One Health. Группа авторов
in all health emergencies, nor are social scientists trained to work with response teams effectively.
To address this concern a consultative meeting was organized, bringing together 72 experts and partners from more than 40 agencies (WHO, 2018).
Since the first edition of this book (Whittaker, 2015; Zinsstag, et al. 2015), there has been an increase in publications on social science research in the field of One Health. This includes special issues in the journals in Social Science and Medicine (2015) and Medical Anthropology Theory (2018). A particular focus has been the role that social science inputs and insights can play in supporting health security issues like major infectious disease outbreaks.
This chapter discusses several approaches that expanded the One Health research and interventions to include social and cultural dimensions. The first set of approaches frame the research interest and concerns theoretically and practically in the disciplinary context of parasitology, epidemiology and other natural and public health sciences, even if they address social and cultural dimensions of the phenomena under study. This mirrors the fact that, in spite of its programmatic emphasis on interdisciplinarity, the biological paradigm clearly dominates the ways in which pathways to improve human, animal and environmental health are framed. The second set of approaches offer more opportunities for contributions and engagement that move theoretical and empirical concerns of the social sciences into the foreground of One Health research and interventions.
Social science can also inform and stimulate reflectivity of practitioners and researchers, to ensure a ‘more holistic approach to joint problem solving and collective knowledge development’ (Cole, 2017, p. 127). Transdisciplinarity, one of the pillars of One Health, behoves us to embrace local and indigenous knowledge, and not privilege Western science knowledge over the vast cultural continuum of knowledge (Schelling and Zinsstag, 2015).
Examining Social and Cultural Aspects of Human–Animal Interactions
The well-known public health tool of the knowledge, attitude and practice (KAP) survey, also called the knowledge, attitude, behaviour and practice (KABP) survey, is widely used in One Health research. Most KAP surveys use predefined questions and the format of a standardized questionnaire to discover characteristic traits in knowledge, attitude and behaviour about health risks, disease and ill health related to religious, social and traditional factors (Médecins du Monde, 2012). The underlying assumption is that these factors may be the source of misconceptions or misunderstandings that often represent obstacles to behaviour change. Numerous KAP surveys have been conducted in response to the Ebola outbreak in West Africa, for instance in Guinea (Buli et al., 2015), Nigeria (Iliyasu et al., 2015) and Sierra Leone (Jalloh et al., 2017). For example 3 months into the 2014 Ebola outbreak in Sierra Leone, Jalloh and colleagues (2017) conducted a national KAP survey. They found a high awareness of Ebola among all respondents. Without being prompted, 60% of respondents correctly cited fever, diarrhoea and vomiting as signs/symptoms of Ebola. Most respondents knew that avoiding infected blood and bodily fluids (87%) and contact with an infected corpse (85%) could prevent Ebola. But they also found widespread misconceptions, for instance the belief that Ebola can be prevented by washing with salt and hot water (41%). Nearly all respondents (95%) expressed at least one discriminatory attitude towards Ebola survivors. Unprompted, self-reported actions to avoid Ebola infection included handwashing with soap (66%) and avoiding physical contact with patients with suspected Ebola (40%). The findings of Jalloh and colleagues directly informed the development of a national social mobilization strategy in the early stages of the epidemic.
Although KAP surveys address topics that are of key interest to social scientists, they have not been developed for research in the social sciences but to conduct operational or implementation research in the field of family planning and populations studies (Launiala, 2009). Since then they have become increasingly popular, mainly for practical reasons; they can be used for low-cost rapid assessments by researchers with little or no social science background (Manderson and Aaby, 1992). At the same time, they have been criticized by social scientists and public health specialists mainly because the underlying assumptions are based on common sense and highly simplified psychological theories about the relationship between knowledge, attitude and behaviour and completely disregard the importance of contextual influences (Manderson and Aaby, 1992; Launiala, 2009; Muleme et al., 2017).
More sophisticated models, such as the behaviour change wheel (BCW) (Michie et al., 2011), which is grounded in a synthesis of psychological and sociological theories, have not, to our best knowledge, yet been used in One Health research. Although the BCW approach also takes as self-evident that biomedical knowledge, attitude and practice provide the golden standard for health improvement, it opens a space for studying what study participants do in real life – not just what they should do – and how their thinking and acting is shaped by the particular context in which they live.
Contextual influences are often conceptualized as social determinants of health, i.e. ‘the circumstances in which people are born, grow, work, live, and age’, and the wider set of systems and forces: ‘economics, social policies, and politics’ (CSDH 2008, p. 35). Woldehanna and Zimicki (2015), for example, have proposed an expanded One Health model that highlights the social and cultural determinants of human–animal interaction on the local level, with a focus on emerging viral diseases transmitted from animals to humans by direct or indirect contact. The key determinants they have identified are: (i) biological characteristics of individuals, for example gender; (ii) social characteristics of individuals, households and communities, including norms, livelihood systems and settlement patterns; and (iii) at the public policy level, local and international governance and politics (Fig. 7.1).
Fig. 7.1. Socio-cultural determinants of One Health. Adapted from Dahlgren and Whitehead, 2006; CSDH, 2008; Woldehanna and Zimicki, 2015.
The newly emerging animal and human infectious diseases arise from, and are spread by, a multitude of social determinants and ecological causes interacting at multiple scales, from the local to the regional, national, international to global levels, and across diverse domains. As Weiss and McMichael (2004) have argued these changing contexts are due to increases in population size and density, urbanization and human encroachment on forests and wildlife, poverty, the increased number and movement of people, food and animals around the globe, and conflict and warfare.
Much attention has been focused on identifying the environmental, ecological and social dynamics underlying epidemic outbreaks of emerging zoonotic diseases like Ebola or Nipah. The Nipah virus, for instance, emerged in Malaysia in 1998 when deforestation destroyed the fruit bat habitat. The bats moved to trees near livestock