Forum on "Unrequited Engagement"
INTRODUCTION
By Yarimar Bonilla (Rutgers University) and Adia Benton (Northwestern University)
The forum below features responses to the article "Unrequited Engagement: Misadventures in Advocating for Medicaid Expansion." In the original article, Emily K. Brunson, Jessica M. Mulligan, Elise Andaya, Milena A. Melo, and Susan Sered describe their experiences in attempting (with little success) to publicize their ethnographic research in health-policy and clinical journals as a way of advocating for the expansion of Medicaid. They explore why their submissions were rejected and why anthropological approaches might at times be deemed unsuitable for public debate. The forum below features reactions to the essay by three prominent public scholars and a response from the original authors.
President Barack Obama delivers remarks at an Affordable Care Act event at Temple Emanu-El in Dallas, Texas, Nov. 6, 2013. (Official White House Photo by Pete Souza)
We present this forum as a first installment in what we hope will be a larger series of “public reviews” in which we share with our readers scholarly reactions to articles featured in the pages of American Anthropologist.
Making Engagement Central to Our Projects
By Sarah Bronwen Horton (University of Colorado Denver)
Brunson et al.’s article helps open an honest dialogue about the imperative of “engagement—about whether it is realistic and what sacrifices it requires. The authors raise philosophical questions about what is lost when anthropologists translate their work for different audiences as well as the nuts-and-bolts, pragmatic questions about how anthropologists might do so.
The authors raise the question of whether anthropological knowledge and frameworks can be translated into policy-related disciplines without significant reduction. Historically, cultural anthropology’s public value has derived from its ability to stand outside the mainstream and hold a mirror to dominant society, challenging individuals’ preconceptions so that they see an issue in a new light. What, then, is lost when a discipline that draws its strength from its resolute stance on the margins enters into discussions with more conventional disciplines, such as public health? Are we diluting the force of our disciplinary stance as “outsiders” by engaging with the mainstream, and does translating our research for public health journals necessarily require endorsing an epistemological stance that accords narrative a second-class status as data? These are vital questions for engaged anthropologists to consider, and the stakes (and answers) will vary according to each project. While a vital mode of self-reflection, this disciplinary hand-wringing can become an excuse for isolationism, if taken too far. Advocating for disciplinary purism by not translating our findings anachronistically recalls the model of the lone fieldworker whose authority lay in his supposed “objectivity.”
The authors’ essay suggests some of the limitations of “engagement” as traditionally conceived. We often think of engagement as secondary to our research objectives. Engaged anthropology is perceived as a researcher first gathering data and then—almost as an afterthought—considering how such data might be put to use. In many ways, this model of engagement bears the traces of positivism, implying that we don’t already come to our projects with a set of pre-existing values and commitments that will shape the use to which we put our findings. In a sense, this is a model of engagement as an “add-on,” as inessential to the core of the research project itself.
Engagement need not be secondary. Yet if anthropologists wish to make engagement central to our research projects, we need to address how we might reach beyond the discipline at the very startof any research project. For those who wish to reach policymakers and the general public, dissemination—and the nebulous and tricky process of creating relationships that make dissemination possible—must be as fundamental to our research design as our methods of data collection and analysis. This may be as simple as partnering with stakeholder organizations with whom our agendas align, and who can serve as a megaphone for our findings. It may be as complicated as forging a set of shifting relationships with diverse stakeholders who do not necessarily share the same interests. Following Latour, anthropologists take for granted the idea that facts are only as stable as the networks that have created them. Nevertheless, our discipline has traditionally abstained from the dirty work of creating the networks that would establish the knowledge we produce as “fact.”
Clearly, not all projects need to make engagement central—or even reach beyond the discipline—in order to yield important results. The model of the “public anthropologist” popularized by Margaret Mead is indeed that of engagement as “add-on”: that of a public thinker who decenters dominant ideas by serving as an intellectual gadfly to the narrow-minded and complacent. Similarly, the authors’ excellent volume on the Affordable Care Act, Unequal Coverage: The Experience of Health Care Reform in the United States, has been put to good use in many classrooms, helping students question the dominant assumptions that structure health care delivery today.
