[MUSIC] Hello and welcome. My name is Danny de Vries. I'm an associate professor at the Anthropology of health at the department of Anthropology at University Amsterdam and a fellow at the Amsterdam Global Health and development. This little video is about the involvement of the social sciences in AMR. I want to start with a little definition of what is social science and looking at the relevance of social science and finally the involvement of the social sciences. So to get going what is a social science? I think it's not going to be very earth shattering to you, but it's the scientific study of human society and social relationships. For example politics, economics, sociology. And there's a number of examples on these slides which you can see. This is not exhaustive but these are the major disciplines involved. Anthropology, demography, development studies, economics, education, environmental planning, human geography, linguistics, management business studies, political science, international relations, psychology, science and technology studies, social work and sociology. There are many more because there's also a lot of hybrids studies and there's also of course something to say about the inclusion of the amenities some extent. History for example is very relevant and also we actually have a lecture by historian here. And another thing to say is that we say social sciences often it's also mentioned that it's the social and behavioral sciences. Behavioral sciences tend to be more psychology and more focused on individual change and social sciences tend to be a bit more focused on the macro structural issues, of course these are stereotypes and things are not that clear cut, but overall this is how you can see it. And so I think we're talking here about the social and behavioral sciences, but as a short and we say social sciences. There's a really nice website about is social science by the Economic and Social Research Council if you're interested then take a look at it. There are some videos there with more reflections on the meaning of social science. So professor Donald at the Institute of Psychology, Health and Society pointed out in the workshop previously on social science in AMR that the relevance of social science in the development of AMR was foreshadowed already during the birth of the first antibiotics. For example, Alexander Fleming in his Nobel prize acceptance speech on December 11th 1945 said the time may come when penicillin can be bought by anyone in shops. And there's a danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistance. Of course now we know that it's not just ignorant man, but it's actually a plethora of issues related to the social complexity which are involved in this challenge. Clearly human behavior plays its role, but we also need to look beyond the behavioral aspects to structural problems and challenges. Social science and behavior science research of course has a crucial role to play here in preserving the efficacy of existing antimicrobials and reducing our societal reliance on them and supporting development of new antimicrobials. Overall a focus is here on changing societal structures. This applies to individuals with equally groups and communities and national and international related issues. So to do this, it's important to understand the linkage between action and policy at a macro level as well as the behavioral outcomes on individuals and groups. And in addition there's a strong need to examine psychological, societal and cultural and structural factors. And this further emphasizes the importance of multidisciplinary collaboration. And there's a few questions here on this slide that help you sort of orient your thinking about what kind of questions social scientists and behavioral scientists may ask. So what are the behavioral practices or economic, political, social and cultural structures that need to be changed? And what do we already know about their behavior about this practice and structures? What are the main factors underlying them? And how can they be modeled, how can that be understood? And what interventions are needed to change behavior, practices and structures to reduce AMR? And how can the success of interventions be evaluated and measured? Just some examples of questions. Considering the importance of the social sciences to help shape interventions and linking between action, structures and policy at a macro level as well as to to behavioral outcomes of individuals and groups. Mecca Pskov and his colleagues identify five characteristics of the global am our health crisis that complicated translation from global attention to effective global initiatives. So they define it as prisms which is a way of looking at the world beyond the theory, which has the quality to be more fundamental. So these five social science prisons of course are far from exhaustive of how social science could address Samar, but they do provide an interesting global perspective that could be pursued further. And they also provides a bit of an insight in sort of a policy perspective for a policy view to the first prison to look at and investigate Samar as a trans boundary crisis. So a trans boundary crisis is characterized not only by being a cross border impact, but also by the fact that solutions demand cross national comparisons. So global coordination is necessary because resistant microbes tend to spread across national borders. For example, this