Post-normal science,

local lay knowledge and

plural rationalities
theoretical foundations for integrating quantitative and qualitative
methodologies and community engagement
within health impact assessment

Presented by Salim Vohra

26th Annual International Association for Impact Assessment Conference, Stavanger, May 2006
Why these three understandings are
important for HIA

affected stakeholder groups

facts + values = decisions

science
contd…

• Clarifies the ambiguity about whether HIA is a

science or not

• Provide a scientific framework for understanding

and fitting affected communities and individuals

• Demonstrates the importance and use of values

both within science and in good science based
decision-making
 HIA not quite science?
“ Is health impact assessment a science?
• It is important to emphasise that HIA is not strictly a science.
• Having said this, it most certainly draws on a scientific knowledge
base.
• Scientific evidence on health impacts of specific determinants forms
the backbone of this creative, interdisciplinary form of enquiry.
• But each HIA is uniquely located in time, space and local conditions
though its evidence base can be evaluated, and the rigour with
which procedures and methods were implemented can (and should)
be assessed.
• Uncertainties encountered during the undertaking of HIAs will
frequently dictate the need to make assumptions, which may result
in challenges to the HIA’s validity: such assumptions are acceptable
as long as they are stated explicitly, so that the reader is free to
agree or disagree. ”
Scott-Samuel, A., Birley, M., Ardern, K., (2001). The Merseyside Guidelines for Health Impact Assessment.
Second Edition, May 2001. 20 pages. ISBN 1 874038 56 2. Published by the International Health Impact
Assessment Consortium.
 Is there a role for communities?
“ So how can we combine participation and HIA?
• …..
• But perhaps a more radical solution would be to suggest that in the
context of HIA, limiting involvement to a small group of experts
might be the most appropriate and efficient means to generate
sufficient information to influence the policy-making process.
• Support for such an approach comes not from a rejection of the
validity of community involvement but because if HIA is to get
beyond the field of purely academic interest and gain credibility with
policy-makers, it must fit policy-makers’ requirements.
• …..
• HIA should explicitly acknowledge the tension between the time
required to deliver on the policy agenda and the time required to
build true participatory partnerships with communities. ”

Parry J, Wright J; Editorials - Community Participation in health impact assessments: intuitively appealing
but practically difficult; Bulletin of the World Health Organisation; Vol 81, No 6, 2003, pg 388.
 Hard values, soft science
“ Health impact assessment are most likely to inform decisions-
making if the decision-makers “own” the assessment and are
closely involved in all stages of the HIA, from scoping (defining all
the elements) to report.
• One might logically conclude from this that decision-makers should
make their own impact assessments.
• While this solution has much to recommend it, it is difficult to
reconcile with the principle of openness, and presents the risk that
matters outside the narrow policy agenda will be neglected.
• …..
• The need for policy-makers to have impartial advice may not fit with
the values of public health.
• …..
• Public health practitioners value health, equity and participation, and
it may be difficult to switch to an impartial assessment.”
Kemm J; Editorials - Perspectives on health impact assessment; Bulletin of the World Health Organisation;
Vol 81, No 6, 2003, pg 387.
 Pos t- no rm al scie nce

• When normal science cannot predict

consequences with any degree of certainty and
societal decisions need to be made

• Then using an extended peer community of

affected stakeholders to review and ‘quality
assure’ the facts and help develop a consensus
on the evidence and the way forward leads to
more accurate and robust science-based and
scientific decision-making
 Pos t- no rm al scie nce
ignorance
High
‘Post-Normal’ Epistemological uncertainty
(reduced by the use of 
Science societal and community consensus 
(uncertain facts, disputed
and community review)
values,
high stakes, decisions
urgent)
DECISI Methodological uncertainty
ON (reduced by the use of 
professional consensus 
Expert- and peer review)
STAKES
Professional
Judgement
(use of judgement and
good practice) Technical uncertainty
(reduced by 
Applied the use of statistics)
‘Normal’ Science
(traditional notions of science)

Low LEVEL OF UNCERTAINTY High

 Local la y knowl edg e
• Individuals and communities have localised experiential knowledge
about their social and natural environment; the key individual,
organisational and institutional actors that work within them; and
how these interact with each other.

• This knowledge, especially in situations where the science is

uncertain, can be incorporated into scientific assessment to
particularise, specify and apply the more universal and general
findings that science provides.

• It means that the experiential knowledge or knowledge not

constructed within an explicit scientific method should not be
dismissed as anecdotal but assessed and evaluated before being
accepted or rejected.
 What do you see?

Margolis, H, Dealing with Risk: why the public and experts disagree on environmental
issues, Chicago, 1996.
Rig ht Scientific A nswer: pe rh aps?
A series of black lines and markings
on a two dimensional white surface that
- when viewed with a binocular vision system
and an arts culture context where three
dimensional objects are represented in two
dimensions –
gives the appearance of a duck or rabbit’s head
and produces a gestalt effect of seeing first a
duck’s head and then a rabbit’s head
and vice versa.
 Plural rationalities
• Individuals, groups and institutions develop a set of values
and ways of seeing, understanding and interacting with the
world around them.

• These rationalities or worldviews are each legitimate and

valid ways of viewing and understanding the world. Most of
the time we tend to be unaware of them.

• This means that in societal decision-making processes,

especially those involving risk and uncertainty, dominant
groups and institutions frame and structure the process in
ways that fit their own values and understandings.

• This is/can be at the expense of the alternative values and

understandings of other affected stakeholders.
Impacts are like an elephant!

Spain, M. Kings Fund newsletter 1998. .

 Conclusion: value for HIA
• Science is a social process
• All knowledge is conditional
• Perceptions are part of reality

• They enable the development of an approach to HIA

that combines quantitative and qualitative
methodologies and community participation in a way
that is scientific, credible, relevant and effective
especially when there is disagreement and conflict
between different stakeholder groups.
Thanks for listening 