friday evening in a kaleidoscope of colour: the largest demonstrations Japan had seen for 50 years. By the time I graduated in July 2013, their numbers had dwindled to the thousands. And when I returned to Tokyo as a PhD candidate in 2016 and 2017, the protestors only numbered in their hundreds. The disaster, once splashed across every newspaper, now garnered only sporadic coverage and evacuees expressed concerns of being forgotten. In numerous settings, I found my interlocutors looking forward to March 2021, mentioning the 10-year anniversary as both a milestone and a moment to reflect. It is in this spirit that I would like to (briefly) examine the first decade of social scientific work on the Fukushima Daiichi disaster, celebrating what has been achieved and diagnosing what is yet to be done.

Figure 1.1. Anti-nuclear protest outside the Prime Minister’s Office Source: Author’s own.

By a happy coincidence, I find myself writing between two anniversaries – one political and one academic – and convinced that the latter might speak to the former. It will shortly be 50 years since Laura Nader called upon anthropologists to ‘study up’ in her seminal essay, Up the Anthropologist (1972). Nader observed a tendency among anthropologists to study social problems from the margins, focusing their empirical work on the poor and disadvantaged, rather than the powerful and established. Her proposal for reinvigorating anthropology was to re-focus attention on the ‘most powerful strata of society’, examining the ‘culture of the powerful’ with the same care that researchers had traditionally detailed the ‘culture of the powerless’ (ibid.: 289).

Nader’s call to study up has enjoyed considerable acclaim, especially in STS, where early laboratory studies established elite ethnography as a core disciplinary method. Nonetheless, an imbalance between the number of scholars who ‘study up’ and ‘study down’ persists. This imbalance is evident in the explosion of ethnographic interest in Japan over the last decade. There is now a wealth of work detailing everyday encounters with “3.11”. From Brigitte Steger’s (2012) memorable account of day-to-day life in an evacuation shelter – with its focus on the role of cleaning in ‘rescuing normality’ – to accounts of farming in the affected territories or the stigmatisation of nuclear evacuees, one can find a range of works that examine the experience of the disaster ‘from below’. The question of how citizens negotiate radiation risks is a central theme in this corpus and one that STS scholars have played a pivotal part in exploring, offering considered accounts of the grassroots citizen science projects that have emerged to monitor civilian radiation exposure (see, for example: Kimura, 2016; Polleri, 2019). In taking seriously the lay knowledges and ‘counter expertise’ of such organisations, these works have collectively answered the author and Nobel Laureate in Literature, Kenzaburo Oe’s call to ‘look at things through the eyes of the victims of nuclear power’.

By contrast, our picture of how the disaster looks ‘from above’ remains hazy. Though the impact of the disaster – on both domestic (see, for example: Samuels, 2013; Koppenborg, 2020) and foreign policy bodies (see, for example: Kinsella, 2013) – has received concerted attention, most of this work has been penned from a distance. To the best of my knowledge, there are no accounts of daily life in one of the Japanese ministries involved in the reconstruction (fukko) of the Tohoku region. Nor do I know of an ethnography of the Reconstruction Agency, established in 2012 to co-ordinate their efforts, or any of the local governments in the Tohoku region. Participant observation of projects run in Fukushima by international policy bodies, such as the International Commission on Radiological Protection (Takahashi, 2020: 121-145; Takahashi, forthcoming) and OECD Nuclear Energy Agency (Takahashi, 2020: 98-120), has been conducted but remains rare. Consequently, our insight into how knowledge circulates through the Japanese state and relevant international organisations, as well as whose expertise counts in which policy settings, remains limited. Given that the organisational culture of the Japanese state is often cited as the root cause of the Fukushima Daiichi disaster, the need for scrutiny is clear. Moreover, analysis that moves beyond a monolithic presentation of Japan’s nuclear industrial complex – or ‘nuclear village’ – might inform strategic intervention. Certainly, one can glean some insight into the internal workings of the state through the diaries and memoires of those who have trodden the halls of power. This genre has proven popular with Prime Ministers, scientific advisors, and local mayors in the last decade; each eager to defend their actions and offer their own perspective. Yet their focus often falls on moments of drama, rather than on the more quotidian negotiations of credibility that STS scholars might wish to examine. Faced with this clear empirical lacuna, there is good reason to echo Nader and cry, “up the STS scholar!”.

One might counter that it is easier to advocate ‘studying up’ than to do it. Those who attempt to get ‘up close and personal with elites’ frequently find themselves hitting a ‘glass ceiling’ (Kuus, 2013; Rhodes, 2011). Though I was forewarned of this difficulty, I only came to viscerally appreciate it at 19, when interviewing a politician for the first time. Having (optimistically) agreed to take the interview at short notice, despite being 500km away, I sped across Japan in a Bullet Train (shinkansen), sprinting across Kasumigaseki to the House of Councilors in 30-degree heat. Slipping a jacket and tie over my sweat-soaked shirt, I entered the air-conditioned building with ten minutes to spare, only to find myself facing airport-style security. Guards. Metal detectors. And a line, inching forwards. I arrived at my interviewee’s office three minutes late[1]. As I received a lecture on my punctuality, bowed deep to 90 degrees, I reflected on how ill-suited traditional anthropological techniques seemed in this environment. Traditional ethnographic methods assume that the researcher is a privileged subject, whose gaze will be welcomed or at least tolerated. Yet the ministry building is a fortress, designed to control access to information. Even the welcome guest, who is ushered through security, finds that the building is organised around the principle of defense in depth (Thomas, 1995). Her path is restricted by passwords and key-cards and she is rarely left unattended. Obtaining the right to be a ‘fly on the wall’ in such settings is not impossible but is exceptionally difficult (see: Rhodes, 2011). Noting that ethnography is not synonymous with observation, some researchers have side-stepped the issue of access to a place of work by socializing with their research informants outside of it (Gusterson, 1997). Yet I could not imagine that the Councilor would agree to ‘hang out’ after hours. Nonetheless, there are avenues forward. Rich ethnographic accounts of senior policymakers’ practices have been produced on the basis of repeat interviews (Kuus, 2013). Moreover, many research sites are not as closely guarded as ministries are – local government offices, international organisations, and laboratories involved in the management of the disaster present themselves as promising and plausible field sites.

