Vulnerability and One Health assessment approaches for infectious threats from a social science perspective: a systematic scoping review.

Vulnerability assessments identify vulnerable groups and can promote effective community engagement in responding to and mitigating destabilising events. This scoping review maps assessments for local-level vulnerabilities in the context of infectious threats. We searched various databases for articles written between 1978 and 2019. Eligible documents assessed local-level vulnerability, focusing on infectious threats and antimicrobial resistance. Since few studies provided this dual focus, we included tools from climate change and disaster risk reduction literature that engaged the community in the assessment. We considered studies using a One Health approach as essential for identifying vulnerability risk factors for zoonotic disease affecting humans. Of the 5390 records, we selected 36 articles for review. This scoping review fills a gap regarding vulnerability assessments by combining insights from various approaches: local-level understandings of vulnerability involving community perspectives; studies of social and ecological factors relevant to exposure; and integrated quantitative and qualitative methods that make generalisations based on direct observation. The findings inform the development of new tools to identify vulnerabilities and their relation to social and natural environments.

Rethinking vulnerability through Covid-19.

In times of crisis, inequalities are more commonly exaggerated than ameliorated - meaning both that vulnerable populations are often forced to make do with what resources are at hand and that many of those who barely manage in 'normal' times are pushed beyond capability and opportunity thresholds. Indeed, new case definitions of vulnerability that emerge in a crisis may push previously unrecognized groups (e.g. service employees, 'care' facility residents) into extreme vulnerability, as borderline coping quickly becomes calamity coping. To understand emerging vulnerability, it is therefore critical for social scientists to have a seat at the table where scarce resources are being allocated - before, during and after a crisis.

I heard it through the grapevine: On herd immunity and why it is important.

A. David Napier has been studying immunology and immunologists for more than three decades. In this article, he argues that the medicalization of viral epidemics has distracted us from the importance of their true social drivers: that is, the behaviour of people when they are together - what epidemiologists call human herds. On their own, viruses cannot 'invade' us. Our cells bring them to life and make them infectious through our social actions. Confusing viruses with invasive microbes not only leads us to misuse antibiotics, but fosters xenophobic responses towards outside carriers - as even our neighbours become categorical 'others' in the face of a foreign threat. Indeed, new work in viral epidemiology indicates that many viruses have infectious potential long before an epidemic develops. It is not only changes within viruses that cause epidemics, but also the condition of human herds - how we behave socially - that ignites the rapid circulation of viral information.

Vulnerability assessment tools for infectious threats and antimicrobial resistance: a scoping review protocol.

INTRODUCTION: This protocol will guide and explain the working process of a systematic scoping review on vulnerability assessment tools in the field of infectious disease outbreaks and antimicrobial resistance (AMR) crises. The scoping review will appraise existing tools or methodologies to identify local level vulnerabilities in the context of infectious disease outbreaks and AMR. Due to this focus on infectious threats and AMR, the review also considers articles using a 'One Health' approach to assess the vulnerability of individuals, groups and practices in human-animal-environment interactions. Given the broad nature of vulnerability, we aim to allocate studies discerning the process of identifying vulnerable or at-risk groups during a crisis, instead of studies taking vulnerability only as a starting point. Because considerable research has been conducted on vulnerability, disasters and climate change, we will also assemble tools developed from these fields. To our knowledge, this is the first planned systematic scoping review of vulnerability assessment tools for disease outbreaks and AMR, taking into account practices at the human-animal-environment interface that can lead to increased risk of exposure of individuals to infections, pathogen spillovers or epidemics. METHODS AND ANALYSIS: To develop the protocol, we used the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist (PRISMA-P 2015) in compliance with the PRISMA Extension for Scoping Reviews Explanation and Elaboration. With the assistance of an experienced research librarian, we developed the search strategy, which targeted the following databases: Medline, Global Health database, Web of Science and Embase. A second strategy was developed for Epistemonikos, African Journals Online and Global Index Medicus because these databases do not provide the infrastructure for an advanced search. We consider studies published between 1978 and 2019 and include articles, book chapters, websites and grey literature from selected non-governmental organisations and non-profit organisations working in the health field. We contact them directly regarding whether they are working with or have developed a vulnerability assessment tool. To address the dynamic nature of our investigation, we develop a flow diagram which we continually update to reflect the selection process. Two reviewers (MJ and LL) independently screen the literature and resolve conflicts through discussion rounds. Data extraction will be conducted by four researchers (MJ, LL, EJ and RK) through inductive and deductive coding. Extracted data will be systematically compared and divergences highlighted. ETHICS AND DISSEMINATION: Ethical approval is not required because this study does not involve collection of primary data. The purpose of this review is to disseminate a catalogue of vulnerability assessment tools and a brief summary of key results and recommendations for SoNAR-Global partners in Bangladesh, Ukraine and Uganda. The catalogue will be made publicly available. On the basis of our results, SoNAR-Global partners will pilot one of these tools.

