Towards "Groundtextual" Public Health: The Need for a Critical and Transformative Approach.

Abstract

Public health theory, practice, and education that do not relate to the context become irrelevant. “Groundtextual” is a neologism of grounded and contextual public health which has both universalistic and particularistic elements in its package and should be capable of responding to local challenges. The purpose of this paper is to reflect on the current state of public health as it is a popular course in many universities and institutes. In any context, public health with a universalistic framework, strategy, or theory and methods needs to face the challenge of the diversities across regions and states. Experience in research with such diversities also prompts this paper as data from such different contexts make it a challenging task to develop uniform strategies. It is also extremely challenging because, in many instances, lack of data reduces public health to a “silent science.” Public health is now reduced to a data science. Especially, the prominence given to statistics, quantitative applications, and some broad theoretical notions means that scholars are unable to respond given the absence of reliable data on many infections except some easy-toimplement microanalyses. However, such prominence of quantification gives it an appearance of a universal science. There exists an assumption among public health scholars, termed as a “laminar view,” which assumes that if one adopts a mechanical methodological approach similar to some of the normal sciences, it is possible to capture the phenomena consisting of issues related to health and health services in an uninterrupted flow. However, this is a myth as there are many conflicting spheres in public health especially when many social, cultural, and political contexts influence the phenomena. Most of the decision-making within the health services system is taken within the political sphere and is largely eminence-based because of the priorities and imperatives of the sphere itself. Such conflicts between the spheres and levels may not be revealed or may be captured only superficially in so-called mythicized and pedantic surveys and statistical research. The social sphere is also difficult to capture unless the researchers have unusually creative as well as responsive abilities. It is unrealistic to assume that any single study should or can investigate the entire gamut of the process and dynamics of the public health phenomena especially because of its complexity. The need for an iterative process which moves from simple level exploratory approaches to more complex and abstract constructions is to be recognized. But this is the missing link that gets lost in the present race for outputs which can be categorized as market-decided research, the so-called flourishing “knowledge market.” This commentary is intended to reflect on these challenges and to create reflexive responses by the scholars in public health. This is especially important given the observation regarding the “silence of majority” of public health scholars to effectively intervene in or being cavalier of issues, both conceptually and practically in responding Edited by: Kasia Czabanowska, Maastricht University, Netherlands