Of course, the relative dearth of elite ethnographies may not just be a function of access but also a matter of taste. Ethnography is an inherently intimate process. To detail how others make sense of the world demands both empathy and extended contact. It is therefore understandable that in deciding who we would like to study, we often gravitate to those whom we like. Outside our professional lives, we might marvel at Louis Theroux’s ability to spend time with members of the Westboro Baptist Church or the Neo-Nazi White Aryan Resistance (WAR). But we do not envy the experience. By contrast, watching Michael Palin interact with peoples of the Sahara or Himalayas is a source of vicarious pleasure, even yearning. Given the choice of being a Theroux or Palin in our work, many of us choose to conduct our fieldwork in the company of those that we are not only fascinated by but also feel an affinity for – collectively ensuring that the bulk of anthropological work continues to reflect our underlying ‘taste for the marginal and the exotic’ (Gusterson, 1997: 114). In the domain of nuclear politics, this is to suggest that the concentration of ethnographic attention on citizen scientists, nuclear evacuees, and anti-nuclear groups may reflect the dominant political dispositions of our intellectual community: namely, a critical stance on nuclear power and the Japanese state’s project of reconstruction. In some cases, researchers foreground their political persuasions by adopting an explicitly activist stance. But it is commonly assumed that our choice of research subjects bears some relation to our politics, even in the absence of such declarations. In explaining that I was working on the ICRP Dialogues to a colleague at an academic conference, I found myself being interrupted. “Wait. You’re not pro-nuclear, are you?”[2] The notion that I might embed myself in the work of a policy organisation in order to study it, without necessarily endorsing its positions, seemed peculiar to them. To their mind, the place of a social scientist was at the margins, “punching up” at the centres of power, not immersing themselves in them. Only on hearing that I was also conducting participant observation of seminars held by the Takagi School of Citizen Science and the Metropolitan Coalition Against Nukes’ weekly demonstrations did my interlocutor soften[3]: “so, you are spending time with some decent (matomo) people.”

A final thought – if our political dispositions sometimes influence who we study, might they also influence how we study them? On the basis of the rich work on Fukushima Daiichi to date, one might tentatively say, “yes”. This is not to suggest that accounts of citizen science, evacuees, or anti-nuclear groups have been hagiographic. (Polleri (2019), in particular, has convincingly complicated a common notion that citizen science is necessarily emancipatory.) Nonetheless, these accounts are often asymmetrical. In many cases, concern about exposure to low dosages of radiation is naturalized. When a citizen comes to measure their exposure and express concern, no further explanation is needed. They have come to recognize ‘the truth’ of their situation. But what of those who read the same measurements as proof of their safety? Here, analysts mobilise a range of sociological factors. Citizens are co-opted or otherwise subjects of (malign) social forces – most commonly, neoliberalism. Such work implicitly treats the state’s narrative of radiation risk as false and anti-nuclear groups’ accounts as true. In so doing, many accounts eschew Bloor’s programmatic notion that true and false beliefs be subject to the same forms of explanation. Consequently, we have myriad descriptions of nuclear normalisation and forgetting, yet scant few sociologies of nuclear fear[4]. As we move forward into a new decade of scholarship on the Fukushima disaster, one hopes that we will ‘study up’ with the same care with which we will continue to ‘study down’ – producing accounts of elite practices and counter-expertise alike, with the Strong Program’s tenets of impartiality, symmetry, and reflexivity firmly in mind.

 

Literature

Gusterson, H. (1996.) Nuclear Rites: A Weapons Laboratory at the End of the Cold War. Berkley, CA: University of California Press.

– (1997.) Studying Up Revisted. PoLAR, 20(1): 114-119.

Kimura, A. (2016.) Radiation Brain Moms and Citizen Scientists: The Gender Politics of Food Contamination After Fukushima. Durham and London: Duke University Press

Kinsella, W.J. (2013.) Negotiating Nuclear Safety: Responses to the Fukushima Disaster by the US Nuclear Security Community. STS Forum on Fukushima, University of California-Berkley, 12 April 2013. Available at: https://www.academia.edu/4016589/Kinsella_W_J_2013_Negotiating_nuclear_safety_Responses_to_the_Fukushima_disaster_by_the_US_nuclear_community_STS_Forum_on_Fukushima_University_of_California_Berkeley?auto=download [Accessed 16 June 2021.]

Koppenberg, F. (2020.) Nuclear Restart Politics: How the ‘Nuclear Village’ Lost Policy Implementation Power. Social Science Japan Journal, 24(1): 115-135.

Polleri, M. (2019.) Conflictual Collaboration: Citizen science and the governance of radioactive contamination after the Fukushima nuclear disaster. American Ethnologist, 46(2): 214-226.

Nader, L. (1972.) Up the Anthropologist: Perspectives Gained from Studying Up. In: Hymes, D. (ed.). Reinventing Anthropology. Ann Arbor, MI: University of Michigan Press, 284–311.

Samuels, R.J. (2013.) 3.11: Disaster and Change in Japan. Ithaca, NY: Cornell University Press.

Steger, B. (2012.) ‘We Were All in This Together’ – Challenges to and Practices of Cleanliness in Tsunami Evacuation Shelters in Yamada, Iwate Prefecture, 2011. The Asia-Pacific Journal: Japan Focus, 10(38): 1–27.

Rhodes, R.A.W. (2011.) Everyday Life in British Government. Oxford: Oxford University Press.

Takahashi, M. (2020.) The Improvised Expert: Performing authority after Fukushima (2011-18). Ph.D. Thesis, Department of Geography, University of Cambridge, Cambridge.

Takahashi, M. (Forthcoming.) “Dialogue as Therapy: The role of the expert in the ICRP Dialogues,” Annals of the ICRP.

Thomas, R.J. (1995.) Interviewing Important People in Big Companies. In Herz, R. and Imber, J. eds. Studying Elites Using Qualitative Methods. London: Sage.

Weart, S.R. (2012.) The Rise of Nuclear Fear. Cambridge, MA: Harvard University Press.

