Mediating Health Information

Wathen, C.N., Wyatt, S. and Harris, R. ( eds ) Mediating Health Information . Basingstoke : Palgrave Macmillan 2008 xviii+ 218 pp £50 ISBN 13-978-0-230-20120-0 (hbk ) Whether at the level of the local community or through state-funded socialised medicine, the social management of health is losing its anchorage in collective social relations and shared knowledges and practices. Increasingly prevalent in public health policy, for instance, is the idea that individuals have an obligation to keep themselves informed about health matters. At the broadest level of analysis this could perhaps be seen as symptomatic of a wider societal trend towards the individualisation of health. Mediating Health Information, however, foregoes such grand theorising in favour of a series of localised analyses that seek to understand the ways and means through which this idea has become-real in various sites. This is timely. For, as the editors of the volume make clear in a strong introductory chapter, the sheer mass of health information present in the public domain has increased exponentially over the past few decades. And through the book’s attention to the localised site, we are able to learn of the ways in which ordinary people have begun to take up the challenge of locating, retrieving, receiving and coping with this mass of readily available health information. The core of the book comprises nine case-study chapters. Empirically, each chapter explores a site, or sites, in which the take-up of this challenge can most readily be identified, e.g. the public library, the personal computer and, further afield, rural communities in Canada and Australia. In each case, however, it is not the site but the various information mediators (‘info(r)mediators’, in Mediating Health Information’s rather inelegant formulation) housed within the site that come to be foregrounded. Ranging along a continuum from the solely technological to the solely human, these mediators bridge the ‘amorphous ground’ (p.182) between individuals seeking health-information and the broad and sometimes murky universe of health information. So far, so obvious, one might think. And yet the distinctive analytical perspective brought to bear on those mediators generates some less than obvious findings. For whereas previous studies have often assumed that mediators act as passive relays, passing unbiased information on to their end-users, this book does not. Drawing second-hand upon the philosopher Serres’ (1982) concept of ‘translation’, each case-study chapter is instead able to approach those mediators as unpredictable transformers. It is suggested that, as health information traverses that amorphous ground, it is nearly always ‘transformed, translated, or even distorted’ (p.9). The gains from this shift in analytical perspective are substantial. Coming at this book from a science and technology studies perspective I found Chapter 5 to be of particular interest. Therein, the software underlying a government-sponsored online health information service is examined. Ostensibly an unbiased mediator, the analysis reveals a system with configurations that render some kinds of information visible, whilst rendering other kinds of information invisible. Silently and without much fanfare, then, the flow of information received by the health information seeker is, in this way, structured and transformed. These same kinds of processes can also be seen at work in the examples of the advice given to internet users by library staff members (Chapter 3), the library internet filter (Chapter 4) and the contextualised digital diagnostic image (Chapter 6). But if these forms of transformation lean towards the deterministic and fixed, then the final three case-study chapters serve as reminders that the mediation of health-information can often be a negotiated and fluid process. Chapters 8 and 9, for instance, deal with attempts that have been made to governmentalise indigenous and remote communities in Canada and Australia. Initially, we learn of a series of tensions between externally imposed ICTs designed around the western biomedical ‘individual’, and community-oriented notions of well-being that pre-existed their arrival. But in each chapter what also becomes apparent is the crucial mediating role of the community health-worker, translating the needs of community members into terms understood by the western health care system, and, conversely, transforming medical information and procedures into culturally appropriate forms of care. All in all, then, a good book. And there is plenty here that will be of interest to those involved in making policy and practice decisions in the provision of health care and health information support. One particularly interesting theme to emerge, for instance, is that despite the enthusiasm for ICTs in policy making circles, human actors engaged in mediator roles remain integral to health information seekers’ ability to find and use health information.

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