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Internationalisation in context: dominant and peripheral discourses

It is quite certain that science cannot progress properly
except by the fullest internationalism.

A.V. Hill (1933, 954)



Hill’s quote is extracted from an article published in Nature at a time when purges and political violence had begun striking German universities under the newly Nazi regime. The quote not only illustrates the deep concern of the Nobel laureate over the rise of fanatic nationalism across Western Europe at the time; it also works as a restatement of the long-held vision of science: its inherent transnational character and solidarity. While according to almost all accounts, science has always had an international dimension, the need to defend or promote its internationalism has not been exclusive of politically convulse times.

With the advent of globalisation (i.e. the higher, faster and more intense connectedness of countries since the second half of the 20th century), as science started to be perceived as an asset to compete in the global economy, internationalisation begun to be regarded as the means to increase economic growth and promote well-being and human development. Science, in other words, was to become more internationalised. 

But what does internationalisation actually mean? With the popularisation of internationalisation strategies since the 1990s, internationalisation has become a buzzword and a container concept that includes everything that relates to the ‘international’ (de Haan 2014; de Wit 2001). 

In general, contemporary notions of internationalisation embrace the assumption that by making science “more international”, it becomes better, i.e. more collaborative, innovative, dynamic, and of greater quality. Such a positive conceptualisation of internationalisation, however, rests on interpretations coming almost exclusively from the Global North that systematically ignore power dynamics in scientific practice and that regard scientific internationalisation as an unproblematic transformative process and as a desired outcome. I argue that in order to understand internationalisation, we need to understand its meanings in different contexts. 


The dominant discourse of internationalisation in STS

The vast majority of the relevant literature on internationalisation comes from Higher Education Studies (HES), where the concept originated in the 1990s. Since then, definitions of internationalisation in HES have undergone various phases (de Haan 2014) to eventually settle as a top-down process of “infusing or embedding the international and intercultural dimension into policies and programs to ensure that the international dimension remains central, not marginal, and is sustainable” (Knight 2003, 3). Though in recent years, some have stressed the need to incorporate views coming from developing countries (Jones and de Wit 2012; de Wit 2013), in general, the dominant discourse of internationalisation in HES has not fully moved away from a western, neo-colonial concept. That is, internationalisation continues to be perceived as a positive process bringing mainly positive transformations in education, and is therefore regarded as a desired outcome.

Unlike HES, in STS thus far there has not been a collective discussion about the meaning of internationalisation (Woldegiyorgis, Proctor, and de Wit 2018). Internationalisation is still a phenomenon largely understood through the lens of the Global North; namely as a process free from conflict that leads to better science. This is observed in evaluation and scientometric studies describing how research impact and visibility are greatly related to practices of international mobility and collaboration (see Sugimoto et al. 2017; Robinson-Garcia et al. 2019; Halevi, Moed, and Bar-Ilan 2016; Edler 2007; Edler, Fier, and Grimpe 2011; Zhou and Leydesdorff 2006). In social studies of science, the influence of the dominant view of internationalisation can be appreciated in studies of the so-called ‘Big Sciences’, namely high-energy physics (Price 1963; Galison 1997; Knorr-Cetina 1999; Shrum, Genuth, and Chompalov 2007). Along with an increase in numbers (e.g. researchers, publications, investments, institutions, disciplines and instruments), Big Science has evolved to entail a process of greater internationalisation involving a geographical expansion and growing multinational cooperation that adds another layer of analysis to understand how science gets ‘big’ (Vermeulen 2009). 

The life sciences are an interesting case of the intervention of the internationalisation discourse in STS. Compared to big physics, the life sciences were not regarded initially as Big Science, but rather as a bodily and lab-bench science governed by an individual ontology (Knorr-Cetina 1999). It has been more recently that research on life has begun to be considered as another form of Big Science. That is, a research field that has become increasingly large, collaborative, international and networked (Vermeulen 2009; Vermeulen, Parker, and Penders 2013). 

Within this body of research, social studies on model organism research – Drosophila and as C. Elegans are well-known examples – are perhaps the clearest cases of the impact of the dominant vision of internationalisation in STS. In general, practices of collaboration and resource exchange (e.g. techniques, specimens and data) are said to be common to all model organism communities, which have themselves become models for good behaviour in science (Kohler 1994; Rosenthal and Ashburner 2002; Ankeny and Leonelli 2011; Nelson 2013). As such, the pillars of these research communities are formed by practices commonly associated with the positive effects of internationalisation, including: more international and increasingly accessible community infrastructures, transnational collaborative networks and a social commitment to openness expressed in actively contributing to develop such community resources. This scientific “repertoire” is crucial to the point that it explains how relatively stable communities of researchers in the life sciences are created, managed and persist in the long term (see Leonelli and Ankeny 2015).