If we wish to be honest about our limitations—as this essay bravely suggests we do—we will acknowledge that most anthropologists lack the incentives and the resources to make engagement an intrinsic part of their research. Learning to speak effectively to policymakers and to present our data in a manner legible to other disciplines requires immersing ourselves in those circles—regularly attending their conferences and engaging in cross-disciplinary dialogue—on top of maintaining our own disciplinary commitments. For many anthropologists housed in traditional academic institutions, then, engagement may necessarily be limited to a secondary consideration—to giving testimony before public bodies, to writing letters, to producing blogs and podcasts.
On a practical level, there is an increasing number of resources to help anthropologists who wish to publicize their research results—even as a secondary objective. The Scholars Strategy Network is a national organization that helps connect academics, policymakers, journalists, and advocates; it assists its members with placing op-eds and producing podcasts, and even hosts workshops on how to engage with the media and with policymakers. Online venues such as The Conversation and Sapiens disseminate research in an accessible way, making significant inroads into the educated lay public. The AAA engages in advocacy efforts and pens position statements(though it could better foster engagement by resurrecting its bank of seasoned public scholars willing to mentor junior scholars in their dissemination efforts). While it is true that our tenure and promotion structures tend to reward this kind of work less highly than producing peer-reviewed publications, the AAA has also published a set of guidelines for tenure and promotion committees that wish to acknowledge the value of such work.
As civic activism is flourishing across the United States, it would be a loss to find anthropologists retreating from these fora. In the current era of public program precarity and mounting xenophobia, there is no dearth of issues on which anthropological perspectives are needed. Yet, as the authors suggest, if we wish to nourish this disciplinary turn toward engagement, we need to embark on an honest discussion of how central engagement is to our agendas, and of the institutional and structural limitations to how we might engage. The authors provide us with a model for how we might frankly reflect on our successes and our failures. Only by doing so can we learn how to best channel our efforts and make an impact.
The Politics of Engagement: Translation, Value, and Social Justice
By Thurka Sangaramoorthy (University of Maryland)
Set against the backdrop of continued uncertainty over the future of Affordable Care Act (ACA), this introspective piece by Brunson and colleagues highlights the benefits of Medicaid expansion to low-income adults. It also analyzes the negative repercussions of the Medicaid gap on people’s livelihoods, health, and well-being. Further, the authors reflect on the challenges facing anthropologists who engage with policy debates surrounding the ACA. Like others, the authors express frustration that their ethnographic research findings, however relevant, have been ignored by both policymakers and other researchers in the public policy and clinical fields.
Such frustrations over fraught science-policy connections, however, are not limited to anthropologists. They also extend to researchers with ostensibly positivist and quantitative methodological orientations. A few years ago, in the journal Nature, a group of British and Australian natural scientists compiled a list of twenty tips directed at improving policymakers’ ability to interpret and analyze science. Their points were well intentioned and constructive, addressing the various qualities and limitations of scientific evidence. They, like Brunson and colleagues, highlighted the continued challenges facing scientists in applying their research to policy domains.
Despite the epistemological and methodological differences in their orientations, I contend that anthropologists and natural scientists have several points of convergence in how they approach engagement with policy and policymaking. The challenges of translation and value presumably lie at the heart of both commentaries. The scientists lament in Nature that policymakers and their advisors “struggle to critically examine scientific evidence,” translating and valuing research unevenly in the policymaking process. Brunson and colleagues, likewise, argue that ethnographic methods and resulting data are often dismissed in public policy and clinical arenas for not being a “good fit.” That is, ethnographic accounts documenting the complexity of people’s lived experiences are deemed at odds with policymakers’ seemingly generalized and simplistic understanding of population health issues. For both sets of authors, culpability for the continued challenges between science and policy rests solely with policymakers and their advisors—even when very little, if any, of the discussion engages constructively with the people who actually make policy.
As such, both commentaries underlie a set of assumptions about policymaking as a straightforward process and policymakers as a uniform group lacking the interpretive skills of the natural and social sciences. Yet, policy decisions, and the processes through which they are made, are rarely simple or static. Health-related policies like the ACA involve a wide range of inputs, complex interactions with other policies, and uneven and unpredictable outcomes. While legal and economic considerations are often paramount to the policymaking process, politics and public opinion are also significant factors. Scientific evidence is one of many factors that impact policymaking. Further, policymakers, like researchers, are not a homogenous group. They possess expertise in a variety of research areas and their actions can be motivated by self-interest.
