Bielefeld School of Public Health

Uncertainty is an important feature of the present. The existential character of events such as pandemics, environmental change, wars and migration movements repeatedly challenge society's need for security and their ability to plan and respond to events. Thus, the present experience of uncertainty is first and foremost a crisis of the experience of security. As such, uncertainty often receives a negative connotation in society as something which needs to be controlled or tamed. However, this views and perceptions fall short on the complex nature of the phenomenon. Uncertainty as a crisis of security can be treated neither as a singular nor limited phenomenon. As a phenomenon of the present, uncertainty gains a new quality on three different levels:

Experiences of Uncertainty: Today, new events and phenomena continue to emerge that directly challenge the safety and functioning of society. Pandemics such as COVID-19 pose an elementary threat to health security. Armed conflicts highlight the limited capacity for action of the existing security institutions of international relations. Migration flows cause discussions in the countries of arrival about the inclusiveness and efficiency of social security systems. Environmental changes such as climate warming threaten the security of biological survival, because ecological change affects habitats, food, water systems and other essential needs. Many such events are happening simultaneously and with layers of complex interactions, reflecting an enormous experience of uncertainty that is constantly observed in all areas of life. As a consequence, an increasing number of people are finding that there are hardly any safe spaces to retreat to. Without these safe spaces, there are no limits to the experience of insecurity. A society of uncertainty would be the result.

Communication of Uncertainty: Information today is not only communicated faster and more directly, but also at a high level of abstraction. The same is true about uncertainty. Through the new media, issues of uncertainty are discussed rapidly and unfiltered in the public. Many people have increased awareness about and pay increased attention to these topics, relaying relevant information promptly through their communities and networks. In addition to changes in the mediums of communication, the communicated information about uncertainty itself has changed. Uncertainty today is often communicated on the basis of data, models and future projections, rather than in a more general or diffuse form. These are the outcome of scientific findings and scientific knowledge, and science communication therefore stands at the centre of the current communication of uncertainty today.

Processing Uncertainty: The confrontation with uncertainty has already led to awareness in society of the need for systematic social responses to it. Concepts like resilience, preparedness and responsiveness are broadly discussed. Resilience is a general concept for the society to respond to the challenges of uncertainty. Within the context of public health, approaches of prevention and evidence play an important role when it comes to dealing with uncertainty. Hence, the current discussion on the processing of uncertainty has to deal with different and potentially competing concepts of how to respond. Any scientific approach to uncertainty has to position itself in relation to these concepts.

From these changes, it is possible to identify new trends in the perception of uncertainty as well as the resulting discussion about its relevance and the ways of processing, managing and addressing it. Is it the unknown, the unexplored, or the unforeseen? In the graduate school, we assume that uncertainty today is primarily associated with non-knowledge or ignorance. Non-knowledge comprises still unknown knowledge, known unknows as well as unknown unknowns. This non-knowledge becomes a major challenge when crises lead to dynamics of ignorance that threaten the security of society as a whole. Understanding how institutions and agents of the health systems process uncertainty, and identify the modes in which they navigate such uncertainty as well the related societal effects is paramount to improve systemic responses for the benefit of society.