 

 

 

[1] Eight really. One should always be early.

[2] The characterisation of actors as either ‘pro-’ or ‘anti-nuclear’ speaks to the Manichean nature of nuclear debates.

[3] My decision to study organisations on different ends of Japan’s nuclear policy debates in parallel owes a debt to Gusterson’s (1996) Nuclear Rites, which drew on ethnographic engagement with both nuclear weapons engineers and anti-nuclear protestors.

[4] The work of Spencer Weart (2012) is a notable exception, though this analysis is global and largely predates the Fukushima disaster.

 

De Madrid al Cielo (From Madrid to the Sky), Let us meet there in 2022

It was at the heart of a fierce debate not so many months ago. During the Easter week, with Europe locked down again in a variety of regimes of restrictions, the first pages of several European newspapers would talk of it as a scandal, as a surprise, as a monument to economic pressures or as a light in the darkness of Covid-19 repressed and depressed reality. We are obviously talking about Madrid, a city of contradictions, of dynamic intersections, and a laboratory of what our possible post-covid futures may hold for us. While the rest of Europe, including the Spanish regions bordering it, was locked down in a precautionary state to prevent the further spreading of the Pandemic, Madrid was open to its citizens and to tourists from all over Europe, with lively terraces, beers and wine, cinemas, theaters and museums. Pure anomaly in Europe, in those days you could hear French, Italian, English and German being spoken across its nineteenth century historical Centre. With the knowledge about outdoor infection rates we have today, it seems that it was not so risky to have people around, socializing around terraces. And yet, this was not at all clear, then. In a successful campaign of the right wing party, which won local elections in May 2021 by a landslide, Madrid was offered to the imaginary of Europe as the city of Liberty.

And yet, Madrid is intriguingly more than that. It is both the richest region in Spain and the one in which less resources are spent per capita in education and healthcare. It is such as successful neoliberal laboratory, that, during Filomena, the worst snowstorm for decades, Madrid citizens – deeply skeptical about the actual intervention of political authorities – bought shovels and went and cleaned the streets, the schools, and the sidewalks. Many took their SUVs and collected people in the street to take them to medical centers, hospitals and emergencies. Madrid today is the heart of a growing rightwing movement and the host of many of its resistances, of its alternatives and of inclusive cultural movements that think and act differently. It is a place where the internal contradictions of modernity, of the European project and of the future that is yet to be born, are dynamically at work. It is, we believe, a crucially symbolic place where the EASST Council has recently decided to hold its next, hopefully presential, bi-annual meeting.

This choice, which we welcome, is full of implications. It is a choice to start again from the South, not as a place to paternalistically involve or integrate, but as a place from where to think our future – the future of our STS community and the future of science, technology and politics – anew. It is a choice to meet each other again in a city that is traditionally very open and tolerant, which often welcomes foreigners as people of their own, without asking them too high a price for integration. It is a city where few people can actually claim to be born but where there is space and a “home” for many. It is a city that may cling on tradition and be restless at the same time; a city that never sleeps and changes continuously. Last but not least, it is a city where political power dwells but is constantly challenged.

In this issue, there is amongst others an interesting piece on Fukushima, which launches a more than ever necessary call for anthropology of the powerful, of the elites, of the winners. Reminding the STS scholars not only of the importance of studying the people at margins, the vulnerable, excluded, the voiceless but also the interactions, imaginaries, contradictions and initiatives of those who inhabit the rooms of power, wealth and decision-making. We find this call very poignant, not only for the growing need of gathering more knowledge about those who do not normally enjoy our solidarity, but also because only a closer and serious study of these will enable our critical work to be truly transformative. If we live in a world of constructed social reality, and we take part in it fully through our own research… if we truly contribute to construct the very world we engage with in our study, then an STS agenda on those who are constantly in the best position to shape our future is all the more necessary.

Critical studies on the ability of these elites – among which we can also count a number of epistemic communities – to shape not only the strategies of the future but also the very idea of what the future may look like are a top priority. More critical work on the kind of knowledge that is selected and legitimated in this powerful communities, on what kind of interactions and transactions are deemed acceptable and on what kind of imaginaries are generated and uphold to shape debates about the future (and what kind of future is conceivable and why) is of crucial importance to unlock and empower the potential of different framings, different knowledge or imaginaries and different collectivities for a new staircase to alternative futures. For whatever kind of future we would like to unlock and pursue, we need first to be able to think of it. A closer study of the social, economic and political dynamics that make the reframing of existing challenges and, thus, of new futures impossible is am urgent task for an STS community that claims to transform the world as it studies it.

 

Statement of the new President

A new chapter begins in my life as I assume the role of president elect of EASST, becoming the new president when Ulrike Felt steps down in a year. I want to thank Ulrike for suggesting that I run for office – and also for her tireless work on behalf of EASST. She is a very tough act to follow. And I am grateful to all of you who put your trust in me. While there was no other candidate :), you have still chosen to vote for me – rather than against. Let me formulate a few words of what you can expect from my presidency. 

Over the years STS has developed into a community of concerned academic citizens with a plethora of interesting tales to tell. Some of us have disciplinary homes within STS departments, educational programmes and groups. Many others are living our academic lives in diverse constellations, where we might feel like visitors and sometimes even intruders. EASST serves a crucial role as a home for us all and a place where we can talk together in our shared languages about issues that concern us. Such a disciplinary home away from home is important – now more than ever as changing career structures and evaluation practices might threaten to marginalize our scholarly activities. 

As a professor at the Technical University of Denmark (DTU), I myself experience contradictory influences. On the one hand, a professorship is a rather secure academic position with a lot of autonomy and I cherish this privileged position. On the other hand, DTU does not provide a disciplinary programme or department in STS. What I and my colleagues have to do is to translate our knowledge and make it associable with DTU’s core activities. I enjoy this process, but it also adds to the importance of having a scholarly home in STS elsewhere. In this regard, EASST is crucial. 

