By Genevie Fernandes and Martyn Pickersgill
Global health policy is typically informed by the biomedical and health sciences, with epidemiology playing a dominant role. Health policy-related decisions are often made based on global burden of disease estimates, as well as economic framings of disease control and prevention. But how do other social sciences fit into this agenda – and how do they challenge it?
A recent British Academy-funded workshop in Edinburgh addressed this very question. Imagine a room filled with an anthropologist from Chile studying the experiences of men who live with HIV/AIDS, a lawyer from Mexico examining the confluence between law and drug policy, a nurse from Nigeria using social theory to improve patient safety, a social scientist from India conducting a historical analysis of the World Bank’s influence in maternal and child health, a physician from the UK using ethnography to study the framing of ‘hotspots’ in controlling trachoma in Malawi, a science and technology studies scholar from Colombia analysing growth monitoring charts for child development, and a health policy researcher from China mapping health inequalities (to name but a few). This diverse group of early career researchers from different social science disciplines engaged in critical discussion about the role of social science in improving global health, with input from a prominent panel of policy and academic commentators.
Researchers made 5-minute long pitches about their work to the panel of global health experts, which featured Anthony Costello (World Health Organization), Sudeepa Abeysinghe (University of Edinburgh), Liz Grant (University of Edinburgh) and David Reubi (Kings College). Costello and co raised questions around the specific methodology to broader policy implications of each research study, and also offered feedback to further strengthen the work (including how to showcase its relevance for policy). During these rapid pitches, researchers discussed fascinating ideas and approaches to understand global health issues and better inform decision-making.
One project vividly illustrated how films shot by men living with HIV/AIDS in Chile can convey their lived experiences of stigma and vulnerability. An ethnographic study in rural Malawi revealed how a government ban on traditional birth attendants was seen as a breach of trust by local communities, highlighting the importance of social norms in adoption of practices such as institutionalised delivery. Similarly, qualitative interviews and ethnographic observations in rural Pakistan explored the meanings of trust for families affected by genetic diseases, and its implications for participation in biomedical research. Another qualitative study examined healthcare access of Thai migrants, raising questions about considerations of migration and gender for national health policy. One researcher discussed a mixed methods approach including the use archival records, financial datasets, secondary literature, and qualitative key informant interviews, to study the role of international health organizations, and create a framework for measuring their influence and accountability. These rich and thought-provoking early-career presentations were followed by a public discussion led by the four experts, which was also open to a a wider audience from the University of Edinburgh and beyond.
Anthony Costello, Director of Maternal, Newborn, Child and Adolescent Health at the WHO, spoke about how social scientists commonly have to try hard to legitimise their roles within the global health community. For instance, international health organizations or government health departments may have a tendency to favour medical expertise. However, Costello (a physican himself) reiterated that clinical and social sciences form two parts of global health, neither of which are more important than the other: both fields offer unique and vital contributions to improving policy and practice. Clinical sciences might tell us about what interventions work, but social science can help us better understand how and why these work, and how we can further improve these for population health. He advised early career researchers to form connections with policy makers, and use clear and succinct communication to convey their research insights and implications.
David Reubi (a social scientist at King’s College London) reflected on the term ‘global health’ and pointed out that the meanings of the word ‘global’ itself is drawn from social science theories around globalisation; he offered several such historical examples of critical global health concepts and practices that have emerged from the social sciences. Sudeepa Abeysinghe (a sociologist at the University of Edinburgh) spoke about sociology of versus in medicine, and discussed how we need to also develop both social science in global health as well as a social science of global health to engage with and inform it. The first investigates how socio-economic and cultural factors affect global health and vice-versa, while the second stream critically analyses the institutions, structures, policies, norms and practices within global health.
Liz Grant, Director of the University of Edinburgh Global Health Academy, concluded the discussion by highlighting the importance of trust in global health. She spoke about how trust is eroding within communities and countries amidst economic crises, conflict and migration and changing political leadership. In this current landscape, we need use social science to better understand and build trust within communities as well as public trust in institutions, if we want to improve population health and well being – as well, of course, as to ensure institutions are indeed worthy of such trust.