Evidence Cultures and Spatial Imaginaries – A Case Study of Addressing Antimicrobial Resistance in Healthcare

Drawing on an empirical case study of policy and practice aimed at addressing antimicrobial resistance (AMR) in English, Dutch and Swedish healthcare systems, this paper seeks to demonstrate the value of bringing a spatial imaginary lens to our understanding of evidence-based policymaking. The decentred state perspective emphasises that governance consists of a diverse range of actors with competing norms, values and practices (Bevir, 2013). Knowledge embodied and practiced by such actors is therefore always “local” (Bevir and Rhodes, 2010). This perspective has influenced the evidence-based policy making literature which acknowledges that evidence is situated within distinct institutional contexts (Head, 2010). Recent expression of this is in the use of “evidence cultures” which draws attention to “the myriad of ways that cultural factors shape the way evidence is conceived of, constructed, translated, interpreted, and employed in policy” (Bandola-Gill et al 2024). In this article, I propose to further develop the concept of evidence cultures by exploring the neglected spatial dimensions of evidence production and use. The spatial imaginaries concept is widely used in urban geography and urban governance literatures (Wong, 2022). Spatial imaginaries refer to shared beliefs about spaces and places and how they relate to one another (Watkins, 2015). Research using this lens examines how practices such as mapping, data visualisation and quantification inscribe spatial imaginaries into material artefacts, serving to both reinforce and interrogate territorial and institutional boundaries (O’Brien, 2019; Shelton, 2017). Despite a similarity in the types of practices analysed, the spatial imaginaries and evidence cultures literatures have yet to be brought. I propose to integrate these perspectives to analyse the way space is mobilised when healthcare professionals discuss evidence production and use to address antimicrobial resistance. By analysing 15 semi-structured interviews with English, Dutch and Swedish medical practitioners, I show that actors mobilise hospital, regional and national boundaries as containers of epidemiological knowledge and clinical governance interventions. By conceiving these as competing spatial imaginaries which influence the perceived truthfulness of knowledge and legitimacy of interventions to address AMR, I highlight that evidence cultures have a spatial character. This paper has the potential to offer various contributions. Firstly, this paper reveals how professionals align themselves to certain forms of evidence and resist others by mobilising spatial boundaries. This occurs within and between institutions, which suggests that evidence cultures are not only an expression of institutional milieu, but also a feature professional socialisation. Secondly, it shows how spatial considerations are an important component within cultures of quantification (Bandola-Gill, 2024). Epidemiological knowledge requires drawing spatial boundaries around patient populations. The multiplicity of these boundaries can create sources of tension. This idea of tension and contestation also problematises the idea of a linear-top-down evidence hierarchy. How actors mobilise space when producing and using epidemiological knowledge therefore offers an interesting provocation for rethinking evidence hierarchies.