I believe STS knowledge and methodologies can make crucial contributions to all of the most fundamental societal crises that we currently face. To do this, we need to make our voice heard outside of our own journals, conferences and academic circles. STS was founded on interdisciplinary research and most of us are very familiar with disciplinary boundary-spanning. However, I believe we can do more to be heard outside of academia and to have greater impact in policy formulation, public discussion, social and industrial innovation and general public engagement with science and technology. We need to raise awareness of our field and its knowledge contribution. Mostly because we have important contributions to make to social and public solution making. But also because we want our field to flourish and grow. 

As president, I will continue the excellent work of the previous president and Council to 1) strengthen the public voices of STS in matters of concern, 2) create more opportunities and venues for us to support each other as a community (to learn, to engage and to have fun), and 3) to diversify further the membership of our society and facilitate inclusive networking. In particular, I would like to initiate a discussion of our meeting structure, as I believe that the time has come for us to consider having an annual meeting of EASST. Sure, it will be more work. However, I think we have all learned from this last year’s experience that we need to gather physically to enjoy good company and stimulating discussions. We also have to provide a place for junior scholars to be integrated into the wider academic community. Finally, in the face of the climate crisis we might appreciate using trains instead of intercontinental flights to achieve our scholarly and collegial fix. 

Another ambition of mine is to strengthen the collaboration with national and regional STS organisations in order to form a strong European network of STSers. Some countries in Europe have well-established associations and a strong trajectory of STS research. Other countries less so. Let us discuss how we can better support each other’s activities.  

EASST is a shared resource for all. I am eager to hear from members how you would like to see EASST develop and what kinds of support you need the most. After all, you are EASST. I look forward to working with all of you. 

EASST election results

Dear Members of EASST,

I am delighted to inform you of the results of the election for EASST Council.

President: Maja Horst
Council Members: Nina Klimburg-Witjes, Sarah de Rijcke, Filip Vostal, Michela Cozza, and Brice Laurent
Student Representative: Sarah Rose Bieszczad

We will have a meeting in late March/early April to ‘hand over’ to the incoming Council members (who will join Richard Tutton and Annalisa Pelizza who will stay on Council for another 2 years).

Please join me in congratulating the successful candidates and thanking the other candidates for standing for election. I know I will be leaving Council in good hands.

All the best,
Ulrike Felt
President of EASST

Webinar Report: “Back to Normal? Social Justice & DOHaD in the COVID Era”

Although the COVID-19 pandemic is far from over, many countries are resuming economic and social activities, with the goal of returning to some semblance of ‚normality‘. But how should this new normal look like? This was the topic of an interdisciplinary webinar entitled Back to Normal? Social Justice and the Developmental Origins of Health and Disease in the COVID Era, which took place on December 7, 2020. The webinar was hosted by the Munich Center for Technology in Society (MCTS) at the Technical University of Munich in collaboration with the International Society for Developmental Origins of Health and Disease as well as the University of Southampton. 

The webinar was the result of a longstanding collaboration between Mark Hanson and Chandni Jacob from the Institute for Developmental Sciences (IDS) at the University of Southampton and Ruth Müller and myself from the MCTS. The IDS is a leading center in the Developmental Origins of Health and Disease (DOHaD) field. This biomedical research field is based on the hypothesis that many chronic diseases have developmental origins (Gluckman, Buklijas, & Hanson, 2016). DOHaD traces how environmental influences like nutrition, stress or toxic exposure during susceptible periods (such as in utero or the first two years of life) can condition the developing organism in ways that make it more likely to develop disease decades later in adulthood. DOHaD has received interest from Science and Technology Studies (STS) scholars because it promises to open up a ‘biosocial perspective’ that considers how social factors shape biological processes and that allows bringing questions of social justice into biomedical thinking and practice (Müller et al., 2017). At the same time, some STS scholars have cautioned against reductionist tendencies in DOHaD that might lead to focusing predominantly on maternal factors and thus re-produce gendered stereotypes that contribute to ‘blaming the mother’ (e.g., Richardson et al., 2014).

In this context, the webinar was part of our ongoing interdisciplinary collaboration with DOHaD researchers on how STS perspectives can contribute to socially responsible DOHaD research and policy translations (Penkler et al., 2019). It brought together in equal parts researchers from DOHaD and STS to discuss what social justice questions arise in the present pandemic. One of our departing premises was that the current pandemic has dramatically highlighted how social inequalities are tied to unequal vulnerabilities, with disadvantaged groups bearing the biggest social, health and economic burden. While associations of adverse effects with so-called ‘pre-existing’ conditions like obesity and type 2 diabetes have been widely reported, it is important to highlight how many of these conditions have their roots in underlying social inequalities. At the same time, the economic and social effects of the current crisis are set to exacerbate existing inequalities, with potentially long-term health consequences as women and children are groups that, while not being at high risks of adverse health outcomes from COVID-19, are particularly affected by the pandemic’s economic and social impact (Penkler et al., 2020).

After an introduction by Mark Hanson and Ruth Müller, Martha Kenney from the San Francisco State University delivered the first presentation on Social Justice and Recovery from COVID-19. In her presentation, she pointed out that a focus on so-called ‘pre-existing conditions’ like obesity runs danger of losing sight of underlying social inequalities and of locating risk and responsibility primarily at the level of the individual. This could reinforce a eugenic logic that separates healthy ‘us’ from unhealthy ‘others’ who are blamed for their own ill-health. Instead, it is important to highlight and address the structural factors that drive health disparities. DOHaD insights on how adverse conditions during early life can increase the risk for later life disease accord with social science insights how social inequalities and structures of inequality become embodied, shaping health outcomes across the life course and generations. Therefore, social justice is fundamental to promoting health in society, and resilience to health emergencies requires systematic rather than individual change. In this context, Kenney ended her talk with recommendations for strengthening the social justice impact of DOHaD research: Collaborating with STS scholars and other social scientists can help design studies that account for both biological and social complexity. DOHaD researchers should further identify concerns and research questions that are relevant to the communities being studied. Additionally, she recommends to focus DOHaD research on investigating structural causes of inequality instead on lifestyle and individual behaviors, and to conduct research on how to promote community resilience instead of focusing mainly on the negative outcomes of adverse early life conditions. 

