Box 1.

The pillars of socially robust knowledge

The ‘robustness’ of a knowledge claim is similar to that of other constructions, such as a bridge. The more well-constructed pillars there are supporting a bridge, the more likely it is to be robust. Our confidence in the construction is increased after the bridge has been tested by a variety of vehicles in different weather conditions.

Scientific knowledge is also constructed: the solidity of scientific achievements is a matter of alignment between data, arguments, interests, dominant values and circumstances [41]. The quality and validity of knowledge are made, and the ‘robustness’ of such constructions is tested, through ongoing debate, new research and the challenges that arise when the knowledge is acted upon.

Scientists tend to consider a knowledge claim more robust when it is based upon more and increasingly specific data, and constructed using ever-improving technical methods. Scientific standards and norms are not always universally agreed even within the scientific community, however, hence the importance of transparency about methods and data, which allows others to test a knowledge claim.

Once the ‘knowledge’ produced by scientists migrates outside of the research community, it faces a broader challenge: it must link up to what matters for those people who make decisions about health policy and practice in concrete local circumstances. In other words, it will be tested against social as well as scientific standards. If those standards have been taken into account when designing the pillars that underpin the new construction, that knowledge will function better in the real world.

Knowledge is always linked to concrete practices and institutions, and has to be understood, accepted and trusted by real people in the broader context of their daily lives and beliefs. As Figure 2 illustrates, knowledge becomes more socially robust when more people, from more diverse communities and institutions with a wider variety of worldviews and practices, understand, accept and trust it, and find it useful for their own aims in their own situation.