One Health. Группа авторов
pigs, from which humans were subsequently infected. The intensification of pig farming associated with the spillover of the virus from bats to pigs to humans was backed by companies and land deals and by broader economic shifts in regional stockbreeding underpinning local dynamics (Epstein et al., 2006; Otte and Grace, 2012; Pulliam et al., 2012). In later outbreaks of Nipah virus infections in Bangladesh and India, no clear evidence of transmission through pigs has been found. Rather, drinking traditional liquor made from date palm sap contaminated by bat excreta was one of the main sources of infection (Luby et al., 2006).
Other studies have shifted the attention from epidemic outbreaks attracting high media attention to endemic and neglected zoonotic diseases. They have examined the complex interactions of poverty and ecosystems in settings where zoonotic transmission usually occurs. Such transmission is often associated with rapid environmental and land-use change and the close contact between humans and wild and domestic animals (Okello et al., 2014). This analysis of the zoonotic transmission takes diverse and context-specific pathways into account (Cunningham et al., 2017).
Complementary to studies emphasizing a contextual analysis of social determinants, comparative research delving in depth into one determinant, such as gender, across diverse settings also contributes to expanding the social One Health agenda, as illustrated by the following case study of a gender analysis of food safety (Case study 1).
Case study 1. How understanding gender can contribute to understanding and improving food safety. Contributed by Delia Grace, International Livestock Research Institute, Nairobi, Kenya.
Background
Food safety is a One Health issue. Foodborne disease (FBD) has a health burden comparable to malaria, HIV-AIDS or tuberculosis (Havelaar et al., 2015). The majority of the quantified causes of FBD are zoonoses and animal source food is an important source of illness (Grace, 2015). Most FBD burden falls on low- and middle-income countries (LMIC) and is the result of food purchased in wet or informal markets where the poor buy and sell.
Motivation for research
To improve food safety, we first had to understand it, and that meant identifying who was involved in making food risky or safe and their knowledge, practices and motivations. We knew women and men in LMICs have important, but usually different, roles in producing, processing, selling and preparing food. We hypothesized that these roles, as well as biological differences between men and women, may have negative and positive impacts on their health, and also lead to differences in health outcomes. This case study summarizes findings on gender roles, risks and opportunities from studies in 20 informal livestock and fish value chains in Africa and Asia (Grace et al., 2015).
Findings
Men were seen as having greater responsibility for keeping cattle, capturing fish and market-oriented production, giving them opportunity for income generation. Where value chains had an important processing stage, this was usually dominated by women (e.g. smoking or drying fish and producing traditional dairy products in West Africa). In all the value chains studied, the majority of meat and fish was sold in small-scale, traditional markets (which may also be called ‘informal’ or ‘wet’ markets). In such markets, women sell fish and poultry, but meat is typically sold by men (Vietnam was an exception). Overall, this means women were more exposed to occupational hazards such as chemicals and risk of injury. On the other hand, participation also increased their access to food and income. As processing became modernized, the role of women often declined.
In all the case studies, women were responsible for preparing and cooking food for family consumption within the household. Men’s and women’s consumption within the household was generally reported to be similar. There was a tendency for women to consume riskier foods such as offal. However, in many cultures, there were taboos about pregnant women eating risky foods such as tripe and dog meat, which may have reduced risk. Moreover, men tended to consume more meat and fish outside households, often in outlets which also sold alcohol: this exposed them to higher risk of meat-borne disease. In most countries, milk was given preferentially to children.
Gender analysis showed how women and men carried out different activities, which led to different health risks. In around half the value chains, women were more at risk and in half men were more at risk. Understanding this helped develop gender-sensitive interventions that would work for the gender most at risk. Our finding that when value chains become more formal, they tend to exclude women who dominate more traditional value chains, drew attention to a possible unintended consequence of modernizing food systems. Such insights into social dynamics can help ensure development is inclusive and ultimately more effective.
Designing and Conducting Reflective and Participatory Social Science Studies and Collaborations in One Health
In their introduction to a special issue of Social Science & Medicine on social science engagement with the One Health agenda, Craddock and Hinchliffe (2015, p. 1) claim that ‘without proper social science engagement, the One Health approach is at risk of derailment’. In order to increase the efficacy and legitimacy of the knowledge produced, their argument goes, One Health research has to: (i) recognize and respect diversity regarding approaches to and understandings of health; (ii) acknowledge and appreciate social and cultural difference; (iii) analyse and take into account uneven power relations; and (iv) pay attention to how associations between disparate social worlds are configured. We affirm that research approaches also need to include consideration of the impacts and contributions of humans on human, animal and environmental health.
Building on Craddock and Hinchliffe’s (2015) argument, this chapter emphasizes the importance of a reflective stance in all stages of the research process. What do we mean by ‘integration’ and ‘partnership’, two key terms used in defining One Health approaches? Who integrates whom under what terms? What are the assumptions underlying the relationship between partners? Who are the experts, whose knowledge and practice counts, when, for whom and why? Improving health, solving health problems and responding to disease outbreaks and other types of ill health seem to be universal human goals. However, if we start to investigate how actors of diverse cultural, gender, social and economic backgrounds understand and judge what experts (e.g. those trained in biomedical sciences, clinical, environmental and veterinary sciences) conceptualize as health problems, emerging or resurgent diseases and proper interventions, we begin to realize that these are not just biological but also cultural phenomena – as already observed by Calvin W. Schwabe.
One Health itself can be analysed as a cultural phenomenon, shaped by social and political relationships. Looking back on its history, Cassidy (2017) sees One Health as a response mounted by specific scientists, clinicians and policy makers, working in specific institutional and organizational contexts, to problems that manifested themselves at particular times and in particular places. Cassidy comments: ‘In contrast to advocates’ claims, it is not a self-evidently beneficial phenomenon, nor the result of inevitable progress, but a contingent and context-bound activity that is actively and continually created through persuasive rhetoric and alliance-building’ (Cassidy, 2017, p. 196). This becomes even clearer when social scientists trace how the One Health movement travels around the globe, for instance to African countries. Okello and colleagues (2014) have shown for Uganda, Nigeria and Tanzania, the ‘goodwill’ of practitioners and policy