Tessa Roseboom from the University of Amsterdam delivered a talk that was deftly named Using the ‘shit’ of the COVID-19 crisis as a fertilizer for the soilbase to build a sustainable society for future generations. Roseboom’s work has focused on the long-term health consequences of prenatal exposures during the Dutch Hunger Winter, which was a famine caused by a German embargo during World War II (Roseboom, de Rooij, & Painter, 2006). Her studies have provided evidence for how adverse conditions during early childhood can have severe long-term impacts on the risk for cardiovascular disease as well as on cognitive function in later life. According to Roseboom, this shows how fundamental early life is for later wellbeing and for the possibility of children reaching what she calls their ‘full potential’. In this context, providing adequate conditions for children to grow and develop is fundamentally children’s rights issue, as captured by the United Nation’s Declaration of the Right of the Child. This is especially pertinent in the current crises, where children and families are particularly affected by increases in domestic violence, a deteriorating economy, increased stress and food insecurities. Given the possible long-term effects, we need to invest in early human development now to lay the foundation for a more just and sustainable future for all.

In her talk, Sarah Richardson reported findings from Harvard University’s GenderSci Lab COVID Project, which show how social factors mediate and drive sex disparities in COVID-19 outcomes. For example, gender-related behavioral factors influence the uptake of preventive practices (e.g., men are less likely to wear masks). Structural aspects are important, too: Gender differences in occupation effectively lead to a gender-segregated structure of exposure, with men being more likely to work in fields that come with a higher risk of exposure. Together, these findings highlight how context matters for interpreting disparities in health and for explaining sex differences that were originally seen as primarily biological in origin (Shattuck-Heidorn, Reiches, & Richardson, 2020). Richardson argued that this provides an important lesson for DOHaD research. The C-19 pandemic will offer an opportunity to study the long-term effects of prenatal and early life exposures. This corresponds to a well-established research approach in DOHaD to work with so-called ‘natural experiments’. However, such study designs run the risk of reducing complexity, as events like the Dutch Hunger Winter or the current pandemic are incredibly complex. The idea that we can study these events at the level of the body is a move that potentially translates modest and uncertain findings into very bold biosocial theories that often locate causality and agency in the intrauterine period. Such an approach risks collapsing very different scales (from the social to the molecular), levels of biological and social analysis as well as different time scales and histories into very specific claims about biological processes like neurocognitive development. According to Richardson, these claims produce potentially very compelling narratives, but they need to be critically questioned. In investigating the long-term effects of the C-19 pandemic, DOHaD researchers should be aware that we are dealing with very complex social factors and that we are reasoning about risk under conditions of uncertainty and large gaps in the data. 

In the final presentation, Shane Norris from Wits University spoke on global health and justice perspectives raised by the current pandemic, with a specific focus on South Africa. South Africa had initially a very rapid and successful response to COVID-19 that ended in preventing many hospitalizations. However, this response had also very uneven effects on its population. In particular, it severely disrupted the informal economy on which many South African communities rely. The substantial economic fallout has disproportionally affected women, who work to a larger extent in the informal economy. This is one example of how multiple inequalities in a very unequal society intersect and reinforce each other, with strong intergenerational effects. According to Norris, we need to pay attention to these inequalities and narrow the gap if we want to achieve better health for everyone. Bringing a better understanding of the social determinants of health and disease to the DOHaD literature is absolutely critical in this context. 

In sum, the presentations and the following lively discussion revealed substantial shared “matters of care” (Puig de la Bellacasa, 2011) between DOHaD and STS scholars. Speakers and participants from both fields shared concerns with how to build a more equitable world that provides better health for everyone. There were also some points for debate: for example, some discussants pointed out the danger of deterministic narratives that describe certain population groups as biologically damaged due to adverse experiences in early life, arguing that this could have eugenic implications. But overall, the webinar provided a strong example for how biomedical researchers and social scientists can engage in mutual and symmetric discussions on how to promote the social justice impact of health research. The next step, from my perspective, will be to further explore how to turn these discussions into actual interdisciplinary collaborations that for example include STS scholars into the design and implementation of DOHaD research studies.

You can find a recording of the webinar here: https://youtu.be/6xgOlVYeufo 

 

 

References

Gluckman PD, Buklijas T and Hanson MA (2016) The Developmental Origins of Health and Disease (DOHaD) concept: past, present, and future. In Rosenfeld CS (ed) The epigenome and developmental origins of health and disease. Boston, MA: Academic Press, pp. 1-15.

Müller R, Hanson C, Hanson M, Penkler M, Samaras G, Chiapperino L, Dupré J, Kenney M, Kuzawa C, Latimer J, Lloyd S, Lunkes A, Macdonald M, Meloni M, Nerlich B, Panese F, Pickersgill M, Richardson SS, Rüegg J, Schmitz S, Stelmach A and Villa, P-I (2017) The biosocial genome? Interdisciplinary perspectives on environmental epigenetics, health and society. EMBO Reports 18(10): 1677–1682.

Penkler M, Hanson M, Biesma RG and Müller R (2019) DOHaD in science and society: emergent opportunities and novel responsibilities. Journal of Developmental Origins of Health and Disease 10(3): 268-273.

Penkler M, Müller R, Kenney M and Hanson M (2020) Back to normal? Building community resilience after COVID-19. The Lancet Diabetes & Endocrinology 8(8): 664-665. 

Puig de la Bellacasa M (2011) Matters of care in technoscience: assembling neglected things. Social Studies of Science 41(1): 85-106. 

Richardson SS, Daniels CR, Gillman MW, Golden J, Kukla R, Kuzawa C and Rich-Edwards J (2014) Don’t blame the mothers. Nature 512: 131-132. 

Roseboom T, de Rooij S and Painter R (2006) The Dutch famine and its long-term consequences for adult health. Early Human Development 82(8): 485-491.

Shattuck-Heidorn H, Reiches and Richardson SS (2020, June 24, 2020). What’s really behind the gender gap in Covid-19 deaths? New York Times. 

