more effective.
Designing and Conducting Reflective and Participatory Social Science Studies and Collaborations in One Health
In their introduction to a special issue of Social Science & Medicine on social science engagement with the One Health agenda, Craddock and Hinchliffe (2015, p. 1) claim that ‘without proper social science engagement, the One Health approach is at risk of derailment’. In order to increase the efficacy and legitimacy of the knowledge produced, their argument goes, One Health research has to: (i) recognize and respect diversity regarding approaches to and understandings of health; (ii) acknowledge and appreciate social and cultural difference; (iii) analyse and take into account uneven power relations; and (iv) pay attention to how associations between disparate social worlds are configured. We affirm that research approaches also need to include consideration of the impacts and contributions of humans on human, animal and environmental health.
Building on Craddock and Hinchliffe’s (2015) argument, this chapter emphasizes the importance of a reflective stance in all stages of the research process. What do we mean by ‘integration’ and ‘partnership’, two key terms used in defining One Health approaches? Who integrates whom under what terms? What are the assumptions underlying the relationship between partners? Who are the experts, whose knowledge and practice counts, when, for whom and why? Improving health, solving health problems and responding to disease outbreaks and other types of ill health seem to be universal human goals. However, if we start to investigate how actors of diverse cultural, gender, social and economic backgrounds understand and judge what experts (e.g. those trained in biomedical sciences, clinical, environmental and veterinary sciences) conceptualize as health problems, emerging or resurgent diseases and proper interventions, we begin to realize that these are not just biological but also cultural phenomena – as already observed by Calvin W. Schwabe.
One Health itself can be analysed as a cultural phenomenon, shaped by social and political relationships. Looking back on its history, Cassidy (2017) sees One Health as a response mounted by specific scientists, clinicians and policy makers, working in specific institutional and organizational contexts, to problems that manifested themselves at particular times and in particular places. Cassidy comments: ‘In contrast to advocates’ claims, it is not a self-evidently beneficial phenomenon, nor the result of inevitable progress, but a contingent and context-bound activity that is actively and continually created through persuasive rhetoric and alliance-building’ (Cassidy, 2017, p. 196). This becomes even clearer when social scientists trace how the One Health movement travels around the globe, for instance to African countries. Okello and colleagues (2014) have shown for Uganda, Nigeria and Tanzania, the ‘goodwill’ of practitioners and policy makers is there, but they face many challenges in planning, executing and budgeting for joint interventions. Inequities (in access, affordability, quality, health rights) may be embedded in policies developed for low-income and indigenous communities. Rock et al. (2017) in discussing rabies control programmes describes this as an ‘entangled phenomenon’ of animals, human injuries, public policies and rabies. These and other social science studies can contribute to gaining deeper insights into not just whether, but how, One Health as an approach for intervention and action may be achieved.
A better understanding of ‘knowledge’, ‘attitude’, ‘behaviour’ and ‘practice’ is key to advancing the One Health agenda, not just for studies on local actors who may be, for example, potentially at risk of being infected by parasites that are transmitted from animals to humans. Words like ‘knowledge’ are terms used in everyday language, but in social science research they must be conceptualized with reference to theory. As the prominent medical anthropologist Arthur Kleinman (2010) elaborated in a Lancet article, a foundational theory in the social sciences is known as ‘the social construction of reality’, introduced by Peter Berger and Thomas Luckmann in the 1960s. According to this theory, the real world not only has a material basis, ‘it is also made over into socially and culturally legitimated ideas, practices, and things’ (Kleinman 2010, p. 1518). As an example, he refers to the spread of the H1N1 influenza virus that was ‘made over’ by global actors into the socially threatening and culturally fearful ‘swine flu’ epidemic. But he also points out that global health problems and programmes can (and often do) take on culturally distinctive significance in different local settings. What may be considered as a highly threatening health risk by global health experts may be regarded as one among many other health challenges by national policy makers and regional or local practitioners, and may not be recognized as a ‘real’ phenomenon by people exposed to this risk. This often leads to tensions between global policies and local reality and poses a challenge to medical and public health practice. ‘A corollary of the social construction of reality is’, Kleinman (2010, p. 1518) concludes, ‘that each local world—a neighbourhood, a village, a hospital, a network of practitioners/researchers—realizes values that amount to a local moral context that influences the behaviour of its members.’
Social constructivist theory, as proposed by Berger and Luckman (1966), refers to an epistemological position in which knowledge – and values – is regarded as constructed on the basis of experiences, in interaction with other social actors and broader cultural, economic and political contexts, and is often not articulated in words but in practice. In this understanding, knowledge is not a ‘thing’ that can be easily elicited, for instance in a survey with predefined questions such as a KAP study, outside the vital context of experience. What constitutes a problem and what is a proper response to this problem is seen through a social lens.
Social constructivist theory is one among several social science theories that foster a deeper understanding of common sense terms like knowledge, attitude, behaviour and practice. We introduce it here because it provides a foundation for designing and conducting reflective and participative social science research in One Health as the following two case studies will show. Case study 2 highlights the deliberate inclusion and role of social sciences from the beginning to the end of a pilot intervention. It emphasizes the importance of reflections by all disciplinarians upon their approaches, beliefs and potentially unconscious biases towards Western science paradigms. It also illustrates the valuable role of the social scientists ‘contextualizing’ decisions to ensure truly participatory knowledge development and design – from conceptualization to policy development.
Case study 2. One Health participatory surveillance and response from diverse Guatemalan perspectives. Contributed by Mónica Berger-González and Brigit Obrist.
Background
Guatemala, like many LMICs, is facing rapidly changing ecosystems that increase the vulnerability of populations where public health care and animal health-care services are poorly implemented, often devoid of cultural pertinence or a good understanding of rural communities’ way of life. The One Health Poptún intervention project aimed to develop a transdisciplinary process (see also Berger-González et al., Chapter 6, this volume) in the subtropical lowlands of Petén, to develop a surveillance and response system for key zoonotic diseases. This is an ongoing proof of concept implementation research between the Swiss Tropical and Public Health Institute, University of Basel, Universidad del Valle de Guatemala, the Ministries of Health and Agriculture, animal production people, the private company Tigo Telecommications Co., the Maya Council of Elders and community development councils. The longer-term vision is to scale up improved interventions into the health system.
With a predominantly indigenous Maya Q’eqchi’ and Mestizo population,