Issues of translation and value also extend to the ways in which knowledge about health and health care are produced and acted upon. A central premise underlying the tips developed by the authors of the Nature commentary is that quantitative data sets are to be treated as unmediated sources of knowledge. But this tendency is no less problematic when ethnographic data are also used as raw data (i.e., vignettes extracted from individual studies) absent of any theoretical scaffolding with which to structure findings. Intersubjective and phenomenological considerations are undeniably critical to understanding how Medicaid expansion (or lack thereof) works on the ground and the serious consequences that it has for ordinary people. Nonetheless, such considerations also serve a translational role—rendering local knowledge and experiences of health and well-being into categories that can be easily understood by policy researchers and clinicians and integrated into their epistemologies. In this case, the authors portray Medicaid as a critical resource necessary for ensuring stable employment with benefits, preventing disability, and averting unnecessary death. Such translations may have the unintended consequence of reinforcing prevailing views of Medicaid as a form of entitlement.
Given these challenges, what can natural and social scientists, including anthropologists, do to better engage with policymaking and policymakers? First, we must consider what critical “engagement” looks like: what, with whom, and why are we engaging? Patricia Hill Collins defines intellectual activism as “the myriad of ways that people place the power of their ideas in the service to social justice.” Her conceptualization of intellectual activism includes speaking truth to power (the academy) and speaking truth to the people (communities and coalitions beyond the academy). While addressing the dilemmas that intellectual activism invariably poses—namely, academic and career advancement—Collins sees these efforts as interdependent and equally important, rejecting the separation between scholarship and activism, and of the processes of thinking and doing.
Striving for intellectual activism as anthropologists requires we move beyond the romanticization of ethnographic practices and to carefully consider the politics of translation and questions of value within our own work. Doing so allows us to better align ourselves with those most negatively impacted by health care policies and partner with community and grassroots coalitions, local and national health initiatives, and interdisciplinary collaborations within and beyond the academy to ensure that our scholarship is recognizable and useful to individuals and communities already engaged in the struggle for rights and resources to address their needs.
More Than Words: Engaging the Public in Public Anthropology
By Mark Schuller (Northern Illinois University)
I read with great interest and sorrow this essay from five brave women, anthropologists, scholars, and “engaged citizens” (both in quotes, both needing more interrogation than I have space for). “Unrequited Engagement” is just the sort of honest, sober reality check necessary for attempting to be “public” anthropologists.
Their documentation of failure is instructive to future anthropologists attempting to influence policy change.
Their heartbreaking analyses of people like Sharon, John, and Carlos, and their vivid life histories, failed to pierce the bubble, and didn’t see the light of day in journals outside of the field, like the New England Journal of Medicine.
Stories like these—not only of the authors’ interlocutors, but of their attempts at advocacy—are all too common, yet few people have the time or courage to share their insights. The authors are all to be commended for offering this cautionary tale.
I wonder to what extent Brunson et. al’s “failure” is really their own. The American Legislative Exchange Council (ALEC), whom the authors cite, have made consistent, coordinated, focused, well-funded, self-interested, and well-connected attacks not only on ACA but on the notion of the public good and social responsibility. As the most significant expansion of the federal government’s support to citizens since the New Deal, the ACA was an easy, visible target for opposition: in government shutdowns, scores of legislation, Romney’s 2012 campaign, and in holding the Supreme Court hostage. In addition to ALEC’s and the Republican Party’s knee-jerk reaction against “socialism,” the vitriol may well be an aversion to Obama himself, the country’s first African American president.
Digging deeper, as the authors note, is a well of sentiment against “dependency” and a deep-seated loathing of the poor. So-called reality television and the most sensationalist, mean-spirited morning talk shows serve to foment this antipathy to the nation’s most vulnerable. The ACA was an easy target because it calls for sorely lacking empathy—precisely what anthropological research seems poised to offer, by sharing Sharon’s or Carlos’s story, humanizing the statistics.