Lived Solidarity in the Austrian Healthcare System

1. Introduction. What is solidarity?

In their daily routine, healthcare workers engage with their patients in various ways, ranging from attentiveness and kindness to inattentiveness or even (un)conscious discrimination. In this article, we analyse healthcare workers’ enactment of solidaristic practices to support disadvantaged groups. On the basis of observational data from interactions of refugees with the healthcare system and qualitative interviews in Vienna, Austria, we suggest that healthcare workers play an important role closing structural gaps within a solidarity-based healthcare system. Drawing attention to these often unnoticed solidaristic practices means to acknowledge forms of what we call lived solidarity.

Solidarity as Practice

During the Covid-19 crisis, solidarity has been a widespread, and maybe overused, term. From global cooperation in vaccine development to neighbours running errands for each other, a wide range of practices have been celebrated as solidarity. The longer the crisis lasts, however, the clearer it becomes that people are not only moving closer together, but that the fault lines between people are becoming more pronounced as well (see Prainsack, 2020). Also for this reason, it is important to define what we mean by solidarity before delving into our empirical analysis. 

Building on the solidarity literature, particularly in the English-speaking world, we see solidarity primarily as practice: and specifically, as practice that expresses the willingness of people to support others with whom they see themselves as having something in common in a relevant respect (Prainsack & Buyx, 2011: 2017). In each case, the specific practice provides the reference point for what is and can be recognised as relevant commonality: For example, if someone sees a call to donate blood, or even a kidney, that person’s willingness to respond to that call will often be influenced by whether they have a personal connection to the issue at hand. If the person has a family member or friend whose life was saved by a blood, or organ donation, then they will often be more willing to respond to the call than if they have no connection to the topic at all.

Moreover, we always practice solidarity in specific situations and contexts. As women, we are not automatically in solidarity with all other women. When we support a woman who has become the target of sexist harassment or discrimination, for example, we may do so because we ourselves have experienced such harassment, or because our friends or family members have. (And one does not have to be a woman to be solidaristic with women who become the target of such discrimination). But we might not be solidaristic with this same woman if she asks us for support in a political campaign that does not correspond to our views. The concrete context of action indicates, in each individual instance, what commonalities or differences give rise to solidaristic action: No one is solidaristic with others in an abstract sense. 

When we observe discrimination and are bothered by it to the extent that we take action against it, we exercise solidarity with those suffering discrimination in a specific instance or context, despite all the other differences that exist between us: the people we support may have different political goals, religious or spiritual beliefs or lifestyles. Solidarity, thus, does not mean ignoring differences and pretending that they do not exist: rather, it means that despite the differences that exist between people, letting the similarities and commonalities become the source of our actions – especially when these similarities or commonalities are not “obvious”.

As Prainsack and Buyx have emphasised in their work (e.g. Prainsack & Buyx, 2017), that the “recognition” of similarities or commonalities in a relevant respect, which is the basis for solidaristic action to emerge, is not, however, a mere determination of “objectively” existing commonalities, which may be essentialist or even nativist. To a large extent, the differences and similarities that we see ourselves as having with others are things we have learned to see. A person who grew up in a family and society that placed emphasis on every person being equal, irrespective of their skin colour, gender, and beliefs, will find it easier to see commonalities amidst all other differences than a person who grew up learning to think of everyone who did not have the same religion, ethnicity, or political views as “different”.  Public and political discourses that play out in different groups of the population against each other can have a big impact on the thinking and perceptions of people in this respect. 

We have already given a few examples of the forms that solidaristic practice can take at the interpersonal level: A person recognises a part of herself in another person (or persons) and does something to support that other person(s), even if it incurs “costs” for her (this cost need not be financial, but it can also be time, comfort, or physical well-being – as is the case with the example of blood or organ donation). Building upon Prainsack and Buyx’ work (2011, 2017), we refer to this interpersonal, person-to-person solidarity, which is primarily about the concrete practices of individuals, as ‘tier 1’ solidarity. But of course, solidarity can also take other forms; for example, when it becomes so “normal” within a collective – a group, a community, an association – that it becomes a shared, expected practice (‘tier 2’). When solidaristic practice expresses itself in administrative, bureaucratic, or other norms, then we speak of ‘tier 3’ solidarity. A progressive tax system is an example for this latter, “hardest” form of solidarity, or a solidarity-based healthcare system into which people pay not in proportion to the costs they will incur according to actuarial calculations, but according to their financial means. And from which each person receives not only the services they can or could pay for, but those they need.

These different levels of solidarity are not only helpful in distinguishing “softer” (fragile, frequently changing) from “harder” (more stable, legally enshrined) forms of solidarity, depending on how quickly and easily they can change. The distinction between the three levels also offers the possibility of a more precise analysis of different forms and institutions of solidarity, rather than simply saying that solidarity is increasing or decreasing in a society. For example, during the Covid-19 crisis, some countries had large fluctuations in the intensity and prevalence of person-to-person (tier 1) solidarity, but continuously increasing support for solidaristic institutions such as publicly funded public health programs and institutions, well-equipped and publicly funded or solidarity-based healthcare systems, and even social housing (tier 3) (e.g. Lievevrouw & Van Hoyweghen, 2021).

In the following, we will derive implications for solidarity from an empirical inquiry into the daily work of healthcare professionals in Austria. One of the authors of this article, Wanda, accompanied medical treatments in Vienna as part of her ethnographic research and interviewed healthcare workers such as doctors, pharmacists and opticians. It is through their everyday practices that we can better understand what interpersonal and collective (tier 1 & 2) solidarity mean in practice and how they are connected to institutional solidarity (tier 3), namely as enactment and as corrective.

 

2. Lived Solidarity in the Austrian Healthcare System

Austria’s healthcare system is based on solidarity in the sense that people pay into the system according to their financial means and receive benefits according to their medical needs – regardless of how much they have paid in. Insurance contributions are based on income and deducted from people’s monthly salaries. In addition, a tax-financed support system covers the contributions for people who cannot pay anything, such as those affected from involuntary unemployment, or asylum seekers (LSE, 2017). While the solidarity-based health system is an illustrative example of institutional solidarity (tier 3), solidarity at the other two levels, namely person-to-person solidarity (level 1) and solidarity within groups such as doctors (level 2), offers a more nuanced picture. Healthcare providers have a significant influence on whether the health needs of their patients are met. Unsurprisingly, migrant patients, in particular, often have a harder time getting medically necessary services, partly due to language and cultural barriers. Some healthcare workers compensate for these structural deficits in their everyday work by going beyond the intended level of service and care or even breaking rules in order to do what seems right and just to them.