While these studies describe – albeit indirectly – the transformative impact of internationalisation dynamics in the life sciences, they tend to decontextualize the very same international research communities they analyse and ignore the power dynamics present in them. In particular, they leave unexamined notions of asymmetry and dependency in practices of resource exchange as well as the structural configurations that determine the norms and expectations operating in these communities. What remains then is a propensity to view such communities as uniform and harmonious international ecosystems governed by a strong and inherent collaborative ethos.

Overall, the lack of discussions on the power dynamics present in these international communities shows the extent in which in the social study of the life sciences, scholars have continued to take for granted the notion of internationalisation.


The Latin American take on internationalisation

While critical perspectives on related concepts such as universalism, transnational, multinational and globalisation exist in the STS literature (Leclerc and Gagné 1994; Hakala 1998; Somsen 2008), it is in Latin American STS where researchers can find a long and rich record of research on internationalisation with a strong critical component. Nearly thirty years before the concept was developed in HES, the first STS thinkers in this region stood up to denounce inequalities present in the international scientific system (see Sábato and Botana 1968; Varsavsky 1969; Herrera 1972). This mixed group of pioneers linked the underdevelopment of Latin American countries to dynamics of dependency and asymmetry in international science and technology, which they saw reflected in the programmes sponsored by international organisations such as the OAS and UNESCO throughout the 1950s and 1960s. 

From the 1980s onwards, Latin American STS began a process of consolidation in which sociological and anthropological research based on case studies gained predominance over the normative analyses of the previous decades (Martínez Vidal and Marí 2002; Thomas 2010). The Latin American STS literature came to fill a gap in the social study of internationalisation and develop a critical perspective that was missing in internationalisation studies. Though sometimes breaking with the classical diffusionist model while in others embracing it fully, this new critical perspective continued to focus on the development question of the previous decades. Particularly, case studies aimed to show how internationalisation both enables and hinders scientific research in the periphery (Cueto 1989; Vessuri 1994; Vessuri, Guédon, and Cetto 2013; Velho 1996; Kreimer 2006; Kreimer and Zabala 2007).

In sum, scholarly discussions around scientific internationalisation in this region have been linked historically to wider questions about dependency, asymmetries and development in (and beyond) science, which continue until present days. Visions of internationalisation in Latin America often portray a mixture of positive and negative connotations, which indicate a more complex conceptualisation of this phenomenon that is often observed elsewhere (Kreimer 2013).


Moving forward

The discourse of internationalisation in science studies has many vertices. The positive conceptualisation of internationalisation can be observed, for instance, in studies confirming the positive correlation between practices of internationalisation and research impact. Opposite to this, critical perspectives in STS have denounced internationalisation’s counter effects, such as the reinforcement of core-periphery dynamics bringing a more restrictive and uneven access to facilities, resources, knowledge and expertise (see Leydesdorff and Wagner 2008; Olechnicka, Ploszaj, and Celińska-Janowicz 2018; Robinson-Garcia et al. 2019). Critical perspectives on scientific internationalisation are not new though. STS scholars from Latin America have traditionally denounced the inequalities of the international scientific system, even before the concept was introduced in HES in the 1990s. However, the works of this group of academics is rarely cited in mainstream STS literature. It is therefore vital that a much needed future conversation about the meaning of internationalisation in STS beings not only by engaging with the concept directly, but also by bringing together dominant and peripheral discourses of internationalisation.





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Lived Solidarity in the Austrian Healthcare System

1. Introduction. What is solidarity?

In their daily routine, healthcare workers engage with their patients in various ways, ranging from attentiveness and kindness to inattentiveness or even (un)conscious discrimination. In this article, we analyse healthcare workers’ enactment of solidaristic practices to support disadvantaged groups. On the basis of observational data from interactions of refugees with the healthcare system and qualitative interviews in Vienna, Austria, we suggest that healthcare workers play an important role closing structural gaps within a solidarity-based healthcare system. Drawing attention to these often unnoticed solidaristic practices means to acknowledge forms of what we call lived solidarity.

Solidarity as Practice

During the Covid-19 crisis, solidarity has been a widespread, and maybe overused, term. From global cooperation in vaccine development to neighbours running errands for each other, a wide range of practices have been celebrated as solidarity. The longer the crisis lasts, however, the clearer it becomes that people are not only moving closer together, but that the fault lines between people are becoming more pronounced as well (see Prainsack, 2020). Also for this reason, it is important to define what we mean by solidarity before delving into our empirical analysis. 

