Qualitative and quantitative approaches to health impact assessment: An analysis of the political and philosophical milieu of the multi-method approach

Abstract

Health Impact Assessment (HIA) is a relatively new, but increasingly important, contributor to both local and national decision-making processes. Adopting a multi-method approach, it incorporates qualitative and quantitative analyses to determine the various health impacts of policies and projects. HIA thus reflects recent developments in sociological theory, which have promoted qualitative techniques and challenged the dominance of quantitative methods. HIA embodies a particular renegotiation of the qualitative/quantitative opposition; each individual HIA represents an empirical instance of this renegotiation. As such, HIA can be conceptualized as a kind of 'political space', in which the opposition in question is structured by various social forces and plays out in concrete ways. Moreover, and notwithstanding the supposed methodological rapprochement, an analysis of a number of HIAs claims to expose a continuing, but perhaps unsurprising, privilege in favour of quantitative methods. In the first place, the paper contends that closer examination reveals this privileging to be unjustified, both empirically and theoretically, and alternative methodological and epistemological configurations are suggested accordingly. Specific gestures are made in this respect toward the work of Martin Heidegger and Jacques Derrida. In particular, the paper argues for a broad hermeneutic approach that both encompasses and situates the methodological tensions HIA stages. Second, attention is drawn to the fact that various and particular sociopolitical conditions maintain the characteristic architecture of the opposition. The political importance of HIA across a series of key issues is underscored in support of a more radical interpretation. For once situated within its wider cultural context, HIA ceases to resemble some straightforwardly neutral technology for health protection and delivery. If, instead, one reads it as an indicative micropolitical phenomenon, then one can begin to interrogate this simple policy tool in more complex ways. HIA both reveals, and is implicated in, a more fundamental and diffuse process that is presently resisting, undermining and regenerating traditional power distributions within the administration of health and beyond. The paper implicitly argues that HIA can only be properly understood within this context and, equally, allows one a certain analytical access to this context.

On Quantitizing

“…Yet glossed by the “familiar architecture” (Love et al, 2005, p. 277) of inquiry as qualitative or quantitative is that the already-quantitative data awaiting combination with the soon-to-be-quantitized qualitative data were themselves the products of quantitizing. A common example is when standardized questionnaire responses are assigned numerical values via the designation of verbal anchors, such as 0 = never , 1 = rarely , 2 = sometimes , 3 = most of the time , 4 = always.…”

“…That is, counting is an intervention that brings objects into being and, thereby, allows them to be talked about as discrete entities (Martin, 2004). Martin’s analysis shows why the “interpretive gesture” (Love et al, 2005, p. 283) is always present in quantitizing of any kind, that is, why quantitizing is never simply quantitative. Indeed, no clear line can be drawn between quantitizing and qualitizing as they entail each other.…”

“…In this article, we address these foundational aspects of quantitizing. We aim to show that such conversions “are by no means transparent, uncontentious, or apolitical” (Love, Pritchard, Maguire, McCarthy, & Paddock, 2005, p. 287), nor even confined to mixed methods research. Although we argue that quantitizing always entails qualitizing, we emphasize quantitizing in this article.…”

Transforming Verbal Counts in Reports of Qualitative Descriptive Studies Into Numbers

“…Yet these strategies show how much interpretive work goes into quantitative conversion, making less distinct the line between quantitizing and qualitizing (Voils et al, 2009). The “interpretive gesture” is always present in quantitizing of any kind (Love, Pritchard, Maguire, McCarthy, & Paddock, 2005, p. 283), which is why quantitizing is never simply quantitative.…”

“Casing” the research case study

“…The case study specifies an intensive focus on one or more cases, whereas qualitative research specifies a class of methodologies. (The “familiar architecture” [Love, Pritchard, Maguire, McCarthy, & Paddock, 2005, p. 277] of inquiry as “qualitative” and “quantitative” is highly contested as well, but discussion of that debate is beyond the scope of this article.) In addition to the diverse array of qualitative methods, case studies may encompass variants of quantitative observational and/or experimental methods (Gerring, 2007; Morgan & Morgan, 2009; Rihoux & Ragin, 2009).…”