Examples of lived solidarity

Wanda accompanied a Syrian woman and her child to an Arabic-speaking specialist. During the consultation, the doctor established trust through a mixture of wit and authority. Almost paternalistically, he inquired not only about his patients’ immediate medical concerns but also about other areas of her life such as the language course that the mother was taking, or the child’s school performance. He even made the mother promise to improve her German and the child to learn well. At the end of the consultation, the doctor turned to Wanda. The Syrian woman mentioned that Wanda is from Nuremberg. The doctor was visibly pleased and explained that he had studied in Germany and then had moved to Vienna. He hesitated briefly and then added with a laugh: “as a refugee”. It was not clear whether he saw himself as a refugee from the country of his birth or as a refugee from Germany to Vienna. He then left the treatment room. 

In this instance, the doctor implemented – in the sense of making concrete – the spirit of solidarity that is built into the institutional fabric of the Austrian healthcare system. Knowing that his patients have a migration history, and considering himself a migrant as well, he opened the door to wider conversations than medical needs in the narrow sense of the word. He thereby invited his patients to bring into the treatment room – quite literally – wider issues that bothered them, supporting a holistic approach to his patients’ health (probably knowing that the life situation of refugees often is entangled with multiple difficulties). 

While healthcare professionals such as this doctor act as the mouths, ears and arms of the healthcare system, solidarity also requires the active closing of structural gaps. An example of how this happens in practice is the following description of a Farsi-speaking general practitioner who takes on gynaecological examinations because there are too few gynaecologists with appropriate language skills in Vienna:

“There are medicines that, for example, only a gynaecologist is allowed to prescribe, yes? I always approve it and add: because of language difficulties; or that [getting an] appointment with the gynaecologist, if she has fungus, would take three months.” 

(General practitioner) 

The doctor went on to explain that many patients with limited financial means went to see private gynecologists with the respective language skills, despite having to pay out of pocket as their services is not covered by their insurance. On the interpersonal level, this doctor engaged with her patients in a caring way (tier 1). Despite the fact that it costs her time and effort, she took the circumstances of her patients into account and went “the extra mile” to meet their needs. But there is also a group identity element to her practice (tier 2): As a physician, and as a representative of a healthcare system that should pay equal attention to the needs of all, she feels responsible to compensate for the shortcomings of the system.

In addition to the solidaristic practices just described, some healthcare workers try to establish new rules, practices, and norms that improve the situation of the disadvantaged and marginalised. For example, members of the Austrian Medical Association are currently campaigning for more doctors with non-German language skills and increased cultural sensitivity to work within the public healthcare system and improve the care of migrant patients.

It quickly becomes clear that solidaristic practices often take place simultaneously at the interpersonal level and at the level of a collective (tiers 1 & 2). The doctors in our study enact solidarity person-to-person and at the group level, as part of the medical community. The following quote clearly illustrates this simultaneity: With a trembling voice, a doctor told Wanda of a child who died of pneumonia because she and her mother were sent home from the emergency room with painkillers for the child. When the child deteriorated and returned to the emergency room, they had to wait for hours to be seen. Shortly thereafter, the child died in the intensive care unit. “That’s when we felt,” he recounted, “…I felt so guilty with this case at the time because I’m just part of the system. […] That must not happen, something like that must not happen with us, yes?” (medical specialist in Vienna)

The doctor held back tears. He was visibly moved. According to this doctor’s assessment, the tragic consequence had occurred because the medical staff in the emergency room had not interpreted the needs of the patient and her mother correctly. The mother of the child wore a headscarf and spoke broken German. Like many migrants, she was insecure and introverted due to previous discriminatory experiences. The doctor, although having played no part in the tragedy that this family suffered, felt responsible nevertheless: He sees himself as part of this failing system and wants to improve it. He told Wanda of the tragic death of the child as one of the decisive moments for his commitment. Together with colleagues, he now seeks to change the system so that it becomes more receptive and responsive to the needs of disadvantaged groups. For example, he and the other members of his network often refer their patients to specific doctors from whom they expect culturally and religiously sensitive treatment. They also organise information events on these issue through the Austrian Medical Association, which he says are well received by Austrian doctors (tier 2).

Summing up the described instances of lived solidarity, we see three different types of solidaristic practice in our data (Figure 1): In the first (concretising solidarity), healthcare workers act as the mouth, ear, and arm of a solidarity-based healthcare system. They shape solidaristic institutions through their everyday practice. In the second form of solidaristic practice (compensating solidarity), they fill gaps left open by institutionalised solidarity in the healthcare system. Through these practices, solidarity becomes an inherent corrective to the system. A third form of lived solidarity (creating solidarity) goes one step further by trying to create new rules that change the existing norms and instruments (e.g. new laws, but also new criteria for the allocation of resources, etc.).

What does the healthcare worker do? Example
Practice 1:

Concretising Solidarity

Healthcare worker concretises institutional solidarity Medical specialist inquires not only about medical condition but also about other areas of life, e.g. language course for refugees
Practice 2: 

Compensating Solidarity

Healthcare worker compensates the lack of institutional solidarity General practitioner takes on gynaecological examinations due to the scarcity of Farsi-speaking gynaecologists and – against the guidelines of the medical association – issues free certificates for cash-poor parents 
Practice 3:

Creating Solidarity

Healthcare worker tries to create new rules and practices Advocacy for more multilingual doctors within the public healthcare system 

Lived solidarity – in the forms of concretising, compensating and creating solidarity – can contribute to better care, especially for disadvantaged groups. These lived instances of solidarity help to expand upon person-to-person (tier 1) and group based (tier 2) solidarity (Figure 2). They sharpen our understanding of solidaristic practices within the healthcare system and beyond.

Figure 2: Interplay between forms of the three tiers of solidarity and lived solidarity of healthcare workers (adapted from Prainsack & Buyx, 2015: 655)

Why do healthcare workers act in solidarity?

