'Undisciplinary' comments from evaluative research in health
Comentários "indisciplinares" da pesquisa avaliativa em saúde
Zulmira de Araújo Hartz
Université de Montréal, Département de Médicine Sociale e Préventive. email@example.com
First, I would like to acknowledge the authors and editors of the magazine for the invitation to participate in this reflection about our research practices, the colleagues and co-authors of another debate that took place 10 years ago at the Escola Nacional de Saúde Pública (ENSP/Fiocruz) The integration of epidemiology and anthropology1 whom I have the chance to share my preliminary (un)experiences in this learning process in which we are still involved today. At that time, I intended to call my speech Epidemiology and Anthropology in the evaluation of services: an 'undiscipline issue'. However, I chose for focusing on the 'rapidity issue', its advantages and challenges, given the conceptual and operational concerns related to the multiple evaluation demands from internationally funded health programs, echoing in the emergency of methodological approaches such as Rapid Epidemiologic Assessment (REA), Rapid Assessment Procedure (RAP), Rapid Ethnographic Assessment (REA), or Rapid Evaluation Methods (REM).
By reading the present paper, with a sound theoretical and empirical foundation, it seems to me that, in the lessons learned from this successful 'collaborative venture', the important issues of internal and external validity, that worried us before, when questioning the flexibilization of some disciplinary postulations of 'rigidity' in the primacy of rapidity and traditional forms of 'multidisciplinarity', have been overcome. It is also clear in the text that the field of health evaluation has been undeniably progressing in terms of the quality and timeliness of answers given by the studies imbued with the necessary 'interdisciplinarity', but, as appropriately remind the authors, there is understanding about the epistemological limitations of both disciplines, an excessive focus on the exchange of methods, and unbalanced power with a relative subordinate position of anthropology.
To modify those and other existing problems, the authors are convinced that "many questions regarding cross-disciplinary fertilization still need answering" in this dual field, but I think that we need to surpass the limits of Epidemiology and Anthropology, recognizing, like Morin2, that cross-disciplinary (transdisciplinarity) today means an "undisciplinary" approach. Without intending to explain all implications and requirements of Morin's work, trying to build a 'complex new science', the most important for me is to break the notion of cross-disciplinary always insisting in the identities defense, as if corresponding to heterogeneous materials, when, in fact, all of us must share the same traditions of empirical observations and interpretations of natural, human and social sciences in our investigations.
In the evaluative research of social policies and programs, public health included, I have already mentioned the necessity for us to accept this disciplinary plurality as a formation and practice shaft in all our investigations, giving up any methodological monism (or dualism) attempt3. Different methods (sociology, history, psychology, biology, linguistic, geography, nutrition, economics, etc.), as epidemiology and anthropology, are mobilized and mixed as hybrid tools (cross-sectional survey, case studies, discourse analysis, focus group discussions, participant observation, structured, semi-structured and unstructured interview, many of them including themselves quantitative and qualitative approach) to offer alternative ways of understanding how people and organizations make sense of social interventions in their contexts. The big challenge now, in my point of view, is try to answer the Green's question4: Is Mixed Methods Social Inquiry a Distinctive Methodology? In this sense, 'undisciplinarity' could be also being conceptualized as a distinct academic field across disciplines, and Green's work give us the first insights (or inspiration for a next debate?) about its four dimensions or domains: philosophical assumptions and stance; inquiry logics; guidelines for practice; and sociopolitical commitment.
Finally, I hope that these brief comments may be enlightening similar concerns of the authors when, in agreement with Van der Geest's position, they considered in their conclusions the disciplinary specialization at the core of inhibited cross-disciplinary research, appealing each one to realize "that disciplines are merely humanly-designed tools to study and interpret and explain reality".
1. Gadelha AMJ, Coimbra Jr CEA, Stotz EN, Castiel LD, Hartz ZMA,Czeresnia D. The integration of epidemiology and anthropology. Hist. cienc saude Manguinhos 1999; 6(3):689-706.
2. Morin E. Introduction à la pensée complexe. Paris: ESF; 2000
3. Hartz ZMA. Avaliação dos Programas de Saúde: perspectivas teórico-metodológicas e políticas institucionais. Cien Saude Colet 1999; 4(2):341 354.
4. Greene, J. Is Mixed Methods Social Inquiry a Distinctive Methodology? Journal of Mixed Methods Research 2008; 2(1):7-22.