The Johns Hopkins University Press has just published Narrative Matters: The Power of the Personal Essay in Health Policy, an anthology of articles from the popular Narrative Matters section of Health Affairs. I can’t review the book in good conscience since, along with my colleagues Ellen Ficklen and Kyna Rubin, I have served as editor of the section and the book. You can guess that I think it’s a good read. But the anthology raises an important question: Why write stories, and, more to the point, why write them for a policy journal like Health Affairs, a publication that brings evidence and quantification to the often imprecise — and sometimes rough-and-tumble — field of health policy?
Is not anecdote the currency of old-fashioned clinical practice, the avuncular, minimally scientific time before the randomized clinical trial and evidence based medicine? “That’s only anecdotal evidence” is a common expression of derogation and dismissal.
The Narrative Matters section in Health Affairs was conceived in 1999 with the explicit intent of bringing personal experience into health policy debates. We believe that stories are quintessentially human, powerful, instructive, and, all said, unavoidable. We all have them. They are the stuff of our memories and identities — the file cabinets of our autobiographies. We categorize events and remember people by the stories of our day-to-day existence.
Balancing Analytics with Anecdotes
Narrative Matters was started in the belief that stories often crystallize and explain complex issues in an economical and clarifying way. While respecting the importance of quantification and the growingly potent analytic methods being applied to our health care system, Narrative Matters unabashedly celebrates the personal perspective in health policy.
All of us are patients. A few of us — including many readers of Health Affairs — are the operatives of the health care system: physicians, nurses, administrators, managers, and teachers. We have good stories, stories that are informed, insightful, and instructive. Narrative Matters is a launch pad for such stories.
This, of course, is not new news. Congressional testimony, the evening news, and the country’s op-ed pages often discuss health policy issues with personal testimony as the lead item. The ubiquity, in fact, of policy stories points out one of the major hazards in their use. Stories are subjective, opinionated, and not necessarily representative of a greater reality. Dan Fox has famously commented that the plural of anecdote is policy, while Harvey Fineberg has noted, admonitorily, that the repetition of anecdote is not evidence. This is the nub of the challenge for Narrative Matters.
Drawing on an expanding circle of Health Affairs writers and readers, we have developed a network of reviewers who participate with us in a refereeing process that considers the relevance, balance, and representativeness of all stories submitted. We believe that the policy narrative, examined and challenged through the review process, is proving an important and enduring contribution to the literature of health policy and to the clarity with which many readers comprehend difficult policy impasses and dilemmas.
We think that Arthur Frank, a sociologist and essayist who contributes frequently to the literature of health and illness, had it right when he wrote of Narrative Matters: “In these stories, we see the faces that health care policy is all about.”