Building on the solidarity literature, particularly in the English-speaking world, we see solidarity primarily as practice: and specifically, as practice that expresses the willingness of people to support others with whom they see themselves as having something in common in a relevant respect (Prainsack & Buyx, 2011: 2017). In each case, the specific practice provides the reference point for what is and can be recognised as relevant commonality: For example, if someone sees a call to donate blood, or even a kidney, that person’s willingness to respond to that call will often be influenced by whether they have a personal connection to the issue at hand. If the person has a family member or friend whose life was saved by a blood, or organ donation, then they will often be more willing to respond to the call than if they have no connection to the topic at all.

Moreover, we always practice solidarity in specific situations and contexts. As women, we are not automatically in solidarity with all other women. When we support a woman who has become the target of sexist harassment or discrimination, for example, we may do so because we ourselves have experienced such harassment, or because our friends or family members have. (And one does not have to be a woman to be solidaristic with women who become the target of such discrimination). But we might not be solidaristic with this same woman if she asks us for support in a political campaign that does not correspond to our views. The concrete context of action indicates, in each individual instance, what commonalities or differences give rise to solidaristic action: No one is solidaristic with others in an abstract sense. 

When we observe discrimination and are bothered by it to the extent that we take action against it, we exercise solidarity with those suffering discrimination in a specific instance or context, despite all the other differences that exist between us: the people we support may have different political goals, religious or spiritual beliefs or lifestyles. Solidarity, thus, does not mean ignoring differences and pretending that they do not exist: rather, it means that despite the differences that exist between people, letting the similarities and commonalities become the source of our actions – especially when these similarities or commonalities are not “obvious”.

As Prainsack and Buyx have emphasised in their work (e.g. Prainsack & Buyx, 2017), that the “recognition” of similarities or commonalities in a relevant respect, which is the basis for solidaristic action to emerge, is not, however, a mere determination of “objectively” existing commonalities, which may be essentialist or even nativist. To a large extent, the differences and similarities that we see ourselves as having with others are things we have learned to see. A person who grew up in a family and society that placed emphasis on every person being equal, irrespective of their skin colour, gender, and beliefs, will find it easier to see commonalities amidst all other differences than a person who grew up learning to think of everyone who did not have the same religion, ethnicity, or political views as “different”.  Public and political discourses that play out in different groups of the population against each other can have a big impact on the thinking and perceptions of people in this respect. 

We have already given a few examples of the forms that solidaristic practice can take at the interpersonal level: A person recognises a part of herself in another person (or persons) and does something to support that other person(s), even if it incurs “costs” for her (this cost need not be financial, but it can also be time, comfort, or physical well-being – as is the case with the example of blood or organ donation). Building upon Prainsack and Buyx’ work (2011, 2017), we refer to this interpersonal, person-to-person solidarity, which is primarily about the concrete practices of individuals, as ‘tier 1’ solidarity. But of course, solidarity can also take other forms; for example, when it becomes so “normal” within a collective – a group, a community, an association – that it becomes a shared, expected practice (‘tier 2’). When solidaristic practice expresses itself in administrative, bureaucratic, or other norms, then we speak of ‘tier 3’ solidarity. A progressive tax system is an example for this latter, “hardest” form of solidarity, or a solidarity-based healthcare system into which people pay not in proportion to the costs they will incur according to actuarial calculations, but according to their financial means. And from which each person receives not only the services they can or could pay for, but those they need.

These different levels of solidarity are not only helpful in distinguishing “softer” (fragile, frequently changing) from “harder” (more stable, legally enshrined) forms of solidarity, depending on how quickly and easily they can change. The distinction between the three levels also offers the possibility of a more precise analysis of different forms and institutions of solidarity, rather than simply saying that solidarity is increasing or decreasing in a society. For example, during the Covid-19 crisis, some countries had large fluctuations in the intensity and prevalence of person-to-person (tier 1) solidarity, but continuously increasing support for solidaristic institutions such as publicly funded public health programs and institutions, well-equipped and publicly funded or solidarity-based healthcare systems, and even social housing (tier 3) (e.g. Lievevrouw & Van Hoyweghen, 2021).

In the following, we will derive implications for solidarity from an empirical inquiry into the daily work of healthcare professionals in Austria. One of the authors of this article, Wanda, accompanied medical treatments in Vienna as part of her ethnographic research and interviewed healthcare workers such as doctors, pharmacists and opticians. It is through their everyday practices that we can better understand what interpersonal and collective (tier 1 & 2) solidarity mean in practice and how they are connected to institutional solidarity (tier 3), namely as enactment and as corrective.


