Population Health and Social Governance: A Review,an Update,Some Clarifications,and a Response

Introduction

Critical theory, as a worldview or research paradigm, promotes pluralism and rejects the idea of a single unified truth; it is a perspective based on the acceptance of multiplicity and the celebration of variation (Lincoln & Guba, 2003). Despite this utopian description, critical theory is neither superior to, nor any less dogmatic than, other paradigms. What is useful about critical theory, however, is that, as a theoretical tool, it can be used to consider the world otherwise (Cheek, 2000; Lincoln & Guba, 2003). That is, researchers, academics, and others can adopt this lens to question and challenge taken-for-granted truths and reposition some of these beliefs as reifications, not as natural evolutions or occurrences (Holmes, Perron, & O’Byrne, 2006).

In 2012, I adopted a critical theory perspective and analyzed what I felt was an increasing use of ethnography in many areas of health research (see O’Byrne, 2012). My goal was not to make proclamations of fact, but, following the tenets of critical theory (Lincoln & Guba, 2003), to add an alternative viewpoint about the sociopolitical roles, functions, and uses of ethnography in health care. I posited that ethnography yields in-depth and nuanced information about identifiable, and often minority, populations, and that some decision-makers and clinicians use these data to ensure identified subgroups conform to mainstream conceptualizations of health and well-being. I concluded that

such a situation does not signal any need to abandon ethnographic research [but] constitutes a warning: if one’s goal . . . is to resist mainstream social dictates, then methodology is not enough . . . new forms of resistance must be developed. (O’Byrne, 2012, p. 866)

In my original article, my goal was to engage in critical reflection about how and in what ways ethnographic research is and can be used, and to ensure researchers agree with these ends. I made no value-laden statements about the importance of health, but suggested that current Western preoccupations with health—which I labeled using what Lupton (1995) called the “imperative of health”—may not be shared by all cultures and subgroups.

In the latest issue of Qualitative Health Research, Brisson (2019) analyzes my postulations and highlights some areas in need of discussion and clarification. For example, in contrast to what I wrote, Brisson (2019) stated that I “discourage[] ethnographic research,” and that my article “may inhibit public health researchers who would like to use this methodological approach” (p. 739). His concern is based on the belief (which I share) that marginalized persons “are too often neglected when it comes to questions of health interventions” (p. 739). However, Brisson (2019) took my comments to mean that I see “rising rates of HIV . . . as a good thing since it challenges a health imperative” (p. 742). I made no such assertions.

It appears that Brisson (2019) may be conflating critique and criticism. By definition, the former is “a detailed analysis and assessment,” whereas the latter is “the expression of disapproval . . . based on perceived faults” (“New Oxford American Dictionary,” 2018). I sought to engage in critique, but it was perceived as criticism. In opposition to Brisson’s claim that “O’Byrne criticizes the use of ethnography in public health research” (p. 1) and that “any effort to promote public health and well-being is understood as intrinsically problematic for O’Byrne” (p. 7), I endorse ethnography and illness prevention, and use this methodology in my work. My point was that “researchers who undertake ethnographic studies must be cognizant that their work could be incorporated into a larger strategy to assimilate, not empower, members of many minority groups” (O’Byrne, 2012, p. 866). I felt this concern warranted debate; it was interpreted as a rejection of the methodology.

Contributing to how Brisson (2019) interpreted my work is what appears to be his assumption that researchers only need to ensure that study procedures conform to ethical standards; he stated, “If research data are subsequently used as the basis for unethical actions (e.g., discriminatory policies), the problem lies not with the production of data but rather the policy” (p. 740). Although no one can control all uses of their work after its release, I feel that ethical evaluations must extend beyond study procedures, meaning that researchers should consider known possible future unethical uses of their data (O’Byrne & Holmes, 2008). Both the means and the ends of research should be ethical, which includes consideration of potential social consequences (Canadian Institutes of Health Research [CIHR], 2005). I, moreover, believe that all forms of data collection should undergo rigorous ethical examination and be considered “high risk” until proven otherwise, and that concerns about how researchers’ work might affect groups ex post facto warrant fulsome consideration. Researchers cannot expunge their responsibilities with claims that research “is not problematic [if] executed in an ethical manner.” To ignore social consequences is unacceptable and potentially dangerous.

