Marco Haenssgen: Health policy and systems
There is long tradition of social sciences in medicine, and the communication with the medical sciences is now improving. Social researchers can help, for instance, better design clinical trials to include social factors, contextualise interventions and put the results at a population level perspective.
My name is Marco Haenssgen, I am a social scientist working at the Centre for Tropical Medicine and Global Health in Oxford, but my position is also shared with the Saïd Business School in Oxford.
When it comes to antibiotic use and the behaviour of people in rural Thailand and Laos, I think the biggest challenge is that we don’t understand it well enough. We have a vague notion of what we should do to improve behaviour using communication, education, but there are so many other factors, structural factors like poverty, histories that people have, cultural histories that drives their behaviour in a particular way. What do people do when they are sick? What meaning do they attribute to medicines for instance? What means could care for them? There are many questions that are worth answering because it influences so much what we should do and what we can do and cannot do to improve behaviour.
In rural Thailand and Laos we carried out a survey to understand health behaviours more generally, the broader pathways that people go through when they are sick. What kinds of public health care providers, what kinds of private health care providers and informal health care providers do they access? What kinds of medicine do they use, how do they even think about medicine and antibiotics? Do they have an understanding of what antibiotics are? Have they heard of drug resistance and what does it means to them? But also how does information spread, for instance in communities? We don’t only have representative surveys but we also have social network surveys. We can apply some quite interesting social research methods to understand and inform something that is quite interesting for the medical sciences.
There is a very long tradition of social sciences in medicine, but its communication with the medical sciences is changing now. I think that this is the most important development that we see at the moment, this cross-disciplinary fertilisation that hasn’t been done so well in the past. Before we were separate camps, now we’re talking to each other more and I think that’s were a lot of inspiration comes from and a lot of new impetus for research and also new solutions – solutions beyond health care.
A practical application of the work that I do relate, for instance, to a recent study we did in diagnostic testing. We contributed to a clinical trial on a diagnostic test, a finger prick test, to help health care workers - nurses - in Thailand and Myanmar, prescribe antibiotics better. What we did as social researchers was to contextualise this whole intervention. We could contribute a better understanding of what happens when you introduce this test, how does this change the relationship between nurses and patients, who do you reach, who do you not reach? Nurses often already have some kind of solution, some kind of tactic and strategy to prescribe or not prescribe an antibiotic, so does this new test change the existing behaviours?
We social researchers have the techniques and the theories available to answer these questions and can ultimately make interventions more effective, maybe locally more appropriate, and it can also help us understand what happens during an intervention.
Social research complements clinical research rather well I’d say. Before a clinical trial for instance we can help understand the context from a patient perspective, for instance where to intervene, what are the behaviours that we need to change, if we want to change them. In our specific case in a clinical trial about antibiotic use, you cannot simply ask the patient “did you take an antibiotic or not” because they wouldn’t understand the question, they might not know what an antibiotic is. Rather one would have to ask, for instance in Thailand “did you take an anti-inflammatory drug?”, we can help inform these questions. What is more, by doing population level research starting with the general population rather than patients specifically, we can give a broad understanding of the diversity of health care behaviours that people have. If there is for instance a clinical trial focusing on primary care in the public sector, then our population perspective can help put this clinical trial into perspective and see, on a population level, what is the impact? Who might be left out? What might be the equity implications? Is it fair to do this? And what else might we have to do to in order to reach, for instance, the poorest of the poor who might be excluded from the primary care level?