2. Lived Solidarity in the Austrian Healthcare System

Austria’s healthcare system is based on solidarity in the sense that people pay into the system according to their financial means and receive benefits according to their medical needs – regardless of how much they have paid in. Insurance contributions are based on income and deducted from people’s monthly salaries. In addition, a tax-financed support system covers the contributions for people who cannot pay anything, such as those affected from involuntary unemployment, or asylum seekers (LSE, 2017). While the solidarity-based health system is an illustrative example of institutional solidarity (tier 3), solidarity at the other two levels, namely person-to-person solidarity (level 1) and solidarity within groups such as doctors (level 2), offers a more nuanced picture. Healthcare providers have a significant influence on whether the health needs of their patients are met. Unsurprisingly, migrant patients, in particular, often have a harder time getting medically necessary services, partly due to language and cultural barriers. Some healthcare workers compensate for these structural deficits in their everyday work by going beyond the intended level of service and care or even breaking rules in order to do what seems right and just to them.

Examples of lived solidarity

Wanda accompanied a Syrian woman and her child to an Arabic-speaking specialist. During the consultation, the doctor established trust through a mixture of wit and authority. Almost paternalistically, he inquired not only about his patients’ immediate medical concerns but also about other areas of her life such as the language course that the mother was taking, or the child’s school performance. He even made the mother promise to improve her German and the child to learn well. At the end of the consultation, the doctor turned to Wanda. The Syrian woman mentioned that Wanda is from Nuremberg. The doctor was visibly pleased and explained that he had studied in Germany and then had moved to Vienna. He hesitated briefly and then added with a laugh: “as a refugee”. It was not clear whether he saw himself as a refugee from the country of his birth or as a refugee from Germany to Vienna. He then left the treatment room. 

In this instance, the doctor implemented – in the sense of making concrete – the spirit of solidarity that is built into the institutional fabric of the Austrian healthcare system. Knowing that his patients have a migration history, and considering himself a migrant as well, he opened the door to wider conversations than medical needs in the narrow sense of the word. He thereby invited his patients to bring into the treatment room – quite literally – wider issues that bothered them, supporting a holistic approach to his patients’ health (probably knowing that the life situation of refugees often is entangled with multiple difficulties). 

While healthcare professionals such as this doctor act as the mouths, ears and arms of the healthcare system, solidarity also requires the active closing of structural gaps. An example of how this happens in practice is the following description of a Farsi-speaking general practitioner who takes on gynaecological examinations because there are too few gynaecologists with appropriate language skills in Vienna:

“There are medicines that, for example, only a gynaecologist is allowed to prescribe, yes? I always approve it and add: because of language difficulties; or that [getting an] appointment with the gynaecologist, if she has fungus, would take three months.” 

(General practitioner) 

The doctor went on to explain that many patients with limited financial means went to see private gynecologists with the respective language skills, despite having to pay out of pocket as their services is not covered by their insurance. On the interpersonal level, this doctor engaged with her patients in a caring way (tier 1). Despite the fact that it costs her time and effort, she took the circumstances of her patients into account and went “the extra mile” to meet their needs. But there is also a group identity element to her practice (tier 2): As a physician, and as a representative of a healthcare system that should pay equal attention to the needs of all, she feels responsible to compensate for the shortcomings of the system.

In addition to the solidaristic practices just described, some healthcare workers try to establish new rules, practices, and norms that improve the situation of the disadvantaged and marginalised. For example, members of the Austrian Medical Association are currently campaigning for more doctors with non-German language skills and increased cultural sensitivity to work within the public healthcare system and improve the care of migrant patients.

It quickly becomes clear that solidaristic practices often take place simultaneously at the interpersonal level and at the level of a collective (tiers 1 & 2). The doctors in our study enact solidarity person-to-person and at the group level, as part of the medical community. The following quote clearly illustrates this simultaneity: With a trembling voice, a doctor told Wanda of a child who died of pneumonia because she and her mother were sent home from the emergency room with painkillers for the child. When the child deteriorated and returned to the emergency room, they had to wait for hours to be seen. Shortly thereafter, the child died in the intensive care unit. “That’s when we felt,” he recounted, “…I felt so guilty with this case at the time because I’m just part of the system. […] That must not happen, something like that must not happen with us, yes?” (medical specialist in Vienna)

The doctor held back tears. He was visibly moved. According to this doctor’s assessment, the tragic consequence had occurred because the medical staff in the emergency room had not interpreted the needs of the patient and her mother correctly. The mother of the child wore a headscarf and spoke broken German. Like many migrants, she was insecure and introverted due to previous discriminatory experiences. The doctor, although having played no part in the tragedy that this family suffered, felt responsible nevertheless: He sees himself as part of this failing system and wants to improve it. He told Wanda of the tragic death of the child as one of the decisive moments for his commitment. Together with colleagues, he now seeks to change the system so that it becomes more receptive and responsive to the needs of disadvantaged groups. For example, he and the other members of his network often refer their patients to specific doctors from whom they expect culturally and religiously sensitive treatment. They also organise information events on these issue through the Austrian Medical Association, which he says are well received by Austrian doctors (tier 2).

