Cultivated co-production: Sexual health, human rights, and the revision of the ICD

Abstract

STS scholars frequently have shown how science and sociopolitical arrangements are ‘co-produced’, typically tracing how scientific actors themselves keep ‘science’ and ‘politics’ far apart. Revealing co-production is therefore deemed the work of the STS analyst, who unearths linkages that the actors might be unaware of, or might ignore or deny. By contrast, the creation of a new chapter on ‘sexual health’ in the recent revision of the International Classification of Diseases (ICD) offers a case of what might be termed ‘cultivated co-production’. Neither oblivious to the linkages between science and politics nor invested in obscuring them, the designers of the sexual health chapter sought support for their work by demonstrating, transparently, how science, ethics, and human rights might properly be aligned. The intentional and visible character of co-production in this case indicates awareness of the need to manage the contested nature of gender and sexuality at a transnational level. It also reflects two changes in the organization of medical politics and medical classification: a widespread recognition of the necessity of reaching out to lay stakeholders and advocates, and the rise of an emphasis on ‘conventions’ as the backbone of transnational biomedical consensus processes.

Representing disabling experiences: Rethinking quality of life when evaluating public health interventions

“…In aligning methodological considerations with broader debate about the social circumstances which reproduce disability, this article questions the extent QoL represents disablement when conducting evaluative research. It highlights how cultivated coproduction (Epstein, 2021) in which a constitutive link between research activity and socio‐political arrangements define conventions that give interpretative meaning to QoL. Consequently, QoL measures reproduce and constitute social life as much as they offer an analysis of it.…”

“…Classification reflects prevailing power relationships that serve to shape the moral and social order (Foucault, 1970). By representing a series of interconnected technical, social, and economic decisions (Bowker & Star, 1999) under the guise of an authoritative and normative objectivity, a definition of disability is generated in which the “politics” has been “scrubbed away” (Epstein, 2021, p. 659). Boundaries are established (and policed) as QoL scores become indistinguishable from the concept with which they are associated.…”

“…Health can become located within the individual who becomes responsible for their own "vulnerability," rather than identified with socio-political structures that reproduce this "vulnerability" (see Foucault, 1994). As they become co-produced and cultivated through public health, socio-political arrangements risk reproduction through research (see Epstein, 2021). QoL enables research to sustain its commitment to improving future health (Rosen, 1957), while reflecting assumptions about what it is to be healthy, fit, and able (Armstrong & Caldwell, 2004).…”

“…This creates moral value (see Millar, 2017). Representation and reproduction become entangled, each reinforcing the other (see Epstein, 2021). To understand this, we explore the explanatory power of QoL scores relative to the social (and political) context in which they are used.…”

The co-production of normal science: A social history of high-temperature superconductivity research in China (1987–2008)

“…Jasanoff and colleagues develop the notion of co-production in an attempt to explore how knowledge-making is incorporated into practices of governance, and how practices of governance influence the making and use of knowledge (Jasanoff, 2004). STS scholars have applied this theory to show how science and sociopolitical arrangements are co-produced, unearthing links of which the actors themselves may be unaware, or may ignore or even deny (Epstein, 2021). The co-production framework generally focuses on interactions between science and its sociopolitical settings: Natural and social orders are produced together.…”