Depth and breadth: a mixed-method investigation of disciplinary approaches to health inequalities and health disparities research
This PhD thesis is an in-depth investigation of the ways academic disciplines shape scientific practice in health equity research, a sub-specialisation of population health. Whilst covering many contexts and aspects of research practice, the thesis is centrally concerned with the way disciplinary training shapes knowledge construction, and the tension this produces in multi-disciplinary research domains. Specifically, the thesis aimed to: 1) identify the blend of formal disciplinary training present among health inequalities and health disparities researchers; 2) explore how disciplinary training appears to shape epistemological approaches to this area of research, manifest in the design and evaluation of research studies, and 3) assess the impact of these differences on interdisciplinary and collaborative research efforts. To address the first aim, a bibliometric analysis was undertaken using data from 29,212 publications. The resulting visualisation of the 250 most-connected health equity scholars illustrates the area’s general structure, and was used as a sampling frame for semi-structured interviews carried out with 45 researchers, representing 16 disciplines, located in eight countries. To address the second and third aims, interview data were analysed using a Kuhnian theoretical lens, anticipating that disciplinary difference operates via what Kuhn termed disciplinary paradigms, and can be understood to manifest as variability in what Kuhn termed the disciplinary matrix. Specificity and detail is added to this general Kuhnian framework via a broad set of theoretical and conceptual tools drawn from diverse literatures including the sociology of scientific knowledge, sociology of professions, higher education research, linguistics, and science and technology studies. Results suggest that disciplinary training powerfully and enduringly shapes the choices which feel ‘natural’ or ‘normal’ for scientists, with multiple kinds of ‘normal’ coexisting within the multidisciplinary domain of health equity research. Specifically, variation was apparent in the kind of knowledge researchers seek, formation of research questions, selection and employment of methods, evidentiary standards, conceptualisations of health, use of theory, approaches to complexity, and the broad purpose of scientific research. These features mapped predictably (though imperfectly) onto interviewees’ disciplinary training, and aligned quite neatly with the four epistemological styles previously described by Lamont in a study of multidisciplinary grant panels (2009). Disciplinary training interacts and intersects with other factors, including national and institutional research foci, funding opportunities, pathways to promotion and publication norms. These factors served to amplify (and, in some cases, were amplified by) epistemological styles. In particular, epidemiological norms and standards emerged as especially important in population health, for researchers working inside and outside epidemiology. While a strong desire to obtain ‘useful’ knowledge cut across disciplines, this was not a unifying epistemological feature as ideas about what is useful varied across disciplinary groups. Interdisciplinary collaboration was presented as important, and desirable, but as being complicated by the challenge of communicating with members of other disciplines. The integration of disciplinary perspectives appears to depend on researchers who speak multiple disciplinary ‘languages’, however this was not felt to be highly valued within (mono-disciplinary) evaluative contexts, such as peer review and academic promotion. Repeatedly, diversity in terminology and meaning appeared to be grounded within (and to reflect) diverse epistemological commitments and disciplinary paradigms. Collectively, findings demonstrate the presence of diverse ways of knowing within health equity research, and the role of disciplinary training in establishing and sustaining these varied epistemological styles. Differences between disciplines are not incidental, but reflect diversity in fundamental epistemological commitments and diverse strategies for selecting and accessing objects pre-supposed to be valuable, and relevant to health. Disciplines have been framed in some literatures as monolithic or obsolete, however, results of this PhD project support a rehabilitation of the Kuhnian view of disciplines: As well as being social entities, academic disciplines are cognitive enterprises which powerfully shape 21st century research about health in important, interconnected ways.