Epidemics: Science, Governance and Social Justice

Description

Recent disease events such as SARS, H1N1 and avian influenza, and haemorrhagic fevers have focussed policy and public concern as never before on epidemics and so-called 'emerging infectious diseases'. Understanding and responding to these often unpredictable events have become major challenges for local, national and international bodies. All too often, responses can become restricted by implicit assumptions about who or what is to blame that may not capture the dynamics and uncertainties at play in the multi-scale interactions of people, animals and microbes. As a result, policies intended to forestall epidemics may fail, and may even further threaten health, livelihoods and human rights. The book takes a unique approach by focusing on how different policy-makers, scientists, and local populations construct alternative narratives-accounts of the causes and appropriate responses to outbreaks- about epidemics at the global, national and local level. The contrast between emergency-oriented, top-down responses to what are perceived as potentially global outbreaks and longer-term approaches to diseases, such as AIDS, which may now be considered endemic, is highlighted. Case studies-on avian influenza, SARS, obesity, H1N1 influenza, HIV/AIDS, tuberculosis, and haemorrhagic fevers-cover a broad historical, geographical and biological range. As this book explores, it is often the most vulnerable members of a population-the poor, the social excluded and the already ill-who are likely to suffer most from epidemic diseases. At the same time, they may be less likely to benefit from responses that may be designed from a global perspective that neglects social, ecological and political conditions on the ground. This book aims to bring the focus back to these marginal populations to reveal the often unintended consequences of current policy responses to epidemics. Important implications emerge - for how epidemics are thought about and represented; for how surveillance and response is designed; and for whose knowledge and perspectives should be included. Published in association with the Economic and Social Research Council (ESRC)

Sarah Dry is a Research Officer at the STEPS Centre. She received her PhD in history of science from the University of Cambridge in 2006. Her research interests include the history of Victorian meteorology and 20th century radiation, and contemporary health policy. Melissa Leach is the main Director of the STEPS Centre, Sussex and a Professorial Fellow at the Institute of Development Studies (IDS), Sussex.

'Amid the epidemic of books on epidemics in recent years, analyses which step back and critically assess how such events are socially constructed have been scarce on the ground. This book provides readers with an intellectually fresh take on contemporary global health policy - epidemics are shaped and understood within specific normative frames. This raises fundamental questions about how we think about health and disease, but also how we practically respond to global epidemics.' Kelley Lee, Head, Public and Environmental Health Research Unit, London School of Hygiene & Tropical Medicine 'This book is of particular interest for those who feel there is a need to change the ways we think and go about the protection of human health, in particular where it comes to invasive intruders lurking in the animal world. Pandemic threats and emerging diseases are invariably the result of human choices and actions. Collectively we create new niches for new diseases. Food and agriculture brings a growing number of influenza viruses. A set of global factors is at work to explain why pathogens flare-up at the animal-human-environment interface. Disease agents invade new areas, turn more aggressive or start infecting novel hosts species. Humans are not the sole victim; plants and animals are also affected by invasive species. It is clear that a business-as-usual approach will not hold back the tide of novel threats. The veterinary and medical professions will continue to try to nip the problem in the bud and prevent escalation. Yet emergency response is only part of the storyline and it alone will not solve the problem. Addressing the root causes of disease emergence concerns the public at large. Healthy animal agriculture and natural resource management are among the requirements to counter disease flare-up. This clearly places people rather than health authorities at the centre stage. As it is convincingly argued in this book, novel diseases - and responses to them - should not be viewed in isolation. Instead they need to be considered and addressed jointly with the challenges of socio-economic development, sustainable agriculture, rural development, and the protection of the environment. Health is the domain of all of us.' Jan Slingenbergh, Head, Animal Health Emergency Prevention System, Animal Health Service, Food and Agriculture Organization, UN 'New and old infectious diseases are emerging and re-emerging across the world. Globalization with its increased and accelerated movement of people and goods has created unprecedented opportunities for infectious diseases to move over long distances with minimum delay. This situation poses a major challenge to local, national and international health systems. Through a series of case studies, this book explores responses mounted against selected diseases in different parts of the world, and, most importantly, the 'actors and mindsets' underlying the chosen responses. By applying this particular lens, the book is a valuable addition to the library of all those concerned with the effects and effectiveness of measures to protect global health.' Joachim Otte, Coordinator Pro-Poor Livestock Policy Initiative, Food and Agriculture Organization, UN 'How best can our agents of government use good science to shape a better future for us? What boundaries and controls do we need to prevent the scientific agendas growing uncontrollably, metastasizing and taking over the other cherished aspects of our lives? These, I believe, are the most important questions of our time - encompassing the issues of global warming, AIDS, maternal deaths, nuclear disarmament, macro-economic stability, satellite and phone-tapping espionage. This book addresses them through specific cases of unexpected infectious diseases: epidemics - one of the most emotive, frightening, and challenging emergencies, during which the usual rules and laws of the land may be suspended and extreme measures may be taken, for example, slaughter of the pigs of Egypt, involuntary detention without trial or charge, known euphemistically as quarantine. During an epidemic our response to the biological reality of a life-threatening infection comes into conflict with our individual rights and autonomy. The outcome of the conflict may easily be influenced by powerful political actors, and could become a tool to enforce a political agenda separate and distinct from the biological problem. In this book you can read the stories of how this has happened, and perhaps recognise a better way.' Professor Samuel J. McConkey, Head, Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland 'Melissa Leach, Sarah Dry and their colleagues at the STEPS Centre have produced a comprehensive book on a wide range of, mainly infectious disease, epidemic situations around the world. This work highlights the complexity of the issues involved and the manifold different scenarios that can emerge. The authors demonstrate the varied perspectives of the many potential stakeholders, from local politicians to public health practitioners to small scale farmers, and argue that policy makers and those in authority need to take all of these views into account in the formulation of their planned actions, to ensure that their responses will be widely accepted and therefore effective and sustainable. This book is a sobering read for anyone who has to take action in the face of the threat from an epidemic.' Dr Jimmy Whitworth, Head of International Activities, The Wellcome Trust 'The book is highly informative, original, and its trans-disciplinary approach is quite appropriate. It broadens our knowledge horizon about epidemics, and should be of equal interest to epidemiologists, public health specialists, social scientists, policy analysts, ethicists, and post-graduate students in international health. It should become compulsory reading for civil servants and policy makers involved in drawing up health policies on epidemic preparedness and response.' Philippe Calain, Senior Researcher, Reflection Unit on Humanitarian Stakes and Practices (UREPH), Mi? decins Sans Frontii? res, Switzerland 'In an age of disease outbreaks and emergent pathogens - and of maybe even more prolific fantasies and fears of biological dangers and threats to life - and in the context of the political and economic instrumentalisation of such vital anxieties, this volume is extremely timely. Offering a theoretically sophisticated and practically useful set of reflections about the epidemics of our times, and the epidemic of social signification that these are set in, the book will be of interest to a very broad readership spanning students of science and technology, sociologists of medicine and anthropologists, and, one hopes, epidemiologists and policy makers, as well as the wider public interested in the relationships between science, politics and social justice.' Wenzel Geissler, Senior Lecturer in Social Anthropology, London School of Hygiene and Tropical Medicine, and Professor, Department of Social Anthropology, University of Oslo