Summing up the described instances of lived solidarity, we see three different types of solidaristic practice in our data (Figure 1): In the first (concretising solidarity), healthcare workers act as the mouth, ear, and arm of a solidarity-based healthcare system. They shape solidaristic institutions through their everyday practice. In the second form of solidaristic practice (compensating solidarity), they fill gaps left open by institutionalised solidarity in the healthcare system. Through these practices, solidarity becomes an inherent corrective to the system. A third form of lived solidarity (creating solidarity) goes one step further by trying to create new rules that change the existing norms and instruments (e.g. new laws, but also new criteria for the allocation of resources, etc.).

What does the healthcare worker do? Example
Practice 1:

Concretising Solidarity

Healthcare worker concretises institutional solidarity Medical specialist inquires not only about medical condition but also about other areas of life, e.g. language course for refugees
Practice 2: 

Compensating Solidarity

Healthcare worker compensates the lack of institutional solidarity General practitioner takes on gynaecological examinations due to the scarcity of Farsi-speaking gynaecologists and – against the guidelines of the medical association – issues free certificates for cash-poor parents 
Practice 3:

Creating Solidarity

Healthcare worker tries to create new rules and practices Advocacy for more multilingual doctors within the public healthcare system 

Lived solidarity – in the forms of concretising, compensating and creating solidarity – can contribute to better care, especially for disadvantaged groups. These lived instances of solidarity help to expand upon person-to-person (tier 1) and group based (tier 2) solidarity (Figure 2). They sharpen our understanding of solidaristic practices within the healthcare system and beyond.

Figure 2: Interplay between forms of the three tiers of solidarity and lived solidarity of healthcare workers (adapted from Prainsack & Buyx, 2015: 655)

Why do healthcare workers act in solidarity?

Most of the healthcare workers this article focused on are immigrants. That is the case because Wanda’s fieldwork, in accompanying refugees in Vienna to medical appointments, often confronted her with doctors whose native language matched the language of the patients. Seeing this and the solidaristic practices she witnessed during such appointments, Wanda oversampled this group of healthcare workers in her interviews – and we can make no claims about the statistical representativeness (or not) of such practices regarding the wider group of healthcare workers in Vienna, or in Austria. What insights from Wanda’s fieldwork show, however, are the forms that solidaristic practice plays within the healthcare system, and what gaps it fills. It was remarkable to see also that the commonality of being an immigrant was not the only – or not even the most important – commonality that shaped concrete solidarity practice. Instead, it was other things that they had in common with their patients – that one was also a mother or father, for example – that guided the actions of healthcare workers. This is apparent also in the following example: written confirmations of certain medical assessments are subject to a fee. These include medical reports for legal proceedings, but also confirmations for schools or employers about the necessity of sick leave. Some schools have made such written confirmations compulsory – which poses difficulties for poor parents. A general practitioner told Wanda that she considered this practice “unfair”:

“I am a mother myself – and when I call [the school] and say ‘my child is sick’, it means my child is sick. Up to three days, the parents can do it themselves [without needing written confirmation from the doctor]. No parents would call if their child was not sick. I mean, what’s the point, yeah? Sometimes it’s really annoying, yes, because it’s unfair, I think.” 

(General practitioner who came to Austria as a child from a Farsi-speaking country)

The injustice that this doctor was addressing was the different treatment of parents whose societal standing is apparently high enough to be believed when they say their child is sick, while other parents need written confirmation to be believed. In addition to being a mother, the doctor based her actions on her sense of justice. Because she felt that the unequal treatment was unfair, she acted in solidarity with the children and their parents: she told Wanda that she regularly calls the school to challenge that a written confirmation (that parents would need to pay for) is required for this particular child. She does not shy away from the emotional effort and time that it takes to deal with the problem. If it cannot be avoided, she even issues appropriate written confirmations free of charge, contrary to the medical association’s stipulation that she has to ask a for a fee. It is important to her to ensure adequate care and to do her job well. Some social groups – due to language barriers, certain previous experiences such as traumatic experiences, cultural differences, low assertiveness, or financial limitations – need more attention to have their health needs met. The solidaristic practices of healthcare workers establish justice in the sense of adequate medical care for all insured persons. Finally, the sense of responsibility of individuals plays a role in motivating people in the health sector. Many of the healthcare professionals that Wanda interviewed take responsibility in order to resolve what they perceive to be unjust or simply wrong. 


3. What to do?

We have shown that healthcare workers are important actors of solidarity in the healthcare system. We have distinguished three forms of solidarity, namely concretising, compensating and creating solidarity. The lived solidarity of people in healthcare professions is essential to ensure that the promise of justice for people with upright insurance coverage – to receive the same good medical treatment – is kept for all patients. It is clear that many of these solidaristic practices compensate for institutional failures. Some people, e.g. disadvantaged groups, are not visible in the imagination of those who have created the healthcare system. A look at solidarity in practice draws our attention to these invisibilities. However, the forms of solidarity in practice that we have discussed (Figure 2, Practice 1-3) also make clear that healthcare workers take on high emotional, time-wise, and other costs for their actions.