For example, would not researchers have an ethical responsibility to weigh the benefits and risks associated with remunerating participants who use injection drugs, and who may use the money they receive from participating in research to purchase illicit substances? Is the researcher complicit in drug procurement? What about if a study participant overdosed on the drugs he or she purchased with the money the researcher provided? What about if the person only participated to obtain money to purchase drugs? What are researchers’ responsibilities in these situations? While my preference is to provide remuneration in such studies, researchers need to consider these (and many other) questions before initiating data collection. These were questions Cynthia Kitson, RN-EC PhD(c), had to address for the University of Ottawa research ethics committee before commencing her doctoral ethnographic study of homeless urban women who inject drugs. I agree with the research ethics board; these points must be addressed before research can start (Collins et al., 2017; Fisher, 2004).

As such, herein, I will overview my original article, provide updated numbers and analysis on this topic, and discuss what I think is an important element raised by this dialogue, which is that a tension in critical theory relates to ethics, action, and analysis. In other words, how does a critical theory researcher work with minority and marginalized populations who, as Brisson aptly stated, experience elevated rates of morbidity compared with other groups? In discussing this last point, I will articulate how I address this tension in my research and clinical practice as a nurse.

“Population Health and Social Governance”: A Review

The basis of my original 2012 article, “Population Health and Social Governance,” was what I felt was an increase in ethnographic research. To evaluate this hypothesis, I reviewed the frequency of the term ethnography in Medline and CINAHL, and found an exponential increase in the occurrence of this keyword between 1982 and 2010. I updated this search for the current article and found that this trend continues. While this increase is likely partially related to a concurrent proliferation of peer-reviewed journals and publications over the same time, in my original article, I took these numbers to support my belief that ethnography was, at least to some degree, increasing in use (and possibly increasing in acceptance as well).

The frequency of ethnography, however, was not my main assertion. I sought to raise the point that ethnographers should not assume that their methodology automatically produces data that “benefit” or “help” the populations they study. I suggested that ethnography may also produce findings that can be used to manage groups whose characteristics, demographics, health status indicators, practices, and so on do not align with hegemonic public and population health norms. In contrast to Brisson’s (2019) claim that “O’Byrne never gives a clear and concrete explanation of how performing qualitative health research like ethnography disciplines researched groups” (p. 741), I devoted all but two pages of my original article to describing how “ethnography disciplines researched groups” using Foucault’s (1975) work about population governance through “training.” To address Brisson’s confusion, I will succinctly reiterate this material.

To begin, for Foucault (1975), training was the outcome of a tripartite sequence of hierarchical observation, examination, and normalizing judgment. Foucault (1975) posited that a key aspect of social governance is that people in positions of moral, social, or workplace authority evaluate subordinates (i.e., hierarchical observation and examination). Persons of authority then identify how the subordinates they examined differ from established norms and work to have these people achieve such norms (Foucault, 1975). This examination can occur through observation, interview, mathematical testing, and so on. Whatever the method used, the goal is inculcation: to have the subordinate internalize the teacher’s instructions, so that he or she will follow these rules in future in situations when hierarchical observation is not present. In other words, the goal is to have people auto-regulate in the absence of authority. This process is evident in schooling: teachers have students write examinations, grade this work, and help those who failed to improve. With Holmes, I suggested a similar process in health care: nurses collect information from patients (through history and examination), compare these findings with established norms (e.g., about blood pressure, weight), and create patient-specific interventions to correct identified abnormalities (Holmes & O’Byrne, 2006; O’Byrne & Holmes, 2009). The goal is to have patients internalize these teachings and follow them without needing the nurse.

In “Population Health and Social Governance” (O’Byrne, 2012), I stated that the principle guiding these corrections related to health was what Lupton (1995) called the “imperative of health,” which she identified as a social belief that people naturally want to be healthy and that they therefore naturally make efforts to be healthy. By extension, those who do not engage in healthy practices (e.g., healthy eating, exercise, preventive screening, etc.) defy nature. From this perspective, Foucault’s training relates to health status examination, comparison of collected data to population norms, and then intervention among groups whose health status is deficient.

In my original article, I applied this line of thinking to ethnography. My starting point was the research which highlights that health interventions that consider group norms are often more effective, compared with those that do not consider such details (World Health Organization, 2014). I theorized that ethnography may be increasingly funded because it generates precisely such refined, high resolution, and nuanced data about identified target groups. That is, ethnography has gained mainstream traction because it generates in-depth understandings about subgroup norms, which can help improve intervention success (O’Byrne, 2012).