image, You can see the movement of two strains of carbapenem resistance clap shell, You know, Mia from 2000 to 2008 within a few years. This these strange spread halfway to globe, which is amazing at the same time, this type of global coordination needed to halt further spread is hampered by the collective action problem, which means that the benefits from misusing antimicrobials are mainly local, whereas the cost of a mar are born globally. So countries might have weak incentives to act against Aymar, even though they collectively stand to gain from maintaining effective antimicrobials. Second Prison focuses Aimar as a wicked and creeping international challenge. A wicked problem is a problem that provides a fundamentally different kind of challenge to the design process. You know, one that makes solution secondary and problem understanding central. So first we need to figure out what's going on, what is the problem and how do we understand it? How do we deal with it? So in the graph here on the left, you can see more characteristics, including that they're also interdependent. There are unforeseen consequences that can be potentially severe to society. There's complexity involved and also social behaviors. And the problem is beyond typical organizational boundaries. So AMR satisfies at least a number of criteria of wicked and creeping challenges. First of all, time is running out to curb AMR. Because new development of antimicrobials has generally held us, while the consumptions keeps them going up. Secondly, medical and other technical advances, they have at the same time caused a problem while also being deployed to provide a solution. Such as investments in new drug development and regulations to alter prescribing behaviors. Third, the central authority need to address AMR is weak or non-existent because the crisis is trans-boundary. And because international authority remains dependent on the willingness and collaboration of states that are, sovereign, independent. And fourth, there is an irrational discounting, that has occurred in many decades that AMR has been known pushing responses into the future. Because more immediate and visible issues occupied political agendas and policy makers. And lastly, AMR is a creeping crisis that builds up slowly over many years without generating much government response. Because it tends to slip on the radar of politicians. A third prism, looks at AMR as a crisis of modernity. The AMR's result of biological evolution brought about by our increasing use of antimicrobials. That is, AMR is a consequence of progress in other areas of modern life. So in this Anthropocene, scholars and practitioners have increasingly recognized that crisis is that AMR has become part of modernity itself. This is a paradox. People expect modern societies to protect them and shield them against more risk. But some global risk and crisis are themselves produced by this modernity. This opens the door for applying some interesting ecological and ethical approaches, of course, to AMR. An image here which refers to the well known work of Claire Chandler and colleagues on infrastructures and that enables the world to work in the way that it does. We can say that AMR here is infrastructural. Because AMR and sorry, antibiotics enable a way thinking and living. Which otherwise would not be possible in a hospital system, which is only kept functioning because of antibiotics where corrects are ignored. So reducing our reliance on antimicrobials, brings with it a number of other things that we may not have expected. How do we remove these drugs without the collapse of normalcy? The prism of advocacy focuses on the attention and support that AMR gets from national and transnational advocacy coalitions, and general public. The challenge for AMR is that, advocacy is almost exclusively driven by health experts. And they tend to function in their own bubble, with little involvements from non-experts, from civil society networks and coalitions. So really the field of AMR lacks non-expert champions, equivalent to what we have for climate change, we have Greta Thunberg as an activist. So there's a need for a broad based advocacy. Because it keeps the issue on the Global Agenda even in the absence of national political tension. And somewhat sluggish diplomatic processes. Finally, AMR can be seen through a Global equity prism focusing on distributive justice. Littman & Viens (2015) published a paper in which I note how the global burden of infectious disease is highly uneven. And lower and middle income countries are disproportionately affected by AMR. In fact, these lower middle income countries as a group, both have the highest antimicrobial consumption, as well as antimicrobial resistance. So globally, this means that the most costly and difficult interventions against AMR, must be borne by countries and regions that are at least capable of carrying them. And these equity issues would need to be addressed when setting up global AMR stewardship programs. And they draw on a long academic tradition of distributive justice, development studies and international politics. Now let's dig a little deeper in social science contributions. So if you look at the number of peer reviewed social science publications on AMR in last decades. As shown in this graph published in a paper by Lu and colleagues. We see that AMR publications tripled from 77 in 2016 to 197 in 2019. This number is taken from a pool of 787 