Despite the important role that the practices of healthcare workers play within solidarity-based health systems, the experiential knowledge of these people has practically no impact on research and policy-making. This needs to change: On the one hand, we need to ensure that lived solidarity in the health system can continue to fill the gaps that a formal institutionalised framework necessarily leaves open. It contributes to better and more equitable health outcomes, especially for disadvantaged populations, but also takes pressure off healthcare workers. Moreover, the solidaristic practices of healthcare workers can show us what other gaps in solidarity exist in the healthcare system that need to be filled and closed by a change of practice and policy.

As a first step, there must be a stronger focus on the solidarity work of the health professions in (basic and applied) research. A systematic recording and evaluation of the experiential knowledge of various health professions will provide information on where there are institutional and structural problems, or where disadvantages occur. In this way, we can determine what actions of healthcare workers should be promoted. This also makes it possible to find out where more or different resources are needed – be it through adjustments to the reimbursable services of the health insurance companies, monetary remuneration or the making available of services such as health navigators. Increased attention to lived solidarity enables us to actively decide what forms of solidarity should be institutionalised (creating practices) or more strongly valued by the system (concretising and compensating practices). The Covid-19 crisis has resulted in a re-valuation of solidaristic institutions, including healthcare systems. Now is a particularly good time to anchor solidarity more firmly as the basis of the healthcare system. To this end, it is important to recognise the lived solidarity in the work of the health professions.

This is a shortened version of Spahl, W., and Prainsack, B. forthcoming. Konkretisieren, erweitern, gestalten: Gelebte Solidarität im österreichischen Gesundheitssystem. In: Hofmann, C. M. and Spiecker gen. Döhmann, I. (Eds.), Solidarität im Gesundheitswesen – Strukturprinzip, Handlungsmaxime, Motor für Zusammenhalt?, Peter Lang Verlag.



Lievevrouw E and Van Hoyweghen I (2021) Respect for public healthcare system gives ‘brave Belgians’ the courage to maintain solidarity. https://bit.ly/3sai9Na

LSE Consulting (2017) Efficiency Review of Austria’s Social Insurance and Healthcare System. London. https://broschuerenservice.sozialministerium.at/Home/Download?publicationId=424

Prainsack B (2020) Solidarity in Times of Pandemics. Democratic Theory 7(2): pp.124-133.

Prainsack B and Buyx A (2015) Ethics of healthcare policy and the concept of solidarity. In: Kuhlmann E, Blank R H, Bourgeault L and Wendt C (eds). The Palgrave International Handbook of Healthcare Policy and Governance. New York: Palgrave. 649-664. 

Prainsack B and Buyx A (2017) Solidarity in Biomedicine and Beyond. Cambridge, UK: Cambridge University Press. 

Prainsack B and Buyx A (2011) Solidarity: Reflections on an emerging concept in bioethics. London: Nuffield Council on Bioethics.

Meanings lost and found: translating ‘sociotechnical’ for a Brazilian counter-hegemonic agenda


‘Lost in translation’ has been a familiar lament, sometimes sardonic.  It was popularised by the 2003 Hollywood film, whose storyline depicted meanings being lost or found in largely non-verbal ways.  But generally the term refers to verbal communication: an original meaning may be lost when translating a phrase across different contexts, cultures or languages. At the same time, a phrase can gain new meanings, which may variously complement, enrich or contradict the previous one.

Actor network theory (ANT) has analysed complementary meanings which can facilitate mutual understanding among disparate actors. Other fields, such as postcolonial and queer studies, have analysed how original meanings are lost through power differentials. Gayatri Spivak criticised such loss through translation into English as the dominant language of power. English ‘translatese’ obscures the distinctive identity of politically less powerful individuals and cultures, especially in the global South (Spivak, 1993/2004).

Indeed, a phrase can be used with different cultural assumptions, norms or aims, often related to power. Diverse meanings arise in appropriating everyday phrases across contexts.  Hence an interpretive framework is necessary for analysing how meanings change across time or place, as well as for making normative judgements on those translations.

STS concepts have helped to analyse how technoscience shapes such translations (e.g. Olohan, 2017), amidst ‘Translation in Times of Technocapitalism’.   But the converse seems more elusive: How do academic concepts undergo translation?  How does each meaning either highlight or obscure socio-political orders of different kinds?

Here let us explore the term ‘sociotechnical’, which has been pervasive in STS literature.  This article first surveys ambiguous meanings of ‘sociotechnical’, and then introduces our research project on Brazil’s solidarity economy. In this  context, ‘sociotechnical’ has been translated for a counter-hegemonic agenda. In translating all citations from Latin American sources, I have attempted to convey the original meanings from my engagement with social movements there.