The final point of my original article was to speculate about the social purpose of the intersections of ethnography, training, and intervention effectiveness. Although many explanations could be offered, such as that ethnography produces data that can be used to help people (as might be argued from a humanitarian perspective), from my critical theory viewpoint, I posited that, without careful attention, ethnographic data could be used to co-opt marginalized and minority populations into adopting mainstream health goals (i.e., the imperative of health). Following the tenets of critical theory and critique, I did not attach a value to this belief. I exclusively stated that, in understanding minority groups through ethnography and subsequently building interventions based on such findings, ethnographers may not only help produce culturally sensitive interventions, but also impose mainstream beliefs on subgroups. My postulation was that ethnography can generate the details required to help make hegemonic norms more palatable for internalization by minority groups; that is, ethnographic data can enhance inculcation.

This last point should not, however, “inhibit public health researchers who would like to use this methodology[y]” (Brisson, 2019, p. 739). A method can simultaneously be critiqued and have identified shortcomings, but not be rejected. As Foucault (1975) stated about power, it is neither positive nor negative; it simply is and warrants discussion. For example, the wall which constrains movement also protects those within its confines from the harshness of the elements. As with ethnography, there are positive and negative aspects. My goal was merely to raise one such point about some potential sociopolitical consequences of ethnography.

The Content of Funded Ethnography: An Update

To update my analysis, I reviewed the CIHR funding database. In my original article, I restricted this review to identify that, in three funding calls in 2008–2009, there was more than Can$2.6 million awarded to 21 studies that were listed as ethnographic (O’Byrne, 2012). For the current article, I extended my analysis by reviewing the content of these funded studies. In this update, I identified 155 studies that used the keyword “ethnography” for a total of Can$155 million in funding. I then obtained the abstracts to these studies and reviewed them using Guest, MacQueen, and Namey’s (2012) applied thematic analysis. My goal was to identify if there were common elements to these studies, and to see how these elements align (or not) with my postulations about ethnography and training.

To achieve this goal, I sought the abstracts for these 155 studies (publicly available on the CIHR website); 140 were available, and I downloaded and printed them. Next, I numbered and read each study title, abstract, and keyword to obtain a global understanding of the project. As the third step, I segmented the abstracts to locate ideas in the text by highlighting the start to finish of identifiable thoughts in the abstracts. I coded these segments to describe the main content within them and, when possible, did this using the abstract authors’ words. I put these codes in a codebook. I then clustered codes based on similarities. As the final step, I reviewed the clusters and identified the main point within them. Four themes ran through these clusters: focus, rationale, data collection strategies, and outcomes. All but four abstracts followed this formulaic structure.

The “focus” theme described the target population and targeted health conditions. Although the health conditions varied (e.g., osteoarthritis, palliative care, myocardial infarction, HIV, hepatitis C), the targeted populations were primarily marginalized, disadvantaged, or vulnerable groups; for example, sex trade workers, men who have sex with men, Indigenous populations, immigrants, the elderly, youth, persons with chronic disabilities or illness, and so on; exceptionally, six articles focused on general primary care clinic populations with pain, and one focused on the experience of a myocardial infarction. Notably, many studies focused on specific subgroups who had intersecting attributes of marginalization; for example, Abstract 61: “Examining the social context of injection drug use and HIV risk among young, Aboriginal women in an urban Canadian setting.” As such, although the health conditions varied from common chronic illness to stigmatized infections, the target populations, while diverse, were mostly minority groups.

The next theme, “rationale,” described justifications for the research, which related to the following: risk and vulnerability, threats and dangers, elevated burdens of illness compared with the general population, the need to empower minority groups, and suboptimal outcomes and associated costs of targeted health conditions. These rationales stated that ethnography was needed because minority groups suffer disproportionately, pose a threat broadly, and require empowerment to address their suffering. No abstracts justified the research using overtly stated desires by the study population to address the health conditions that were identified in the “focus.”

The third theme, “data collection,” described the authors’ intended strategies to obtain information during their ethnographic studies. This data collection included meta-ethnography (a technique to synthesize the findings of many previous qualitative studies), interviews (about participant perceptions and experiences), observations (to describe and understand practices), artifact review (of written materials, policies, etc.), and quantitative data collection (e.g., surveys, biometric data collections, and questionnaires to yield thick descriptions of study populations). In short, many combinations of data collection procedures were proposed to gain thick, in-depth, and nuanced understandings of the subgroups that the researchers sought to explore.