Modern systems of public health are promising not only medical treatment in case of individual health impairment, but also the best possible prevention of and protection from health threats at an individual, community and population level. Equipped with the necessary resources, public health systems can offer a maximum security for the health of the people in a society. In addition to the optimal provision of resources, this also requires an efficient organisation of institutions for medical and health care as well as for the monitoring and evaluation of possible health hazards. As many threats to health sit outside of the health system, this also requires that a range of stakeholders and sectors collaborate in multi-sectoral and cross-cutting ways. The institutions for monitoring also need to be able to anticipate possible emergencies and develop plans for crisis management and preparedness.
However, the Covid-19 pandemic has clearly shown the limits of systems of public health that promises certainty and security.  The pandemic exposed the limits of the assumptions of achieving security through order and control or through securitised, biomedical approaches. Instead of security, uncertainty is the defining feature of the present and the decisive, still unsolved challenge for public health. At the same time, the crisis of public health has demonstrated a new level of uncertainty. Until this crisis, it was assumed that uncertainty is mostly consisted in terms of non-knowledge about possible dangers. For example, within the meaning of the risk society, the lack of knowledge about the potential dangers of new large-scale technologies such as nuclear energy has been discussed. Therefore, new approaches to systematic observation have been developed. But it has also been realised that achieving comprehensive or perfect knowledge in complexity is unrealistic.
In the case of Covid-19, but also the climate crisis, the contribution of uncertainty by non-knowledge is limited. Emergency plans, training exercises within the WHO, global monitoring of diseases provide sufficient knowledge about the hazards. Instead, the current factors that cause uncertainty in public health systems are the “known unknowns”, i.e. (affective) dynamics of non-knowledge and competing strategies of the management of non-knowledge, as well as “unknown unkowns” which require a true paradigm shift in the approach to deal with uncertainty.
Consequently, the question is how public health systems can fulfil their promise of producing security while moving beyond the conventional paradigm of taming and controlling uncertainty, towards approaches that inherently incorporate, effectively deal with and eventually even use uncertainty to design their systems of preparedness and response.

• Emergent modes of coordination of health policy in the European Union under uncertainty, including patterns of cooperation between system actors and institutions, and emergence of governance architectures to navigate uncertainty at local, national, or international/global level
• Spatial approaches to healthcare utilization and health needs in view of subjective or objective uncertainty
• Migration regimes and creation, use and mis-use of uncertainty as well as societal and health consequences
• Innovation, drug therapy efficacy and quality of life measurements in uncertain therapy regimes and consequences for policy making
• Health system financing and fluctuations in view of uncertainty
• Regional planning for health services and nursing in view of uncertainty related to low resource settings, underserved regions, workforce shortage and migration, or climate change
• Statistical learning methods in public health to embrace uncertainty for health policy and decision-making

• Analysis of the effects on healthcare utilisation of socio-economic uncertainties (e. g. fear of/realised unemployment or pandemic control measures) with data from the German Socio-Economic Panel (SOEP)
• Socio-economic uncertainties as results of the interaction between individual and contextual/small area uncertainties (e. g. perceived or measured deprivation) based on the analysis of the SOEP longitudinal data and other data sources.
• Policies and Programs in Health Systems for Coping with Uncertainties
• Economic fluctuations and stable contribution financing
• Estimation of long-term efficacy for one-off drug therapies and relation to decision-making for health policy
• Quality-of-life measurement in the case of uncertain therapy courses and consequences for health policy
• Long-term cross-sectoral regional health care planning
• Effect of new pharmacy regulation on the density and quality of car
• Uncertainties in the context of health services research and nursing, including in low resource settings or underserved regions, workforce shortages and migration, climate change (e.g. in long-term care settings, hospitals), or related to achievement of the UN Sustainable Development Goals (SDG)
• Uncertainty of medicalization: heterogeneity of medicalization and difficulties of its operationalisation
• Statistical learning methods in health demography
• Coordination of health policy in the European Union under uncertainty
• Cooperation between systems of social security and local authorities in prevention and health care
• Modernisation of Public Health Service as a strategy for and a source of uncertainty
• Organisation and restructuring of the health insurance system
• Institutional innovations in health care

As a doctoral candidate in the Graduate School “Health Policy and Systems in Uncertainties”, you will work in an interdisciplinary and highly innovative research environment. In close exchange with your supervisors and other doctoral candidates, you can implement your research project on an important contemporary issue. Although you are writing a free doctoral thesis (i.e. not a doctoral study programme), you will benefit from a supportive teaching programme. This programme will provide you with the necessary research capacities and competences. The programme will also bring together the collaborative findings for the issue of the graduate school. In addition to presence time, we also offer online courses, which make it easy for international doctoral students to work at the graduate school. The graduate school and involved PhD students will closely collaborate with and benefit from the intellectual environment of the Center for Uncertainty Studies (CeUS), as well as from international partnerships, exchange and mentorship.