Sociotechnical: ambiguous meanings

The term ‘sociotechnical’ has diverse, ambiguous meanings:  Sometimes its usage implies a rhetorical contrast with purely a technical content or process.  But does the latter exist anywhere?  More subtly, the adjective can highlight a specific way of integrating social with technical aspects –  by contrast with alternative ways, which otherwise would be obscured or pre-empted.

For example, grassroots innovation has arisen in informal settings, which may remain publicly invisible.  An STS research agenda has investigated how a ‘sociotechnical process’ links such innovation with alternative forms of livelihoods and problem-definitions:

We therefore stress again the importance of studying what informal operators and marginalized households and communities themselves do to produce new products, processes, or services. These activities are inevitably going to be rooted in their own ingenuity and knowledge, some of which will be traditional or place-based. Their innovations are as likely to be socio-technical as technological, and these innovations must be included in the research agenda (Cozzens and Sutz, 2014: 25).

Those authors don’t presume the existence of an a-social technological innovation. Rather, the latter provides a rhetorical contrast with a distinctive kind of sociotechnical process: ‘The more collective the innovative process, the more it will require dialogues, conflict-solving procedures, and ultimately innovation-related governance issues’ (ibid: 20). Participants enrich their own roles in knowledge-production, thus shaping how the innovation process links social with technical aspects.

From an STS perspective, conventional top-down, capital-intensive innovation likewise emerges from a sociotechnical process.  It entails several possible ways of linking social and technical aspects.  If these are obscured or are portrayed as temporary obstacles to an obvious outcome, then the process may appear as simply ‘technological’.  The reverse can happen through controversy over a technoscientific development, whose sociotechnical character thereby becomes more explicit and obvious.

Hence the need for an STS framework to analyse omnipresent sociotechnical processes for their diverse forms and public representations.  For example,  the social aspects may be kept implicit,  hidden as ‘technical’ — or instead may be made explicit by the actors, even changed by them.  Likewise there are diverse frameworks to analyse how a sociotechnical process deals with conflicting aims, both internal and external.  Given all those parameters, how to conceptualise ‘sociotechnical’?

In Actor Network Theory (ANT) an innovation process has been generally conceptualised as sociotechnical assemblages or networks.  This concept denotes linkages among various human actors and non-human actants, whereby both can influence the outcome.  An enrolment process can link more actors and actants, align their efforts, adjust the original design and make an outcome more robust (e.g. Latour, 2005).  These dynamics can help to explain why some initiatives gain success.

In such a process, the category ‘actants’ has been meant to take account of Nature as an interacting agent, beyond simply a malleable object of human control. According to some critics, however, this framework may do the converse, namely: understand human relationships like interacting things. This can obscure a distinctive human agency, central to pervasive conflicts over societal values,  futures and orders.

Keeping in mind that ambiguity, let us return to the original theme: How does the term ‘sociotechnical’ undergo change, perhaps translation?  How can the concept illuminate rival socio-political orders, even facilitate interventions?  How to sharpen its meaning?  As a modest contribution, this short article will explain how the concept ‘sociotechnical network’ has become a strategic concept for a counter-hegemonic agenda, contesting the dominant socio-political order.


Solidarity Economy (EcoSol) in Latin America

EcoSol networks: international and Brazilian

In the past couple decades, boosted by the first World Social Forum in 2002, ‘solidarity economy’ has become a global agenda to improve livelihoods through reciprocal mutual-aid activities (RIPESS, 2012).  In Latin America, continent-wide support networks have linked and stimulated local initiatives for an Economia Solidária or EcoSol for short. This agenda creates solidaristic interdependencies among enterprises, each gaining capacities for democratic self-management.  It opposes the dominant socio-political order, where market competition drives labour exploitation through employer-employee power relations (Dos Santos and Carneiro, 2008; Schüttz and Gaiger, 2006; Singer, 2016; RIPESS, 2018).

Through short supply chains, producers are brought closer to consumers, who thereby support production arrangements which are democratically cooperative and environmentally sustainable. Brazil’s  EcoSol networks have popularized such means towards a more socially just, sustainable development  (FBES, 2012).  As a key concept, Bem Viver has various meanings, e.g. a harmonious life respecting Mother Nature and humanity; it originates from indigenous Andean languages (Bolivia, 2008).   Here Nature denotes agro-biodiversity, complementing socio-cultural diversity (Leff, 2001).

For the agri-food sector, for example, the EcoSol agenda has opposed the techno-diffusionist, capital-intensive form of modernisation.  This model serves agribusiness interests in exploiting or dispossessing small-scale cultivators, while also degrading national resources.  Opponents have promoted agroecological innovation through knowledge-exchange networks, often called diálogos de saberes; these link small-scale producers with each other and with external experts who facilitate the process.