The last theme, “outcomes,” described the ultimate purpose of the ethnographic research. These descriptions were relatively homogeneous and related to (a) increasing data, (b) informing and/or improving policy, and (c) making interventions more applicable to, and used by, targeted populations. Central to these studies was the stated goal for the researchers and/or others to use these ethnographic data to intervene and address the identified health conditions with practical concrete solutions. Absent from the abstracts was input from these target populations, other than for them to be the research focus. Indeed, these groups were often described passively, either or both as the focus of the research and/or as the victims of suffering who required intervention. It was then stated in almost all the abstracts that the researchers’ ethnographic data could inform initiatives to help these affected persons. In response to Brisson’s (2019) statement that “If someone wants to discipline cultural groups, it is a prior motivation, not a consequence of a methodology” (p. 742), I would suggest that he is correct, with the issue being that this “prior motivation” was evident in all but six of the abstracts of the CIHR-funded studies.

Analysis

From my critical theory perspective, this review of abstracts yielded a few noteworthy points. First, the data collection strategies that the funded authors included in their abstracts aligned with the description of ethnography I provided in my original paper: “O’Byrne . . . is not talking about a methodology when using the word ‘ethnography’ but about the ‘in-depth study’ of cultures [which] could therefore involve almost any methodology, including strictly quantitative research” (Brisson, 2019, p. 4). My description also aligns with that of Hammersley and Atkinson (2003) who noted that ethnography involves “collecting whatever data are available to throw light on the issues that are the focus of the research” (p. 1). The alignment between my description, Hammersley and Atkinson’s (2003) writings, and that contained in the CIHR abstracts supports my point that the term ethnography can be used to broadly describe various data collection methods about unique and identifiable cultures, groups, and subpopulations.

This alignment between my assertions, that in the abstracts, and Hammersley and Atkinson (2003) also makes Brisson’s (2019) point confusing because, after noting that I do not restrict my discussion to qualitative data collection, he stated that it is

difficult to understand O’Byrne’s harsh criticism of a qualitative methodology like ethnography as producing ‘valuable data’ for the imposition of the imperative of health, when other methodologies clearly produce data that is [sic] just as ‘valuable’ to the promotion of public health messages (e.g., statistics). (p. 742)

I think this confusion relates to a conflation of study design and procedures, in that there was a lack of appreciation of that my focus was on what is being described (i.e., a culture) versus the method by which such descriptions could be obtained. Specifically, I argued that the ideas of training and discipline could apply to the output of any research, provided that the study yielded sufficiently robust, nuanced, and in-depth understandings of the culture being studied.

This leads to a second point of interest. In my original article, in describing the intersection of ethnography and training, I restricted my discussion to the secondary use of these data. To be clear, while Brisson (2019) stated that, “methodology itself cannot discipline” (p. 739), I never made such a claim. I posited that, “ethnography answers questions about how health initiatives can be implemented in culturally specific ways to ensure that the groups which resist the imperative of health are better governed” (O’Byrne, 2012, p. 864). I was clear that it was the secondary use of data, not the research process or methodology, that I was discussing in the disciplinary process.

In raising this point, which was beyond the scope of my original article, I wish to be clear that I disagree with the assertion that “methodology itself cannot discipline” (Brisson, 2019, p. 739). Through observation, interview, survey distribution, and any other in-depth data collection tool, researchers have study participants engage in self-reflection and introspection about their behavior and lives. This occurs because participants answer questions about themselves and because they know they are under observation. Ethnographic data collection thus functions in the same way as Foucault’s (1975) examination in training. Holmes and I (2006) previously discussed this “confession” during HIV testing, in which nurses assume a training role by asking patients about their sexual practices, condom use, and other HIV prevention activities. Following Cheek’s (2000) work, we argued that, in collecting these data, nurses (in their position of authority) collect information from and about patients (examine) and then provide counseling and intervention regarding identified abnormalities, including patients’ risk practices (normalizing judgment). The same sequence and analysis can be applied to ethnographic data collection. Researchers may feel their actions are benevolent and altruistic, but such a view is not the only one on this matter.

Another interesting point that emerged from reviewing the combination of my original article, Brisson’s commentary, and my thematic analysis of the CIHR abstracts is the identification of a tension in critical ethnographic health research. On the one hand, epidemiologic and other forms of data collection identify increased burdens of illness, disease, and suffering among many minority and marginalized population. According to the reviewed abstracts, this increased burden exists for HIV, hepatitis C, and type 2 diabetes mellitus, and for limited access to pain, palliative, and long-term care. Ethnographic research can help address these health issues by generating data to inform policy and develop interventions that are culturally sensitive and efficacious (World Health Organization, 2014). In this vein, ethnography is useful because it generates information that can be used to address suffering (World Health Organization, 2014).

