Edited by GabrieleBammer and MichaelSmithson Published by Earthscan , UK . March 2008 , 400 pages . Paperback , ISBN 9781844074747 , RRP $59.95.
Reviewed by: Liz Eckermann
School of History, Heritage and Society, Arts and Education Faculty, Deakin University, Victoria
This 28-chapter volume emanated from a symposium organised by the editors to bring together perspectives on uncertainty and risk from 20 distinct disciplines, practices and policy areas. The participants came from a variety of science, arts, humanities, social science, practice and policy backgrounds. The objective of the symposium, and subsequent edited volume, was to trade information and ‘build on the resulting new insights’ (p5). It is thus hardly surprising that there are as many interpretations of what constitutes ‘risk’ and ‘uncertainty’ as there are chapters and in many chapters the two terms are used interchangeably. The absence of theoretical debates around risk throughout the volume suggests the editors have been overambitious and may have been better confining the book to seminal perspectives on, and practices around, uncertainty rather than including risk. The literature on risk has been so vast over the past two decades, particularly since the publication of Beck's 1992 Risk Society, that the absence of sophisticated analysis in the multidisciplinary perspectives represented in this volume is both surprising and a significant omission.
Critiques of ‘the Western intellectual pursuit of certainty’ are not new. Questions about the absoluteness of truth statements have been part of epistemological debates since ancient times and more recently culminated in the relativist philosophies on scientific method of Polanyi, Kuhn and Popper half a century ago. What is new in this volume are strategies from economics, law, politics, history, the visual arts, music, religion, physics, statistics, philosophy, complexity science, futurists, psychology, disaster management, and health researchers being ‘connected, contrasted and synthesised to develop better tactics, and methods, for conceptualising and coping with uncertainty’ (p9–10). Thus, it is more like a handbook for dealing with uncertainty, than a comprehensive overview of new theoretical approached to risk and uncertainty as the title of the book implies.
The key message of the volume is that ‘uncertainty is not just a problem to be overcome or managed, it is also an essential source of opportunity, discovery and creativity’ (p11–12) and Smithson suggests that ‘the negative stance towards uncertainty is a mainline thesis pervading Western Culture’ (p18). Ironically this volume is largely based on Western theory and experience. Even the chapter by Plant on dealing with the SARS outbreak in Vietnam is written from a Western perspective of what constitutes uncertainty and risk. The brief analysis of the role of superstition in managing uncertainty is written from the point of view of Western doctors using ritual preventative measures such as garlic and alcohol to control the unknown rather than traditional Vietnamese superstitious practices.
The editors believe that this ‘study of uncertainty has a rightful and central place in the world's intellectual endeavour’ (p12). Public health practitioners and researchers interested in the role of uncertainty in constructing understandings of health would be best advised to concentrate on the four health-related chapters rather than ploughing through the full 28 chapters of the book.
The four chapters on health (Ritter on Uncertainty and Heroin Injecting, Plant on the SARs outbreak in Vietnam, Furler on uncertainty in public health and Handmer on emergency response to disasters) contribute significantly to shared appreciation of the potential for uncertainty to mobilise creativity, camaraderie and greater community engagement. Plant, an Australian epidemiologist, provides a practice-based analysis of how emergency response teams flown into Vietnam during the SARS outbreak were forced to make difficult decisions about priorities for treatment in an uncertain epidemiological setting which led to substantial anxiety on the part of health workers. She highlights the strategies used to dispel this anxiety. (p48–51). Ritter, an Australian drug researcher, adopts a policy practitioner perspective to highlight the problems of uncertainty about the prevalence of heroin use, about policy options and about effective treatment (p159). Furthermore, Ritter points to dilemmas around whether legal, health or moral imperatives should prevail in deciding on intervention arguing that ‘for some issues evidence is not enough- values are also important and, if not dealt with, exacerbate the uncertainties ‘ (p164). Furler critiques the use of ‘review and restructure if in doubt’ to manage uncertainty in the Australian health care context (p184) and Handmer addresses the benefits and costs of emergency management to tame uncertainty in society and ‘between society and nature’ (p231).
All the health chapters stress that, in most health settings, it is not lack of information holding back solutions to issues but ‘resistance to taking up a better way of dealing with uncertainty’. All argue that uncertainty can, in fact, be a very positive element in decision-making but the ‘challenge is to appreciate, deal with and, where appropriate, harness those uncertainties’ (p167–8). They all show us how to use imagination, alongside available evidence, in deciding on the best course of action in situations of uncertainty. However, they tell us very little that we do not already know about risk and nothing about non-Western theories and strategies for managing risk and uncertainty.