ABSTRACT
There has been in the UK in the past few years a remarkable surge of investment in the development of ‘health alliances’ (interagency and intersectoral partnerships for health) – and to a lesser extent in their evaluation. As yet this has not been accompanied by a marked improvement in understanding what makes for success or failure in such initiatives. Two new perspectives are offered as ways of encouraging dialogue and informing critical and creative practice in this field of work. Both are illustrations of the broadly socio-cultural approach that seems essential in a situation where contested and competing frames of thought are prominent.
First, the idea of ‘multiple metaphors’ in reading and designing organisations is used to draw attention to the ‘trap’ that linear, mechanistic, additive (‘hard systems’) thinking still poses in work on health alliances, and to highlight the range of non-linear models now emerging that offer promise for future development and evaluation work. Second, the concept of ‘thirdspace’ – borrowed from cultural and urban studies – is adapted to suggest an agenda for working directly ‘at the edge’ where multiple viewpoints, difference and discordance are juxtaposed; an agenda that requires negotiating across such barriers and borderlines in order to create new, ‘hybrid’ entities and new shared meanings at several levels. By working across the ‘bar of difference’, the much talked about benefits of health alliances may be achieved, but – this ‘interstitial perspective’ insists – only so long as nobody (and nothing) stays the same.
It is suggested that the future of alliances for health at local level will hinge on the readiness of agencies to learn to change their root metaphors, to abandon stereotypic thinking, to move towards new, more flexible and open deployments of power and to renegotiate continuously their own boundaries and their various institutional identities. The agenda is challenging; but if it is not taken forward, the radical promise offered by new partnerships for health at local level will not be fulfilled.