On the other hand, ethnographic research produces what Pronger (2002) called a public exposé of these minority groups under the pretense that “more meaningful and relevant” interventions are required (Abstract 153). The question is, who has decided these interventions are desired? Was it members of the study groups? Although an absence of any mention of input from study groups cannot be taken to mean that all CIHR-funded studies were top-down, there did appear to be an unstated assumption in the study abstracts that these cited metrics of health were inherently concerning, which made participant input irrelevant. That is, higher rates of any disease were positioned as sufficient to justify research and intervention, which supports my position that funded ethnographic research focuses not only on understanding, but also on providing interventions to, marginalized groups. Data collection and ultimate intervention seem to be inextricable in these studies.

This tension between alleviating suffering and undertaking unsolicited research warrants more consideration and is likely the most interesting point raised from the dialogue created by Brisson’s review of my article. Specifically, this tension can be posed in the following way: How does one address pain and suffering and elevated burden of illness and disease without imposing one’s cultural ideas onto other groups, most of whom are minority populations? This brings to the surface a major historical issue with ethnography: it was colonialist (Pels, 1997; Pels & Salemink, 1994; Stocking, 1991). Educated White men measured other cultures who, otherwise, had not sought to engage in the research process. The outcome, in many cases, was to “help” these other groups become Westernized, or at least to benchmark them against Western norms. However, the ability to “help” others is not an invitation to do so. All of this to say that when Brisson (2019) requested “concrete examples of ethnographic research that led to ‘discipline’ cultures,” it was evident he did not review the expansive anthropology literature addressing this topic (Pels & Salemink, 1994, 2008). His request also demonstrated a poor understanding of causality: no study design could ever establish a clear link between any form of data collection and the complex outcomes associated with Foucauldian training. This was a theoretical debate that was firmly placed within a critical theory paradigm: I did not seek to make new proclamations of truth, but to offer an alternative viewpoint about increased execution of ethnographic health research.

Accordingly, concerns about the imperative of health and colonialism should not outright prevent efforts to offer expertise if/when groups seek it, or when persons (or patients) agree that an identified health problem is mutually considered a concern (Pels, 2008). The importance is to recognize this position and remember history, and to make efforts not to blindly repeat it.

My Preferred Approach

Following my critical theory lens, I will now detail my preferred approach, and how I have reconciled how I practice within this paradigm. I will not, however, outline a so-called “best” strategy to address the foregoing tension, as to do so is incommensurable with my stated theoretical positioning (Holmes, Murray, Perron, & Rail, 2006).

Simply put, the tension I face arises from being a professor of nursing who engages in ethnographic research, and a nurse practitioner who works in an STI (sexually transmitted infection)/HIV testing clinic and at a downtown health clinic for marginalized populations (e.g., homeless individuals, persons who use injection drugs, trans-clients). In my role as a nurse, I see pain and suffering firsthand during every clinical shift. My approach has been one in which I cannot ignore this distress due to concerns about imposing hegemonic ideals about the imperative of health. I diagnose persons with HIV; I provide care during and after drug overdose; I prescribe medications to treat hypertension, dyslipidemia, and infection. I also see people who, despite their wishes, cannot obtain the health services and interventions they want. For example, I encounter patients who are at high risk for HIV but cannot obtain HIV preexposure prophylaxis (PrEP) due to prohibitive costs. I feel it would be not only a violation of my code of ethics as a nurse to do nothing about these situations (Canadian Nurses Association, 2017), but also morally deplorable to ignore the plights of persons who, as Brisson (2019) stated, are sometimes unhealthy due to a “‘lack of access to health care’ and a ‘lack of resource to health’” (p. 744). I agree with this point and do intervene.

Interestingly, my intervention strategy follows the exact sequence I critiqued. I have tailored clinical services using the data from my qualitative (often ethnographic) studies on gay bathhouses, on gay circuit parties, on persons who use injection drugs, on swingers, and on persons who seek sex using the Internet (Gastaldo, Holmes, Lombardo, & O’Byrne, 2009; O’Byrne, 2018; O’Byrne & Holmes, 2011; O’Byrne, Orser, MacPherson, & Valela, 2018; O’Byrne & Watts, 2011). One outcome of these studies was GayZone, which is a clinic I helped develop in 2008 due to local gay community advocates’ concerns about ongoing HIV transmission. To address this situation, I used the subcultural understandings I developed through my ethnographic research to make clinical services culturally sensitive. The outcomes of this clinic fit the predictive model that ethnographic studies can help yield effective interventions: GayZone had good uptake, had high rates of patient satisfaction, and had higher than expected rates of STI/HIV diagnosis among patients (O’Byrne, MacPherson, Ember, Grayson, & Bourgault, 2014; O’Byrne & Watts, 2014). In 2014, I similarly used my findings from these ongoing studies to implement a nurse-led clinic for HIV postexposure prophylaxis (PEP) and, more recently, in 2018, a nurse-led PrEP service (O’Byrne, MacPherson, Roy, & Orser, 2017). These clinics provide services to people who request them, and have been specifically customized based on the findings of my ethnographic studies.