Faced with all of this, how can any single advocacy effort be expected to not “fail”?
It might be time to rethink some of the core assumptions behind “public” anthropology. Low and Merry’s by now classic text outlines several modes of engagement, including social critique, collaboration, advocacy, and “activism.” Like the effort discussed in this article, much of the current push for public anthropology is a blend of social critique and advocacy.
If only our words were so powerful.
Missing from the “toolkit”—and in this article—is an analysis of power. In community organizingterms, Who is the “target” or decision maker? How specifically does power work, and in what arenas?
The ACA’s reception was not helped by the ways in which it was rolled out. In no small part, Obama’s community organizing experience helped him win a close race for the Democratic nomination and then the presidency. Working with groups like the now-defunct, deliberately targeted ACORN, which brought at least two million new voters to the polls, Obama’s street game was brilliant, energetic, and effective.
The New Deal, upon which ACA was grafted almost seventy years later, was not only a result of the mandate for change following the Great Depression. Alinsky shares a story of FDR’s meeting with Huey Long, labor stalwart, about social security. The president told Long, “Ok, you convinced me. Now go outside and pressure me.”
This core understanding, which helped Obama make history in 2008, seemed almost deliberately forgotten. Rather than empower the base to publicly push for Medicare expansion or “single payer,” Axelrod cut ties to activist groups, abandoning the various town halls, which became incubators for the Tea Party.
Understanding how social change, including major expansion of social welfare-state entitlements requires that anthropologists take a look at how similar our toolkit is to community organizing.This, in turn, requires us to ask, Who is—or should be—the “public” of public anthropology?
So what steps can anthropologists take for our engagement to be requited? While it’s not an easy answer, Brunson and her colleagues’ useful self-critique should highlight once and for all that our words alone are not enough. Yes, we need to reframe these discourses, and to blog the hell out of our work, but we must also engage people different from us, whose worldviews are shaped by decades of deliberate sabotage of the public good and hegemony of the media. Empathy matters.
And so does an assessment of both bottom-up and more formal policymaking.The 2018 elections offer another set of lessons and opportunities: an openly socialist Latina unseated a white male Democrat incumbent to an almost certain general election victory for House of Representatives, joined by two Muslim women. All have displayed an anthropological imagination, citing empathy and underscoring the importance of humanity in their political discourse, whose lives matter.
While our words are important, we also need to be, to borrow a line from Hamilton, in the room where it happens: going to community meetings and engaging our neighbors in discussing what is to be done, establishing relationships and building trust. In addition to walking the walk and valuing this engagement, particularly as anthropologists, we should be open to learning, challenging our own assumptions and “worldview,” and not always act as “experts.”
REFERENCES CITED
Alinsky, Saul David. 1971. Rules for Radicals; a Practical Primer for Realistic Radicals. First edition. New York: Random House.
Bobo, Kimberley A., Jackie Kendall, and Steve Max. 2010. Organizing for Social Change: Midwest Academy Manual for Activists. Second edition. Santa Ana, CA: Forum Press.
Low, Setha, and Sally Engle Merry. 2010. "Engaged Anthropology: Diversity and Dilemmas, An Introduction to Supplement 2." Current Anthropology51 (S2): S203–26.
Sen, Rinku. 2003. Stir It Up: Lessons in Community Organizing and Advocacy. San Francisco, CA: Jossey-Bass.
Response from Emily K. Brunson, Jessica M. Mulligan, Elise Andaya, Milena A. Melo, and Susan Sered
ADVOCACY IS NECESSARY
First and foremost, we would like to thank Sarah Horton, Thurka Sangaramoorthy, and Mark Schuller for their thoughtful and provocative comments. Public anthropology—in this particular case, political advocacy—is an important issue for each of us. The uninsured, marginally insured, and recently covered individuals we worked with called on us, sometimes explicitly, to tell their stories with the purpose of enacting change.
