Analysis and interpretation

There exist a number of suggested frameworks for conducting a Foucauldian inspired analysis of discourse. These frameworks vary in the emphasis that they place on the different components of a Foucauldian framework, with some approaches privileging the importance of genealogy and historical inquiry (Hook, 2005), some focused on the utility of Foucault’s concept of governmentality (Kendall & Wickham, 2004), while others are oriented towards providing step-wise guidance for the analysis of a corpus of texts (Arribas-Ayllon & Walkerdine, 2008; Graham, 2011; Willig, 2013b). What is repeatedly highlighted across all of these texts however, is that a Foucauldian approach to discourse analysis cannot be reduced to a recipe of formal principles, but rather the suggested steps should be understood as “methodological signposts” in undertaking such an analysis (Arribas-Ayllon & Walkerdine, 2008, p. 11).

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It was the suggested steps put forward by Willig (2013b) which I found to be most accessible in conducting my first FDA. One omission however from this six-step approach is the tracing of the historical evolution and transformation of the object of study. As such, I have included here an additional step, ‘Step 0’, which refers to the content presented earlier in Chapter 2, and which I feel plays an important role both in understanding the context for the emergence of the upstream parable, while also providing a conceptual framework for the analysis. I will discuss each of these steps in turn before concluding the section with an overview of how I applied these steps to the two datasets in the study. Step 0: Tracing history

Arribas-Ayllon and Walkerdine (2008, p. 14) suggest that as long as an FDA is “conducted in terms of recognizing the ‘genealogical background’ of the study, then any context or setting is suitable for analysis”. By this, the authors are suggesting that analysts should first engage with the ways in which discourses have operated over time to construct the object of interest in the study, and power-knowledge relations facilitated through dominant discourses. In Chapter 2, I traced the historical evolution of the object of interest in this study, health inequalities, and endeavoured to illustrate how different discourses, at different points over the last two centuries, have found themselves elevated to the status of truth and have thus been highly influential both in shaping the construction of the problem of health inequalities, and in shaping efforts to address them. In particular, I highlighted the role of neoliberal, behavioural, and evidence-based policy and practice discourses in recent years, which have resulted in a slippage in action away from materialist/structural explanations for health inequalities, to engage in what McKinlay (1979, p. 583) describes as “short-term, problem-specific tinkering”. It is in direct response to this slippage that counter-discourses such as the upstream parable emerged in an effort to reorient thinking and action to work at the root causes of health inequalities. Thus, it is against this genealogical background that the present analysis is situated.

Step 1: Look for discursive constructions

Willig (2013b) suggests that the first step of an FDA is to highlight all instances in the text where there is an implicit or explicit reference to the object of interest in the study. Initially, I was unsure as to whether I should be identifying references to ‘health inequalities’ or working ‘upstream’ in the texts. However, after trial and error, and after revisiting my research questions, it seemed most sensible to repeat this step for both ‘health inequalities’ and working ‘upstream’ to identify the ways in which authors or participants were, through different discourses, constructing each object within the texts. As Graham (2011, p. 668) summarises, the objective of this “foundational starting point’ of the analysis is to “trace

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the relationship between words and things: how the words we use to conceptualise and communicate end up producing the very ‘things’ or objects of which we speak”.

While Willig (2013b) uses the language of “discursive constructions”, I see this expression as synonymous with the idea of problematisations. Thus, in this step in the framework we are looking to go beyond definitions of health inequalities, to see what systems of knowledge and thought people are drawing upon when they are making sense of health inequalities, and offering them up as a particular type of problem to be addressed. In this way, it is possible to identify the ways in which people may employ similar, or indeed stock definitions of health inequalities, but actually produce very different problematisations or discursive constructions within the texts.

Step 2: Look for discourses

In this second step, the task for the researcher is to locate the various problematisations or discursive constructions within wider discourses or “ways of seeing the world” (Willig, 2013b, p. 388). As outlined in Step 1, what can appear as the same discursive object, when situated within wider discourses, can actually be constructed in very different ways. It is these wider discourses that proved particularly useful in bringing to light the ways in which authors and participants had come to understand and look at the problem of health inequalities. Additionally, it is through identifying wider discourses that it then became possible in the analysis to organise authors and participants into groups with distinct ways of seeing the problem.

Step 3-6: Look for the action orientation of discursive constructions

Step 3 of the approach involves looking for the action orientation of discursive constructions within the text. This layer of analysis involves asking of the text, what is gained, or what happens, when people construct health inequalities and working ‘upstream’ in particular ways? The focus is not so much on the role of the speaker, but rather on the function of discourse, and different discursive constructions. I have presented the final steps together in this section as it is my interpretation that Steps 4-6 of this approach make up the action orientation or the ‘effects’ of different discursive constructions.