The term ‘sociotechnical’ has become prominent in Brazil’s agroecology agendas linking local initiatives.  According to a national survey, the ‘network’ concept denotes the construction of democratic processes: ‘Their articulation through networks includes a sociotechnical dimension creating environments more favourable to innovative forms which can articulate among actors, practices and resources. Together these facilitate shared means to manage knowledges’ (Schmitt, 2020: 70).


Sociotechnical networks for Economia Solidária

Over the past decade such EcoSol networks have been built within and among many places.  The case-study focus here is the Baixada Santista, a coastal area southwest of São Paolo.  Training courses brought together diverse participants especially small-scale producers.  The main organizers were agricultural extensionists who had rejected the techno-diffusionist model, instead promoting knowledge-exchange among and with agri-producers to improve artisanal agri-food methods.

The organizers elaborated the concept ‘sociotechnical network’ as follows:  The training courses ‘had success only when constructing a sociotechnical network and when the extensionists….  promoted the necessary alliances among the other actors for the construction of the network’.  This approach gained the confidence of producers who would benefit from the activities (Silva e Pinto, 2015: 3).   The organizers cited ANT as follows: A ‘sociotechnical network’ integrates human and non-human entities, individual or collective –  defined by their objective roles, identities and programmes –   who are put into intermediation with each other (Silva e Pinto, 2015, Silva et al, 2018, citing Callon, 1999 & Latour, 1987 in Portuguese translation).

For the organizers’ agenda, however, the concept ‘non-human entities’ disappeared, and their anti-capitalist agenda became central as follows:   A ‘sociotechnical network’ integrates diverse actors (e.g. agroecological producers, consumers, extensionists, public authorities, researchers, etc.); each group brings its own objectives and competences.  Such a network creates a cooperative interdependent space facilitating innovative practices which were not previously specified. This space enables diverse participants to achieve their respective aims through common practices, which help them to overcome challenges posed by the capitalist market (Silva e Pinto, 2015).

As they also explained, a cooperative space depends on a translation process to facilitate mutual understandings among the network’s participants. Such translation can help to avoid or overcome internal conflicts, thus influencing the success or failure of an EcoSol initiative (Silva et al, 2018:  210-211, 186).  For this general concept, the authors cited the sociology of translation (e.g. Callon, 1999 and Latour, 2005).

FESBS logo
EcoSol Mulher (feminist network)

Elaborating those two concepts – sociotechnical networks and translation – EcoSol coordinators have facilitated cooperative relationships that could generate such networks, as both alternative and antagonistic to capitalist social relations.  Beyond the government-funded programmes, they extended the capacity-building process through the Fórum de Economia Solidária da Baixada Santista (FESBS, 2020).  This Fórum has organised training for collective self-management by continuously mobilizing and linking diverse stakeholder groups, e.g. women producers, civil society, municipalities, academic researchers, etc.

When their EcoSol initiatives faced the Covid-19 pandemic, the concept ‘sociotechnical networks’ informed their strategy discussions and was popularised in newspaper articles (e.g. Silva et al., 2020).  Bem Viver likewise has been popularised there, especially for a feminist anti-patriarchal agenda around agroecological production methods (see FESBS hyperlink); this concept too has needed translation across different societal groups and contexts.


‘Sociotechnical’ in translation

In sum: Originating from actor network theory (ANT), the concept ‘sociotechnical network’ has appeared widely in academic literature and beyond.  Through this process, various meanings have been lost and found in translation.    As described here, it has been taken up for creating solidaristic alternatives to profit-driven patriarchal social relations, while also seeking to displace them.  This is an overtly counter-hegemonic socio-political agenda (which remains rare in ANT case studies).  As regards human-nature relationships, its EcoSol agenda abandoned ‘non-human actants’ from ANT. Instead it promotes Bem Viver, whereby agrobiodiversity complements socio-cultural diversity as mutual human constructs.   Along those lines, the term ‘sociotechnical network’ has been appearing more widely in Brazil’s EcoSol-agroecology literature (e.g. Schmitt, 2020).

Beyond that agenda, the term ‘sociotechnical’ has undergone diverse usages and thus translations. Likewise other STS concepts have meanings which may be lost or found in translation.  These conceptual translations warrant methods to identify divergent meanings, perhaps at once analytical and normative ones.



This article comes from the AgroEcos project on the ‘Agroecology-based Solidarity Economy in Bolivia and Brazil’,  https://projetoagroecos.wixsite.com/meusite/

Its trilingual bulletin highlights how EcoSol networks have responded to the Covid-19 crisis (AgroEcos, 2020).  Our new journal paper applies STS co-production theory (Levidow et al., 2021).




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