University of Edinburgh



The Social Sciences, Humanities, and HealthMartyn Pickersgill, Sarah Chan, Gill Haddow, Graeme Laurie, Devi Sridhar, Steve Sturdy, and Sarah Cunningham-BurleyExamples abound of the positive influence of the humanities and social sciences on health experiences, care, and expenditure. As one recent report demonstrates, social science research has led to many success stories.1 These include, inter alia, self-management for diabetes, provision of psychological therapy, handwashing, hospital checklists, the Scottish Government’s stroke guidelines, England’s Tobacco Control Strategy, the response to the Ebola outbreak in West Africa and Zika in Brazil, and many more. Researchers have demonstrated time and time again the political, practical, economic, and civic value of education and research across fields like anthropology, history, and philosophy. Still, there are some who enjoy playing political football with these disciplines (as they do at other times with medicine and healthcare). In February, Theresa May announced a review of UK higher education funding, with Education Secretary Damien Hinds implying that undergraduate degrees in the humanities and social sciences should have their fees cut. This has been widely reported as relating to the allegedly poorer value for money offered by those courses in terms of future employment prospects – claims which have been challenged and refuted on multiple occasions. Many robust defences of the value of the humanities and social sciences have been made – including from those working in biomedicine. This is hardly surprising: innumerable clinicians have benefited from interventions and policies developed by social scientists, and thousands of medics were trained in universities that have for decades included sociology and ethics as core aspects of clinical curricula. Specialities like public health, let alone global health, are unimaginable without the insights of both qualitative and quantitative social science. The influence of the humanities within medical schools has also been growing. Practitioners now commonly finish their degrees conversant not only with the ethical and legal aspects of their immediate practice, but also with the ability to think more broadly about the moral, social and political dimensions of health, disease, and healthcare. Long-held fears of a divorce between the science and art of medicine are being laid to rest as doctors and those who train them embrace a rounded vision of medicine as at once scientific and humanistic in its grasp of human problems.Funders such as the UK’s Medical Research Council and the Wellcome Trust, and the US National Institutes of Health, have actively developed the disciplines of sociology of health and illness, history of medicine, and bioethics. Wellcome argue in their Strategic Plan, for example, that research is necessary that will “bring new perspectives and ways of thinking to the historical, ethical and cultural contexts in which medical science takes place”.2 Work they have supported has shaped the effective governance of biobanks and data linkage,3 demonstrated how political concerns impact vaccine development,4 elucidated how the economic ideology of the World Bank contours the landscape of global health,5 and generated new insights about how diagnostic categories are introduced and influence scientific, clinical, and legal practice.6 Such humanities and social science research not only provides answers to questions those working in biomedicine and healthcare are already asking - it also helps to frame new questions that demand urgent attention and engagement that is critical, creative, and collaborative. Healthcare researchers and clinicians increasingly welcome these inquiries, the analyses they enjoin, and the findings they uncover; they now need to make this clear, in the face of narrow-minded and damaging attacks by government and other detractors. Today, we also need to think more about how to do social science and humanities research with biomedicine and its practitioners, not just for or on it.7 This involves different disciplines working alongside and with one another, co-defining problems and developing solutions together, from patient-level research to policies emanating from governments and international institutions. This is the vision for the University of Edinburgh’s new Wellcome Trust-supported Centre for Biomedicine, Self and Society. There are, to be sure, challenges.8 But the benefits of overcoming those are immense. In psychiatry, shifts in understanding about the nature and diagnosis of classic disorders like schizophrenia have huge implications for access to services, state welfare, and mental health law. In oncology, ever more fine-grained approaches to characterising disease are expanding the number of people who consider themselves to be at risk of cancer, and who consequently develop health anxiety or undergo pre-emptive surgery within sometimes straitened healthcare systems. These are not simply scientific or healthcare delivery problems: they are intrinsically entangled with cultural norms and values and with social expectations and constraints. Interventions from the social sciences and humanities that are carried out with biomedicine ‘in the making’ are thus ever more essential to improving health worldwide. The value of these disciplines should be abundantly clear, and biomedical funders, international organisations, and professional associations need to play a full part in asserting this. References1Campaign for Social Science. The Health of People: How the Social Sciences can Improve Population Health. London: Sage, 2017.2Wellcome Trust. Strategic Plan 2010-2020: Extraordinary Opportunities. London: Wellcome Trust, 2010. 3Sethie N, Laurie G. Delivering proportionate governance in the era of eHealth: making linkage and privacy work together. Medical Law International, 2013; 13: 168–204.4Huzair F, Sturdy S. Biotechnology and the transformation of vaccine innovation: the case of the hepatitis B vaccines 1968-2000. Studies in the History and Philosophy of Biological and Biomedical Sciences, 2017; 64: 11–21.5Sridhar D, Winters J, Strong E. World Bank’s financing, priorities, and lending structures for global health. BMJ, 2017; 358: j339.6Pickersgill M. Sociotechnical innovation in mental health: articulating complexity. In: Flear M L, Farrell A, Hervey T K, Murphy T, eds. European Law and New Health Technologies. Oxford: Oxford University Press, 2013: 323–342.7Broer T, Bal R, Pickersgill M. Problematisations of complexity: on the notion and production of diverse complexities in healthcare interventions and evaluations. Science as Culture, 2017; 26: 135–160. 8Callard F, Fitzgerald D. Rethinking Interdisciplinarity across the Social Sciences and Neurosciences. New York: Palgrave, 2015.AcknowledgementThis work was supported by the Wellcome Trust [Grant number: 209519/Z/17/Z]. The authors also acknowledge the following sources of support: Wellcome Trust [Grant numbers 100597/Z/12Z (SS); 103360MA (GL); 104831/Z/14/Z (SCB); 106612/Z/14/Z (MP); 106635/Z/14/Z (DS); 201652/Z/16/Z (SC)]; and the British Academy [EN160164] (MP). No authors were paid to write the article by pharmaceutical company or other agency. The corresponding author had full access to all relevant data and final responsibility for the decision to submit.Declaration of InterestsThere are no conflicts of interest.Author ContributionsAll authors contributed to developing ideas and analysis; MP was responsible for drafting the manuscript; SC, GH, GL, DS, SS, and SCB provided critical revisions. ................
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