Study protocol for the Cities Changing Diabetes programme: a global mixed-methods approach.

INTRODUCTION: Urban living has been shown to affect health in various ways. As the world is becoming more urbanised and almost two-thirds of people with diabetes now live in cities, research into the relationship between urban living, health and diabetes is key to improving the lives of many. The majority of people with diabetes have type 2 diabetes, a subset linked to overweight and obesity, decreased physical activity and unhealthy diets. Diabetes has significant consequences for those living with the condition as well as their families, relationships and wider society. Although care and management are improving, complications remain common, and diabetes is among the leading causes of vision loss, amputation, neuropathy and renal and cardiovascular disease worldwide. We present a research protocol for exploring the drivers of type 2 diabetes and its complications in urban settings through the Cities Changing Diabetes (CCD) partnership programme. METHODS AND ANALYSIS: A global study protocol is implemented in eight collaborating CCD partner cities. In each city, academic institutions, municipal representatives and local stakeholders collaborate to set research priorities and plan implementation of findings. Local academic teams execute the study following the global study protocol presented here. A quantitative Rule of Halves analysis obtains measures of the magnitude of the diabetes burden, the diagnosis rates in each city and the outcomes of care. A qualitative Diabetes Vulnerability Assessment explores the urban context in vulnerability to type 2 diabetes and identifies social factors and cultural determinants relevant to health, well-being and diabetes. ETHICS AND DISSEMINATION: The protocol steers the collection of primary and secondary data across the study sites. Research ethics board approval has been sought and obtained in each site. Findings from each of the local studies as well as the result from combined multisite (global) analyses will be reported in a series of core scientific journal papers.

Культура имеет значение: учет культурных контекстов здоровья при выработке политики

Данный аналитический обзор подготовлен в связи с растущей осведомленностью лиц, формирующих политику, и специалистов общественного здравоохранения о важной связи, которая существует между культурой и здоровьем. Отражение осведомленности в вопросах культуры в выработке политики имеет огромное значение для формирования адаптивных, справедливых и устойчивых систем медико-санитарной помощи, а также для общего прогресса во многих вопросах здоровья и благополучия населения. В обзоре рассматриваются три ключевые сферы общественного здравоохранения – питание, миграция и окружающая среда – и демонстрируется, насколько важную роль осведомленность в вопросах культуры играет в понимании концепций здоровья и благополучия и в выработке более эффективных и справедливых стратегий здравоохранения. В нем утверждается, что научные исследования в сфере гуманитарных и социальных дисциплин, имеющих отношение к здоровью, способны внести немалый вклад в выработку политики в области общественного здравоохранения.

Culture matters: using a cultural contexts of health approach to enhance policy making

This policy brief has been developed in response to the increasing awareness among policy-makers and the public health community of the important relationship between culture and health. Incorporating cultural awareness into policy-making is critical to the development of adaptive, equitable and sustainable health care systems, and to making general improvements in many areas of population health and well-being. By exploring the three key public health areas of nutrition, migration and environment, the policy brief demonstrates how cultural awareness is central to understanding health and well-being and to developing more effective and equitable health policies. Consequently, it argues that public health policy-making has much to gain from applying research from the health-related humanities and social sciences.

Nonself help: how immunology might reframe the Enlightenment.

The classical immunological paradigm is predicated on the body's ability to recognize and eliminate "nonself." However, the "self­nonself" model has yet to facilitate any resolution of the field's major concerns, and may thus prove to be of limited use. Merely discarding it is no solution, as the juxtaposition of "self" and "nonself" persists in research, in clinical settings, and in everyday practice despite the best efforts of theoretical immunologists. Instead, the very conception of "selfhood" may prove to be key. Replacing immunology's prior and persistent "self" with less static concepts derived from non-Western contexts not only resolves immunology's famous paradoxes but also offers a new and more accurate model that allows immunology to reframe what may become an outmoded Enlightenment construct of "self." In such a new paradigm, immunology's well-known system of protection and defense is replaced with a view in which nonself becomes less the body's enemy than its primary mechanism for the creative assimilation of difference. This incorporative model­in which the "immune system" functions more as a search engine than as an expeller of difference­both resolves outstanding paradoxes, and complies more accurately with contemporary knowledge and research practice.

Jinn, psychiatry and contested notions of misfortune among east London Bangladeshis.

This study examines understandings of misfortune among east London Bangladeshis, particularly with respect to the role of jinn spirits. It reports on the findings of ethnographic interviews among 40 members of this community. Appeal to jinn explanations is commonplace at times of psychological disturbance and unexplained physical symptoms. Resort to traditional healers is frequent. These explanations are contested by different groups in the community. The findings are examined within the context of a discourse on tradition and modernity with particular emphasis on Islam and modernity.