Author:

Keywords:

environment and health, policy analysis, institutionalization environmental health arrangement, complex risks

Abstract:

The main objective of this thesis is to reconstruct and analyse the dynamic emergence and the institutionalization of the Flemish environmental health arrangement. More precisely, the impact of new discourses on environmental health and changing thoughts regarding complexity on the institutionalization process is investigated. Complexity reveals at two levels. Complexity at the level of variables refers to its multi-dimensional character (its embeddedness in a broader physical, social, economic and political context), multi-causality (multiple sources, agents, pathways, exposures, health effects), non-linear behaviours, long delay periods between cause and effect, cross-bordering time and scale, and the unclear sense of all consequences and/or the cumulative impact of collective action. As a consequence, complex problems are intrinsically clouded with uncertainties and imperfect understanding. Second, environmental health problems are complex at the societal level. After all, these problems are interwoven with moral, financial, economic, environmental, socio-cultural, and socio-political norms and values, resulting in a plurality of legitimate – often conflicting and controversial – perspectives. These two key features of complexity – radical uncertainty and a plurality of legitimate perspectives – induce challenges for science, politics, and the science-policy interface. As such, complexity goes parallel with three related shifts: 1) beyond the modern positivistic epistemology, characterized by rationality, full knowability and disciplinary reductionism towards Post-Normal Science and co-production of knowledge; 2) from traditional, sectoral policy arrangements and levels within government towards multi-actor and multi-sector governance; and 3) towards new types of boundary arrangements at the science-policy interface, reconsidering the role of knowledge, as science is no longer the unquestioned source of legitimacy for policy arguments. From a discursive institutional perspective, the assumption is that new and changing discourses are the driving forces behind institutional dynamics, challenging the development of novel organizational facilities and methodological tools, within the (scientific) knowledge-production as well as the (political) decision-making processes. In order to study the impact of the newly emerging discourses about environmental health and complexity on the institutionalization process of the Flemish environmental health arrangement, a historical analysis was performed, which covered a forty years period, from the Nineteen Seventies until the first decade of the twenty-first century. The developments within the Flemish environmental health arrangement are studied against the background of the international and European context in order to determine the strongest triggers and drivers for institutional change and continuity. Data were gathered, analysed and interpreted according to a qualitative approach, and using a triangulation of methods (document analysis, in-depth interviews and participated observation) to get a detailed and balanced picture of this institutionalization process. Although, a historical analysis is in most cases not associated with policy oriented research, and the institutionalization process of the Flemish environmental health arrangement is still on its way, an attempt was made to evaluate the performance of the arrangement. Based on a non-exhaustive list of indicators, concrete recommendations were formulated to optimize the content as well as the organizational structures of the Flemish environmental health arrangement. The following paragraphs present the main conclusions of this thesis. The establishment of the Flemish environmental health arrangement is characterized by a process of gradual, but eventually far-reaching institutional transformation. The impact of the top-down approach, characterized by a more systematic, proactive, forward-thinking, and realistic environmental health policy and planning approach, enforced by the European governmental level, was limited. The identified primary triggers for institutional dynamics were the gradual discursive shifts in response to four local environmental health incidents related to: 1) the metallurgic activities in Hoboken, 2) the cadmium pollution in the Northern Kempen, 3) the dioxin deposition by two waste incinerators in Wilrijk near Antwerp, and 4) the Belgian dioxin crisis in the food chain. More precisely, the series of environmental health incidents gradually shifted the discourses of Flemish politicians, scientists, and the population in general, about environmental health risks and uncertainties. This epistemological shift, in turn, led to new scientific organizational and methodological challenges, on the one hand, and changing discourses about the environmental health policy arrangement and the science-policy-society interface, on the other. Related to the (scientific) knowledge-production, an increased need was determined: 1) to manage uncertainties appropriately, 2) to extend the research team with several scientific disciplines as well as non-scientific forms of expertise, and 3) to shift the research focus from mortality and severe health effects to moderated health effects and negative effects on well-being. To summarize, these discourses altogether require a more integrated approach of the knowledge-production process, at the organizational (interdisciplinary and trans-disciplinary research teams) as well as methodological (integrated risk assessment) level. The observed key discursive governmental changes reflect: 1) the need to differentiate various target groups when establishing environmental quality standards, as one realized that some societal groups are more vulnerable; 2) the need to better coordinate and even integrate the environmental and public health policy (multi-sector governance or policy integration); 3) the need to increase stakeholders’ participation in order to take into account all types of knowledge, perceptions, values, etc. in the decision-making process (multi-actor governance); and 4) the need to develop efficient and effective communication strategies in response to scientific uncertainty. These gradually changing epistemological and governmental discourses caused by the accumulation of incidents within a short time period, shortly followed by elections that enabled the Green Party to profit from public concern and ultimately join the newly formed government from 1999 until 2004, created a window of opportunity to rethink the current affairs about environmental health and to achieve institutional change. Through the years, each discursive shift transformed – to a greater or lesser extent – the Flemish environmental health arrangement into a rather stable arrangement. After all, the changing discourses gave the opportunity to new agencies and organizational structures to enter the arena (e.g., Local Environmental Health Officers, Administrative Services on Environment and Health, the interdisciplinary Flemish Centre of Expertise on Environment and Health), establishing new rules, legislation and decision-frameworks (e.g., Guidelines on Risk Communication, Decision-framework for uncertain risks, Flemish Decree on Preventive Health Policy), and developing tools and methods to ameliorate the science-policy interface (e.g., Flemish Programme on human biomonitoring, Phased Action Plan, environmental health indicators). The institutionalization occurred across the boundaries of science and policy and the increased interaction between science, policy and society is also considered as one of its strengths. Related to the science-policy interface, the Flemish environmental health arrangement evolved from the Enlightenment and Bureaucratic Model, characterized by a strict demarcation between science and politics, towards the Advocacy Model and the Mutual Learning Model in which all stakeholders are involved. The performance analysis has made it clear that the current Flemish environmental health arrangement succeeds in increasing the exchange of information: 1) between the local, the Flemish, the federal and European governmental level; 2) between scientists and policymakers; 3) between environmental civil servants and public health civil servants; 4) between the general people and the experts or policymakers. Moreover, the human biomonitoring surveys, in combination with the work of the local environmental health officers, succeed in detecting potential environmental health problems quickly, thus preventing concerns or problems from evolving into crises. Nevertheless, the analysis also provided insights into some shortcomings and recommendations to ameliorate the content and the organizational structure of the arrangement in the future. The contents’ recommendations regard: 1) the development of a formalized procedure to ensure appropriate uncertainty management, 2) the integration of environmental health objectives structurally and explicitly in all relevant policy domains, 3) the optimization and strengthening of the Phased Action Plan as a boundary object, 4) the optimization of the Flemish decision framework for uncertain risks and making it operational in practice, and 5) further research and a socio-political debate about good environmental health indicators. At the organizational level, points of interest in future research relate to: 1) the strategies facilitating co-production of knowledge and multi-actor governance, and 2) mechanisms that facilitate and ensure the innovative capacity of the Flemish Centre of Expertise on Environment and Health in the long run.