As individuals, we have done this through a variety of methods, including, but not limited to: writing blog posts and op-eds, speaking at community forums, working with local grassroots organizations, and protesting at state capitals. As a group, our work was also informed by a commitment to share our ethnographic findings with one another—other anthropologists who understood our methodological and theoretical orientations. While cathartic, we wanted this collective effort to have meaning outside our group. Our strategy to do this—and, particularly, to shift the conversation away from the antipoor rhetoric that usually dominates discussions of Medicaid—was narrow (as opposed to the broader conversation about public anthropology and advocacy reflected in these comments). Our goal was to take part in the policy conversation about health reform that takes place in the pages of the country’s leading policy journals. These journals perform a gatekeeping function; their recognition of authors and disciplines creates legitimacy that, in turn, influences policy discourse and agenda setting. The ACA itself, for example, was authored by health-policy experts who read these journals. Ultimately, we were unsuccessful in this process, hence our article in American Anthropologist focusing on the gatekeeping and epistemological issues we encountered.
At this point, we have mixed feelings about the experience. We are unhappy with the political landscape in general, especially the unwillingness we perceive from all angles of the political spectrum to consider others’ perspectives. We are angry at the editors of some of the journals we tried to work with who were seemingly dismissive of not only our methodology but also the message of our work. And we are frustrated with our own lack of success in making our voices heard. At the same time, it is good to be reminded that the broad political climate in the United States is difficult right now, and we are encouraged by the additional insights we have developed as we read the comments to our article and discussed them with one another.
ENGAGEMENT NEED NOT BE SECONDARY!
We agree with Schuller that it may be time to rethink some of the core assumptions behind applied anthropology. While this redefining is work that needs to be done on a larger scale (perhaps a set of panels and working groups at the AAA or SfAA meetings, or both), we believe that Horton identified a critical point: engagement does not need to be secondary in our work—that is, an afterthought or something that is tacked on at the end. This will require us, as anthropologists, to fundamentally change perspectives on our own work, including thinking of research and engagement as two sides of the same coin and planning specific strategies for dissemination and engagement while we plan our research. This will be a substantial shift for some of us, but, as Horton and the other commentators underscore, it is critical if advocacy and engagement are to form a core part of our work.
HOW TO CREATE A MORE ENGAGED, APPLIED, AND APPLICABLE ANTHROPOLOGY
Schuller’s point that we should “blog the hell out of our work” resonated with us in the following way: we need to be public with our work. This can include doing what we’ve been doing, like writing blog posts and op-eds, but we think it also includes finding new opportunities, like partnering with organizations like the Scholars Strategy Network suggested by Horton, that provide ways to publish in forums and in genres that are not already familiar to us, in an effort to work smarter instead of harder. And as we do these things, it is essential that we share this knowledge with our students and colleagues. Too many times we, as individuals, re-create the wheel. This should not happen. We need to be willing to have open conversations about what works and what doesn’t, including how we can remain both self-conscious and deliberately instrumental in how we translate our work for other audiences—from scholars in other disciplines to the public, and especially to those in positions of power. We need more models and roadmaps of how this can, and should, be done.
To do so, we, as a discipline, need a better understanding of how policy work happens. As Sangaramoorthy points out, policymaking is impacted by a variety of factors that intersect and act in opposition to one another at various points, including, but not limited to, legal and economic considerations, political motivations, and public opinions. Likewise, policymakers themselves are a nonhomogeneous group with different backgrounds, interests, and motivations. All of this speaks to Schuller’s point that we need to study power, so that, as Schuller started by quoting Hamilton, we can “be in the room where it happens.”
Some of the ways in which anthropologists can better influence policy are clear. As Horton suggested, we should not “abstain from the dirty work of creating the networks that would establish the knowledge we produce as fact.” As part of this network building, perhaps a solution to our conundrum of “no one (at least no one who really matters) will listen” is finding the policymakers/people in power/people with influence whose views align with ours so that we can work with them to spread our message. Another critical aspect of network building is identifying the sources policymakers use to gather information. As one of us (Sered) has experienced through her volunteer efforts on political campaigns, policymakers often receive information from their staff, including interns. If we can find ways to network with these individuals, we may find that our efforts at advocating are significantly enhanced.