In the first place, Step 4 involves looking for positioning or the different subject positions made available through different discursive constructions. For example, as discussed in Chapter 3, previous qualitative work in this area found that participants tended to construct the problem of health inequalities in terms of a reduced inclination for low income groups to look after their own health, and as a consequence be less receptive to health promotion information and intervention. Thus, this discursive construction situates the drivers of

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health inequalities at the level of the individual and positions them in terms of a discourse reminiscent of the ‘feckless poor’ (see Section 2.1).

Step 5 involves looking for the ways in which different discursive constructions, and the associated subject positions which they produce, operate to “open up or close down opportunities for action” (Willig, 2013b, p. 387). In the example just discussed, depending on the subject positions produced through the discursive constructions, the implications for action could involve reducing spending on health promotion for low income groups as it is seen to be a waste of money, or in contrast, it may be the case that subject positions function to advocate for more intensive intervention in low income areas to compensate for the proposed resistance to change. Importantly, subject positions are not limited to individuals affected by a problem, and indeed it may be the case that particular discursive constructions operate to position some professional groups as best suited, or as having the ‘expert’ knowledge or skill sets needed to address the problem as it is presented.

And finally, Step 6, while arguably closely related to the idea of subject positions, involves looking for subjectivities that result from particular discursive constructions. Subjectivities refer to the implications of different discursive constructions for how people may think and feel. Willig (2013b, p. 389) provides an illustrative example of this idea of subjectivities, describing how the male sex drive discourse may allow “a man not only to publicly disclaim responsibility for an act of sexual aggression, but to actually feel less guilty about it as well” (emphasis in original). These final steps in the analysis are reflective of Foucault’s power-knowledge relation, and serve to describe both the productive power of discourses in producing subjects, and the subtle ways in which discourses operate by acting upon the actions of others.

4.4.1.Approach to the analysis

When it came to devising an approach to applying the steps described above to the included texts, I first employed NVivo software for qualitative analysis. Having previously used NVivo in qualitative studies, I expected that it would allow for an efficient approach to keeping track of my coding, along with providing a mechanism for speedy retrieval of passages of text when writing up the analysis. Additionally, for reasons of data safety I was reluctant to produce hard copies of the interview transcripts. However, after multiple efforts, in various ways I had the sense that an analytic approach of this nature did not lend itself quite so well to the rigid structure of codes and nodes afforded by the NVivo software, and as a consequence I quickly reverted to a traditional approach of pen and paper.

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I worked through the exact same procedure for the analysis of both the academic texts and the interview transcripts. In line with the framework, I first highlighted all explicit and implicit references to either ‘health inequalities’ or working ‘upstream’. I created two separate Word documents for each dataset, and developed a structure that would allow for the organisation of extracted passages from the texts which were relevant to the six steps of the analytic framework. Prior to populating this Word document, I first applied the six steps to each individual text, making notes both on the printout of the texts themselves, and also supplemental notes in a notepad. I worked through the texts repeatedly until I felt that I had exhausted all of the possible discursive constructions, and resulting action orientations. Using these detailed notes, I produced more compact summaries in the Word document, an example of which is shown in Appendix H. I chose this particular example as it was one of the shortest texts and so allows for the clearest presentation of the analytic approach. The content of these summaries were also developed into summary tables which provided the key findings from each text (example shown at the top of Appendix H). Looking across these summaries, and the resulting tables, I was able to see patterns in discursive constructions and wider discourses, which were then used to inform the structure for presenting the findings. While I made every effort to be consistent and diligent in documenting my analysis, when it came to transforming the analysis of the individual texts into an overall interpretation of the data, I found there was still much work to be done. Thus, a further layer of analysis ensued through the process of developing a structure for presenting the findings in the respective chapters. Beyond applying the analytic steps and producing summaries of the individual texts, the process of drafting and redrafting the findings chapters formed an integral part of developing a ‘helicopter view’ of both datasets, and in this way further allowed for the identification of patterns, subgroups, agreements, disagreements, and indeed new insights across the entire dataset.

While the theoretical and methodological approaches employed proved to be appropriate to answer the research questions of the thesis, they were not without their limitations. Therefore, in the final section of the chapter I briefly reflect on how I found myself employing a Foucauldian inspired analysis of discourse, and some of the challenges and implications of such an approach.