In describing these clinical interventions, I appear to contradict myself. Based on my critical theory perspective, my critique of the imperative of health, and my concerns about colonialist health care provision (Pels, 1997, 2008; Pels & Salemink, 1994), how can I engage in ethnography and then use these data to implement the interventions I just described as a covert way to train minority and marginalized groups? The way I reconcile this tension is by having study participants and the members of these identifiable groups guide my work. GayZone was a response to community requests for assistance, in which I did not instruct community members about what I felt they needed, but informed them about how I could use my knowledge (both ethnographical and clinical) to develop novel service delivery techniques. This clinic was a bottom-up development, which does not mean, however, that it is free of critique as a disciplinary tool (see my review of my work in O’Byrne & Watts, 2014). I simply take this to mean that the driving force for these interventions is requests from the public who use them.

Meanwhile, for my PEP and PrEP studies, while I again tailored services based on ethnographic data, I also obtained study funds to ensure uninsured patients had equitable access to the PEP and PrEP medications that they otherwise would not have been able to afford (O’Byrne et al., 2017). In these cases, I sought funds to produce multiyear initiatives, and subsequently provided the intervention that community members and advocates requested. I used my position and my research to address social inequity.

I thus see what I do as community-driven events, not top-down research and intervention strategies. Community members and patients inform me of what they want, and I help them obtain services in the ways they want. I offer my expertise and knowledge, and let members of these groups decide if, how, and in what ways my skillsets can be useful. Following Pels (2008), this is different than, for example, studying minority groups because they have elevated infection rates, and then designing interventions to address these concerns because public health workers wish to address such rates. When approached in this manner, I find that, although my practices still constitute impositions of hegemonic norms onto minority groups, I am comforted in knowing that I respond to community requests and do not attempt to have members of any group understand how and why I think they should adopt my White, educated, heterosexual male ideas about health.

Critical theory positions that multiplicity and difference is the natural order (Lincoln & Guba, 2003). I remind myself that simply because I believe in how I live and how I see the world, I have no right to assume that my positions, my privilege, or my views are superior or “best,” or that I am “helping” when I impose them on others. I thus think that Brisson (2019) erred when he made a value statement about what constitutes “a legitimate reason to purposefully put one’s health in jeopardy” (p. 745). What is legitimate is in the eye of the beholder, not that of an academic, a health care provider, or anyone else. Regarding ethnography, I think critical theory helps us move away from studying the historically labeled “savage,” and toward an appreciation that no culture is superior; each is simply different (Pels, 2008). With humility, we must remember this point.

Final Remarks

Herein, I updated my previous 2012 article “Population Health and Social Governance,” clarified key points, and responded to important questions raised by Brisson (2019). In doing this, I explained my position that clinicians, policy makers, and public health professionals, to name a few, can use ethnographers’ research data to design interventions that train and discipline minority and marginalized groups. To reiterate my previous point, I do not think this means that ethnography should be abandoned (O’Byrne, 2012). I simply wish to offer an alternative sociopolitical conceptualization about the roles and functions of ethnographic data, and to engage in debate about this possibility. Ethnographers should consider such a point, but not take this to mean they should ignore their positions of privilege, thereby subjecting minority and marginalized groups to ongoing suffering that they wish to alleviate. In such situations, attempting to work on equal footing by offering one’s expertise, knowledge, and skills when and in the ways these groups dictate can help resolve the ethical tensions between critique, action, inaction, and social equity. The tenets of critical theory are important, but begin to impose inequity when, for example, academics criticize colleagues for responding to requests of marginalized groups; this does not mean, however, that efforts to “help” should automatically be free from critique. Following such a strategy might enable ethnographers to destabilize the status quo which propagates some people’s disadvantage and other’s privilege. If nothing else, such considerations might add to an important debate about if/how the world can be seen otherwise.