Other aspects of how we can better understand policymaking and power are not as clear. Many anthropologists, including some of us, have long-standing experience working with grassroots organizations (i.e., from the bottom up). As a discipline more generally, however, we struggle to study power at its source (i.e., from the top down). There are real, and not insignificant, access issues to be overcome for this type of work to be possible, but it is clear that attempts need to be made, and made again and again. Relatedly, it may be necessary for us to reach outside of our own discipline for insight. This means not simply reading articles or books from scholars in other fields, or having conversations with colleagues in other academic departments, but having entire professional meetings (or at least a significant segment of professional meetings) where political scientists, communication experts, politicians, political aides, advocacy experts, and others are invited to share their insights and engage in dialogues with each other and with us as anthropologists. Likewise, for those in the academy, it might be necessary to require students to take classes in other disciplines in order for them to develop the skills we lack. Too often, anthropologists tend to want to find the solution within anthropology. While this is common in other disciplines as well, it is not necessary or a good idea. This preference for disciplinary insularity also results in the wheel being reinvented again and again. Unless we change this approach, we will be left with a mountain of wheels but no carts, wagons, or cars in which to move forward.
Of course, as Sangaramoorthy points out, anthropologists are not the only ones who struggle with making their work public, applicable, and meaningful in a policy sense. Just as we can find value from others, it is important to remember that we bring something of value as well. “Stories” that put a human face on issues, for example, may be important, and even desired, by politicians, advocates, and others who could use them to make their points. In this process, it is critical that we learn from the efforts of others, work to better understand how policy works, be open to collaborating with researchers using a different approach, and be willing to create and succor networks.
RESIDUAL ISSUES
In building connections with others, sharing our insights, and asking for our voices to be heard, one aspect that we may need to consider is our tendency, as a discipline, to lean to the political left. As Schuller pointed out, anthropological voices may be limited, or entirely cut off in some cases, due to their overt or seemingly leftist nature. In some cases this is unavoidable, but in others it may be yet another area of translation that we could improve upon. Medicaid expansion, for example, is generally cast as a concern of those on the left, but is there a way to translate our research in ways that would be acceptable and even meaningful to those on the right? In this context, we are painfully aware of the relative paucity of ethnographic research on perspectives held by conservative and right-leaning populations in the United States that might provide a resource in this effort. At the same time, we also believe that anthropology is not, nor does it need to be, value-neutral. In today’s political climate arguing that all people’s voices and experiences are important is inherently a political statement. In these cases, anthropologists must also be wary of how fieldwork findings (like stories of uninsured people who use illicit drugs to manage pain or who “borrow” a friend’s insurance card to get care) can be used against the people we are attempting to help.
Another obstacle to a truly public anthropology is the limitations inherent to academic appointments, and particularly the need to publish articles in peer-reviewed journals for tenure and promotion. Unlike Collins (and Sangaramoorthy, who quoted Collins in her commentary), we do not believe that the tension between scholarship and activism can simply be rejected. As Horton points out, we need to assess, and work to change, the institutional and structural limitations we face in attempting to engage policymakers, the public, and others. Possible solutions may including working with organizations like the Scholars Strategy Network, building collaborations with anthropologists and others working outside of academia so that research goals can include a combination of academic publications and other forms of outreach from the outset, or developing more awards from professional organizations like the AAA to recognize advocacy and other “public” efforts (although not the same as peer-reviewed publications, such professional recognition can be helpful as academics undergo review processes).
IN CONCLUSION
As we have gone through the process of sharing our work with one another, trying to publish a co-authored article in journals outside of anthropology, publishing a reflection piece in American Anthropologist, and reading and writing a response to the comments on this article, we have gained great insight into the advocacy process. At the same time, we recognize that there is much left to be learned. For this reason, we strongly believe that this is a conversation that needs to continue within the discipline. As anthropologists, we know that relationships matter. That insight is the foundation on which our disciplinary theories and research methods rest. As we move forward, both as individuals and as a discipline, it is essential that we consider the kinds of relationships (interpersonal but also, and perhaps particularly, institutional and organizational) we must develop and nurture if we want our holistic, contextual, and multivocal anthropological insights to resonate beyond our own disciplinary journals and conferences. This is not something we can do as individuals; we must learn from and work with each other, and those outside of our discipline, to make this possible.