Most of the healthcare workers this article focused on are immigrants. That is the case because Wanda’s fieldwork, in accompanying refugees in Vienna to medical appointments, often confronted her with doctors whose native language matched the language of the patients. Seeing this and the solidaristic practices she witnessed during such appointments, Wanda oversampled this group of healthcare workers in her interviews – and we can make no claims about the statistical representativeness (or not) of such practices regarding the wider group of healthcare workers in Vienna, or in Austria. What insights from Wanda’s fieldwork show, however, are the forms that solidaristic practice plays within the healthcare system, and what gaps it fills. It was remarkable to see also that the commonality of being an immigrant was not the only – or not even the most important – commonality that shaped concrete solidarity practice. Instead, it was other things that they had in common with their patients – that one was also a mother or father, for example – that guided the actions of healthcare workers. This is apparent also in the following example: written confirmations of certain medical assessments are subject to a fee. These include medical reports for legal proceedings, but also confirmations for schools or employers about the necessity of sick leave. Some schools have made such written confirmations compulsory – which poses difficulties for poor parents. A general practitioner told Wanda that she considered this practice “unfair”:

“I am a mother myself – and when I call [the school] and say ‘my child is sick’, it means my child is sick. Up to three days, the parents can do it themselves [without needing written confirmation from the doctor]. No parents would call if their child was not sick. I mean, what’s the point, yeah? Sometimes it’s really annoying, yes, because it’s unfair, I think.” 

(General practitioner who came to Austria as a child from a Farsi-speaking country)

The injustice that this doctor was addressing was the different treatment of parents whose societal standing is apparently high enough to be believed when they say their child is sick, while other parents need written confirmation to be believed. In addition to being a mother, the doctor based her actions on her sense of justice. Because she felt that the unequal treatment was unfair, she acted in solidarity with the children and their parents: she told Wanda that she regularly calls the school to challenge that a written confirmation (that parents would need to pay for) is required for this particular child. She does not shy away from the emotional effort and time that it takes to deal with the problem. If it cannot be avoided, she even issues appropriate written confirmations free of charge, contrary to the medical association’s stipulation that she has to ask a for a fee. It is important to her to ensure adequate care and to do her job well. Some social groups – due to language barriers, certain previous experiences such as traumatic experiences, cultural differences, low assertiveness, or financial limitations – need more attention to have their health needs met. The solidaristic practices of healthcare workers establish justice in the sense of adequate medical care for all insured persons. Finally, the sense of responsibility of individuals plays a role in motivating people in the health sector. Many of the healthcare professionals that Wanda interviewed take responsibility in order to resolve what they perceive to be unjust or simply wrong. 

 

3. What to do?

We have shown that healthcare workers are important actors of solidarity in the healthcare system. We have distinguished three forms of solidarity, namely concretising, compensating and creating solidarity. The lived solidarity of people in healthcare professions is essential to ensure that the promise of justice for people with upright insurance coverage – to receive the same good medical treatment – is kept for all patients. It is clear that many of these solidaristic practices compensate for institutional failures. Some people, e.g. disadvantaged groups, are not visible in the imagination of those who have created the healthcare system. A look at solidarity in practice draws our attention to these invisibilities. However, the forms of solidarity in practice that we have discussed (Figure 2, Practice 1-3) also make clear that healthcare workers take on high emotional, time-wise, and other costs for their actions.

Despite the important role that the practices of healthcare workers play within solidarity-based health systems, the experiential knowledge of these people has practically no impact on research and policy-making. This needs to change: On the one hand, we need to ensure that lived solidarity in the health system can continue to fill the gaps that a formal institutionalised framework necessarily leaves open. It contributes to better and more equitable health outcomes, especially for disadvantaged populations, but also takes pressure off healthcare workers. Moreover, the solidaristic practices of healthcare workers can show us what other gaps in solidarity exist in the healthcare system that need to be filled and closed by a change of practice and policy.

As a first step, there must be a stronger focus on the solidarity work of the health professions in (basic and applied) research. A systematic recording and evaluation of the experiential knowledge of various health professions will provide information on where there are institutional and structural problems, or where disadvantages occur. In this way, we can determine what actions of healthcare workers should be promoted. This also makes it possible to find out where more or different resources are needed – be it through adjustments to the reimbursable services of the health insurance companies, monetary remuneration or the making available of services such as health navigators. Increased attention to lived solidarity enables us to actively decide what forms of solidarity should be institutionalised (creating practices) or more strongly valued by the system (concretising and compensating practices). The Covid-19 crisis has resulted in a re-valuation of solidaristic institutions, including healthcare systems. Now is a particularly good time to anchor solidarity more firmly as the basis of the healthcare system. To this end, it is important to recognise the lived solidarity in the work of the health professions.

This is a shortened version of Spahl, W., and Prainsack, B. forthcoming. Konkretisieren, erweitern, gestalten: Gelebte Solidarität im österreichischen Gesundheitssystem. In: Hofmann, C. M. and Spiecker gen. Döhmann, I. (Eds.), Solidarität im Gesundheitswesen – Strukturprinzip, Handlungsmaxime, Motor für Zusammenhalt?, Peter Lang Verlag.

 

References

Lievevrouw E and Van Hoyweghen I (2021) Respect for public healthcare system gives ‘brave Belgians’ the courage to maintain solidarity. https://bit.ly/3sai9Na

LSE Consulting (2017) Efficiency Review of Austria’s Social Insurance and Healthcare System. London. https://broschuerenservice.sozialministerium.at/Home/Download?publicationId=424

Prainsack B (2020) Solidarity in Times of Pandemics. Democratic Theory 7(2): pp.124-133.

Prainsack B and Buyx A (2015) Ethics of healthcare policy and the concept of solidarity. In: Kuhlmann E, Blank R H, Bourgeault L and Wendt C (eds). The Palgrave International Handbook of Healthcare Policy and Governance. New York: Palgrave. 649-664. 

Prainsack B and Buyx A (2017) Solidarity in Biomedicine and Beyond. Cambridge, UK: Cambridge University Press. 

Prainsack B and Buyx A (2011) Solidarity: Reflections on an emerging concept in bioethics. London: Nuffield Council on Bioethics.