I'm Papreen Nahar, a Senior Research Fellow in Medical Anthropology and Global health, in the Department of Global Health and Infection, at Brighton and Sussex Medical School at the University of Sussex. I'll be talking about social lives of medicines. The social scientists have already argued, although the mechanisms which lead to antimicrobial resistance are biological, the conditions promoting or influencing these biological mechanisms are profoundly social. Therefore, it's now time to refocus this textbook, so both the problems and solutions of AMR are viewed as social influence. One way to understand how a social and structural systems construct the organizations within insurance antibiotic, and it's use is to trace antibiotics to these systems. Thus the theory of social lives of medicines, helps to trace the lives of medicine within a social structural system. The idea that an object, like a drug or medicine has a social life, has been introduced by the medical anthropologists, have Van Der Geest, together with Susan Whyte, and Anita Hardon, in 1996. Later they have developed this concept Hardon in 2002. They were inspired by the anthropologist Arjun Appadurai, and his colleagues who introduced the concept of Social Life of Things in 1986. The theory suggests that the meaning that people attribute to things necessarily denied from him in transaction and motivations, particularly from how those things are used and circulated. Whyte et al, suggest, "This notion that things have biographies is useful analytically to trace the careers of material things as they move through different settings, and are attributed values as singularities or as commodities for exchange." With this notion, they argued that medicine has a pharmaceutical life, as well as social life. They promoted the idea that medicine need to be understood via its biography. Social life of medicines emphasizes that cultural relativity of its transaction, interactions, meaning that different stake holders attached to it based on their different contexts. Social life of medicine process proposes, that medicines have lives with people, and between people. These lives are lived in relation to problems and contexts. It is more concerned with medicine's social aspects, and consequences, than with their chemical structure and biological items. Whyte et al, so this stage, the biography should follow a number of sets. Each phase has its own particular contexts and actors. Also each phase is characterized by different sets of values and ideas which they call transactions and meanings. Departments of biography of medicines, therefore focuses on medicines production and marketing. Its prescription, and distribution through interviewing formal and informal channels. The pathways also focuses its depth to one way or another form of consumption, and finally, their lives after death in the form of efficacy in modifying bodies. Using this theory of the social lives of medicines, we have conducted a study in Bangladesh to investigate the pathways of dispensing antibiotics, and understand the AMR problems in relation to the Bangladesh system. While exploring the biography of antibiotic, we followed each step from production to consumption as described in the previous slide. Pathways of antibiotic use in Bangladesh, the course study, included the analysis of the pattern of pathways of use of antibiotics in Bangladesh, and knowledge and understanding of antimicrobial resistance, both from the providers and users perspectives. However, social life of medicines tool has been used to understand the provider's dimensions of pathways of antibiotics forming. This study analyzed the social conditions promoting and influencing the mechanisms of antimicrobial resistance in Bangladesh, beyond the biological factors. As the focus of this discussion is influence of systems and structures on antibiotic use, the study considered health system, and service context in Bangladesh as a background. Medical pluralism is a common feature in Bangladesh. Along with the biomedical sector, various traditional medicines are simultaneously practiced. For example, I did a umami homeopathy, traditional naming and religious meaning sisters, both grand tradition, and folk traditions. While biomedicine is the most prominent health system within biomedical sector, there is plurality as well. For instance, there are formal and informal biomedical practitioners, and private and public practitioners. Social lives of medicines framework was applied to understand antibiotic use within these health systems all based on Bangladesh, which is extremely complex. It's important to note, informality and deregulation plays role in medicine used in Bangladesh. The in-place of country's political and historical dimensions are also prominent phenomenon in use of antibiotics in the contexts. The learning from the finding of this case study in Bangladesh has implications for other similar low and middle-income countries as well. As we have learned from this study, antibiotics are produced, distributed, marketed, described, and consumed in a particular sociocultural systems, and also health system and structure. The social lives of antibiotics approach can help to find out the source of the problems and culturally sensitive, locally suited solutions for settling AMR issues. Uncritical transfer of models from high-income countries, to low-income countries to mitigate AMR issues could be problematic even within the low, and middle-income countries. Merck has certain features for overuse of antibiotics, which needs to be understood in that context. It's crucial to contextualize AMR within specific system structure. The social lives of medicines model can help in contextualizing the covenant, specifically when there is a complex rural health system. Thank you.
