DEBATE DEBATE

 

Debate on the paper by Celia Almeida & Ernesto Báscolo

 

Debate sobre el artículo de Celia Almeida & Ernesto Báscolo

 

 

Raquel Abrantes Pêgo

Centro Inter-americano de Estudios de Seguridad Social, México DF, México. rabrantes@ciess.org.mx

 

 

The authors' point of departure is their recognition of a relationship between experts and the state, a field of analysis in the political sciences with its own history, and a rereading of this relationship motivated by the processes of change in health systems, within a context that imposes a "single thinking" for achieving development. This rereading was not coincidental: it responds to the new guidelines for constructing legitimacy, in which the experts participate by indicating the most adequate knowledge for making reform possible and achieving given objectives. In other words, research had a very clear pragmatic purpose, an internal intention in the concept of its duty to contribute to the reform's dynamics, deal with the political interference disturbing the rational order, and neutralize the role of power groups in the health policy formulation process. In this context, the article highlights the importance of knowledge for decision-making, an issue that is no less important for understanding the rise of "rational-instrumental" criteria for policymaking in health.

The inventory by Almeida & Báscolo of political science output and the recent debate in the health field leads them to a critique of the instrumental view adopted by political science, which emphasizes objective action by decision-makers based on knowledge. They also reclaim the various contributions based on recognition of the diversity of theoretical perspectives or disciplinary approaches participating in the debate. Consequently, the authors discuss the specialized literature with a very real concern, questioning the capacity of the available analytical models to situate knowledge producers, the accumulated knowledge per se, and the relationship between knowledge and decision-making in social relations, all of which referred to the social structure, ideologies, and the concrete experiences of actors with differentiated powers in a given context.

With this approach, Almeida & Báscolo seek to situate knowledge and its producers in the institutional framework of public policies to reflect on the limits of professionals' instrumental legitimacy in relation to the play of interests generated around a decision. The literature reviewed by the authors allows recognizing that public policies have a technical and scientific dimension that requires a specific knowledge. This knowledge, as a power resource for decision-making, is not neutral or uniform in relation to the orientations that ascribe value and meaning in a given situation. Knowledge is not divorced from society. It becomes a particular mode of social action, and this implies the researchers' presence in their field of interest1.

In line with this perspective, Almeida & Báscolo link the "policy" dimension, i.e., policy content, to that of "politics", namely the struggle for distribution of resources. This allows us to recognize that shaping a technical and political sphere within the state to answer for explicit social policy expresses not only socioeconomic and cultural-ideological interests, but also a scientific worldview. In other words, the link between experts and decision-makers is not independent of the various ideologies that give meaning to social life or the way by which decisions are made, although any knowledge production should follow the same path dictated by the scientific method (instrumental legitimacy). This is because the power base for professionals derives both from market functioning (their capacity) and their links to the state.

Consequently, the experts provide knowledge to power by interpreting and ordering social problems, and hence provide the framework for action. The authors present the notion of power as a central element for explaining under what conditions the professions wield influence in social life and in the political sphere. In other words, "when" and "how" the specialists, defined as social subjects that construct social realities and products, participate in the decision-making process, as well their role in this process. That is, what determines their participation and which mechanisms professionals use to articulate as a power group.

In my view, the authors provide an important contribution by situating knowledge and its producers as part of the public policy-making process. The knowledge to be incorporated into decision-making cannot be generated outside of the problem; rather, it is part of the problem, and the researcher is a participatory observer.

 

 

1. Torgerson D. Entre el conocimiento y la política: tres caras del análisis de políticas. In: Aguilar-Villanueva LF, organizador. El estudio de las políticas públicas. México DF: Editorial Porrúa; 1992. p. 197-237.

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br