title: The productive techniques and constitutive effects of 'evidence-based policy' and 'consumer participation' discourses in health policy processes.
abstract: For over twenty years there have been calls for greater 'consumer' participation in health decision-making. While it is recognised by governments and other stakeholders that 'consumer' participation is desirable, barriers to meaningful involvement nonetheless remain. It has been suggested that the reifying of 'evidence-based policy' may be limiting opportunities for participation, through the way this discourse legitimates particular voices to the exclusion of others. Others have suggested that assumptions underpinning the very notion of the 'affected community' or 'consumers' as fixed and bounded 'policy publics' need to be problematised. In this paper, drawing on interviews (n = 41) with individuals closely involved in Australian drug policy discussions, we critically interrogate the productive techniques and constitutive effects of 'evidence-based policy' and 'consumer participation' discourses in the context of drug policy processes. To inform our analysis, we draw on and combine a number of critical perspectives including Foucault's concept of subjugated knowledges, the work of feminist theorists, as well as recent work regarding conceptualisations of emergent policy publics. First, we explore how the subject position of 'consumer' might be seen as enacted in the material-discursive practices of 'evidence-based policy' and 'consumer participation' in drug policy processes. Secondly, we consider the centralising power-effects of the dominant 'evidence-based policy' paradigm, and how resistance may be thought about in this context. We suggest that such interrogation has potential to recast the call for 'consumer' participation in health policy decision-making and drug policy processes.
authors.affiliation: Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Australia, Australia. Electronic address: k.lancaster@unsw.edu.au.
authors.forename: K
authors.initials: K
authors.lastname: Lancaster
authors.affiliation: Faculty of Law, Monash University, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Seear
authors.affiliation: Centre for Social Research in Health, UNSW Australia, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Treloar
authors.affiliation: Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Australia, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Ritter
mesh_terms: D001315:Australia; D003256:Community Participation / Q000379:methods* / Q000523:psychology; D003657:Decision Making; D055317:Evidence-Based Practice / Q000379:methods*; D006291:Health Policy; D006801:Humans; D036301:Qualitative Research
keywords: Australia; Consumer participation; Drug policy; Evidence-based policy; Poststructuralism; Subjectivity