unique articles that were published in 294 journals. Social sciences have been contributing to AMR research in several different domains. And from surveys and risk assessments of AMR to promotions of appropriate use of antimicrobials in primary care and clinical settings. But there's been less emphasis in the literature on agriculture and food sectors as major drivers of the problem. Even though these sectors are expected to account for about two thirds of the future antibiotic use in the coming decade. They also note that authorship of articles, shows that only about 30% of the social science studies on AMR involved non high income countries, that have 85% of the global population. The situation is changing a little bit. Because Western developed countries, although they contributed the most in the past decades, research now is really coming a lot more from Asia and Africa, particularly in last year's. Another paper of interest is a paper by Fred Nilsen and colleagues. They show the ratio of social science contributions relative to natural science contributions, across the selection of health challenges from 1991 to 2018. So the ratio can be explained by saying if the number is below one for example, say it's a half. This means that there are half the number of social science publications compared to natural science publications. In the case of AMR, these natural sciences are mostly microbiology and medical sciences. So just like the paper by Lu and colleagues. What we see for AMR, which is the green line here at the bottom, is an increase since what is it 2012/13. In this case a doubling of social science publications relative to natural science papers. However, clearly this attention is dwarfed by social science scholarship in most other large public health issues, as well as climate change. You can see particularly with AIDS. And still well below the average contribution ratio shown by the dotted line. The study also made a network analysis of citation patterns. So these are. Parents of about 50,000 citations within all existing social science contributions. So who is citing who? And that's a way to visualize scholarly discourse and what are the communities of people who are talking to each other. And the data that they used was from 1956 to 2018. And the result you can see on the right although I don't think you can really see it. Based on this day, conclude that despite growing interest in AMR social science research lags other health crisis. Social science publishing is fragmented and peripheral and scientific discourse on AMR. And the core of the network consists of medical and microbiology journals that do not aim to publish social science research, like the Journal of antimicrobial chemotherapy, applied environmental microbiology, New England Journal of Medicine and the British Medical journal. Over 55% of the network shortest paths passed through these journals and the journals also receive a large share of the total citations of social scientists. So on the other hand there are few social science journals that are a bit on the periphery that are still included. These are social science and medicine, which makes the greatest impact but also health policy in the American Journal of Public health. But what we see is that most social science research is published in interdisciplinary public health outlets like your surveillance. So what we don't see is the evolvement of more specialized social science journals. This points that most articles from social scientists may not engage with theories, methods and debates that really belong particularly to the social science and disciplines. This also includes health economics, which is the most sided journal in its field but did not receive enough citations to be included in this network, which is a bit surprising considered the economics was the first discipline really to focus on AMR. And finally looking at training, also here we see kind of a lack of attention to the social scientists. We have a long way to go. And so capacity building is important, to make social sciences aware of the relevance of AMR in their work or by clarifying the relevance of social science perspectives and tools to non-social scientists. In a paper published by and colleagues which analyzed social science trainings and one of those colleagues myself. A clear gap was we saw in educational resources for social scientists on AMR. We looked at trainings from all over and those were mostly open access trainings that we could find that we're not academic training, but we looked at all the trainings. We did the analysis in the end of about 28 trainings, and what we saw in those trainings that AMR, most of those trainings actually were not specifically about AMR but about something else. So AMR was just a part of it. And then when you looked at them, you also started three of the 28 training courses covered AMR primarily from a social science perspectives are only three of 28. So in those days, all of the 28 it was something about AMR and only three of those was social science. Also, we saw that only 14% of the educators involved had any social science background or expertise and only 1% of the learning objectives were social dimensions. So overall we also judge the quality of the social science education to be low. So that's it. That's a little introduction on what are the social sciences, quieter relevant and here have we been in the challenge of AMR. Thank you. [MUSIC]
